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Job growth has risen steadily in recent years, with millions of Americans back at work since the last recession. In many industries, demand outpaces the supply of available candidates. For employers, attracting and retaining skilled workers have again become priorities.

With the cost of employee recruitment, training and retention estimated to be between 10 and 40 percent of a typical annual salary, employers are seeking to increase employee loyalty.1

Many companies believe population health programs can help achieve that goal. However, there is little empirical research examining the association between such programs and employee retention.

With that in mind, Optum® conducted a research study of employers to determine whether employee participation in health programs in combination with health risk surveys may lead to improvements in employee retention.

This article examines:

  • The impact of participation in population health programs on employee retention
  • The types of health programs that most influence employee retention

Study background

  • Employer sample size: 272 companies offering employee health plans and population health programs such as telephonic wellness coaching and health risk assessments
  • Employers with at least 500 employees eligible for health programs
  • Health plan membership used as a proxy for employee retention (researchers did not have access to actual employee tenure data)
  • Employees age 18–65 who were newly insured through their employer in 2012 and remained insured through 2014

Limiting the sample to newly insured employees in 2012 helped improve the likelihood that the researchers could estimate whether a relationship existed between participation in new health promotion programs and subsequent retention.


Programs offered

Researchers examined several types of population health initiatives offered by the employers. The programs fell into two categories:

Telephonic programs

  • Disease management/care coordination
  • Wellness/decision support
  • Complex case management

Health surveys

  • Health risk appraisals (HRAs)

Study samples

Seven study samples (see chart) were created to determine how grouping employees into different combinations of programs might influence employee retention.

For some samples, participants and non-participants were defined as those qualified for one or more phone-based programs. For others, participants and non-participants did not qualify for telephonic programs; participation status was based on completion of HRAs alone.


Improved retention rates

To examine differences in the probability of retention, researchers used propensity-weighted regression and econometric models. These models adjusted for age, gender and other demographics, as well as the potential issue of reverse causality.

Reverse causality could have occurred if longer tenure was more likely to lead to eventual program participation, rather than the other way around.2

Results (see chart) showed that participants were between 71 percent more likely to 5 percent less likely to remain with their companies over the three-year study period, compared with non-participants, depending on the sample and model used.

Sample 6, which included employees participating in telephonic programs or completing HRA surveys, were at the high end of this range (71 percent).

After correcting for potential reverse causality bias, retention was significantly more likely (17–71 percent) for all samples of program participants, compared to rates among similar non-participants.


The proportion of employees retained for each sample showed retention rates from 2012 to 2014 ranged from 16 to 46 percent.


The value of targeted strategies

These results suggest that when employers strive to create relevant, targeted health management strategies for their employees, focusing on both healthy and at-risk individuals may help to achieve higher retention rates than focusing solely on at-risk employees. 

Concluding thoughts

In this study, participation in health promotion programs was associated with health plan retention among new health plan members, which researchers speculate may be a viable proxy for employee retention.

The results suggest that efforts to maintain or increase health activation among employees, at a minimum by increasing participation in HRA surveys, may lead to increased retention.

The value of investment in population health management is not limited to its impact on medical cost trend. Future research should continue to explore the relationships between participation in health management initiatives and other financial and nonfinancial outcomes.

  1. Mitchell RJ, Ozminkowski RJ, Hartley SK. The association between health program participation and employee retention. Journal of Occupational and Environmental Medicine. 2016:58(9):896–901.
  2. Econometric models to address reverse causality supplement results originally published in Mitchell et al.