Cleveland Clinic Employee Wellness Program
Executive Summary
From 2007 to 2019, Cleveland Clinic implemented a comprehensive employee wellness program under the leadership of Dr. Michael Roizen that achieved unprecedented healthcare cost savings while significantly improving employee health outcomes. The program demonstrates how a systematic approach to preventive health can deliver measurable financial and wellness results at scale.
The Challenge
Cleveland Clinic faced escalating healthcare costs typical of large healthcare organizations, with medical expenses rising at the national average of 7.6% annually. With over 43,000 employees and dependents, unsustainable cost growth threatened the organization's financial stability while employee health metrics remained suboptimal. Traditional wellness programs showed minimal engagement and limited impact on actual health outcomes.
The Solution
Dr. Roizen implemented an evidence-based wellness program that shifted focus from traditional activity-based wellness initiatives to achieving specific, measurable health targets. The approach was grounded in longitudinal research, particularly a 1946 study of Chicago public workers that tracked health variables until death, demonstrating that individuals meeting certain health criteria lived 30% longer after age 65 with approximately 50% lower healthcare costs.
Rather than encouraging generic wellness activities, the program established clear, medically validated targets across eight key health indicators. This outcome-focused approach provided both employees and the organization with concrete, measurable goals that directly correlated with improved health outcomes and reduced healthcare utilization. The program operated on a voluntary basis but included financial incentives tied to achieving these specific health benchmarks rather than simply participating in wellness activities.
6 + 2 Metrics
- Blood pressure below 125/85 mmHg
- Body mass index between 21-29.9 or waist circumference less than half height
- Fasting blood sugar below 107 mg/dL or HbA1c below 6.4%
- LDL cholesterol below 130 mg/dL (optimized target below 70 mg/dL)
- Tobacco-free status verified by urine cotinine testing
- Active participation in stress management programs
Plus
- Annual preventive care visits with primary physician
- Current immunization status
"These targets helped drive the right health and wellness solutions for the workforce to 'keep the healthy ones healthy and help the unhealthy become healthy. We've now gone from 6% to 44% of our employees achieving those 6+2 normals, and $180 million in healthcare cost savings over the last few years."
-Dr. Michael Roizen
Implementation Approach
The program operated on a voluntary basis with financial incentives tied to achieving specific health targets rather than activity participation. Employees received premium reductions and other financial rewards for meeting the 6+2 criteria, validated through medical screenings and physician verification.
Cleveland Clinic supported the program through comprehensive infrastructure changes including the elimination of tobacco use on all properties, removal of sugar-sweetened beverages from facilities, improved cafeteria options, on-site fitness facilities, smoking cessation programs, and stress management resources.
Results Achieved
Improved Participation
Employee participation increased from 6% in 2008 to 44% by 2019, representing voluntary engagement of nearly half the workforce in achieving specific health targets— today more than 75% are voluntary participants.
Health Outcomes
43.6% of participating employees achieved the complete 6+2 health criteria, demonstrating significant improvement in key health indicators across the population.
Financial Impact
The program generated $1+ billion in healthcare cost avoidance from 2010-2023 compared to national commercial healthcare cost trends. Healthcare cost growth slowed from the national average of 7.6% annually to just 0.3% for Cleveland Clinic.
Reduced Absenteeism
Employee absenteeism decreased by 33%, with participants experiencing 12 additional years of disability-free life expectancy. The program achieved a return on investment of $3.27 in healthcare savings plus $2.73 in reduced absenteeism costs for every dollar invested.
Conclusion
Cleveland Clinic's 6+2 wellness program achieved a 733% increase in employee participation over 11 years while generating $1+ billion in healthcare cost avoidance. The program's success demonstrates that workplace wellness initiatives can deliver measurable financial and health outcomes when designed around specific, medically validated targets rather than generic activities.
The critical factors driving these results were outcome-focused metrics tied to financial incentives, voluntary participation with positive reinforcement, integration with primary care for medical validation, and comprehensive support addressing both physical and mental health needs. This evidence-based approach proved that systematic workplace wellness programs can simultaneously reduce healthcare costs and improve employee health outcomes when properly implemented.
Cleveland Clinic's model provides a replicable framework for other large organizations seeking to address escalating healthcare costs while improving workforce health. The program's emphasis on measurable health targets rather than activity-based wellness represents a fundamental shift that other healthcare systems and employers can adapt to achieve similar results.