Employers seeking a program that "works" are urged to consider their goals and whether they have an organizational culture that can facilitate success. Employers who choose to adopt a health promotion program should use best and promising practices to maximize the likelihood of achieving positive results.

This study demonstrates the contribution of quality program components to superior program engagement rates and health outcomes.

This study suggests that incentive value, incentive type, supportive worksite culture, and comprehensive communications strategy may all play a role in increasing HRA participation.

Efforts to improve worker productivity should take a holistic approach encompassing employee health improvement and engagement strategies.

The purpose of this research was to determine whether participation in the health risk assessment (HRA) component of a comprehensive health promotion program has an impact on medical costs, and whether the addition of participation in interventions has an incremental impact. Program participants (n = 13,048) were compared with nonparticipants (n = 13,363) to determine program impact on paid medical costs. Overall, HRA participants cost an average of $212 less than eligible nonparticipants. As HRA participation increased, cost savings also increased. Additionally, although participation in either an HRA or activities alone resulted in savings, participation in both yielded even greater benefits. The findings indicate that there is an independent benefit of each of these elements of participation, and that the sum of the elements provides a greater benefit than the impact of either of the individual elements alone.