The down economy is affecting employers' bottom lines across all aspects of business, which means expenses are getting squeezed. Benefits surely are no exception, even ones that yield a positive return on investment, like health management and wellness programs.

Organizations may think twice before purchasing big-ticket wellness items, such as hiring full-time wellness staff or building an onsite health clinic or gym. Instead, employers may gravitate toward lower-cost items, such as a walking program during lunch or revamping the cafeteria menu with healthier food items.

Still, experts seem to agree that, despite tough economic times, employers remain committed to their wellness and health management programs, even though some are holding off on adding higher-cost elements.

Although it's still too soon to tell how the current state of the economy has truly affected corporate wellness and health management programs, according to the Society of Human Resource Management, 41% of employers offered health screening programs in 2008, down from 47% last year, while 21% provided an onsite fitness center, a decrease from 25% in 2007. In addition, the SHRM 2008 survey of benefit trends shows that 31% of companies offered a weight-loss program, compared to 32% in 2007.

The good news is that 67% of employers offered vaccinations onsite, up from 62% from last year, and 36% provided fitness center membership reimbursement, up from 30% in 2007, notes SHRM.

Considering new ideas

A slowdown means employers have to be more creative and think outside of the box, says Brian Passon, wellness consultant and director at Corporate Fitness and Health, a company that focuses on wellness in the workplace.

"For some employers, when times are going well, they have a tendency to just settle in with some of their employee benefits programs and not be diligent at looking at them every year. Yet in a downward business cycle, employers are looking at doing things differently with their health and wellness programs," he says.

For instance, some employers are going to their health insurance carriers to seek services that they feel they are not getting from their wellness providers or trying to figure out which services performed by their wellness vendors that they might be able to obtain through their health plan provider.

A tight economy also means that an employer's health-related vendors, individuals involved in worker's compensation, occupational health, wellness and the health plan, must be on the same page. That requires "getting everybody together once or twice a year to examine how are we improving the health of our employees, and making sure we are not duplicating services. In tight times, you want to ensure that you are only paying for the services that you need," Passon says.

Taking the long view

Of course, employers want to lower health care costs, but they also see engaged, healthy and productive employees as being a positive offset to the economy, which many organizations are concerned about, says Chris Boyce, CEO of Virgin HealthMiles, a Massachusetts-based wellness program provider.

"The conversations that we have had with employers is that wellness programs are not discretionary spending, because organizations realize that they are already spending a lot of money on health care, which keeps increasing," Boyce says.

In a slow economy, there's more of an imperative to try to figure out how to control health care costs and keep employee morale high. "They find investing in wellness during a tight business quarter is necessary because their health care costs have not changed that much and they are looking for ways to reduce that costs," he adds.

Tight business cycles raise the question whether employers are continuing to invest in their health management and wellness programs at the same levels that they did a few years ago.

"Some organizations are saying, 'We are going to slow down a little bit, and we may not do everything we intended to do, especially with higher-cost elements of the program,'" says David Anderson, senior vice president and chief health officer, StayWell Health Management, a health management program provider.

However, "wise employers, the ones that are taking a long-term view of their programs, recognize that the fundamental value of their program is only going to be realized if they integrate it into their organization," says Anderson.

This means, despite the state of the economy, senior management must continue to show support for the company's current health management programs, he adds.

"Over the years, we have done all we know how to do on the medical side to control costs and still offer quality care. You can only do so much in that arena before you start cutting benefits, which we did not want to do," says Bill Reynolds, corporate director of benefits and compensation at Interface Inc., a Georgia-based carpet manufacturing company.

The company started its wellness program in January 2008. "We felt that the best approach for us would be to take a stab at wellness to see if we could get some savings as a result of trying to get our workers to live healthier lifestyles," says Reynolds, pointing out that the company just started a walking program.

"That's a huge potential for us, but we are only in our first year," he adds. "It's going to be a while before we see the results, but we are willing to make that long-term investment."

Most employers do realize that wellness and health management are not short-term strategies, says Carol Tavella, a senior manager at Chicago-based consultancy SMART.

Yet in light of the economy, some employers are beefing up their programs

"The reason for that is a good health management program is going to focus on the big health influencers, such as tobacco use, nutrition, weight management, physical activity and stress reduction," she says. "Those are the things you start to think about in terms of behavioral interventions."

Interventions, such a walking program, bringing in Weight Watchers, brown bag lunches about nutrition and having experts speak about stress reduction, are low-cost items.

Tavella further explains that if an employer did decide to scale back on its wellness and health management programs, then it should get rid of something that does not cover a large number of individuals or an initiative in which company data shows the program has not been effective.

The other interesting thing about the current economic climate is that it can be leveraged to increase the perceived value of wellness incentives, which are a key driver to get people to participate in wellness programs.

Tavella notes: "All of sudden, when that $25 gift certificate, which in the past might not have had much value to a worker, becomes a $25 gas card, then that is something that everyone covets."