The (In)effectiveness of Workplace Wellness Programs
Once popular workplace wellness programs may be leveling off, a survey by the Society for Human Resource Management found last month. Three years ago, approximately half of U.S. employers with 50 or more employees had wellness programs. Today, services offered through wellness programs are decreasing. Last year 61% of employers offered flu vaccinations at work, which decreased slightly to 54% this year. Additionally, a 24-hour nurse line, health and lifestyle coaching and discounts for not using tobacco products and participating in weight loss programs have also decreased. It could be that employers are simply altering their wellness programs to fit workplace needs, but the next few years of data will tell us if programs are downsizing.
Whether services are shrinking or not, the more important question is do wellness programs even work to improve employee health?
Workplace wellness programs are used to promote health and productivity among employees and reduce health-related costs for the employer and employee. Program design can differ greatly between employers. Some offer multi-component programs with health risk screenings and preventative and chronic disease control programs, while others focus on one intervention such as physical activity or health education. More recently, wellness programs now address things like financial, emotional and mental health. The benefits can be offered through the employer, external vendors, group health plans or a combination of these.
Rigorous evaluation data on wellness programs’ impact on health is seriously lacking, but of what does exist, wellness programs don’t seem to actually work. Although a 2013 RAND study found statistically significant improvements in exercise frequency, smoking behavior and weight control, the smoking results were only short-term and no impact on cholesterol was found. Additionally, when taking a closer look at the data, the impacts were modest at best. Three years of participation in an employer weight control program resulted in a loss of 0.9 pounds for an average woman of 165 pounds and 5’4” in height. For a man, it was an average of 1 pound.
Despite meager health results, wellness programs have grown into a $6 billion industry and employers spent an average of $521 per employee in 2013, which was double the amount they spent 5 years prior to that. However, a few rigorous studies have found that wellness programs do not save costs. The RAND study found that wellness programs had an insignificant cost savings after 4 years and in insignificant reduction in cost for use of emergency department or hospital care. Although employers expressed confidence that wellness programs were reducing medical costs, only half of employers said they formally evaluate their program impacts and only 2% report actual savings estimates.
When programs do save healthcare costs for employers, it may be because the cost is simply being shifted to employees who aren’t as healthy. In May, the Equal Employment Opportunity Commission ruled on federal regulations for employers offering incentives to employees to participate in wellness programs. Incentives can be designed as bonuses for those that meet health program goals, but they can also become financial penalties for the less fit employee. Employers shift higher costs of health care onto workers who don’t meet the benchmarks of wellness programs. Lawsuits were filed calling this a form of discrimination. The new rules on incentives seek to ensure that employers only see aggregate health data and cannot discriminate based on health status, disability, and genetic information.
It may be that a targeted combination of interventions that makeup a wellness program can be successful in improving employee health and reducing costs for employees and employers, but so far the results aren’t promising. It is likely going to take a lot more than adding a wellness program to workplaces to get the positive impact on health we wish to see.