Do wellness programs work? Are employers getting their money worth? Will free preventive services improve health or simply add to costs?

Do wellness programs work?  The answer depends how “work” and “wellness” are defined. 

There is also the fundamental question of whether the employer has the obligation or the incentive to invest in such activities.  Some would argue that wellness on the job pays dividends in terms of lower health care costs, and improved productivity and presenteeism.  The PPACA puts new emphasis on wellness by requiring new plans to provide 100% coverage for many preventive services, tests and screenings.   Cancer screenings, including mammograms and colonoscopies, as well as obesity prevention services, immunizations, blood pressure screenings and tobacco cessation services are among those that will be available to consumers without a copayment or other direct costs for consumers on new health plans after Sept. 23  On the other hand, PPACA also spells the gradual demise of the employer-sponsored health benefits plan meaning that Americans will be more and more on their own to evaluate, obtain and utilize their health benefits…the 170 million with employer coverage today in any case.

Here is the standard case for employer-based wellness programs:

Given what we know about the negative impact of unhealthy behavior, for both employees and businesses, it is not enough to focus solely on insurance premiums when we have an opportunity to do so much more. Employees represent a company’s most valuable asset, and creating a healthy workforce is a business strategy that can lead to cost savings and increased productivity — as well as improved employee satisfaction.

In fact, employers are likely to see a productivity impact long before they see an impact on their claims experience. So there is a tremendous advantage in helping healthy employees to stay that way — and in motivating those with existing conditions to take a more active role in managing their health.

Workforce health initiatives, such as programs that promote healthy eating, exercise, or disease management, can do a lot to support this effort. A great way to start is by encouraging employees to take advantage of the rich resources already available to them. For example, all Kaiser Permanente members enjoy access to self-care tools, health education classes, coaching, and more. And employers can supplement their employees’ self-care by bringing programs to their workplace, where employees normally spend the majority of their days.

Workforce health programs can change the lives of employees and can also have a real impact on their job performance. Imagine for a moment how much better employees feel when they exercise regularly and eat healthy meals — and when they can manage and control their symptoms of asthma or depression. Consider what effect their positive outlook can have on their work, as well as on the cost of their health care.

Kaiser’s Christine Paige, on designing a wellness program that works

Clearly encouraging wellness is never a bad thing and many large employers have invested heavily in such activities, but few, if any, can provide empirical data to quantify the benefits.  Keep in mind that most such programs primarily focus on the employee, but about 60% of all health care costs for a group plan are incurred by the dependents enrolled in the plan.  These folks (and their health care costs) are largely unaffected by employer based wellness programs except for educational communication.

Then there is the question of participation, when programs are offered do a sufficient number of employees participate to make a real difference on the entire workforce?  When annual screenings are held or the employee completes a health risk assessment, is there sufficient follow up to make a difference?  There is also some evidence that in the short run routine screenings actually increase health care costs.

Employee turnover is another issue for employers.  If an employer invests in wellness, will the employee still be employed when the long term benefits are achieved?  With the average person holding six to eight jobs in a career, it is hard to see how any one employer will benefit.

Finally there is the question of incentive.  One would think that better health and quality of life on their own would be sufficient incentive for an individual to take care of himself or herself.  Sadly, we know that not to be the case, but should the employer pay the cost to get people to change behavior, is it just a good and nice thing to do or a wise investment?  Under PPACA many employers will have little choice in providing some preventive services.  The rules to maintain grandfathering for existing plans are so onerous that it is unlikely many plans will keep that status for long and thus will become subject to the requirement to provide 100% coverage for many preventive services.

Covering a new array of services with no cost sharing by patients may increase demand, probably will drive up prices because of that demand and will definitely add significant cost to all health benefit plans.  Whether there is a return on that new investment remains to be seen.  We may be prolonging or saving lives, but there is no guarantee that any of this will help control health care costs.  People are people and unless we change attitudes and behaviors all the free stuff from their employer or the government will not matter.

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