Can a wellness program work?
How many employees take advantage of their wellness plans?
Does your workplace offer a wellness program? The likelihood is close to flipping a coin - about half of U.S. employers offer them. Out of these, 80% of employer wellness programs screen their employees for health risk. Most plans also offer:
- Nutrition and/or weight loss counseling
- Smoking cessation
- Fitness tips or programs
- Alcohol and drug abuse programs
- Stress management advice, and
- Health education
Is it really any surprise that wellness programs have no consistent effect on employer healthcare costs?
However, when these plans are offered, only 46% of employees participate. When participants are identified as needing an intervention, less than one-fifth do something about it (7% participate in smoking cessation and 10% in weight loss programs). Is it really any surprise that wellness programs have no consistent effect on employer healthcare costs, even in properly conducted randomized studies? (Workplace Wellness Programs Study, Rand Corporation, 2013; JAMA April 16, 2019 Volume 321, Number 15)
The structure of employer wellness programs is governed by the Affordable Care Act (ACA), Americans With Disabilities Act (ADA), and the Genetic Information Nondiscrimination Act (GINA). Wellness programs offer members rewards or penalties upon participation, which must be voluntary. Despite the structure being regulated, the substance of the programs can vary greatly. They may be as simple as offering coaching or onsite exercise, or they may ask members to answer questions regarding their health risk, obtain blood work, and take other measurements or examinations.
Participatory Programs, one type of wellness program, are not based on a health condition and are open to anyone. The rewards for participation or penalties for not being in a program can range from $100-$500 without being coercive.
The second type of wellness program is Health Contingent. This type of program requires a member with a specific health condition to meet a goal or participate in an activity that promotes the goal. Members must be given at least 2 options to earn the reward or avoid a penalty. If one option is a health goal, for example, a diabetic achieving an A1C of less than 8%, the alternative cannot be another level of A1C. It must be something else altogether, such as attending diabetic counseling sessions - an activity.
A smoker can either stop smoking (a health goal) or attend smoking counseling sessions (an activity). For smokers, the reward for participating or penalty for not participating can be up to 50% of the premium cost.
Do wellness plans work?
With these conditions that members must meet, you might be wondering about their effectiveness. In our experience, wellness problems do work, but only if two conditions are met:
- There’s a high level of participation
- The member’s primary care provider reviews the results with the member
We have found by trial and error that the only way to get high participation levels is if the financial reward is meaningful and if the barriers to participating are eliminated. We do the latter by offering paid time off and no cost for the key physician visit. We also offer a mobile-friendly questionnaire and obtain bloodwork and measurements at the worksite.
What is the future of wellness programs?
However, what we have found to work may have to change. The regulations governing wellness programs have been under continuous litigation since 2015. The Equal Employment Opportunity Commission (EEOC) has just released its proposed new regulations for public comment.
Health Contingent wellness programs are substantially left alone in the proposed regulations. Participatory programs, however, can only offer di minimis rewards for participation, such as a water bottle.
If the proposed regulations become the rule, the focus of wellness programs will have to shift entirely to people with known health conditions, to the extent that those can be determined without a Participatory Program designed to detect those health conditions.
Because larger incentives are key to a wellness plan's success, Participatory Programs should remain the same or become even easier for members to use. Removing incentives will only make the programs less effective.
Want to learn more about our unique, results-based approach to wellness and group health insurance? Contact us today!
