Do corporate wellness programs work?

On a recent trip to Lincoln, NE, I visited Lincoln Industries, a company that makes chrome trims for Harley-Davidson motorcycles. I was curious about the firm’s award-winning wellness program, especially since more employers are penalizing workers by making them pay more for their health insurance if they fail to meet certain health goals.

At the heart of Lincoln Industries’ wellness program is its Platinum Scorecard, which awards points to workers who achieve good results on several markers of health such as blood pressure, cholesterol, tobacco use, waist circumference and blood sugar levels. For example, if waist circumference for men is less than 40 inches and for women less than 35 inches, they earn one point. If they don’t smoke, they get three points.

Apparently it’s not easy to score between eight and ten points, but those who do get an all-expense paid trip to climb a mountain in the Rockies. This year, 200 employees out of a workforce of 510 qualified to climb 14,000 ft. Mt. Elbert in Colorado.

High scorers also pay less for company-sponsored insurance. Workers who don’t participate or who score three points or less pay the standard premium, which this year is $6,744. Those who score more than seven points pay nearly $2,700 less — a hefty discount meant to encourage better life-style health behaviors.

Most companies offer these programs to save on health insurance and other health-related costs, such as absenteeism and productivity. At Lincoln Industries, company officials told me this year the firm hopes to save two dollars for every one dollar it spends on its wellness activities, which include a gym and an onsite clinic. Workers who are sick can stop in at the clinic rather than lose a half of a work day sitting in a doctor’s office.

It’s quite possible Lincoln Industries will meet its goal. But despite individual success stories and rewards to climb mountains, the data show that wellness programs don’t deliver the dramatic savings that sellers of these wellness packages promise. The latest evidence comes from RAND Corp., which studied such programs under a contract from the U.S. Departments of Labor and Health and Human Services.

RAND researchers said that when they compared program participants to nonparticipants, they found “statistically significant and clinically meaningful improvements in exercise frequency, smoking behavior, and weight control, but not cholesterol control.” RAND, however, noted no “statistically significant decreases in cost and use of emergency department and hospital care” but noted that over time there’s reason to believe direct medical costs would come down if employees stayed with these program.

Motivation seems to be the key. RAND researchers found that participation in these programs is not great. Fewer than half of all employees undergo initial screening, and of those identified for needing intervention, less than one-fifth choose to participate.

We’ve known for a long time that evidence for the effectiveness of wellness programs is limited or lacking. A review of the literature by the California Health Benefits Review Program, which advises the California legislature about health insurance mandates, found, for example, that the preponderance of evidence from randomized controlled trials suggests wellness programs do not lower blood pressure, blood sugar, or cholesterol (risk factors for disease). The California review also found that randomized controlled trials have shown that participating in smoking cessation programs increases the chances people will quit.

What’s the evidence for making workers who fail to achieve certain targets pay higher insurance premiums? The California review identified no randomized controlled trials that examined the impact of premiums and cost sharing for health insurance linked to participation in workplace wellness programs. In other words, it’s not really clear the carrot and stick approach works in the workplace.

So why do such programs persist? RAND observed that employers are probably unaware of the academic literature, possibly because they are not evaluating their own programs. Perhaps, though, there’s another reason. There may be intangibles that can’t be measured. Says Greg Howe, Lincoln Industries’ wellness manager: “A lot of blue collar Nebraska workers have never been out of the state. They’ve never taken a vacation in their life. A day later they are standing on top of a mountain. They’ve accomplished something they’ve never dreamed of.”

Trudy Lieberman is a journalist and an adjunct associate professor of public health, Hunter College. She blogs regularly on the Prepared Patient blog.

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  • Pansalus Consulting

    Do corporate wellness programs work?

    Yes, but let me qualify my response. Most corporate wellness initiatives do not work even though we have seen a few successful organizations, which under the right conditions, are able to make wellness work. Organizations like Lincoln Industries weave wellness into their business strategy making health part of what they do–it is their culture. Lincoln intentionally planned their strategy, they believed it and they lived it. Many organizations are not willing to do the necessary steps to make wellness part of their business identity. If the business doesn’t believe it, how can they expect the population to engage and live it?

    According to the Kaiser Family Foundation Study, about 60 percent of the workplace population is engaged at any one-time in a company sponsored wellness initiative. Sixty percent would be great, if the population was actually getting healthier. But the population’s health risks and health care costs continue to worsen.

    Participation in wellness typically doesn’t include the high risk, high cost individuals because wellness works for the well people. The healthy people are typically the ones who engage in wellness. I’ve seen companies implement a 10,000 steps walking program – and nevitability- the long distance runner typically wins. And yet the reason the program was started was to engage the high-risk, non-active individual. Because the high-risk individual rarely is able to walk 2,000 steps, let alone 10,000, they typically lose. Because of the failure, the high-risk individual become less motivated and is less likely to engage in future initiatives. The programs a company may implement are creating the lack of motivation. So all though I agree with the findings in the RAND report that motivation is a factor, it is not the problem.

    I have previously worked for a wellness organization that deployed wellness coaches into the workplace. It was a good process for those that were self-motivated and physically able to implement the suggested changes. Others were socially stimulated through monthly interactions with their coach. The problem was not the motivation–it was the culture. A coach would spend a few minutes interfacing with an employee, make a few recommendations and then reinsert the employee back into the negative environment that manifested the poor behavior. The culture was never set-up to successful stimulate and support the behavior changes needed for the employee to be successful. The result: program failure. Wellness programs become dependent on the coach, the incentive or the vendor.

    In order to engage the entire population companies have resorted to employee accountability strategies like, HRA’s, FSA’s, cost shifting and now Outcomes-Based Wellness. With Outcomes-Based Wellness, employers can finally reward the healthy people for being healthy. However, if employees have just one risk factor, they could potential pay a non-healthy surcharge – a penalty charge! With this method, we are forcing people to be healthy or pay more. Will this be the solution? The question should be “if not implemented strategically, what kind of culture will Outcomes-Based Wellness leave behind?” I have seen company’s force Outcomes-Based Wellness on their people and have a high level of engagement, but at the cost of increased absenteeism, lower productivity, dissatisfied employees and poor product delivery, etc. which were far more costly. So how can you make wellness work for you?

    You must first decide what you want to accomplish and build it into the business strategy. Second, you will need to understand the culture
    and the people in order to create a workplace conducive to a successful and sustainable wellness program. Finally, you must measure what works and adjust your strategy to match the needs of the changing population.

    Wellness cannot be a one-size-fits-all approach. Healthy,engaged people are safer, more productive and cost your company less.
    - Pansalus, Making Wellness Work

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