Wellness incentives at work barely make dent, study finds
Healthier behavior is reported but measures of health don’t budge.
Most large employers offer some type of workplace wellness program — efforts to get workers to lose weight, eat better, stress less and sleep more — with growth fueled by incentives in the federal Affordable Care Act.
But no one has been sure that the $8-billion industry improves employee health or reduces employers’ medical costs.
Studies over the years have provided conf licting results, with some showing savings and health improvements while others saying the efforts fall short.
Many studies, however, faced a number of limitations, such as failing to have a comparison group, or figuring out whether people who sign up for such wellness programs are somehow healthier or more motivated than those who do not.
Researchers from the University of Chicago and Harvard may have overcome some of these obstacles with one of the first large-scale studies that employs more sophisticated research techniques. It was published Tuesday in the Journal of the American Medical Assn.
They randomly assigned 20 BJ’s Wholesale Club outlets to offer a wellness program to all employees, then compared results with 140 stores that did not.
The big-box retailer employed nearly 33,000 workers across all 160 clubs during the test.
After 18 months, it turned out that yes, workers participating in the wellness programs self-reported healthier behavior, such as exercising more or managing their weight better than those not enrolled.
But the efforts did not result in differences in health measures, such as improved blood sugar levels; how much employers spent on healthcare; or how often employees missed work, their job performance or how long they stuck around in their jobs.
“The optimistic interpretation is there is no way we can get improvements in health or more efficient spending if we don’t first have changes in health behavior,” said one study author, Katherine Baicker, dean of the Harris School of Public Policy at the University of Chicago. (Dr. Zirui Song, an assistant professor of health policy and medicine at Harvard Medical School, was its coauthor.)
“But if employers are offering these programs in hopes that health spending and absenteeism will go down, this study should give them pause,” Baicker said.
The Kaiser Family Foundation’s annual survey of employers found that 53% of small firms and 82% of large firms offer a program in at least one of these areas: smoking cessation, weight management and behavioral or lifestyle change. (Kaiser Health News is an editorially independent program of the foundation.)
Some programs are simple, offering gift cards or other small incentives to fill out a health risk assessment, take a lunch-andlearn class or join a gym or walking group. Others are far more invasive, asking employees to report on a variety of health-related questions and roll up their sleeves for blood tests.
A few employers tie financial incentives to workers actually lowering risk factors, such as high blood pressure or cholesterol, or making concerted efforts to participate in programs that might help them do so over time.
In the study reported in JAMA, the incentives were modest. Participants got small-dollar gift cards for taking wellness courses on topics such as nutrition, exercise, disease management and stress control. Total potential incentives averaged $250. About 35% of eligible employees at the 20 participating sites completed at least one module.
Results were compared with 20 sites where workers were not offered the wellness gift cards and classes.
Wellness program vendors said details matter when considering whether efforts will be successful.
Jim Pshock, founder and CEO of Bravo Wellness, said the incentives offered to BJ’s workers might not have been large enough to spur the kinds of big changes needed to affect health outcomes.
Amounts of “less than $400 generally incentivize things people were going to do anyway. It’s simply too small to get them to do things they weren’t already excited about,” he said.
An accompanying editorial in JAMA noted that “traditional, broad-based programs like the one analyzed by Song and Baicker may lack the necessary intensity, duration, and focus on particular employee segments to generate significant effects over a short time horizon.”
In other words, don’t give up entirely on wellness efforts, but consider “more targeted approaches” that focus on specific workers with higher risks or on “health behaviors [that] may yield larger health and economic benefits,” the editorial suggested.