April 18, 2019

Do workplace wellness programs actually lower costs? No, according to a new study.

Daily Briefing

    Participating in a workplace wellness program encourages employees to exercise and manage their weight, but does not result in better health outcomes or lower health care spending, according to a study published Tuesday in JAMA.

    Cheat sheets: Evidence-based medicine 101

    Background

    The Affordable Care Act (ACA) allows companies to reward employees who participate in wellness programs with financial incentives that equate to up to 50% of employees' monthly health premiums, deductibles, and other health insurance costs. As part of the wellness programs, companies offer their employees a variety of services, such as access to gyms, screenings for reversible conditions, and weight-loss assistance. To date, many studies of wellness programs have shown encouraging results, suggesting that such programs make employees healthier.

    But nearly all of those analyses have been observational studies that compared groups of people who joined wellness programs with their colleagues who did not, and tried to determine whether participating in wellness programs actually leads to better health. There are many hazards in comparing workers who join wellness programs with those who do not, because the employees most likely to enroll in wellness programs typically are those who already live a healthier lifestyle, according to Aaron Carroll, a professor of pediatrics and a prominent health care columnist.

    Carroll said a more reliable study would involve a randomized controlled trial, in which employees are randomly assigned either to join a wellness program or not. According to Carroll, the Illinois Workplace Wellness Study addressed some of the limitations of previous research on workplace studies by recruiting nearly 5,000 University of Illinois at Urbana-Champaign employees to be randomly assigned to a wellness program or not. That trial found no significant difference between the groups. 

    New study details

    The study published Tuesday is among the first large-scale, peer-reviewed, randomized clinical trials to evaluate wellness programs. For the study, researchers from the University of Chicago and Harvard University examined how wellness programs effect employees' behaviors, employment outcomes, health outcomes, and health care spending and use from January 2015 to August 2016.

    The trial involved employees at a total of 160 BJ's Wholesale Club stores. The researchers randomly assigned 20 of the stores to offer their more than 4,000 employees a wellness program, which gave participants small-dollar gift cards for enrolling in courses on disease management, exercise, nutrition, and stress control. The remaining 140 stores did not offer their more than 28,000 employees a wellness program.

    Findings

    The researchers found that, after 18 months, employees who participated in the wellness programs reported engaging in more healthy behaviors—such as exercising and actively managing their weight—than employees who did not participate in the wellness programs.

    But the researchers did not find significant differences between the two groups when it came to:

    • Blood pressure levels;
    • Body mass indexes;
    • Cholesterol levels;
    • Health care spending;
    • Health care utilization;
    • Job attendance; and
    • Job tenure.

    Discussion

    Zirui Song, a co-author of the study and an assistant professor of health care policy and medicine at Harvard Medical School, said, "These findings suggest that employers who may be thinking about investing in workplace wellness programs or people who manage public dollars [who] might be interested in workplace wellness programs perhaps should temper their expectations of such programs to generate a large return on investment in the short run."

    However, Song noted the study period might have been too short to identify a clinical difference between employees who participate in wellness programs and those who do not. Song and study co-author Katherine Baicker, dean of the Harris School of Public Policy at the University of Chicago, said they plan to publish a second study with three-year data on the wellness program's effects once the results are finalized.

    Baicker said, "[I]f employers are offering these programs in hopes that health spending and absenteeism will go down, this study should give them pause." However, she added that 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."

    Mark Brittingham, CEO and co-founder of corporate wellness technology provider BSDI, said, "It just makes sense that if [a] population does engage in healthy behaviors they will have healthier outcomes and they will be more productive." Brittingham said he suspects employees who participated in the study's wellness program over reported the amount of time they exercised, which would explain why their health did not improve. He added, "No company should feel that they can just go drop a wad of cash on a program like this and magically get a reward in terms of medical savings over the short term. Any vendor that says in 18 months we're going to show you a huge return on your investment is simply not telling you the truth."

    Jean Marie Abraham, a professor of health care administration at the University of Minnesota, in an editorial accompanying the study wrote, "[T]raditional, 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." But she wrote that the study's results do not mean employers should not invest in employee wellness. Instead, employers might need to consider "more targeted approaches" focusing on employees with higher risks or on "health behaviors [that] may yield larger health and economic benefits," she wrote.

    Steven Aldana, CEO of the wellness program vendor WellSteps, said workplace wellness programs should involve number of strategies to help employees improve their health. For instance, wellness programs should involve changing the food served in office cafeterias and employees' spouses, who can help encourage them to eat better, exercise more, or quit smoking, Aldana said. He added, "Behavior is more complicated than simply taking a few wellness modules. It's a lifestyle matrix or pattern you have to adopt" (Appleby, Kaiser Health News, 4/16; Owens, "Vitals," Axios, 4/17; Ross Johnson, Modern Healthcare, 4/16; Abelson, New York Times, 4/16).

    Learn more about why study design matters

    Been awhile since your last statistics class? It can be difficult to judge the quality of studies, the significance of data, or the importance of new findings when you don't know the basics.

    Download our cheat sheets to get a quick, one-page refresher on some of the foundational components of evidence-based medicine.

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