Under the assumption that improved employee health could reduce the burden of healthcare costs to employers, workplace wellness programs have become increasingly popular in U.S. businesses. However, recent analysis has determined wellness programs actually increase employer spending on healthcare with no net health benefit, and can even pose additional health risks, according to a recent article in Health Affairs.
Wellness programs include a range of healthcare services designed for improving employees' behavior and encouraging healthy lifestyles with the hope employees will require fewer medical services in the future. Some companies even require employees to pay higher percentages of their premiums if they opt out of wellness programs.
As it turns out, employers incentivizing their employees to participate in such programs may need a confidence check. The following observations discuss why wellness programs are not the solution to high healthcare costs many employers hoped they would be, according to Health Affairs.
Wellness programs cost more than they save.
According to the article, wellness programs produce a return on investment of less than 1-to-1 savings to cost. Authors of a 2014 American Journal of Health Promotion meta-analysis found a negative ROI in randomized controlled trials when testing the efficacy of wellness programs. According to the authors of the study, wellness in general loses money when correctly measured.
Past studies misrepresented outcomes.
Past wellness studies commonly compared participants of wellness programs to non-participants or compared a subset of participants (typically high-risk individuals) to themselves in a longitudinal manner, according to Health Affairs. Despite the savings these studies usually showed, closer analysis reveals the savings from wellness programs were exclusively attributable to disease management activities for a small subset of the population, usually pre-existing medical issues — not from promoting healthy behaviors to a broader population. Furthermore, the reduction in medical spending was only $1 for every $3 spent on the programs.
Individual attitudes and motivation prevent reliable comparisons.
The article points out that it is impossible to determine whether participant vs. non-participant savings in medical expenses are due to wellness programs or to varying attitudes the employees have regarding their health. For example, smokers who volunteer to participate in a smoking cessation program may simply be more predisposed to quit smoking than smokers who opt out of such programs. While it's possible to compare the healthcare cost each incurs, it's impossible to determine what factors contributed changes in behavior, and subsequently, health.
Essentially, comparing motivated volunteers to non-motivated non-volunteers simply cannot yield reliable results, according to Health Affairs.
Lack of clinical evidence to support efficacy.
According to Health Affairs, there is no clinical evidence to support that the three pillars of workplace wellness are cost-effective. These pillars include annual workplace screenings, checkups for all employees (and sometimes spouses) and incentivized weight loss. The United States Preventive Services Task Force only recommends blood pressure screenings, according to the article.
Potential false positive, over-diagnoses and over-treatment pose potential harms that exceed the possible benefits of annual screenings as wellness programs require, according to Health Affairs.
There are serious risks associated with incentivized weight loss, too, according to the article. Disordered eating such as crash dieting and binging before and after weigh-ins could result from such incentives. Some plans even offer weight-loss drugs that medical professionals argue could have potential harmful effects.