I was eager to dive into the RAND Corporation and the U.S. Department of Labor’s recently-released follow-up study on workplace wellness programs. With wellness programs becoming more and more common in the United States, the study puts them to the test by asking a simple question: do they actually work?
Expanding on RAND’s 2013 report, this study looked at:
- use of incentives among employers; and
- program participation and utilization among employees.
Researchers solicited participation for the study from a random sample of 3,000 public- and private-sector businesses that employed at least 50 people. About 20 percent responded, yielding a final sample of 589 employers.
The study looked at two primary research questions:
- Which employer characteristics predict program availability, program configuration, and incentive use?
- Are there typical program configurations—such as the combination of certain screening and health management interventions—and how are these configurations related to
Here’s what they found:
- 69 percent of employers offered some type of wellness program.
- Of those that offered a wellness program, 3 out of 4 offered incentives to participate.
- Larger employers (more than 1,000 employees) are more likely to offer a wellness program compared to smaller employers, in large part due to cost.
- The most common program configuration (34 percent) was “limited,” meaning an employer offered limited services in screening to detect health risks; lifestyle management; and disease management. So in some senses it’s a box-checking exercise; employers say they have a program, but don’t really offer much in the way of quality or comprehensiveness.
Now to the interesting stuff: incentives. How were they used? And more importantly, did they work?
- Use of incentives usually meant higher participation. Without incentives, average participation rate was only 20 percent. Not a surprise here. When it comes to health, fewer people respond through intrinsic motivation. The paradox here is that intrinsic motivators result in sustained habits or behavior over the long-term compared to extrinsic motivators (eg money, discount, gift card, etc), even though its the extrinsic factor that forces (or coerces) a change in the short-term.
- Though only about 1 in 10 employers offered comprehensive wellness programs, they had the highest participation rate (59 percent) and were less sensitive to incentive schemes. In other words, if the employer offered a quality, comprehensive program, they didn’t have to rely on incentives to bate employees to participate.
Then researchers dug a bit deeper using one Fortune 100 company as a case study. Again, they focused on employee characteristics that predict participation, incentives, and how any of this is influencing employee health.
A few highlights:
- Healthier employees and those residing in higher-income ZIP codes were more likely to complete an initial health risk assessment questionnaire.
- Older employees and those with multiple chronic conditions were most likely to participate in disease management components of wellness programs.
- The introduction of a $600 surcharge for smokers who didn’t participate in a smoking cessation program was associated with a significant DECREASE in program uptake by about 18 percentage points.
- Participation in lifestyle management wellness programs was NOT associated with significant changes in overall health care costs or utilization. Even when there was higher exposure to wellness programs (ie more participation in service offerings) it wasn’t associated with greater health care costs savings. RAND’s 2013 study of wellness programs found similar results.
Workplace wellness programs are an exciting area of research at the moment. Many are still in their infancy and we’re just beginning to understand the impact (or lack of) they are having against their stated goals. Most importantly, as more employers introduce these types of programs, and many others evaluate the ones they already have, I hope this type of research will help inform more effective programs in the future.