Wellness Programs on Trial
Now may be a good time to reflect upon the problems HR leaders are trying to address with wellness programs.
I’ve been involved in wellness in one way, shape or form my entire life. Raised by parents who believed life was a balance of work, love and play, I grew up with a rainbow of colors on my dinner plate, ballet lessons, bicycle rides, basketball and other childhood games, high expectations for doing my best in school and church on Sundays.
In hindsight, it’s not a surprise I gravitated toward combining my love of science and mathematics with physical activity and health. I ultimately found myself studying physiology and biophysics in graduate school, and accepting my first job as part of an interdisciplinary team that used science to maximize the performance of both elite athletes and the general public.
It was during my first work experience that I encountered employees whose participation in our programs was subsidized by their employers. It was the late 1980s and the corporate world was dizzy with excitement about the possibilities associated with supporting a healthy workforce. Within relatively short order, we found ourselves placing these workers into one of two categories: the short-timers and the worried well. The short-timers lasted one to four weeks. No matter how often we worked with them to customize their health experience with us. The worried well were with us for life with no extra effort required.
I learned early on that corporate wellness initiatives largely served the worried well workers. There was absolutely nothing wrong with providing these individuals with programs to support their health, but it was also clear there was no health-cost savings from this initiative either.
So I was not surprised when recent headlines touted that workplace-wellness programs saved no money for employers, or at least after the first year of what is a four- to five-year prospective study called the Illinois Workplace Wellness Study. As WBUR summarized, this large-scale, randomized controlled trial found virtually zero benefits from a workplace-wellness program during its first year: no lower health costs, no fewer sick days, no extra trips to the gym, no rise in productivity.
And guess what? Employees who chose to participate in the workplace-wellness program were already healthier before the program began than those who did not. In other words, they were part of Team Worried Well.
There were, however, two positive findings in this sea of no impact. The first was that workers who joined the wellness program became likelier not only to seek screening for health issues but also to say they thought their employer placed a high priority on employees’ health.
The second positive finding was similar to one found in research I helped conduct on the impact of employee-assistance programs: Even when employees did not use the EAP, they were less likely to take sick days, and returned to work more quickly if they were out than workers whose employers did not offer an EAP.
It appears that a company’s decision to offer health-related programs is associated with employees having a more favorable opinion of their employers. (It is important to note that this is an association of circumstances and is not a cause-and-effect outcome.)
Another recent story in the New York Times summarized that preventive care only saved money in two circumstances: childhood immunizations and the counseling of adults on the use of low-dose aspirin. An additional 15 preventive services were found to be cost-effective (meaning that they cost less than $50,000 to $100,000 per quality-adjusted life year gained).
The author of that piece cited many good arguments for increasing our focus on prevention, but they have nothing to do with saving money and everything to do with quality of life. This is no small outcome.
Given all of the above, I was somewhat astonished by the uproar heard across the country by employers and wellness vendors when John D. Bates, the federal judge presiding in the case of AARP v. Equal Employment Opportunity Commission, vacated the ruling that employers can offer incentives equal to up to 30 percent of the total cost of employee-only coverage to encourage workers to voluntarily participate in wellness programs. (Note: This ruling only applies to medical exams and certain types of inquiries such as those often used in health-risk assessments.)
I participated in a webinar on the implications of this decision in January and a number of people asked me to expand on this topic in this column. So I went back to my Businessolver hosts and asked Bruce Gillis, the company’s strategy practice leader of health, welfare and compliance, to provide further guidance for HR executives.
The judge’s decision can be a challenge for HR, benefits and wellness leaders who historically incorporate medical exams, biometric testing and health inquiries within their wellness initiatives. Unless the EEOC provides guidance faster than it previously indicated it could, Gillis says, employers will finalize their 2019 wellness-plan designs without additional direction. He suggests that, in the absence of this information, employers might consider the following options in planning their changes for 2019:
- Add an alternative wellness option that does not require a biometric screening or ask health-status questions. These alternatives could take the form of education-oriented programs and can be positioned to earn an equivalent incentive as the biometric screening. This approach gives employees multiple paths to earn the incentive and makes participation in the screenings truly voluntary.
- Some employers may choose to reduce the reward associated with participation in the biometric screenings or risk assessments. With additional guidance from the EEOC, Gillis notes, this may become a popular option. There was agreement from AARP that some level of incentive was acceptable, but without final direction from the EEOC it is difficult to predict what that acceptable level may be. (In the Illinois Workplace Wellness Study, a $100 incentive for participation appeared to be almost as good as a $200 reward in terms of spurring participation.)
- Employers may choose to fully eliminate incentives within their wellness program while they await further guidance.
- Employers could modify their programs such that the incentives employees earn are solely for non-biometric screening or risk-assessment programs. For example, programs that currently use blood screenings to detect the presence of nicotine may instead simply ask the employee if he or she is a tobacco user and adjust the premiums based on the response provided. In addition, a health-education program could be put in place that employees could choose to earn incentives without being required to answer questions about their individual health status.
As always, employers should work with their advisors to determine a program that works within the evolving climate, while still allowing them to remain engaged in and supportive of their employees’ health and wellness.
I asked Rae Shanahan, Businessolver’s chief strategy officer, to comment on the AARP v. EEOC ruling as well, since she and I are often of similar minds when it comes to empathy and the workplace. True to form, Shanahan sees the disruption caused by this case as an opportunity for employers to re-evaluate the reasons they offer wellness programs.
“Let’s use ‘empathy’ as a verb and put it into practice,” Shanahan says. “The spirit and intent of the wellness exams, health-risk assessments and biometric screenings were good, yet it became mass- produced.”
When we deploy empathy and appreciate health literacy from employees’ perspective—and assume positive intent in their behaviors and choices—we can use this ruling to look at things differently. As Shanahan suggested, employees knowing their biometric numbers alone does not help employees to better navigate our healthcare system.
I will conclude by returning to something even more basic. We should use this time following the AARP v. EEOC decision to reflect upon the problems we were trying to address or solve with wellness programs. Most employers were aiming to reduce healthcare costs. Others were attempting to shift healthcare costs to their employees—especially if they didn’t participate in wellness programs. And still others wanted to improve employee productivity. But we can see from the disciplined design of the Illinois study that wellness programs don’t reduce healthcare costs or improve employee productivity.
If we use empathy, as Shanahan recommended, we will hear what employees have been telling us over the last 12 months. Employees want two things: flexibility, and paid leave for the care of their own health conditions and those of people for whom they care. Perhaps it’s time we incorporated those desires into our workplace-wellness design.