25 Oct Has “Outcomes-Based Wellness” Run Its Course?

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As Bravo celebrates its 8th year since launching into the corporate wellness space, I reflect on all of the change we’ve seen, the lessons we’ve learned and the lives we’ve touched. It’s truly an honor to lead this great organization and to support employers in their quest to enhance the performance of their team, while controlling expenses for the sustainability of their companies.

Starting with the HIPAA wellness rules, watching the onset of Obamacare, navigating the ACA wellness regulations, reacting to EEOC lawsuits, and most recently, incorporating the ADA and GINA wellness regulation has created an annual minefield of new twists and turns that impact program design. Knocking on wood here…2017 is the first year I can recall in our company history that the rules seem like they will be somewhat stable. It’s exciting!

Why such change? Why do government agencies seem to have zero problems with companies that don’t invest a penny into the well-being of their employees, while they go on the attack against employers’ efforts to provide individuals with free gym memberships, smoking cessation tools and coaches to improve their health? It seems counterintuitive, right? As with most laws and regulations, the ugly maze that has evolved is necessary because of the outliers that abuse the intent of the safe harbor created for wellness programs. The programs that have a different opinion of what it means to be “reasonably designed” or “not overly burdensome,” or even more often, the mere fact that original regulations left the potential for backdoor underwriting, discrimination and abuse, gave rise to the need for greater guardrails.

I’ve recently heard conference speakers and various bloggers say that outcomes-based wellness incentives have failed and that the pack has moved on to “total well-being.” In its failure to demonstrate ROI, the industry is focused on VOI (value on investment) and is now aligning well-being investments with more holistic initiatives like training, employee engagement and team building. Popular wellness elements such as biometric screenings, tobacco penalties, and even things like walking programs are viewed by some as archaic and even barbaric in their attempts to motivate health improvement and cost savings. After all, people just need an encouraging nudge, creative health education, resiliency training and games that make these things fun, right?

Here’s the thing. If the latest interventions, mobile apps, team challenges, games and health quizzes are effective, shouldn’t there be a measurable result at some point? When companies go from years with modest (3 to 5 percent) increases in health care costs and strong earnings, to tougher years with double-digit health care cost increases and/or years with slumping EBITDA, the initiatives that cannot demonstrate financial results will be among the first to go. Thinking that ROI doesn’t matter is shortsighted.

Am I saying these are a waste of money, bad ideas or ineffective strategies? No, I’m not saying that at all! In fact, some of the biggest enhancements to Bravo’s suite of services include state-of-the-art team challenges, gamification, online, in-person and telephonic coaching, financial wellness support and more. What I am suggesting is that these are “and” strategies rather than “or” strategies. Add these enhanced tools for outreach, motivation and behavior change to your benefit design and your use of incentives tied to health improvement and meaningful results. Don’t throw the baby out with the bathwater.

Has outcomes-based wellness run its course? In some cases, yes. The idea of a program that says “have a BMI under 25 or pay a 20 percent penalty” is long gone (as it should be). The draconian theoretical examples of what some think an outcomes-based design consists of are dead. The idea, however, of encouraging health plan participants to identify a primary care provider, establish a meaningful health goal, reduce a risk and/or make progress toward that goal and receive discounts on health plan contributions is stronger than ever and will be integrated into more and more health plan designs.

I recently attended a presentation by Dr. Mike Roizen of the Cleveland Clinic. Many will recall the arrows the Clinic incurred as a pioneer in linking the cost of joining the clinic’s health plan with an individual’s participation and accomplishments in the employer wellness program. Was it worth it? Absolutely. The Clinic has experienced a decrease in claims per employee over the last six years and can document sustained health improvement. The problem with most incentive programs, Roizen said, is that the incentives are too small. He added: “Incentives don’t work. Large incentives work.” Bravo’s results support this 100 percent. If you just want to cost-shift, use a small penalty. People just roll their eyes and pay it. When the dollars are meaningful, the goals are realistic, the tools are effective and the probability of success is high, people go for it and they succeed. It really is a win/win.

It truly is an art and a science. Bravo is proud to report over 90 percent retention in our business. And among those who adopt our suggested designs and interventions, it’s nearly 100 percent. Well-designed incentives linked to the achievement of a realistic yet meaningful goals are working extremely well as a way to reduce high risks and save money—especially when combined with the latest strategies and interventions for total well-being. Want to take your program to the next level? Ask us how today.