Yesterday, I had the privilege to be on a HERO webinar panel with researchers who published a new study on the efficacy of a workplace wellness program. Their findings are summarized in a Bloomberg article titled “Workplace Wellness Programs Really Don’t Work”.
Notice in my first sentence I wrote “a workplace wellness program”, not “workplace wellness programs”. There’s a big difference here and I’ll explain in a few paragraphs.
Why study workplace wellness programs?
Many workplace wellness programs struggle to prove effects on health outcomes and medical spending, and have trouble driving enrollment and participation.
That’s why the efficacy of wellness programs, and whether or not money can motivate participation, have been targeted by hundreds of research studies with mixed results.
First, let me genuinely applaud the work that was done. The quality of the research conducted was outstanding in that it included truly randomized participants, carefully constructed scenarios and thorough analysis. I sincerely think it’s an impressive body of work.
My concern is not with the study methodology but with the conclusions that some seem to be drawing from it.
Conclusions on the use of incentives
This study put a lot of effort into comparing the impact of a $100 incentive to a $200 incentive for participation. I’m in no way surprised that there wasn’t a big difference in the impact observed. We consider all incentives under $600 to be “small incentives” relative to both health plan premiums and in general motivation for behavior change.
Average individual health plans in 2018 cost $6,690 and family plans cost $18,764 (Kaiser Family Foundation and Health Research and Education Trust). Since the hot debate is whether or not 30% of premium ($2,007) should be permitted as a wellness incentive, learning the difference between $100 participation incentive and a $200 participation incentive fails to impact the conversation.
It would be powerful to repeat the study using $100, $1,000 and $2,000 incentives to better reflect tipping points for participation and behavior change.
Conclusions on participation
In addition to the incentives for participation, the study looked at the impact of randomized opportunities for individuals to engage in healthy behaviors such as going to the gym, classes on weight management, Tai Chi and similar activities where they could earn up to $75 per semester (in total).
Again, not surprisingly, the study revealed that healthier people were more likely to engage in these activities. In fact, they measured participants who ran the Illinois Marathon and found no difference in participation rates between those with no wellness incentives and those who were incentivized. Of course…
As experts like Dr. Michael Roizen at the Cleveland Clinic have observed and shared, small incentives generally just pay people who are already doing things. They tend to be a waste of money relative to inspiring behavior change. He added “incentives don’t work, large incentives work”. To hear more about the Clinic’s successful program – click here.
Imagine if your medical plan annual deductible was only $100 more for out of network doctors than in-network doctors? Participants would go to whatever provider they liked most and cost the plan significant dollars in lost network discounts. It’s rare now to see less than $1,000 if steerage is expected.
This is certainly also true for Emergency Room utilization, brand vs. generic drugs and more. You really won’t see behavior patterns change when dollars are insignificant (notwithstanding change that can also be accomplished through motivational interviewing, great communications and personalized coaching, but this can take a very long time and be very expensive to offer).
Conclusions on claims spending improvement over time
When measuring the impact on claims spending, expectations must be realistic. Starting Tai-Chi today will not prevent my lung cancer in 90 days. This study measured activities through April 2017 and claims through July 2017. What would be valuable to measure is screening results (risk reduction) from year to year.
As individuals move from pre-diabetes to normal, from hypertensive to normal, from morbidly obese to overweight etc., the long-term impact on claims as well as productivity and work injuries are obvious.
A call for more conclusive studies of best-practice wellness programs
Unfortunately, we’ve yet to see a single study suggest that a program will fail when it includes the pillars of behavior change and well-being improvement (e.g. larger incentives tied to challenging but achievable improvement goals, tools and resources to empower behavior change, and a cultural environment that supports progress). Of course, an individual’s personal physician can always override a program improvement goal by giving a modified goal or even a waiver.
A great scenario for future study would be linking the incentive with health improvement instead of program participation. Lots of studies show that programs won’t prove ROI (especially not in one year). They may however serve as a nice employee perk that helps with recruiting, retention and culture (all other valid reasons an employer may still purchase them). But our experience suggests that if you really want improvement, you should reward improvement.
Again, I applaud and respect the quality of the study mechanics but strongly caution putting too much weight into the headlines or conclusions.
Relatively small incentives may indeed motivate individuals to participate in things that are convenient, easy and painless, especially if they are things they are already doing. Large incentives may be less popular (like lower deductible for preferred doctors) but employees “get it” and they are very effective in engaging those who otherwise wouldn’t engage.
We are hopeful that future studies measure the long-term impact that various programs and incentives can have in measurable risk reduction.