In late May, the administration clarified how the programs should also comply with the ACA and with rules issued jointly by the Department of Health and Human Services, the Labor Department, and the Treasury Department. In a statement HHS said, "The final rules support workplace health promotion and prevention as a means to reduce the burden of chronic illness, improve health, and limit growth of health care costs, while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status."
The ACA also set aside $10 million from the Prevention and Public Health Fund for the Centers for Disease Control and Prevention to work with small and mid-sized employers to develop wellness programs. The CDC announced in June that 104 employers had voluntarily chosen to participate in the National Healthy Worksite Program.
Do they improve health or cut costs?
Wellness programs have been envisioned as a way to get employees interested in being engaged in their own health care, but they also are seen as a way to reduce health costs. The evidence so far suggests the programs have done more to improve health than to cut costs, but the database is fairly thin – despite the growing adoption of the programs.
A recent survey of 800 large and mid-sized employers by Aon Hewitt found that 83% said they offered an incentive – the vast majority, a reward – for participating in basic programs such as completing a health risk survey or biometric screening.
Another study by the RAND Corporation, conducted for the Department of Health and Human Services and issued in late May, found that at least half of employers with more than 50 workers offer a wellness program.
Employee participation was underwhelming, though. Less than half of workers participated in even the most basic screenings, and only 7%-21% took part in programs designed to help them lose weight or lower their blood pressure, for instance.
The literature is mixed on whether wellness programs cut costs or save employers money. The RAND researchers reported that a review of randomized controlled trials found significant cost decreases, ranging from $11 to $626 per year per employee. More than half of the employers surveyed believed that their programs saved money, and an even greater number thought they reduced absenteeism and increased productivity. Interestingly, however, according to the report, "less than half of the employers reported regularly evaluating their wellness programs, and only 2 percent provided actual savings estimates."
The RAND group concluded that wellness programs were successful when it came to diet, exercise, smoking, and alcohol use, but that there was "limited evidence for effects on absenteeism and mental health." Even so, the authors said their findings should be viewed with caution because most of the studies they looked at were not particularly rigorous.
A study published in Health Affairs in 2010 found medical cost savings of $3.27 for every dollar spent on wellness programs, and that absentee day costs dropped by about $2.73 for every dollar spent. The authors concluded that "the wider adoption of such programs could prove beneficial for budgets as well as health."
A more recent article by Jill R. Horwitz, a professor at the University of California, Los Angeles, School of Law, suggests that wellness programs create savings by essentially shifting costs onto employees – and are discriminatory, to boot. "The most vulnerable employees – those from lower socioeconomic strata with the most health risks – probably bear greater costs that in effect subsidize their healthier colleagues," Ms. Horwitz and her colleagues wrote. The study was funded by University of Michigan Law School Cook Fund.
The laws governing wellness programs allow employers to give employees a discount for meeting health goals of up to 30% of the premium. For quitting tobacco, the discount can go as high as 50%. Employers can also penalize workers by the same amounts.
Most surveys have shown that, for now, employers are giving discounts, not levying penalties. That could change. According to the Aon Hewitt survey, within the next few years 58% of employers plan to "impose consequences" on workers.
What’s in it for you?
Ostensibly, workplace wellness programs can assist physicians in helping patients to make lifestyle changes. But there’s also the possibility that the programs can increase the paperwork without any real improvement in patient outcomes.
In comments to HHS, the Labor department, and the Treasury department in January, ACP’s immediate past president, David Bronson, wrote that the organization was "concerned that plans may impose an undue administrative burden on physicians and their staffs."