Wellness Programs May Not Significantly Impact Healthcare Spending

Wellness programs may influence health behaviors, but demonstrated little impact on healthcare spending, health outcomes, or employment outcomes, a study published in Health Affairs uncovered.

It has been debated whether workplace wellness programs, a common preventive care strategy among insurers and employers, have a significant impact on employee wellness.

“The more recent findings of limited short-run effects raise a key question: Do short-term improvements in health behaviors translate into improvements in other outcomes over a longer period?” the researchers explained. 

“This question may be particularly important to US employers, who retain workers for a median of 4.2 years, as well as to policy makers and clinicians aiming to improve chronic health conditions. In this study we evaluated the effect of a clustered randomized controlled trial of a longitudinal workplace wellness program through three years.”

From 2015 through 2017, the researchers conducted a study of a randomized set of warehouse retail sites owned by a single large employer. The study implemented a wellness program that had 12, four- to eight-week-long modules covering a variety of wellness and preventive care subjects.

The study involved both individual and group segments and employed rewards for completed tasks.

Researchers collected data in four categories: self-reported health and behaviors, clinical health measures, healthcare spending and utilization, and employment outcomes.

The study observed over 48,000 employees across the different sites, approximately half of whom were employed full time. Work sites were divided into treatment sites and control sites so that researchers could compare those in the wellness program to those not in the program.

However, program participation at the treatment sites was not stable. Program participation grew over the course of the modules, from 12.3 percent in the first module to as much as 37.6 percent in later ones.

There were varying rates of completion for the program overall. Nearly three in ten employees completed at least a single module (28.4 percent).

Over 2,700 people filled the self-reported health and behaviors category. Of these, those who were at treatment sites reported a 5.9 percentage point higher rate of regular exercise than the control group. 

Also, those at the treatment sites had a 6.9 percentage point higher rate of weight management. This translated to an 11 percent increase in contrast to the control group and an 18 percent increase among those in the wellness program.

There were no significant changes in clinical health measures, healthcare spending and utilization, or employment outcomes such as absenteeism.

“The results differ from much of the prior literature on workplace wellness programs, which generally used nonrandomized designs and often found positive and large returns on investment,” the researchers explained.

“Given selection bias and other methodological concerns in observational studies, randomized trials likely provide more reliable estimates of program effects. However, results from any specific wellness program, employer, or worker population might not generalize to other programs or settings, and rigorous observational studies with empirical strategies to minimize bias can provide important complementary evidence.”

Studies have demonstrated mixed results on the subject of wellness programming in the past. While the Health Affairs study does not necessarily end the debate over wellness programs’ effectiveness, it does add more data for payers and employers to consider.

“To the extent that these results are representative of other wellness programs, they temper expectations of substantial improvements in health outcomes or financial returns on investment from wellness programs up to a three-year horizon,” the Health Affairs article researchers concluded.

The coronavirus may have impacted trends in wellness programming utilization, according to a UnitedHealthcare survey published in August 2020.

The survey found that the pandemic reshaped members’ health behaviors. Walking became a common preferred activity, eating habits changed, and stress and mental healthcare needs escalated.

As these needs became amplified, experts suggested that wellness programs might respond by serving those needs. Employees said that wellness programs had a positive impact on their health or improved their awareness about their health.

Subsequently, payers have found that some digital wellness programs saw a positive member engagement during the pandemic and strong results in tackling the obesity pandemic.