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Paying People to Be Healthy Might Not be Working

Nov. 16, 2016
“Participation in wellness programs is notoriously low, and financial incentives have led to only modest employee and dependent uptake. Some employees see the programs as intrusive or a waste of time and resources.

There is a question employers are asking themselves. Is the current wellness strategy, which typically includes collecting biometrics such as cholesterol readings and weight measurements from employees, worth the investment of paying incentives?

Research is showing that traditional wellness programs have often disappointed employers, concludes Jeff Levin-Scherz, MD and Steve Nyce, based on a study done for Willis Towers Watson.

“Participation in wellness programs is notoriously low, and financial incentives have led to only modest employee and dependent uptake. Some employees see the programs as intrusive or a waste of time and resources.

"We are finding employees are actually very unhappy at the thought an employer would penalize somebody with a high body mass index (BMI), and that includes employees who don't themselves have high BMIs and who are supportive of the employer playing a positive role in health care."

And they point out that rigorous academic studies fail to show substantial cost savings, even as vendors continually promise glowing returns on investment.

Employers are re-examining incentives. Greg Goth explored this in an article on the Society of Human Resources Mangers.  He talked to an owner of a benefit firm, Christopher Sears, a partner in the employee benefits group of Indianapolis-based law firm Ice Miller, about what he’s seeing in the field.  

"I do think there are some employers who wonder if this is really the best use of a subsidy or premium discount," said Sears, citing the Pareto principle, the 80-20 rule that postulates 20% of a given population usually accounts for 80% of costs.

"Could that money better be used to pay a vendor and do a deep dive into the data and target chronic diseases and disease management programs to help the 20% manage their disease?,” Sears added. “They're starting to think they should try to promote prescription compliance and diabetic-diet compliance to try to tackle those larger costs."

Employers are adjusting their program, according to the Willis Towers Watson's 2015-16 Global Staying@Work survey, which found that:

  • 70% said their primary strategy to promote healthy behaviors was to offer direct financial incentives, but only 47% said they expected financial incentives to be their primary strategy in 2018.
  • 34% said they focused their health-promotion efforts primarily on strategies to create an organizational culture around workforce health and well-being, but that rises to 64% who expected to pursue that route by 2018.

Levin-Scherz recommends the when companies reevaluate their well-being programs they consider:

  • Yesterday’s wellness programs don’t meet today’s needs. Cold calls and computer-based learning modules have given way to digital hubs, apps and text-based coaching on demand.
  • Members as consumers need a wide choice of programs. Offer meaningful choices, as each member’s needs are different. Some members may want a nutrition or weight loss program; others value a program aimed at prediabetes or insomnia, while others may be attracted to athletic competition.
  • Programs should move beyond physical wellness. Wellness programs are increasingly being recast as well-being programs, with a focus on not just physical health but also emotional, financial and social well-being.
  • Well-being programs will improve only if they are rigorously evaluated. Include structural measures (did the program vendor have all elements in place on time as promised?), process elements (what level of sustained participation was achieved?) and outcome elements (including member satisfaction and demonstrated behavior change) in your well-being evaluation, and design and implement measures prior to program launch.

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