Wellness Programs: Benefits Pending
While the U.S. Departments of Health and Human Services, Labor and the Treasury jointly released rules about workplace wellness programs under the Affordable Care Act (ACA) last week, the financial and health improvement value of the programs has not yet been proven, according to several panelists at a briefing late last week co-sponsored by the Alliance for Health Reform and the Robert Wood Johnson Foundation.
How effectively these programs work is especially important now: beginning in 2014, employers will be allowed to charge their workers up to 30 percent more for health insurance premiums if they don't meet certain health goals. Currently, nearly half of large companies offer wellness programs, which can range from smoking cessation programs to penalties for employees who don’t meet employer-defined health targets in such areas such as cholesterol, blood pressure, and Body Mass Index.
Some employee groups worry that the new ACA regulations open the door to penalizing workers, particularly ones least able to afford it, who don’t meet benchmarks under the new rules. “Coverage has been available to everyone [in the large group markets] for decades at the same rate...wellness programs risk introducing underwriting to the large group health insurance market,” said Karin Feldman, benefits and social insurance policy specialist at the AFL-CIO.
Several panelists cited a Rand Corporation study on wellness programs for over that was requested by HHS and published last week that reviewed wellness programs at more than 600 employers and also analyzed medical claims data from the Care Continuum Alliance (a trade association for the health and wellness industry) and found only minor benefits for health improvements and savings, including:
- Participants lost an average of only 1 pound a year for 3 years
- No significant reductions in total cholesterol levels
- Successful smoking cessation appeared to be only short term
- Average annual savings from the programs were under $160 per participant, which the Rand researchers said were statistically insignificant
- Statistically insignificant reduction in cost or use of emergency rooms department or hospital care
Panelist Jill Horwitz, a professor at the UCLA School of law, is a co-author of a recent study in Health Affairs that challenged the cost savings of workplace wellness programs. Horwitz says there is little evidence that wellness programs can easily save costs through health improvement without being discriminatory and that savings to employers may come from cost shifting, with lower-income employees probably bearing greater costs that in effect subsidize healthier colleagues. “I hope more rigorous study will be done before [workplace wellness programs] are more widely adopted,” said Horwitz at last week’s briefing.
Panelists generally agreed that evidence of the value of the programs is still lacking. "We’re not sure what works. There’s got to be peer-reviewed data and it’s simply not there,” said Troyen Brennan, executive vice president and chief medical officer of pharmacy chain/pharmacy benefits manager for CVS Caremark. Brennan said CVS/Caremark is “embedding experiments in all of our wellness programs” to try to find out what will work. “The annals of health care are full of things that seem like a good idea but show no effect,” said Brennan.
UCLA’s Horwitz says she does have anecdotal evidence of one related program working. Having seen UCLA employees exercising on the campus during the work day she asked about impact and found that workers’ compensation claims appear to have gone down.
>>Highly Recommended Reading: Recently, Health Affairs, with financial support from the Robert Wood Johnson Foundation, published a policy brief on workplace wellness programs that delves into the intricacies of the hopes for, but also potential pitfalls of the programs, especially for lower-income employees.