By Zirui Song, M.D., Ph.D. and Katherine Baicker, Ph.D.
JAMA, April 16, 2019
Question: What is the effect of a multicomponent workplace wellness program on health and economic outcomes?
Findings: In this cluster randomized trial involving 32,974 employees at a large US warehouse retail company, worksites with the wellness program had an 8.3-percentage point higher rate of employees who reported engaging in regular exercise and a 13.6-percentage point higher rate of employees who reported actively managing their weight, but there were no significant differences in other self-reported health and behaviors; clinical markers of health; health care spending or utilization; or absenteeism, tenure, or job performance after 18 months.
Meaning: Employees exposed to a workplace wellness program reported significantly greater rates of some positive health behaviors compared with those who were not exposed, but there were no significant effects on clinical measures of health, health care spending and utilization, or employment outcomes after 18 months.
From the Introduction
Workplace wellness programs have become increasingly popular as employers have aimed to lower health care costs and improve employee health and productivity. In 2018, 82% of large firms and 53% of small employers in the United States offered a wellness program, amounting to an $8 billion industry. This growth has been aided by public investments such as the Affordable Care Act, which included funds to promote the development of workplace wellness programs.
Among employees of a large US warehouse retail company, a workplace wellness program resulted in significantly greater rates of some positive self-reported health behaviors among those exposed compared with employees who were not exposed, but there were no significant differences in clinical measures of health, health care spending and utilization, and employment outcomes after 18 months. Although limited by incomplete data on some outcomes, these findings may temper expectations about the financial return on investment that wellness programs can deliver in the short term.
By Don McCanne, M.D.
With the very high costs of health care in the United States, it is no wonder that businesses latched onto products offered by the purveyors of wellness programs that promised lower costs for their employer-sponsored health plans, not to mention the benefit of having a healthier workforce. Great concept, so how is it working out?
Roughly a tenth of the employees in this meticulous study of a wellness program reported that they were more attentive to their personal exercise and weight management programs, “but there were no significant differences in clinical measures of health, health care spending and utilization, and employment outcomes after 18 months.” It did not produce the outcomes the employer was promised.
Employers have tremendous problems with their health benefit programs. The costs continue to increase. Employment is unstable with 66 million leaving their jobs each year. Continual changes in insurers, provider networks and benefits covered increase the instability of health care for the workers and their families. And now this desperate attempt to create “wellness” is failing them.
Quite a few years ago, I co-authored a paper with the chairman and CEO of a Fortune 100 company who was also the chair of the Health Committee of the Business Roundtable. The topic was Medicare for All. The intent was to show that an icon of the business world and a health care justice activist could come together to support health care reform that would work well for all of us. Although the article was encouraged by the editor of the leading health policy journal, a junior editor was assigned to send us the rejection notice. The medical-industrial complex was simply not ready for a single payer model of reform.
But look at the wealth of health policy knowledge that has continued to spring up. By any objective criteria, the single payer Medicare for All model is vastly superior in that it achieves all essential goals of reform while using a financing system that is equitable and affordable for each of us. About that last point, none of the other models come close on affordability for all individuals and families, yet, with our three and a half trillion dollar health care bill, we absolutely have to get that one right. Besides, enacting and implementing a health care financing system that works for all of us sounds to me like a pretty good start to a universal wellness program.
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