The following in an excerpt of what originally appeared on
The Upshot (copyright 2014, The New York Times Company) and is coauthored by Austin Frakt and Aaron Carroll:
... Wellness programs have grown into a $6 billion industry because employers believe [they actually work]. In fact, asked which programs are most effective at reducing costs, more firms picked wellness programs than any other approach. The Kaiser survey found that 71 percent of all firms think such programs are “very” or “somewhat” effective, compared with only 47 percent for greater employee cost sharing or 33 percent for tighter networks. (Recent research on public employee plans in Massachusetts found that tighter networks were associated with large savings.)
What research exists on wellness programs does not support this optimism. This is, in part, because most studies of wellness programs are of poor quality, using weak methods that suggest that wellness programs are associated with lower savings, but don’t prove causation. Or they consider only short-term effects that aren’t likely to be sustained. Many such studies are written by the wellness industry itself. More rigorous studies tend to find that wellness programs don’t save money and, with few exceptions, do not appreciably improve health. This is often because additional health screenings built into the programs encourage overuse of unnecessary care, pushing spending higher without improving health.
However, this doesn’t mean that employers aren’t right, in a way. Wellness programs can achieve cost savings — for employers — by shifting higher costs of care onto workers. In particular, workers who don’t meet the demands and goals of wellness programs (whether by not participating at all, or by failing to meet benchmarks like a reduction in body mass index) end up paying more. Financial incentives to get healthier sometimes simply become financial penalties on workers who resist participation or who aren’t as fit. Some believe this can be a form of discrimination.
The Affordable Care Act encourages this approach. It raises the legal limit on penalties that employers can charge for health-contingent wellness programs to 30 percent of total premium costs. Employers can also charge tobacco users up to 50 percent more in premiums. Needless to say, this strikes some people as unfair and has led to objections by workers at some organizations, as well as lawsuits.
Another way that wellness programs can help employers is by putting a more palatable gloss on other changes in health coverage. For instance, workers might complain if a company tries to reduce costs through higher cost sharing or narrower networks that limit doctor and hospital choice. But if these are quietly phased in at the same time as a wellness program that’s marketed as helping people become healthier, a company might be able to achieve those cost reductions with less grumbling. ...
