Yet-to-be-released study delivers blow to popular workplace efforts
NEW YORK (Reuters) — A long-awaited report on workplace wellness programs, which has still not been publicly released, delivers a blow to the increasingly popular efforts, Reuters has learned, casting doubt on a pillar of the Affordable Care Act in the U.S. and a favourite of the business community.
According to a report by researchers atRAND, programs that try to get employees to become healthier and reduce medical costs have only a modest effect. Those findings run contrary to claims by the mostly small firms that sell workplace wellness to companies ranging from corporate titans to mom-and-pop operations.
RAND delivered the congressionally mandated analysis to the U.S. Department of Labor and the Department of Health and Human Services last fall.
The report found, for instance, that people who participate in such programs lose an average of only one pound a year for three years.
In addition, participation "was not associated with significant reductions in total cholesterol level." And while there is some evidence that smoking-cessation programs work, they do so only "in the short term."
Most large U.S. employers believe the programs improve workers' health and reduce or at least keep the lid on medical spending.
"Companies from the CEO on down feel that these programs are bringing value," said Maria Ghazal, a vice-president at the Business Roundtable, the association of chief executives of big companies. "The criticism is surprising, because companies are not hearing that internally."
Some experts not involved with the new report say even the modest benefits RAND found need qualification.
"The strongest predictor of whether someone will lose weight or stop smoking is how motivated they are," said Al Lewis, founder and president of the Disease Management Purchasing Consortium International, which helps self-insured employers and state programs reduce healthcare costs. "Since the programs are usually voluntary, the most motivated employees sign up. That makes it impossible to credit the programs with success in smoking cessation or weight loss rather than the employees' motivation."
For its report, RAND collected information about wellness programs from about 600 businesses with at least 50 employees and analyzed medical claims collected by the Care Continuum Alliance, a trade association for the health and wellness industry.
Industry experts noted that whenever researchers analyze hundreds of programs, there are inevitably more effective and less effective ones.
"Traditional workplace wellness barely scratches the surface," said Keith Lemer, president of WellNet, which provides programs to Cumulus Media, Viking Range and the Charlie Palmer Group of restaurants, among others. "Done right, (the program) requires the integration of clinical data, wellness, health coaching, and work flow."
The initiatives succeed if they have "senior level support and a high-degree of employee engagement in healthy behaviours," he said.
SAVINGS OF $2.38 A MONTH
The report's conclusions about the financial benefits of workplace wellness programs are also grim. In theory, the programs should reduce medical spending as employees become healthier and thereby avoid expensive conditions such as heart disease, cancer and stroke.
In fact, workers who participated in a wellness program had healthcare costs averaging $2.38 less per month than non-participants in the first year of the program and $3.46 less in the fifth year. Those modest savings were not statistically significant, meaning they could have been due to chance and not to the program.
More surprisingly, workplace wellness did not catch warning signs of disease or improve health enough to prevent emergencies. "We do not detect statistically significant decreases in cost and use of emergency department and hospital care" as a result of the programs, RAND found.
The RAND report was mandated by the Affordable Care Act, the healthcare reform law known as Obamacare. Two sources close to the report expected it to be released publicly this past winter. Reuters read the report when it was briefly posted online by RAND on May 24 before being taken down because the federal agencies were not ready to release it, said a third source with knowledge of the analysis.
FROM SUBISIDY TO PENALTY
Starting next year, the healthcare reform law allows employers to reward employees who participate in workplace wellness programs with subsidies equal to 30 per cent of the cost of insurance premiums, or about $1,620 annually per worker.
If wellness programs do not reduce healthcare spending, some employees could suffer financially. If an employer is subsidizing employees who use its program but is not reaping lower healthcare costs, it has three choices. It can absorb the costs, perhaps figuring it helps recruit or retain valued employees. It can raise healthcare premiums across the board. Or it can raise costs only to workers who do not participate, through higher deductibles or premiums, by at least that US$1,620.
Cost-shifting seems especially unfair if wellness programs don't deliver medically or financially, said senior counsel Dania Palanker of the National Women's Law Center, which generally supports the programs: "We've seen plans that appear to cost-shift, with wellness programs rolled out at the same time that premiums or deductibles are increased."
$6-BILLION INDUSTRY
Workplace wellness is a $6 billion industry in the United States, with an estimated 500 vendors now selling the programs. Fifty-one per cent of employers with 50 or more workers offer one, the RAND report found. Medium-to-large companies now spend an average of $521 per employee per year on wellness incentives (gift cards for losing weight, for instance), double the $260 in 2009, according to a survey by Fidelity Investments and the National Business Group on Health released in February.
For many employers, wellness programs are a recruiting and retention tool, attracting the health-conscious employees they prefer. The programs also promise to control an employer's healthcare spending. By getting workers to stop smoking they should reduce expensive emphysema treatments, for instance, and by nudging workers to get annual physicals they are expected to help companies avoid such financial black holes as cancer treatment and stroke rehabilitation.
Although the RAND report's conclusions seem counterintuitive — how can wellness programs not improve health? — other recent studies agree.
This year researchers at the University of California conducted an analysis of dozens of existing studies of workplace wellness programs at the behest of the California state senate. Based on gold-standard studies, similar to those that evaluate a new drug, participating in work-based wellness programs does not lower blood pressure, blood sugar or cholesterol and rarely leads to weight loss, said Janet Coffman, a health policy expert at the University of California, San Francisco, Institute for Health Policy Studies.
"Even in studies that found statistically significant weight loss, it was not always sustained," she said.
Similarly, after years in which vendors and others claimed that the programs return $3, $9 and more for every $1 invested, rigorous studies have found the opposite, also providing support for the RAND findings.
Earlier this year, economist Gautam Gowrisankaran of the University of Arizona and colleagues found that employees who participated in the wellness program at BJC Healthcare, a St. Louis, Missouri-based hospital system, had fewer hospitalizations for illnesses such as heart disease and diabetes. But their overall spending did not decrease, the researchers reported in the journal Health Affairs.
The main reasons, said Gowrisankaran, were that employees who fill out company surveys assessing their health risks ("what is your blood pressure?") or get health screenings at company-sponsored health fairs ("you better see a doctor about that") led to more office visits and medication use. In-patient costs fell $22 per employee per month, on average, but other costs rose $19. The program cost $500,000 per year.
"The wellness program just didn't save money," Gowrisankaran said.
To understand how that can be, experts offer the example of what happens when a workplace wellness program identifies hypertension (by requiring participants to get a physical) in someone who never suspected she had it. That might keep her from having a stroke in 20 years, but in the meantime it leads to physician visits and drugs to manage a condition that had gone untreated — and that therefore had previously cost the company or its insurer nothing, explained Vik Khanna, a benefits consultant in St. Louis.
Employers told RAND they were "overwhelmingly" confident that workplace wellness reduces medical costs. Yet only 44 per cent have actually evaluated their efforts, and only two per cent had precise savings estimates. Most leave those calculations to companies that sell them the programs, or to consultants, opening the door to creative accounting, say skeptics.
Tom Emerick, president of Emerick Consulting and former vice-president of global benefits at Walmart, is one of them: "Many of the vendors reporting savings are making it up."
Ghazal of the Business Roundtable acknowledged that calculating savings from wellness programs is tricky: "Sometimes the benefits are way down the road, when the person is not at that employer anymore."
On the bright side, the RAND report says healthcare costs and use of expensive medical services rose more slowly for program participants than nonparticipants. That offers hope "that a reduction in direct medical costs would materialize if employees continued to participate."
