COST: Does Workplace Wellness Trim Spending (and Waistlines?)

Another reminder that with health policy, we often know less than we think we know. And that even when things like job-based wellness programs make sense intuitively, the supporting evidence might not materialize as quickly as we'd like —or work out exactly as we hope when we hope it.

Health and Wellness Initiatives: The Shift from Managing Illness to Promoting Health, released this week by the Center for Studying Health System Change, found that health plan initiatives to promote workers' health and wellness are now common—partly because of the mounting concern about U.S. obesity rates. But we don't yet know whether the investment is paying off —or for whom.

The programs, more common among large employers, are part of the search for long-term tools to address rising costs and reflect the "consumer-based" strategies for giving workers more responsibility for their health care decisions and costs. But the financial payoffs have been difficult to demonstrate—although that could change with time as many of the wellness programs are relatively new, and designers and sponsors are still experimenting with what kind of incentives or enticements get workers to take advantage of wellness options. UnitedHealthcare, for example, offers a product to employers where the worker can lower his deductible by not smoking and meeting targets for body-mass index, blood-pressure, and cholesterol.

"Ultimately, the credibility of health and wellness activities to improve health and contain costs will depend on evidence demonstrating both health improvements and a positive return on investment," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded in part by the Robert Wood Johnson Foundation. The study focused on 12 metropolitan areas, which the center has tracked since 1996.

This isn't about screening, like mammograms or colonoscopies, or about managing a disease like diabetes once it's been diagnosed. It's more about things like weight management, smoking cessation, and getting workers off the couch and into the gym. The idea is that healthier people will use fewer medical resources and be more productive. As the report says:

Employers hope that health and wellness activities will reduce absenteeism and improve productivity, as well as avoid major, costly medical events. A recent American Hospital Association report, for example, estimated that three chronic diseases—asthma, diabetes and hypertension—result in 164 million days of absenteeism each year, costing employers $30 billion. As a northern New Jersey plan medical director surmised, "When employers look at employees and see many are obese and understand the implications for diabetes and cardiovascular disease, they start keeping an eye on wellness."

(One more question that comes to mind, which the report alludes to: What if the programs do keep people trimmer and healthier but we discover that most of the savings don't show up now in terms of productivity gains, but in health care over the long haul? Might companies decide they don't want to pay for wellness, if most of the health care savings won't show up for 20 or 30 or 40 years—by which time the worker is long gone from this job, or on Medicare or on someone else's health plan? Will we be able to come up with some way of still making it worthwhile for the employer or the health plan to keep people fit and trim if the payoffs are somewhere off in the hazy horizon?)

The report also describes a new development, the use of health risk assessments. That's usually a questionnaire, often online. The worker provides information about his or her personal and family medical history, exercise, diet, smoking, and drinking etc. That could be used to encourage or provide incentives for the individual to engage in specific kind of health promotion activities, or seek medical screening or early intervention where the person may have some risk. In all these areas, questions remain about the best incentives, privacy protection and the like. The trend at the moment is to reward people who participate, rather than punish those who don't—i.e. pay for Weight Watchers dues, not dock their pay if they are caught eating a cupcake.

In the meantime, while we realize that the evidence isn't all in yet, we still think these programs hold some promise. As we pursue health and insurance reform as a nation, it will be helpful to know what programs really do get results, and keep us healthier, and what kind of policies work best to encourage them. And until we get that data, we can't help paying at least a little attention to our intuition—good health, after all, is probably a pretty good investment.