The Value of Employee Wellness Programs

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Recently the Chicago Sun-Times reported on Mayor Rahm Emanuel’s effort to bring down high health care costs among Chicago city employees. The article, “10,000 Additional Employees Join Emanuel’s Wellness Plan,” details Emanuel’s decision to raise monthly health insurance premiums by $50 for employees who do not participate in a wellness plan to manage chronic conditions. This effort is in response to the city’s high health care costs—nearly 10 percent of the city’s budget is spent on employee health care. The Chicago story is one example of increasing employer interest in workplace wellness initiatives as a means to control costs, as well as potentially improve worker health and productivity. In a 2011 survey, Willis North America reported that 60 percent of more than 1,200 employers surveyed reported offering wellness programs to their employees, a 17 percent increase over 2010.

In addition to addressing rising costs, employers are also using innovative strategies to engage employees in actively managing their own health care.   In one recent example, the Wall Street Journal reports on efforts by Humana, Cigna, and UnitedHealth Group to offer apps and online games to engage patients in their health. 

Research and evaluations will be needed to measure results from the variety of approaches to improving employee health and engagement and determine whether wellness programs offer a beneficial return on investment both for overall employee health and employers’ fiscal health. 

HCFO-funded research offers insights into the value of different initiatives to improve employee health and lower costs for employers: 

1. Large Employers’ Use of Workplace Health Clinics (December 1, 2009-December 31, 2010). Ha Tu, M.P.A., The Center for Studying Health System Change. The researchers explored the workplace health clinic model by examining the following research questions: (1) what are the key motivations and objectives, and major strategies and approaches being used; (2) how are workplace clinics structured and organized and how do they fit into the overall structure of an employer's health benefits; (3) to what degree do these clinics affect the delivery of care, access, quality and coordination; (4) what is the return on investment relative to short and long-term health care costs, as well as indirect costs of absenteeism and productivity; (5) are successful strategies replicable; and (6) are there employer characteristics that contribute to the effectiveness of workplace clinics? The objective of this project was to better understand the full spectrum of employer strategies concerning workplace clinics, the barriers faced by employers, and the impact of different strategies and models on cost containment and care delivery. To date, this grant has produced one publication:

• Tu, H.T. et al, Workplace Clinics: A Sign of Growing Employer Interest in Wellness, The Center for Studying Health System Change, Research Brief No. 17, December 2010. Tu and colleagues found that interest in workplace clinics has intensified in recent years, with employers moving well beyond traditional niches of occupational health and minor acute care to offering clinics that provide a full range of wellness and primary care services. Employers view workplace clinics as a tool to contain medical costs, boost productivity and enhance their reputations as employers of choice. The authors note that measuring the impact of clinics is difficult, and credible evidence on return on investment varies widely. While well-designed, well-implemented workplace clinics are likely to achieve positive returns over the long term, expecting clinics to be a game changer in bending the overall health care cost curve may be unrealistic.

2. Uptake and Impact of Health Risk Appraisals (December 1, 2005-May 31, 2007). Meredith Rosenthal, Ph.D., Harvard School of Public Health. What is the potential for Health Risk Appraisals (HRAs) to engage consumers in health improvement?  HRAs are structured surveys designed to identify a wide range of health risks, including genetic predispositions to disease, poor health habits (e.g. smoking, overweight) and lack of adherence to recommended care for a chronic condition. HRAs allow health plans and employers to engage consumers in health management before acute events occur. Using data from Cigna HealthCare, the researchers addressed the following specific aims: 1) examine the overall rates of HRA completion in a privately-insured population; 2) examine the impact of a consumer financial incentive on HRA completion; 3) examine the characteristics of consumers who opt to complete an HRA; and 4) look for early effects of HRAs on utilization and health behavior. The objective of the project was to help employers and health plans better tailor their outreach programs, evaluate whether to offer incentives, and better understand the impact HRAs will have on enrollee behavior. To date, this grant has produced one publication:

• Huskamp, H.A. and M.B. Rosenthal. “Health Risk Appraisals: How Much Do They Influence Employees’ Health Behavior?,” Health Affairs, Vol. 28. No. 5, 2009, pp. 1532-40. Health plans often use health risk appraisals (HRAs) as a starting point in engaging members in behavioral change. We examine characteristics associated with the voluntary completion of HRAs among enrollees in employer-sponsored insurance plans. We compare health care use, costs, and participation in disease management programs for HRA completers and similar enrollees in plans that do not offer an HRA. Women, healthier people, and people in consumer-driven health plans (CDHPs) are more likely than others to complete an HRA. Among those who complete an HRA, use of office visits, prescription drugs, and cervical cancer screening increases compared to those who are not offered an HRA.

Other related work includes:

The Impact of Retail Clinics on Overall Utilization of Care
Grantee Institution: RAND
Principal Investigator: Ateev Mehrotra, M.D., M.P.H.
Grant Period: November 1, 2010-April 30, 2012