Workplace wellness programs fail to improve health

Workplace wellness programs have been touted as a powerful tool that can improve employee health and productivity while reducing health care costs, but new research suggests that such interventions produce results. less than impressive.

The findings of researchers at the University of Chicago and Harvard University, published April 16 in the Journal of the American Medical Association, raise questions about the effectiveness of such programs proposed by 80% of large US employers in the workplace wellness industry, valued at $ 8 billion.

The analysis, which is the first large-scale, multi-site, large-scale randomized controlled trial of a workplace wellness program, shows that people working at sites offering this program had significantly higher rates. some healthy behaviors, but no significant difference between the others. behaviors compared to the control group. Employees working on the sites offering this program did not have better clinical measures of health such as body mass index, blood pressure or cholesterol after 18 months, and showed no less absenteeism, better performance professionals, and no less use or expense in health care.

Workplace wellness programs are designed to encourage employees to engage in health-promoting behaviors to reduce health care costs, increase productivity, and improve the workplace.

"Our ultimate goal is to inform policy and ensure that decisions and investments are based on lucid analysis rather than intuition," said co-author of the study. , Katherine Baicker, Dean of the Harris School of Public Policy. "These findings suggest that workplace wellness plans may affect health behaviors, but have no overall effect on health outcomes."

"Our results show that health-related behaviors can respond to a workplace wellness program, but they also moderate expectations for significant return on investment in the short term," said the co-author of the program. 39, study, Zirui Song, assistant professor of health policy and medicine at Blavatnik Institute of Harvard Medical School and physician in internal medicine at Massachusetts General Hospital.

Baicker and Song stated that their goal was to explore the causal effects of workplace wellness programs using the rigorous methods of an experimental model, in order to help policy makers and decision makers alike. employers to make informed decisions about investing in well-being.

The workplaces offering the wellness program had a higher rate of 8.3 percentage points of employees reporting regular exercise and a higher rate of 13.6 percentage points. employees who reported actively managing their weight, compared to those working in sites where the program was not available to them.

The program had no significant effect on other outcomes, including 27 self-reported measures of health and behavior, such as self-reported health, sleep quality, and dietary choices; 10 clinical markers of health; 38 cost and usage tracking measures for physician visits, medical tests and procedures, and prescription drugs; and three employment outcomes: absenteeism, duration of employment, and job performance.

The reason for being well-being at work

The motivation for job-based wellness programs is simple. If employers can help workers reduce alcohol consumption, quit smoking or exercise, workers' health will improve, which will save money on health care, reduce the number of workers days of illness and improve overall wellbeing. productivity of the workforce.

In addition to private investments in workplace wellness programs, the Affordable Care Act also provides public funds for wellness programs. In the broader context of health system reform, wellness programs are part of a series of ideas that promote preventive medicine, coordinated care, and wellness education as ways to keep health and wellness in mind. healthy people and reduce medical costs.

Previous research has shown that workplace wellness programs could be a good investment. In 2010, Song, Baicker and David Cutler, Professor of Applied Economics Otto Eckstein at Harvard University, published a meta-analysis of previous research on wellness programs, which uncovered a return on investment of about three to one for such interventions. However, as the authors noted in this meta-analysis, much of the earlier literature was limited by the absence of a robust control group, leaving open the possibility that estimates are biased, as well as sites, samples and limited results. measures.

The new findings of the study complement the findings of a recent randomized controlled trial conducted at the University of Illinois by Damon Jones, an associate professor at Harris and his coauthors. In this study, individuals (rather than entire workplaces) were randomized into a wellness program or control group, found that the impact of these programs is negligible and that incentive programs can be used selection mechanisms to attract healthy employees. A full description of Jones' research can be found on the NBER website at www.nber.org/workplacewellness.

L & # 39; s experience

To improve evidence on wellness programs, Baicker and Song decided to implement a large-scale controlled experiment. To eliminate unwanted effects of self-selection and other biases inherent in non-randomized studies, Baicker and Song proposed randomized wellness programs at different work sites and tracked the results achieved by all workers.

"When assessing the potential benefits of a workplace wellness program, it is essential to distinguish confounding factors. Companies that choose a program may have employees who are already more health conscious than those in the business without a program. And employees who choose to participate may have different health profiles from those who do not, "said Baicker. "Our study allows us to isolate the effect of the program itself from these confounders."

To do this, the researchers teamed up with BJ's wholesale clubs to offer new wellness programs at randomly selected sites, which they then compared to control sites that function normally. This allowed the researchers to grasp the effects the program might have on workplace culture change and individual behavior.

And then?

Song said that experimental evaluations in the area of ​​wellness promotion are still relatively rare. While this study provides important information on some of the types of programs currently in use, many questions remain about the best ways to improve the health of the population, he said. A series of questions directly related to the JAMA Does the study consider whether a program like this has a sufficient impact over 18 months, or whether the type of healthy behavior change produced by the program is taking longer to produce measurable health benefits?

"As we better understand how to encourage healthy behavior, workplace wellness programs may play an important role in improving health and reducing the cost of care." of health, "said Song. "For the moment, however, we should be cautious about our expectations of such interventions. Rigorous research to measure the effects of such programs can help us spend the best money on the health and well-being of society. "

Quote: "Effect of a workplace wellness program on employees' health and economic outcomes," Zirui Song and Katherine Baicker, JAMA, April 16, 2019. doi: 10.1001 / jama.2019.3307

Funding: National Institute on Aging, Robert Wood Johnson Foundation and Abdul Latif Jameel, Anti-Poverty Laboratory, North America.

-The article originally appeared on the Harris Public Policy website.