Wellness That Didn’t Work Out

It seemed like a good idea at the time. Build incentives for employees for wellness into health benefit packages. Employees “volunteer” to give up some health privacy in order to have their employers collect health data on them. They get a little financial incentive to participate and then more incentive if their health data improves. Of course, a big part of the focus was on prodding employees to lose weight. Back when wellness programs were a hot concept, we had our doubts about these schemes. Now, a new study in JAMA Internal Medicine gives us hard data on outcomes from wellness that didn’t work out.

An RCT of Corporate Wellness

This was a randomized controlled study of 4,834 employees at the University of Illinois. For the control group of 1,534 employees it was business as usual for their health benefits. But the other 3,300 employees received financial incentives for participating in the university’s workplace wellness program. They submitted themselves to weight, height, waist, and blood pressure measurements in return for time off and financial payouts. Cholesterol and glucose measurements, along with health behavior profiles were all part of it, too. Finally, they participated in wellness activities sponsored by the university as part of the program.

Unfortunately, the outcomes were unimpressive. After two years, this program made no difference in health outcomes, medical diagnoses, or even weight. In fact, only two differences resulted from this ambitious program. First, employees felt more optimistic about their health. Second, more of them (92% vs. 86%) said they had a primary care doctor at the end of the study.

Impact on utilization of healthcare services was nil. So all that lofty talk about saving money through workplace wellness amounted to nothing in this study. This beautiful plan for wellness and cost savings didn’t work out so well.

Where Do We Go from Here?

Once again, JAMA called on Jean Marie Abraham to put a happy face on these lousy outcomes. A year ago, she told us that these programs should be working because “people respond to incentives in everyday life.”

Now in an invited commentary, she suggests that these findings will help employers reassess how to spend their money on wellness programs:

It is premature to reach a conclusion on the effectiveness of wellness programs. Program designs can vary extensively across employers in the scope and intensity of offered components, mode of delivery (online vs in person), availability and structure of incentives to encourage participation, and how organizational leaders implement them.

But then again, maybe your boss at work doesn’t need to be telling you to lose weight. Maybe this money would be better spent on improving access to real medical care. Increasingly, smart employers who want to have an impact on obesity are adopting smarter benefit designs that don’t make it hard or humiliating for people to seek help and care.

That’s the kind of innovation we need.

Click here for the study and here for the invited commentary.

Well Aged, photograph © Gene Wilburn / flickr

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May 27, 2020