Your Money Adviser: Study Raises Questions for Employer Wellness Programs

If you work for a big employer — or even a small one — you probably have encountered some sort of workplace wellness program. You most likely filled out a health questionnaire, which may have led to a recommendation that you attend exercise classes, quit smoking or participate in telephone coaching to help you control diabetes or asthma.

The programs have become increasingly popular, as companies aim to lower their medical costs and lift productivity by promoting healthier behavior among workers. About half of employers with at least 50 workers offer them, as do 90 percent of employers with more than 50,000 employees, according to a study for the Labor Department by the RAND Corporation, a nonprofit research group. Some companies offer financial perks to employees who participate, like lower health insurance premiums, gift cards or even cash.

But a study by RAND researchers and executives of PepsiCo, published online Monday in the journal Health Affairs, found that programs aimed at helping people with chronic illnesses stay healthy, by educating them and reminding them to take medication, resulted in significant cost savings. But so-called lifestyle management offerings, which aim to reduce health risks through programs focusing on weight loss or stress management, resulted in no net savings at all.

The study examined more than 67,000 people eligible to participate in PepsiCo’s “Healthy Living” wellness program, which includes both disease management and lifestyle components for employees and their families. (PepsiCo provided funding for the study.) The researchers found that seven years of continuous participation in the program — whether in its disease management component, its lifestyle component, or both — resulted in an average monthly reduction of $30 in health care costs per member. But when researchers looked at each component separately, they found the savings was largely attributable to disease management.

Researchers estimate that disease management lowered health costs by $136 per member per month, mostly thanks to a 29 percent reduction in hospital admissions. Lifestyle programs, however, had no significant effect on health care costs.

That isn’t necessarily surprising, said Soeren Mattke, a senior natural scientist at RAND and the study’s senior author, since it’s easier to save money by addressing the problems of those whose baseline medical costs are already significant. “Cutting one hospital admission saves a lot of money,” he said.

Other analyses have shown cost savings for lifestyle programs — perhaps, researchers said, because they looked at older programs that were introduced when habits like smoking were more prevalent and cholesterol-lowering drugs were just becoming available, so gains from intervention were greater. Another study at the University of Minnesota, with a design similar to the PepsiCo study, also found that savings resulted from disease management programs rather than lifestyle programs.

The RAND findings don’t mean that lifestyle programs don’t have benefits; participants reported a small drop in absenteeism, for instance. But the lifestyle portion of the program “did not provide more savings than it cost to offer,” Dr. Mattke said.

Researchers estimate that for each dollar spent, the disease management program saved an average of $3.78, compared with 48 cents for the lifestyle offerings, taking into account the impact on both health care and absenteeism. (Together, the programs saved $1.46 for each dollar spent.)

The study also found that savings were greater among people who participated in both the disease management and lifestyle components of the program — $160 a month, with a 66 percent drop in hospital admissions. That suggests that better targeting may improve the financial performance of the lifestyle programs, researchers said.

It’s possible that lifestyle programs, like smoking cessation or weight loss, save money, but over a longer period of time. But, the study concluded, “employers and policy makers should not take for granted that the lifestyle management component of such programs can reduce health care costs or even lead to net savings.”

Jeff Dahncke, a PepsiCo spokesman, said no one from the company was available for an interview Monday.

Here are some questions to consider about workplace wellness programs:

■ Could companies stop incentives for people who participate in “lifestyle” programs, or even eliminate such programs, if the programs don’t demonstrate big savings?

That’s unlikely, said Helen Darling, president of the National Business Group on Health. Keeping workers healthy can prevent them from developing high-cost diseases, like diabetes, she said. Plus, “these programs aren’t just there to save money, per se,” she said. Demonstrating a commitment to health helps companies recruit talented workers, providing a competitive advantage. “It sends a message that this company cares about people,” she said. “It will attract people who want to work for a company that demonstrates a culture of health.”

■ What should I look for in a wellness program?

Ideally, the program should be tailored to your specific needs. For instance, your employer should try to accommodate your schedule, Dr. Mattke suggests; if you aren’t able to take a lunch break, a midday exercise class program isn’t likely to help.

■ Do disease management programs lower my personal medical costs, as well as those of my employer?

The study didn’t look specifically at costs to employees, which can vary depending on the details of coverage provided by your health insurance plan. A program that results in you taking medication regularly may, for instance, increase your prescription drug co-payments. But a program that reduces hospital stays is likely to save you money, Dr. Mattke said.

Article source: http://www.nytimes.com/2014/01/07/your-money/study-raises-questions-for-employer-wellness-programs.html?partner=rss&emc=rss