Study Stokes Fresh Scrutiny of Wellness Programs' Value

New findings from a major three-year study on workplace wellness programs have again raised questions about the return on investment (ROI) from health-promotion initiatives. Other research, however, indicates that efforts to help people manage chronic conditions can lead to sustained health improvement.

Clinical Measures Unmoved

The study questioning wellness programs' ROI, Health and Economic Outcomes Up to Three Years After a Workplace Wellness Program: A Randomized Controlled Trial, was published in the June 2021 edition of the journal Health Affairs. The lead researchers—Katherine Baicker, dean of the Harris School of Public Policy at the University of Chicago, and Zirui Song, an assistant professor of health care policy at Harvard Medical School—summarized their findings for a general audience in The Washington Post.

Building on previously released results from study years one and two, the year-three data again showed little evidence of improvements in employees' health at worksites that offer typical wellness programs including health risk assessments.

The researchers, however, concluded that workplace wellness programs are popular among employees. They found that program participation led to better self-reported health behaviors, with about an 11 percent higher share of participants reporting that they were actively managing their weight due to the program. Nevertheless, the program did not produce significant differences in clinical measures of health; health care spending or use; or absenteeism, tenure or job performance.

The research focused on middle- and lower-income employees of BJ's Wholesale Club, a large, national retail warehouse company in the U.S.

"Our partnership with BJ's allowed us to use a truly randomized controlled trial design," Baicker and Song wrote in the Post.

Working with the vendor Wellness Workdays, they tracked some 4,000 employees at 25 BJ's worksites that offered wellness programs focused on nutrition, physical activity, stress reduction and related topics, and also tracked nearly 29,000 employees in 135 randomly chosen stores as a control group.

There were no significant differences in clinical measures of health; health care spending or use; or absenteeism, tenure or job performance.

The results, the researchers noted, were similar to those from a study by the University of Illinois at Urbana-Champaign that found a lack of health improvement among wellness program participants after two years.

[Want to learn more about wellness programs? Join us at the SHRM Annual Conference & Expo 2021, taking place Sept. 9-12 in Las Vegas and virtually.]

Still, a Valued Benefit

Worldwide, spending on corporate wellness programs is expected to exceed $94 billion by 2026, up from $61.2 billion in 2021.

Does the lack of a significant reduction in health claims, Baicker and Song asked, "mean that wellness programs are a waste of money?" Their response: "It depends on what you want to get out of them. Employees seemed to value the benefit, had heightened awareness of the importance of healthy behaviors and were trying to implement them."

Consequently, they wrote, "If employers are seeking to add benefits that workers value (or attract workers who value those benefits), the programs may be worth it. But if the goal is to save money by reducing health care costs and absenteeism, or to improve chronic physical health conditions, the evidence so far is underwhelming."

Health-Improvement Potential

While the Baicker/Song research found little to no improvement in health claims among workers generally, another recent project highlighted that wellness programs have the potential to improve health and reduce health care spending when outreach efforts are focused on people with chronic conditions.

Results from the U.K.'s Diabetes Remission Clinical Trial (DiRECT) study were published in the May issue of Diabetologia, the monthly peer-reviewed journal of the European Association for the Study of Diabetes. The research was funded by Diabetes UK, a British-based research charity.

The DiRECT study involved 143 participants with high blood pressure who had early-stage diabetes. To significantly alter their diets, participants worked, through the office of their general practitioner, with a practice nurse or dietitian who received 12 hours of training and ongoing mentoring from the study research dietitians.

Among the results, participants' overall blood pressure measurements fell significantly from the start of total diet replacement (week 1), were significantly lower at week 20 and remained lowered after two years. In addition, 53 participants achieved sustained remissions of diabetes at 24 months.

"The study further highlights the links between diet, weight, type 2 diabetes and hypertension, and how long-term support to maintain weight loss is vital," study co-author Michael E.J. Lean, a professor of nutrition at the University of Glasgow's medical school, told the Royal Australian College of General Practitioners. While the study did not look at claims cost, participants' improved health metrics would be expected to lower their future health care spending.

Because employers need to respect the confidentiality of employees' health information, as required by the Health Insurance Portability and Accountability Act (HIPAA), outreach efforts to help workers manage chronic conditions are best left to health insurers or to third-party wellness or disease management program providers. 

Earlier Research, Similar Results

The findings from both studies support the conclusions of an often-cited 2014 report by the nonprofit Rand Corp, which looked at wellness programs at PepsiCo. 

The Rand researchers concluded that employers can significantly lower health care costs by helping workers to better manage chronic diseases—but that encouraging workers to adopt healthier lifestyles may not noticeably reduce an employer's health costs or lead to lower net savings for otherwise healthy people.