Workplace Wellness Programs: Who Really Benefits?

Article excerpt

The baby boom generation is aging, as is America's workforce. By 2018, one in every four workers in the nation will be at least 55 years old. Developing effective health promotion interventions for these workers will be crucial to maintaining a healthy and productive workforce.

Evidence-based workplace wellness programs that offer tools to support healthy aging can help older workers maintain active lives. Research shows that offering free support and activities, such as nutrition classes or walking clubs, can help workers make healthy lifestyle changes. One study in the American Journal of Public Health by Hughes et al. (101: 2011) found that certain supports, like inperson health coaching, are particularly effective for older workers.

Achieving Wellness: Who Pays the Price?

However, not all workplace health promotion strategies are evidence-backed. A growing number of employers are offering penalty-based wellness programs, which charge higher health insurance premiums, deductibles or copayments to employees who do not meet requirements. Such programs are advertised to reduce healthcare spending by helping employees improve their health. But a recent Health Affairs study by Horwitz et al. (32: 2013) found no conclusive evidence to back such claims. It found that penalty-based programs may achieve savings for employers by shifting costs to workers with health problems- a shift that could disproportionately harm older workers, lower-income employees and minorities since they are at a higher risk for many conditions these programs penalize (e.g., high cholesterol, high blood pressure and obesity).

Penalty-based wellness programs fall into two categories: those requiring workers to achieve health outcomes (such as cholesterol levels below a certain threshold), and those requiring workers to participate in activities (like nutrition classes).

Under federal law, penalty-based wellness programs tied to achieving health outcomes can vary employees' healthcare costs by up to 20 percent of workers' total health insurance premiums (including the employer's contribution). Beginning in 2014, this maximum penalty will increase to 30 percent of total premiums, and, if the penalty is tied to whether a worker uses tobacco, the maximum penalty will be 50 percent of total premiums. In participation-based wellness programs, there are no penalty limits.

What could this mean for workers who struggle with health risk factors targeted by penalty-based programs? Based on the average cost of job-based coverage in 2012, a 20 percent penalty could mean $1,000 higher annual healthcare costs for workers who do not meet wellness criteria. A 30 percent penalty would mean $1,500 higher yearly healthcare costs.

No scholarly research suggests that charging individuals more for healthcare motivates them to make healthy behavior changes. On the contrary, a significant body of research, including a study from the Commonwealth Fund (http://goo.gl/ Yql6b), shows that nominal increases in out-of-pocket costs cause people to delay or forgo necessary care. This raises serious questions about whether penalties might create barriers to care, making it more difficult for employees to improve their well-being. …