This blog was co-authored with Andrian McAdams, MPH Candidate & Graduate Research Assistant, Redstone Global Center for Prevention and Wellness, the George Washington University Milken Institute School of Public Health.
A week after the CDC released data showing that nearly 40% of American adults and 18% of children have obesity, it was heartening to see the Senate Health, Education, Labor, and Pensions (HELP) Committee hold a hearing on improving health outcomes and reducing health care costs through workplace wellness programs (WWP).
The potential of WWPs to help address obesity and other health issues is clear: adults spend most of their waking hours at work and WWPs provide a structured pool of readily available clients for intervention and prevention. Furthermore, employers have a strong financial incentive to keep their workers as healthy as possible. Should be a win-win.
Unfortunately, WWPs have had only moderate success in improving health and driving down healthcare costs. Poorly designed WWPs may further stigmatize people with obesity, making it more difficult for them to address health issues. A major issue is that WWPs have often focused on outputs (e.g. number of exercise classes attended) rather than outcomes (e.g. effects of programs on HbA1c levels) and have set targets for groups rather than for individuals. Incentives for hitting group targets, such as a set Body Mass Index (BMI), can be arbitrary in their lack of scientific support for why a particular threshold was chosen, and exclusionary, encouraging those already close to the target while discouraging those who are further away. Badly designed WWPs suffer from low participation rates and high dropout rates.
What makes a good WWP? Witnesses at the HELP hearing offered several success stories. The Cleveland Clinic’s Employee Health Plan (EHP) incorporates preventive health initiatives such as free weight-loss and smoking cessation classes, and looks at multiple measures of wellness, including BMI and chronic stress, to paint a fuller picture for each individual. The Clinic saved $250 million over seven years because of their WWP.
Safeway’s Healthy Measures program offers rewards up to $600 per year for meeting certain biometric target measures, such as blood-pressure. Approximately 85% of all employees enrolled in the program and obesity rates among participants decreased from 28% to 21%.
The hearing highlighted the key role that behavioral economics can play in determining the incentives that engage employee participation. While financial incentives can be important, they are not sufficient. Successful programs provide individualized goal setting and focus on relative progress. Utilizing support groups was also highlighted as a valuable tool to increase participation.
WWPs have always raised privacy and discrimination concerns. Large incentives raise concerns about how voluntary a program really is because of their coercive effect. While HIPAA privacy laws create a firewall between an employee’s health records and their employer, turning over sensitive health information to a WWP can provoke anxiety, particularly because employers can discover differences in premiums associated with participation rates in WWPs. It was troubling that House Members introduced legislation earlier this year to exempt WWPs from many discrimination and civil rights protections. Such efforts would likely reduce participation and increase the likelihood of abuse, with no recourse for participants. Fortunately, no companion bill has been introduced in the Senate.
Combating and ultimately reversing the obesity epidemic in the U.S. will require a coordinated, multi-faceted effort from individuals, organizations, and government. While WWPs are only a part of this work, Senate HELP Committee has clearly realized that they have the potential to be a major catalyst for change.
Going forward, lawmakers should ask the federal government to lead by example and push the Office of Personnel Management implement innovative programs for civil service employees. The Department of Defense (DOD), the nation’s largest employer, could also benefit from wellness and prevention programs that increase readiness and decrease retiree health care costs. Such large-scale policy changes by some of the nation’s largest federal employers can inspire private sector and other state and municipal level government employers to change. Therein lies a great opportunity for Americans’ health.
