Incentives that are not tied to a health-related standard, such as participation in a diagnostic testing program, are not held to these incentive limits, so long as the incentive is available to all similarly situated individuals, and comply with other applicable federal laws, such as the Genetic Information and Nondiscrimination Act GINA and the Americans with Disabilities Act ADA , and state laws.
The RAND Employer Survey results indicate that nationally, more than two-thirds of employers 69 percent with at least 50 employees and workplace wellness programs use financial incentives to encourage program uptake, and 10 percent use incentives that are tied to health-related standards.
A fifth of employers 20 percent administer incentives both directly and through their plans. Larger employers are more likely than smaller employers to administer their incentive schemes themselves. We also find that results-based incentives are more commonly administered by the employer directly rather than through the health plan and linked to health coverage. According to the RAND Employer Survey, about 7 percent of employers that offer wellness programs reported administering results-based incentives through their health plans Figure 6.
The average amount of results-based incentives for these employers was less than 10 percent of the total cost of health coverage, far from the current regulatory threshold. NOTES: The graph represents information from employers with at least 50 employees with wellness programs or which offer lifestyle management as a component of a wellness program.
Among employers with a lifestyle management intervention, 77 percent offer programs that target smoking, 79 percent target weight management, and 72 percent offer fitness programs.
According to the RAND Employer Survey, the most common types of incentive triggers are HRA completion and participation in lifestyle management interventions; each is offered by about 30 percent of employers with a wellness program.
Incentives are typically framed as rewards, with 84 percent of employers reportedly using rewards rather than penalties. Incentives are offered in financial form e. Novelty items were used by nearly half of all employers who offer any incentives. Four out of five employers in our case studies reported using some form of financial incentive, and all five employers used novelties e. NOTE: The table represents the subset of employers with at least 50 employees that offer a wellness program 51 percent.
According to the RAND Employer Survey, employers use incentives to increase employee participation in wellness screening activities 31 percent for HRA completion and 20 percent for clinical screenings and encourage employees to join intervention programs 30 percent for lifestyle management and 4 percent for disease management. Employers who use incentives for screening activities report significantly higher participation rates than those who do not 63 percent versus 29 percent for HRA completion and 57 percent versus 38 percent for clinical screenings.
Using a simulation model, we find that the incentive amount for HRA completion had a significant effect on HRA completion rates. Data from the RAND Employer Survey indicate that smoking cessation is the behavior that is primarily targeted with incentives tied to health standards.
For other behaviors e. Smoking is also the only health risk behavior for which achieving the goal is rewarded with a higher incentive than participation in a program. Similarly, four out of five case study employers penalized smokers, but only two had incentives tied to other health standards. The peer-reviewed literature indicates that financial incentives may attract individuals to enroll or participate in smoking cessation programs and increase initial quit rates, but they generally do not achieve long-term behavior change Cahill and Perera, ; Osilla et al.
See Figure 7. NOTES: The graph represents information from employers with at least 50 employees that offer a monetary incentive for participation in a lifestyle management intervention or for improving health behaviors. Among employers with lifestyle management interventions, 77 percent target smoking, 79 percent target weight and obesity, and 72 percent target fitness. With respect to effectiveness, our analyses of employer data in the CCA database imply that incentives for HRA completion and program participation can significantly reduce weight and smoking rates and increase exercise.
However the size of these effects is small and unlikely to be clinically meaningful. Five factors to promote wellness program success emerged from our case study analysis and the literature review:. Effective communication strategies: All five organizations in our case studies employ strategies to communicate wellness program information to employees, ranging from face-to-face interaction to mass dissemination.
Employers cited the importance of broad outreach and clear messaging from organizational leaders, especially for those organizations with a large and geographically dispersed workforce.
Opportunity for employees to engage: Those included in the case study discussions revealed that making wellness activities convenient and easily accessible for all employees are strategies that employers use to raise the level of employee engagement.
Some focus group participants cited limited access to wellness benefits because of wait times and rigid work schedules. Leadership engaged at all levels: Evidence from case studies suggests that for programs to be a success, senior managers need to consider wellness an organizational priority to shift the company culture.
Buy-in from direct supervisors is crucial to generate excitement and connect employees to available resources. Use of existing resources and relationships: All organizations in our case studies leverage existing resources and build relationships, often with health plans, to expand offerings at little to no cost.
Continuous evaluation: Organizations from our case studies approach wellness with a continuous quality improvement attitude. Though no employers from our case studies conducted formal evaluations, all five solicit feedback from staff with the goal of improving future wellness programming. Three employers conducted needs assessments to develop an understanding of the wellness needs of their workforce.
This project represents the most comprehensive analysis of worksite wellness programs to date and evaluates current program participation, program effects, and the role of incentives.
Our project combined a literature review, a national survey of employers, case studies of workplace wellness programs, and statistical analyses of medical claims and program data to assess the current use of workplace wellness programs in the United States, to estimate the effect of programs on employee health and health care cost, and to evaluate the role of incentives in program engagement.
We find that that workplace wellness programs have emerged as a common employer-sponsored benefit that is now available at about half of U. Large employers are more likely than small employees to offer a wellness program and also tend to offer programs with a greater variety of options. Most employers are committed to long-term support of wellness programs, regarding them as a viable strategy to contain health care costs, thereby ensuring the affordability of health coverage.
In spite of their popularity among employers, the impact of wellness programs are rarely formally evaluated. Pandemic Inequity December 23, Challenge Upon Challenge December 15, Starting a lab is hard enough. Now do it in a pandemic. Breaking Down Boosters November 22, What happens to our immune systems when we get a booster? Next generation mRNA vaccine shows improved protection against disease. First Name. Last Name. Email Address. Which publications would you like to receive?
Harvard Medicine magazine three times a year. Harvard Medicine News weekly. Game elements, social features, and incentives remain prevalent at this tier. For small businesses, simple solutions, like the company-wide walking program detailed below, can be just as effective as a customizable enterprise solution. Small businesses should focus on scalability to ensure the program can keep up with a growing workforce. They should agree with the need for an employee health and wellness program , as well as understand the value it will add.
Below are some talking points for making the case with key executives:. Your IT department can help you create a shortlist of providers to evaluate for long-term viability. Integration with current systems and robust security guarantees is also important, so involving your IT team early on is necessary.
Be sure to discuss benefits such as little required investment in new infrastructure or hardware, as most wellness programs are cloud-based. Your chief financial officer will want to know how much a wellness program will cost on the front-end and long-term, how it can reduce costs and grow revenue, and when your business can expect to see measurable returns. Aside from the cost of the actual system, be sure to discuss healthcare cost savings, using actual case studies like the one below that illustrate the positive effects of a health and wellness program on financials and employee productivity.
Of course your CEO will want to know about cost and technology, but be sure to show how an employee health and wellness program can improve your core business model and help you gain a competitive edge. These programs have a positive impact on longstanding HR workforce challenges employee retention and engagement, worker satisfaction, positive culture, attracting top candidates , so be sure to talk about benefits such as improved teamwork and feelings of positivity towards employers.
Solution: Keas. Incapital, a finance company, implemented Keas to encourage employees to address issues that were impacting their health. Incapital had previously initiated a wellness program to improve employee productivity, but, despite their best efforts, saw low participation. Key employee benefits achieved through Keas rollout:.
Keas is one of the top employee wellness platforms on the market and can be customized to meet the needs of any-sized business. To find the best software for your business, compare corporate wellness vendors by using our Product Selection Tool. What will motivate your employees?
Among those who completed at least 1 module, Participation in the personal health assessment survey and biometric screening at the month mark June was Among individuals employed in June , mean participation in surveys and screenings was Tables show effects of working at a treatment worksite and of participating in the wellness program on main outcomes Table 2 , Table 3 , Table 4 , Table 5.
Full results across domains and for alternative populations are shown in eTables in Supplement 2. Effects on self-reported health and behaviors are shown in Table 2. The number of individuals providing these outcomes ranged between and Randomization into a treatment worksite led to a higher proportion who reported engaging in regular exercise by 8. For some outcomes, such as smoking and alcohol use, randomization into treatment had a statistically significant effect by traditional P values, but statistical significance was not robust to multiple inference adjustment.
For rates of smoking, the unadjusted treatment group mean was For number of alcoholic drinks per week, the unadjusted treatment group mean was 4. In the standardized treatment effect, health behaviors were 0. There was no detectable effect on the standardized treatment effect for mental health and well-being 0. As a single index, standardized treatment effects do not have adjusted P values.
Results for clinical measures of health are shown in Table 3. High cholesterol levels Results for health care spending and utilization are shown in Table 4. The sample size was or Workers were absent sick or personal time for a mean of 2. Employees scored better than 3 out of 5 on their job performance review Workers were employed for a mean of For self-reported health and behaviors, participation in the wellness program defined by participation in at least 1 module led to a higher share who reported regular exercise No other outcome in this domain was significantly affected by program participation.
The standardized treatment effect showed that health behaviors were 0. When alternative definitions of participation were used, the effect of participation was numerically greater among participants who completed at least 3 modules than those who completed at least 1 module, although most estimates were not statistically significant eTable 12 in Supplement 2. Estimates using the stably employed subsample were similar to those from the full sample eTables in Supplement 2. Analyses of spending, utilizations, and employment outcomes at the worksite level yielded similar results to those obtained at the individual level eTables in Supplement 2.
Estimates of program effect using only exposure weights produced similar estimates to the main findings eTable 1 in Supplement 2. For binary outcomes, estimates using logistic regressions were similar to those using linear models eTable 14 in Supplement 2.
Comparisons of preintervention characteristics between participants and nonparticipants in the treatment group provided evidence of potential selection effects. Participants were significantly more likely to be female, nonwhite, and full-time salaried workers in sales, although neither mean health care spending nor the probability of having any spending during the year before the program was significantly different between participants and nonparticipants eTable 15 in Supplement 2.
There was no evidence of differential selection into completion of surveys or biometrics between treatment and control groups on baseline covariates eTable 16 in Supplement 2.
Moreover, an observational approach comparing workers who elected to participate with nonparticipants would have incorrectly suggested that the program had larger effects on some outcomes than the effects found using the controlled design, underscoring the importance of randomization to obtain unbiased estimates eTable 17 in Supplement 2.
This randomized clinical trial of a multiyear, multicomponent workplace wellness program implemented in a middle- and lower-income population found that individuals in workplaces where the program was offered reported better health behaviors, including regular exercise and active weight management, but the program did not generate differences in clinical measures of health, health care spending or utilization, or employment outcomes after 18 months.
That the program affected self-reported health behaviors, but not health or economic outcomes, may be interpreted in several ways. Given that workplace wellness programs focus on changing behavior and that behavior change may precede improvements in other outcomes, these findings could be consistent with future improvements in health or reductions in spending.
On the other hand, behavior change is likely easier to achieve than improvements in clinical or employment outcomes. Thus, there may remain no detectable effects on those outcomes, which would have implications for the return on investment in wellness programs. The finding of no significant effects on clinical measures of health, health care spending, or employment outcomes is consistent with a recent trial of a wellness program implemented at the University of Illinois, which evaluated similar outcomes after 1 year.
Moreover, we found that participants did not have lower preintervention spending than nonparticipants, although there was selection on other dimensions.
Unlike the Illinois study, this intervention was implemented at the worksite level rather than varying across individuals within the same worksite , perhaps better facilitating changes in workplace culture and providing greater social supports for behavior change.
This intervention was also fielded in a different population, set of geographies, and employment setting, making it difficult to isolate the causes of any differences in findings. These findings stand in contrast with much of the prior literature on workplace wellness programs, which tended to find positive and often large returns on investment through, for example, reductions in absenteeism and health care spending.
This study has several limitations. First, although this population was diverse, results may not generalize to other workplace settings or populations. Second, the ability to detect treatment effects was limited by statistical power, despite prespecified strategies to maximize power. This challenge was augmented by our very conservative approach to multiple-inference adjustment, which grouped a wide array of outcomes rather than narrowly construing related outcomes.
It was further limited by employee turnover that restricted the workers present to participate in end-of-study primary data collection, although the mean duration of employment was similar among the 3 groups of the trial Figure , suggesting that entry and exit from the sample was due to natural exogenous employment turnover, not the wellness program.
Third, not all employees contributed data for every outcome. Survey and biometric data were available only for individuals employed at the month mark who chose to participate in primary data collection.
However, there was no evidence of differential selection into completing the survey and screening. Claims data were available only for employees with Cigna coverage, although no data were missing in this sample.
Overall, all available data on employees were analyzed; rates of missing data were similar between groups and may thus have affected the precision of estimates but do not seem to have adversely affected the validity of the findings.
Fourth, this study was unable to disentangle effects of particular elements of the wellness program, nor assess the effects of a differently configured wellness program.
Rather, it evaluated the program as a package, with implementation that varied only idiosyncratically in small ways across worksites. Such design features are in fact common in most wellness programs. Among employees of a large US warehouse retail company, a workplace wellness program resulted in significantly greater rates of some positive self-reported health behaviors among those exposed compared with employees who were not exposed, but there were no significant differences in clinical measures of health, health care spending and utilization, and employment outcomes after 18 months.
Correction: This article was corrected on April 16, , for data errors in the Abstract and Figure and for omissions to the Additional Contributions section. Author Contributions: Drs Song and Baicker had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design, acquisition, analysis, or interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis, obtained funding, administrative, technical, or material support, and supervision: Both authors.
Conflict of Interest Disclosures: Dr Song reported no disclosures. Dr Baicker reported receiving personal fees from Eli Lilly outside the submitted work and reported serving on the board of directors of Eli Lilly. We thank David Molitor, PhD, and Julian Reif, PhD, University of Illinois at Urbana-Champaign, for guidance on the statistical software for multiple inference adjustment they created in the University of Illinois wellness study, which was used in this study, without financial compensation.
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