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Employer wellness programs controversial, ineffective, expert says

Many employer health programs require measurable results, like blood pressure data, which some employees say is a violation of their privacy.

One of the things that causes many of us to think we need to recharge is our jobs, but now, many employers offer workplace health and wellness programs. An expert in the field joined “Take Care” to shed some light on these programs and the controversy behind them.

Julie Appleby is a senior correspondent for Kaiser Health News who previously spent 10 years covering the health industry and policy at USA TODAY. She said about 80% of large employers and more than half of small employers offer some sort of health program, which is indicative of a growing trend.

“Their idea of this is, ‘Hey, we’re paying the bills for health insurance. We really ought to be able to have some kind of say in trying to get our employees healthy,’” Appleby said. “They see it as a perk. They see it as something that people might like to do.”

Appleby said employers also care about the bottom line.

“They want to do something about their rising health care costs,” she said. “They see this, perhaps, as one way to try to do something about that, try to do improve employee behavior.”

"As these programs have grown, some of them have become more intrusive, and that has raised concerns by privacy advocates and some employees that these really aren't voluntary."

Health and wellness programs have an interesting history, starting before but being accelerated by the Affordable Care Act, Appleby said.

“They existed before the Affordable Care Act, but what the Affordable Care Act did was say that employers could offer as an incentive up to 30% of the cost of a single-only employee health plan,” she said.

Because there are so many programs, they vary considerably company to company, Appleby said. Some are simple, like a stop smoking class, a weight management class, a lecture about nutrition or a gym discount. Others include health checkups and physical tests to incentivize healthier practices.

This second category is where controversy as risen. Some companies require measurable results to receive financial and other incentives, resulting in complaints about violation of privacy.

“As these programs have grown, some of them have become more intrusive, and that has raised concerns by privacy advocates and some employees that these really aren’t voluntary,” Appleby said.

Many employers offer incentives to try to bring employees into the health and wellness program, with the perks ranging from something as simple as a gym membership discount to a pay increase. If an employee needs the money from a financial incentive, they may have no choice but to join the wellness program, Appleby said, which many claim violates the policy that these programs have to remain voluntary.

Ultimately, Appleby said, employers are trying to provide enough of an incentive that gets employees involved in the programs while not making the financial incentive so high that it becomes an involuntary program. That balance is not always easy, she said.

“How much money gets people to participate without becoming coercive?” Appleby said. “That’s the line they’re all trying to walk.”

Just recently, AARP filed a lawsuit against Yale, saying Yale’s health and wellness program was not voluntary because nonparticipants missed out on an extra $25/week, which many need to survive financially.

Though the programs are designed to both improve employee health and save the employer money, Appleby said there is little evidence they do either.

“What some of the studies have found is that people who participate are generally those who are already doing some of these activities or are already healthy, so it doesn’t necessarily improve health or lower the bottom line,” Appleby said.

Many studies designed to test the effectiveness of these programs lack a control group, Appleby said, which led a team at the University of Chicago to conduct a study involving BJ’s Wholesale and a large control group.

The team randomly selected 20 BJ’s Wholesales and offered a wellness program, while offering no program to 140 other stores. After one year, the data showed that there were benefits and drawbacks to the program. The good news was employees reported feeling better, like sleeping better and eating healthier.

“The bad news was the efforts did not result in differences in health measures such as better blood pressure or glucose levels, and it didn’t reduce how much employers spend on health care or how often employees missed work,” Appleby said. “Short term, it didn’t show a huge benefit for the employer or for the employees for the most part.”

Despite all the controversy, Appleby said these programs aren’t going anywhere. There will still going to be large companies offering wellness programs, though the programs might change depending on privacy lawsuit results.

“They’re not going to stop trying to offer some perks to keep their employees because that’s what their health benefits are all about, and wellness programs are seen as part of the health benefits, so I don’t think they’re going to change that in the future,” Appleby said.