This column was published in USA Today on September 9, 2013.
More patients are coming to my primary care clinic with forms from their employer, asking me to measure their blood pressure, or check their sugar and cholesterol levels. Companies requesting medical data drive employee wellness programs, a booming $6 billion business, with approximately half of large employers offering such plans.
Coaching and financial incentives are often offered to help employees meet certain health metrics, such as losing weight, lowering cholesterol or quitting smoking. The results of these tests are often tied to the cost of health insurance, with less healthy workers paying more. Under the Affordable Care Act, up to 30% of an employee’s premium in 2014 can be influenced by these programs, an average of$1,620 annually per worker.
Wellness programs are designed to lower costs for employers and keep workers healthy, but do they accomplish either goal?
True health cost savings?
Wellness plans are often promoted as saving $3 or more for every dollar invested. But a recent RAND Corporation analysis found that fewer than half of companies took the time to calculate whether these programs saved them money. If they did, the numbers might have startled them. That same study also concluded that wellness programs did not significantly reduce employer health costs.
Why? Health screenings generally promote more doctor visits, prescription medications or further tests. While this might benefit workers’ health, it doesn’t necessarily save money.
If there are no measurable savings, employers pass on the cost of these programs, as much as $500,000 per year, to workers by raising their insurance premiums.
Whether wellness programs improve health is also dubious. This year, the California Health Benefits Review Program, which advises the state’s legislature, found that employees’ blood pressure, blood sugar or cholesterol did not improve by participating in a corporate wellness plan. Weight loss was minimal, with the RAND researchers finding that workers lost about 1 pound annually for three years.
Furthermore, there was no improvement in the rate of hospitalizations and emergency room visits.
Some short-term benefits
While there was a short-term gain in the rate of smokers quitting, it came with a qualification. Fewer than half of employees participate in wellness programs, which are mostly voluntary. Those who participate are often the most motivated, making it hard to tell whether their smoking cessation was due to the wellness program or the employees’ motivation.
Wellness programs also require tests more frequently. For instance, many require blood sugar and cholesterol screens every year in healthy adults, far in excess of recommended guidelines, which call for checking these levels once every three and five years, respectively. Such over-testing doesn’t necessarily make patients any healthier and contributes to the $210 billion our health system spends annually in unnecessary care.
Because I want my patients to save money on their insurance premiums, I dutifully fill out their wellness forms and order the requested screening tests that might not be needed. But it’s doubtful I’m saving these companies money or making my patients healthier by doing so.
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