Congress raises the stakes for employees with worker wellness programs

On May 31, representatives across stakeholder interests gathered for a panel sponsored by the Alliance for Health Reform and the Robert Wood Johnson Foundation to address an important and timely question: Do worker wellness programs work? Troy Brennan, M.D., M.P.H., J.D., executive vice president and chief medical officer of CVS Caremark, may have offered the best answer when he said, “It seems like a good idea, but … it’s safe to say we don’t know what works.”

Worker wellness programs are designed to encourage workers to improve their health; programs frequently offer financial incentives for participation and can be conditional on reaching particular health outcomes.

Over 90 percent of businesses with at least 200 employees currently offer worker wellness incentive programs. According to new regulations released Wednesday, workers who do not fulfill “reasonable” outcome-based performance measures will experience increased payments of total health costs at rates up to 50 percent for tobacco users and 30 percent for non-tobacco users. Congress just bet billions of dollars with worker’s paychecks and health care payments, perhaps on borrowed chips.

From an economic perspective, not receiving a reward and being hit with a penalty are the same thing. Increasing expected employee contribution to total health care payment is another way to say “cost shifting.” Alongside health, cost outcomes must be part of the worker wellness discussion, Karin Feldman, J.D., of AFL-CIO explained on Friday.

With countless monetary and non-monetary incentives to quit smoking and lower one’s BMI, there is no behavioral economic-based evidence that these programs can offer the final push to improve worker wellness, as this New England Journal of Medicine article illustrates.

When programs result in improved health outcomes, minority populations are often left behind. People with low socioeconomic status, especially women, nonwhites and individuals with lower educational attainment, often have trouble improving their health, according to panelist Jill Horwitz, J.D., a UCLA law professor. For more information, see her recent Health Affairs article, “Wellness Incentives in the Workplace: Cost Savings Through Cost Shifting to Unhealthy Workers.”

Although the panel answered the question “Do worker wellness programs work?” as inconclusively as the RAND report, the event showed the health policy community there is more to success than cost sharing. Considering who saves money and how will offer a more comprehensive picture of worker wellness programs and likely show that the newest regulations raise the stakes even higher for at-risk workers.

-Caitlin Feuer
National Academy of Social Insurance (NASI) ACHP intern