Workplace Wellness: Managing Expectations

Zirui Song, MD, PhD, an assistant professor of health care policy and medicine at Harvard Medical School and an internal medicine physician at Massachusetts General Hospital, discusses workplace wellness programs.

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More than 60% of American businesses offer workplace wellness programs. This $8 billion dollar industry promises a return on investment (ROI) by reducing health care costs. Although initial studies suggested these programs could be effective, even returning $3 for every dollar invested, more recent research has found wellness programs may have little impact on health costs or ROI. Given this change in course, what should employers do?

Zirui Song, MD, PhD is an internal medicine physician at Massachusetts General Hospital and assistant professor of health care policy and medicine at Harvard Medical School who studies workplace wellness. He answers three questions about his most recent research, the implications for employers and other options for improving employee health.

Interview edited and condensed for clarity.

Your recent research on the effectiveness of workplace wellness programs showed little or no improvement on critical measures like self-reported health, sleep quality, weight, cholesterol, absenteeism and job performance. Why do you think these programs have been relatively ineffective at improving health?

First of all, it’s important to point out that ours is one study of one program at one employer. There are many workplace wellness programs around, which differ in intensity and scope. But our findings do provide several generalizable insights.

Our study was randomized, a design that is better shielded from selection bias than earlier observational studies. In most studies of wellness programs, the comparison is between participants and nonparticipants. Intuitively that might make sense. It feels like comparing treatment and control groups. The problem is selection bias: people who decide to participate in wellness programs may be healthier or more motivated than those who don’t. When researchers conduct observational studies comparing participants to nonparticipants, it may look like wellness programs lower health care costs. But participants whose health care costs were lower to begin with could be driving those results.

One take-home lesson of our study and a similar study in Illinois is that when you randomize participation, the results appear to be more modest compared to prior studies.

What are the implications for companies? Is there research that supports focusing on specific aspects of wellness, or should companies not bother with workplace wellness programs?

Probably the number one reason that companies invest in these programs is to lower health care costs. If companies are looking for an immediate ROI, this recent research might give them pause. The Illinois study followed participants for one year. Our study lasted 18 months. If a company’s sole objective is to save money within that kind of timeframe, it may want to think twice about investing in a typical wellness program to achieve that goal.

But there are many other reasons a company might consider investing in a wellness program. Employers can use these programs to improve worker morale, encourage teamwork, boost workplace productivity or compete for talent in a tight labor market.

In addition, I would caution how people interpret the results of our study. It may take longer for behavior changes to translate into health care savings. That’s one reason why we are currently starting a follow-up study that will follow participants for three years.

It is easy to be overly definitive about what our results mean. For example, we found that the wellness program was linked to what could be a $475 savings in health care costs per person, per year — about a 10% reduction. But this finding was not statistically significant, which is why we conclude there is no financial return on health care costs over these 18 months. Different managers might interpret the results differently. Our three-year study, with a larger sample size and follow-up, will provide more information and perhaps help settle the question.

Aside from workplace wellness programs, what are other ways companies can promote health and wellness among their employees?

They have many options. For example, if the goal is to reduce stress or improve workplace morale, an employer could offer coaching, education or leadership by example. Changes in workplace culture could occur after executives model the behavior they value in employees. Encouraging workers to take breaks, or learn mindfulness, or turn off work email on weekends might be other strategies.

Another option is to remind workers to see a primary care physician and get the flu vaccine — and maybe offer time off to do so during the work week. Employers can also enable employees to eat healthier meals. One big obstacle is time. Perhaps an employer could partner with a local business to make more nutritious options available.

All of these options are effective and none require purchasing a wellness program.

Continue the conversation with us @HMS_ExecEd or with Dr. Song @HMSHCP. Join Zirui Song at our upcoming program for the International Foundation of Employee Benefit Plans on "Evidence, Insight and Strategy for Optimizing Health Benefits," July 9-11, 2019.

— Ann MacDonald