Most employers are planning to boost spending on wellness programs this year despite the mixed results on their efficacy.
More than 80% of employers said they are planning to increase their health and wellness budgets over the next three years, which is up sharply from 61% last year and more than double the 34% who planned to in 2009, according to an annual workplace study from UnitedHealth Group's Optum.
Of the 544 companies polled across multiple sectors, more than twice as many employers also indicated that workplace well-being programs are more important to their employee benefits mix than they were a decade ago as they predominantly look to reduce healthcare costs, attract and retain talent, reduce absenteeism, and improve morale.
There is a big push around addressing complex and chronic conditions like cancer, heart disease and diabetes that are driving healthcare costs, said Seth Serxner, chief health officer at Optum. Behavioral health and women's health are also emerging areas of interest.
"I would say employers do see wellness programs having a good impact around managing chronic conditions," he said. "While they recognize that they can do some on the supply side and benefit design side to reduce costs and improve outcomes, employers are seeing a need to get to the root cause."
The estimated $8 billion wellness industry is growing at a fast clip, and is expected to continue on that trajectory. But thus far, research has showed that the returns are limited. Part of that is because the research has not analyzed best-practice and state-of-the-art wellness programs, Serxner argues.
Other experts found that wellness efforts have minimal or no impact on health metrics. "It is possible that maybe some of these firms should temper their expectations on the returns for investment of these programs," said Julian Reif, assistant professor of finance and economics at University of Illinois at Urbana-Champaign who, along with his peers, studied the impact of wellness programs at the university.
While it is still possible there may be some smaller effects from these programs, the evidence indicates that there won't be huge returns, and further research is needed to determine if there are any returns at all, he added.
Reif and his cohorts took two randomized control groups in those who were eligible to participate in wellness programs and those that were not eligible. This differentiated their analysis from other observational research, which showed significant reductions in cost and improvements in health, he said.
The University of Illinois working paper found no significant difference in the health of employees or healthcare costs over one year. The researchers suggested participants likely were already healthy and had low healthcare costs.
A similarly designed study published in JAMA revealed that while workplace wellness participants have healthier behaviors than those who don't participate, they don't have lower body mass index, blood pressure or cholesterol.
Another 2009 study in Health Affairs from Dr. Zirui Song, assistant professor of healthcare policy and medicine at Harvard Medical School and Dr. Katherine Baicker, dean of the University of Chicago Harris School of Public Policy, found that medical costs fell $3.27 for every $1 spent on wellness programs. Costs associated with absenteeism dropped by $2.73 for each dollar spent.
"I do believe employers understand that healthier people cost less, but they know it is tricky to prove sometimes," Serxner said.
Nearly 90% of employers in the Optum survey said they are planning to address stigma surrounding mental health—a similar number are concerned about the level of access to behavioral health services. They are addressing the issue by integrating physical and behavioral health programs, implementing digital tools as well as virtual visits, bolstering their provider network and offering more timely appointments.
The vast majority are also concerned about substance-use disorder and aim to increase education, alter benefit design and offer counseling.
In addition to behavioral health, 84% of employers plan to increase investments in women's health services. The largest increases from 2016 to 2018 include programs addressing fertility, neonatal and first year of life.
Telemedicine was one of the fastest-growing health programs adopted by employers, with utilization increasing 171% since 2014.
Also, more than three-quarters of employers are deploying a centers of excellence strategy for specific high-cost, high-risk surgeries and chronic conditions.
Going forward, one of the main issues will be how to best engage employees to increase participation, particularly among those with the most complex conditions, Serxner said. That requires good communication, strong leadership and peer support, and appropriate incentives, he said.
The cost to implement programs is minimal compared with the potential return in reducing absenteeism, improving business performance and limiting turnover, Serxner said.
"But it is not as simple as changing co-pays or benefit design," he said. "It requires a culture shift to one of health and well-being."