Employer-based wellness programs are increasingly prevalent in the United States, with a 2016 Kaiser Family Foundation study finding more than 80% of organizations with 200 or more employees offered some form of wellness program. Yet, the evidence of these programs' efficacy is mixed at best. A 2013 study by RAND Health found employers have an overall ROI for health and wellness interventions of $1.50 per employee, but that disease management programs drive much of the savings. Wellness programs deliver, on average, only about a $0.50 ROI. In the beginning of 2018, the Illinois Workplace Wellness Study found no statistically meaningful impact of wellness programs on employee medical spend, productivity, health behaviors, or health status (Jones, Molitor, & Reif, 2018).
Is it time to give up on workplace wellness programs?
If I may be bold: No.
There's still plenty of promise in workplace wellness programs. There are so many opportunities for organizations to do better with how these programs are designed, structured, rolled out, and measured. Part of our business at Mad*Pow is applying best practices that can help. Here are some.
Offering the right mix of programs is essential.
No single intervention will be the right fit for every single person. People have different tastes and preferences. Some people might distrust an employer-offered program; I've seen this many times, especially when people aren't sure why the program is being offered or where the data is going. And some employees may not be able to easily find an appropriate intervention among their employer's offering -- think someone who's seriously chronically ill, or someone who's unusually healthy and fitness-focused. Whether someone finds an intervention that's the right match for them really matters for the program's outcomes. I always think of Seligman's 1995 study where he found that no one type of psychotherapy outperformed the others, because people self-selected into what worked for them.
Replicating this in a workplace wellness environment means offering a curated menu of options so most people can find something that works for their needs. What if employers offer a mix of digital, in-person, and group-based interventions, and let people choose (or guide them so that the higher cost interventions are judiciously assigned to the people who need them most)? The recent Illinois Workplace Wellness Study did offer intervention options, but almost all of them were scheduled classes. That probably limited participant success right out of the gate due to a combination of logistical complexity and preference mismatch. What if there had been a robust digital option as well? We've created successful ones on many occasions, most recently for Joslin Diabetes Center.
Incentives often backfire, and should be minimized, if not avoided.
I also always look for ways to reduce or eliminate extrinsic participation incentives. Research consistently shows an undermining effect for extrinsic rewards, where people stop enjoying activities if they're compensated for doing them (Murayama, Matsumoto, Izuma, & Matsumoto, 2010). Research also suggests people perform better when they're doing something for their own personal reasons (Wrzesniewski et al., 2014). At the same time, the behaviors that receive an incentive in workplace wellness aren't usually the behaviors that drive meaningful change; completing an HRA doesn't lower blood pressure. So why are we pushing employees to participate for extrinsic incentives and then expecting them to make meaningful long-term behavior change? Better to design a set of interventions that align with what people already value and offer options that fit their lives, so those who do choose to participate have tools that work.
Science above all.
Undoubtedly there are some low-quality workplace wellness programs on the market. But there are also many that are built on a strong evidence base and have been proven to have positive effects for some people. One area where the evidence is particularly compelling is behavioral health. Take depression: There are often access limitations for in-person care, and some people avoid talking to anyone because of embarrassment or concern about stigma. Recent evidence suggests digital interventions may be an effective way to alleviate symptoms of depression (see Firth et al., 2017; Geraghty et al., 2016; Mohr et al., 2017). A top priority of anyone curating a set of interventions to include in a workplace wellness offering needs to be assessing the evidence base for each one.
An iterative measurement map.
Too often, organizations either hyper-focus on leading metrics like program enrollment or survey completion, or they underplay the importance of outcomes in favor of market parity. Related to selecting individual interventions on the strength of their evidence base, it's also important to have a detailed measurement plan for your organization's overall program. A good measurement plan will account for leading indicators like enrollments, but also will outline how those metrics lead to the behavior changes that ultimately produce outcomes like biometric improvements and reduced health care costs. This sort of outcomes map makes it possible to more granularly measure the impact of your wellness program, so you can quickly identify and address problems, rather than discovering retrospectively that your ROI is poor.
There is hope. We can't ignore the evidence that the typical workplace wellness program just isn't achieving real behavior change. But let's not give up on the idea entirely. By exercising scientific rigor in how we select interventions, triage employees into them, and measure their progress, we can undoubtedly get closer to healthy behavior change for all.
To share your thoughts, or get a full reference list, email abucher[email protected]
Powered By Mad*Pow
June 26-27th, 2018
Royal Sonesta, Boston MA
The annual HXD conference provides a unique crossroads for a diverse community of creators, practitioners, researchers, and developers, to help accelerate the transformation of our health system. Attracting over 500 visionaries across the health ecosystem, this event is created to drive real world change.Learn More
Ethical Guidelines for Designers
The Designer’s Oath is a tool that helps multidisciplinary teams define the ethical guidelines of their engagements. Designers are responsible for creating more than ever before and with this increased influence, we must take a step back and recognize the responsibility we have to those we design for.Learn More
The Center for Health Experience Design (CHXD) is a community that is designed to foster connection across the health ecosystem. It is only by working together that we can solve the toughest health challenges.Learn More
October 24 & 25, 2018
Convene, Boston MA
Join design and business leaders from Insurance, Fintech, Banking and more to discuss how experience design strategies can be applied to drive market solutions that achieve social good and profit alike.Learn More