A new study by researchers at the University of Chicago and Harvard, recently published in the Journal of the American Medical Association, sheds new light on the impact on increasingly popular workplace wellness programs on employees’ actual health outcomes. The effectiveness of these programs has not been extensively researched, as they are relatively new and rely on an evolving set of strategies and technologies, and studies so far have drawn mixed conclusions. The new research, Kaiser Health News senior correspondent Julie Appleby explains, had a more sophisticated design than many past studies in this area: The researchers randomly chose 20 BJ’s Wholesale Club outlets to offer a wellness program to all their employees, then compared their results with 140 other stores with no program, covering a total study group of almost 33,000 employees.
Unfortunately, the researchers found no significant correlation between the introduction of the wellness program and a strong improvement in employee health:
After 18 months, it turned out that yes, workers participating in the wellness programs self-reported healthier behavior, such as exercising more or managing their weight better than those not enrolled. But the efforts did not result in differences in health measures, such as improved blood sugar or glucose levels; how much employers spent on health care; or how often employees missed work, their job performance or how long they stuck around in their jobs.
The BJ’s wellness program offered small incentives for participation: Employees could receive about $250 in small-dollar gift cards for taking courses on nutrition, exercise, and other wellness topics. Around 35 percent of eligible employees completed at least one course throughout the duration of the study. One wellness program vendor commented to KHN that the limited impact of the program may have come down to the incentives being too small:
Jim Pshock, founder and CEO of Bravo Wellness, said the incentives offered to BJ’s workers might not have been large enough to spur the kinds of big changes needed to affect health outcomes. Amounts of “of less than $400 generally incentivize things people were going to do anyway. It’s simply too small to get them to do things they weren’t already excited about,” he said.
High-deductible health plans have become an increasingly popular means for employers to keep health care costs under control. According to data released last summer by the Centers for Disease Control and Prevention, between 2007 through 2017, the percentage of adults 18-64 with employer-provided health insurance who were enrolled in an HDHP with a health savings account increased from 4.2 percent to 18.9 percent, while the percentage enrolled in an HDHP without an HSA rose from 10.6 percent to 24.5 percent.
Over the past three years, however, our benefits research at Gartner shows that their popularity has been leveling off, as deductibles for individual plans have actually been trending downward. (Gartner Total Rewards Leadership Council clients can view our full report on medical plan trends and observations for 2018 here.) This trend suggests that employers are having second thoughts about whether the benefits of HDHPs outweigh the downsides.
A new survey published last month by the nonprofit Employee Benefit Research Institute (EBRI) and research firm Greenwald & Associates provides some insight into these pros and cons. The survey found that people enrolled in HDHPs were more likely to compare cost and quality when selecting non-emergency health care and to make cost-conscious decisions like choosing generic prescription drugs over brand names. HDHP enrollees also more likely to be offered and to participate in wellness programs through their employers, including programs that involve biometric screenings.
On the other hand, this cost-conscious behavior may not be entirely voluntary: 30 percent of HDHP enrollees said they delayed care in the previous year because of costs, compared to 18 percent of respondents covered by traditional health insurance plans. While the EBRI study does not clarify whether this care was essential or non-essential, another recent study of diabetics found that switching to a high-deductible plan increased their likelihood of delaying essential care.
A recent data brief from the Centers for Disease Control and Prevention illustrates the growth in popularity of high-deductible health plans (HDHPs) over the past decade. Between 2007 through 2017, the CDC data show, the percentage of adults 18–64 with employer-provided health insurance who were enrolled in an HDHP with a health savings account increased from 4.2 percent to 18.9 percent, while the percentage enrolled in an HDHP without an HSA rose from 10.6 percent to 24.5 percent. In 2017, enrollment in HDHPs was highest among adults aged 30–44 than among other age demographic.
The greater an individual’s family income level and educational attainment, the more likely they were to be enrolled in an HDHP with an HSA, the CDC found, while the likelihood of enrollment in both traditional health plans and non-HSA high-deductible plans decreased as income and education rose. This may reflect a greater understanding of the investment value of HSAs among higher-earning and more educated employees.
Other recent data tells a similar story: Last year, Bank of America Merrill Lynch’s Plan Wellness Scorecard found that more employers were offering HSAs, more employees were using them, and their account balances were growing. That report also found that employees were using about 70 percent of their HSA contributions to cover health expenditures during the year and saving the other 30 percent for future expenses.
However, while the adoption of HDHPs has certainly grown over the past decade, our benefits research at Gartner shows that their popularity has been leveling off over the past three years, when deductibles for individual plans have actually been trending downward. (Gartner Total Rewards Leadership Council clients can view our full report on medical plan trends and observations for 2018 here.)
Amazon is considering opening its own primary health care clinics for employees at its Seattle headquarters, CNBC reported on Thursday, becoming the latest in a series of major US companies pursuing innovative approaches to health care outside the traditional group insurance model. Two people familiar with the confidential discussions told CNBC that the company was planning to start with a pilot clinic for a select group of employees later this year, then expand the program in 2019:
Amazon was previously looking to outsource its clinics and brought vendors in to pitch their services. After numerous rounds of discussions, Amazon ultimately decided to develop clinics internally, one of the people said. Providers including Crossover Health and One Medical offer on-site or nearby services for other companies, including those in the technology sector. …
Amazon started its effort by hiring primary care experts, beginning last year with Christine Henningsgaard, who was previously vice president of operations at One Medical. In January, the company brought in Martin Levine from Iora Health, a primary care group with clinics in Seattle.
If Amazon moves ahead with this plan, it will be pursuing a similar path to Apple, which announced earlier this year that it was establishing a network of health clinics for its employees in and around its headquarters in Cupertino, California. To staff this initiative, Apple has since hired a number of employees away from the provider that operates some of its on-site clinics in other locations, along with a variety of wellness professionals and “care navigators” to help guide patients in choosing the appropriate care for their health needs.
General Motors has made a deal with Henry Ford Health System, a Detroit-based hospital system, to provide a new health care plan to its salaried employees and their dependents in southeast Michigan, the Wall Street Journal reported on Monday. The optional ConnectedCare plan, which will be available to some 24,000 GM employees and their dependents starting next year, replaces traditional group health insurance with a direct-contract system wherein Henry Ford will manage nearly all of the participating employees’ health care needs.
The company’s existing health insurance options will remain available, but the ConnectedCare plan is expected to save them anywhere from $300 to $900 a year compared with the current cheapest option. According to a press release from the Henry Ford system, the plan will give GM employees access to more than 3,000 health care providers offering “a comprehensive range of health care services including primary care, more than 40 specialties, behavioral health services, hospitalization and emergency care as needed, as well as pharmacy and other services.”
Under the five-year contract, the hospital system agreed to specific goals for quality, cost and customer service. For instance, plan participants are promised same-day or next-day appointments with primary care physicians and appointments with specialists within 10 business days. They will also have access to a range of digital health tools, wellness services, and assistance in managing their care and choosing the right health care options, Henry Ford said in its statement.
Blue Cross Blue Shield of Michigan, GM’s insurance provider in that state, will continue to manage claims-processing and other functions, while again continuing to provide the PPO plans GM already offers its employees. ConnectedCare will not apply to GM’s large unionized workforce in Michigan, whose health benefits are negotiated under a labor agreement.
Financial wellbeing programs that help employees better manage their finances, pay down debt, and plan for retirement have become commonplace among private US employers. Employees want this kind of help and employers are increasingly eager to offer it. Bank of America Merrill Lynch’s 2018 Workplace Benefits Report, however, finds that only one third of employees are actually participating in these programs, even though many more are struggling with financial fitness, Nick Otto reports at Employee Benefit News. One potential explanation for this low level of engagement is that the financial wellness benefits employers are offering are misaligned with employees’ own priorities:
Employers tend to focus on actions to manage immediate financial needs, such as budgeting and handling expenses, according to the study. Meanwhile, employees mostly prioritize long-term financial goals, such as tactics that help them save and invest for the future. The report finds workers are looking to their employers to help manage their financial lives, shining a light on what employees seek in an employer-sponsored financial wellness program.
Employees feel the best approach to improve financial wellness is getting a personal financial assessment, supported by specific actions to take. Additionally, employees would also like help measuring their progress, through tracking and measuring of accomplishments.
Another notable finding from the report is that few employees recognize the role of health care costs in their financial planning: 7 percent identified health care as a key component of financial wellness, even though more than half said they had skipped or postponed a medical need to save money. The connection between health care costs and financial wellbeing is particularly salient in the US; for instance, many experts have promoted the use of health savings accounts as long-term savings and investment vehicles, comparable to 401(k) plans for retirement.
The latest data from the Labor Department shows that the percentage of private sector employees in the US offered health insurance through their employer rose from 67 percent in 2017 to 69 percent this year, the Wall Street Journal reported earlier this month. This figure had dwindled from 71 percent in 2010, when the department began conducting this survey, and this latest uptick represents the first year-over-year increase since 2012.
The Labor Department report showed that 86 percent of full-time private sector employees were offered health benefits, along with 21 percent of part-timers. Union members were significantly more likely to be offered these benefits (94 percent) than non-union employees (66 percent). Of those private sector employees offered medical benefits, 72 percent chose to take advantage of them.
Smaller employers, who are not required to offer health insurance under the Affordable Care Act, had driven most of the decline over the past eight years: Among organizations with fewer than 50 people, 51 percent offered health insurance to their employees in 2018 compared to 55 percent in 2010. Large businesses, with over 500 workers, have been more consistent in offering these benefits, with the percentage of large employers providing health insurance hovering near 90 percent since 2010.
The ACA mandates that organizations with 50 or more full-time equivalent employees offer at least a minimum standard of health benefits to employees working 30 or more hours a week, or pay a penalty of $2,000 per employee. Most large businesses already offered medical benefits before the ACA took effect and continued to do so, but some mid-sized employers have chosen to pay the penalty instead, as the cost of covering their employees would be greater, Paul Fronstin, director of the Health Research and Education Program at the Employee Benefit Research Institute, told the Journal.