Association for Public Policy Analysis & Management

Research objective:  Employer wellness programs (EWPs) are a widely used strategy for promoting health improvement and economic benefits in the U.S. working population.  Today more than two-thirds of U.S. employers offer a general wellness program as part of their health benefits package. In 2010, the Affordable Care Act (ACA) increased attention on EWPs by raising incentive ceilings to encourage employee participation in health-contingent programs, which require individuals to meet a certain standard related to health outcomes in order to earn a reward. However, there is very limited evidence regarding employees’ experiences in health-contingent wellness programs, both in terms of participation as well as the impact of such programs on health and economic outcomes.  This study analyzes factors associated with participation and evaluates the impact of participation on several biometric outcomes and medical expenditures.

Study design: This study uses 2011-2014 longitudinal biometric screening, employee participation and medical claims data from a large employer headquartered in the Midwestern United States. The organization implemented a health-contingent wellness program during this period, using biometric data to qualify individuals that fall within healthy ranges on dimensions such as BMI, weight, and blood pressure for monetary incentives to cover out-of-pocket health care costs. Those who do not fall within this range must participate in additional wellness activities to receive the incentives.  We begin by evaluating differences in demographic and disease burden, total medical spending, and out of pocket expenses among those who were screened and fell within a healthy range versus those who did not. Among those that do not fall in the healthy ranges, this study then models the probability of participation in additional wellness activities, controlling for demographics and health status. As a second study aim, we use difference-in-differences multivariate analysis to examine whether program participation in a physical activity tracking program leads to improvement in biometric outcomes and reductions in medical spending over time.

Population studied: The overall study sample includes employees and adult dependents (n=78,782). Analyses for understanding the impact of program participation on health and spending outcomes is restricted to a subset of this sample for which the necessary biometric screening data are available (n=35,426).

Principal findings:  Analyses of changes in biometric outcomes show that participation in the physical activity tracking program provides some health benefits in terms of slowing adverse trends in BMI and weight. In model specifications that capture intensity of participation, those in the highest intensity group lost significantly more weight on average.  There are no statistically significant findings however, of the effect of participation on changes in medical care spending. Participation results are forthcoming.

Implications for policy: Little is known about whether health-contingent employer wellness programs are beneficial for employees and employers with respect to generating improvements in health outcomes and/or reductions in medical care spending. This study is one of the first to evaluate both participation determinants, including the presence of selection based on baseline health status and spending, as well as the incremental effect of participation in a wellness program on health and spending outcomes.