As we skeptics said all along about workplace wellness programs: No effect in clinical markers of health; care spending/utilization; or absenteeism & job performance after 1.5 years

Effect of a Workplace Wellness Program on Employee Health and Economic OutcomesA Randomized Clinical Trial. Zirui Song, Katherine Baicker, JAMA. 2019;321(15):1491-1501. April 16, 2019, doi:10.1001/jama.2019.3307

Key Points

Question  What is the effect of a multicomponent workplace wellness program on health and economic outcomes?

Findings  In this cluster randomized trial involving 32 974 employees at a large US warehouse retail company, worksites with the wellness program had an 8.3-percentage point higher rate of employees who reported engaging in regular exercise and a 13.6-percentage point higher rate of employees who reported actively managing their weight, but there were no significant differences in other self-reported health and behaviors; clinical markers of health; health care spending or utilization; or absenteeism, tenure, or job performance after 18 months.

Meaning  Employees exposed to a workplace wellness program reported significantly greater rates of some positive health behaviors compared with those who were not exposed, but there were no significant effects on clinical measures of health, health care spending and utilization, or employment outcomes after 18 months.

Abstract

Importance  Employers have increasingly invested in workplace wellness programs to improve employee health and decrease health care costs. However, there is little experimental evidence on the effects of these programs.

Objective  To evaluate a multicomponent workplace wellness program resembling programs offered by US employers.

Design, Setting, and Participants  This clustered randomized trial was implemented at 160 worksites from January 2015 through June 2016. Administrative claims and employment data were gathered continuously through June 30, 2016; data from surveys and biometrics were collected from July 1, 2016, through August 31, 2016.

Interventions  There were 20 randomly selected treatment worksites (4037 employees) and 140 randomly selected control worksites (28 937 employees, including 20 primary control worksites [4106 employees]). Control worksites received no wellness programming. The program comprised 8 modules focused on nutrition, physical activity, stress reduction, and related topics implemented by registered dietitians at the treatment worksites.

Main Outcomes and Measures  Four outcome domains were assessed. Self-reported health and behaviors via surveys (29 outcomes) and clinical measures of health via screenings (10 outcomes) were compared among 20 intervention and 20 primary control sites; health care spending and utilization (38 outcomes) and employment outcomes (3 outcomes) from administrative data were compared among 20 intervention and 140 control sites.

Results  Among 32 974 employees (mean [SD] age, 38.6 [15.2] years; 15 272 [45.9%] women), the mean participation rate in surveys and screenings at intervention sites was 36.2% to 44.6% (n = 4037 employees) and at primary control sites was 34.4% to 43.0% (n = 4106 employees) (mean of 1.3 program modules completed). After 18 months, the rates for 2 self-reported outcomes were higher in the intervention group than in the control group: for engaging in regular exercise (69.8% vs 61.9%; adjusted difference, 8.3 percentage points [95% CI, 3.9-12.8]; adjusted P = .03) and for actively managing weight (69.2% vs 54.7%; adjusted difference, 13.6 percentage points [95% CI, 7.1-20.2]; adjusted P = .02). The program had no significant effects on other prespecified outcomes: 27 self-reported health outcomes and behaviors (including self-reported health, sleep quality, and food choices), 10 clinical markers of health (including cholesterol, blood pressure, and body mass index), 38 medical and pharmaceutical spending and utilization measures, and 3 employment outcomes (absenteeism, job tenure, and job performance).

Conclusions and Relevance  Among employees of a large US warehouse retail company, a workplace wellness program resulted in significantly greater rates of some positive self-reported health behaviors among those exposed compared with employees who were not exposed, but there were no significant differences in clinical measures of health, health care spending and utilization, and employment outcomes after 18 months. Although limited by incomplete data on some outcomes, these findings may temper expectations about the financial return on investment that wellness programs can deliver in the short term.

Introduction

Workplace wellness programs have become increasingly popular as employers have aimed to lower health care costs and improve employee health and productivity. In 2018, 82% of large firms and 53% of small employers in the United States offered a wellness program, amounting to an $8 billion industry.1,2 This growth has been aided by public investments such as the Affordable Care Act, which included funds to promote the development of workplace wellness programs.

Workplace wellness programs tend to focus on modifiable risk factors of disease, such as nutrition, physical activity, and smoking cessation. Despite widespread adoption, causal evidence of such programs’ effects on health and economic outcomes has been limited. Meta-analyses have produced varying estimates of benefits relative to costs.3-5 Observational studies have often been limited by a lack of valid control groups, selection bias, and small samples.6-8 Experimental studies of comprehensive wellness programs have been scarce and have produced mixed results, with most of the more rigorous studies now dated.9,10 Other experimental studies have focused on certain components of wellness, such as smoking cessation and weight loss, using an intervention of limited duration.11-14 A recent rigorous randomized study used individual-level rather than workplace-wide randomization, making it difficult to assess the effects of the tools used by many programs aiming to improve workplace culture or harness peer effects.15

Using a design that randomized the implementation of wellness programming at the worksite level, this study evaluated the effect of a multiyear workplace wellness program on health and economic outcomes over 18 months in a middle- and lower-income employee population at locations across the eastern United States.

Discussion

This randomized clinical trial of a multiyear, multicomponent workplace wellness program implemented in a middle- and lower-income population found that individuals in workplaces where the program was offered reported better health behaviors, including regular exercise and active weight management, but the program did not generate differences in clinical measures of health, health care spending or utilization, or employment outcomes after 18 months.

That the program affected self-reported health behaviors, but not health or economic outcomes, may be interpreted in several ways. Given that workplace wellness programs focus on changing behavior and that behavior change may precede improvements in other outcomes, these findings could be consistent with future improvements in health or reductions in spending. On the other hand, behavior change is likely easier to achieve than improvements in clinical or employment outcomes. Thus, there may remain no detectable effects on those outcomes, which would have implications for the return on investment in wellness programs.

The finding of no significant effects on clinical measures of health, health care spending, or employment outcomes is consistent with a recent trial of a wellness program implemented at the University of Illinois, which evaluated similar outcomes after 1 year.¹⁵ However, our study found a sizeable and robust improvement in some self-reported health behaviors. Moreover, we found that participants did not have lower preintervention spending than nonparticipants, although there was selection on other dimensions. Unlike the Illinois study, this intervention was implemented at the worksite level (rather than varying across individuals within the same worksite), perhaps better facilitating changes in workplace culture and providing greater social supports for behavior change. This intervention was also fielded in a different population, set of geographies, and employment setting, making it difficult to isolate the causes of any differences in findings.

These findings stand in contrast with much of the prior literature on workplace wellness programs, which tended to find positive and often large returns on investment through, for example, reductions in absenteeism and health care spending.^3-9,23,24 Given that most prior studies were based on observational designs with methodological shortcomings such as potential selection bias, results based on random assignment of the intervention are likely more reliable.