Care and health management activities, in all their permutations, have always been controversial in regard to whether they reduce health spending and how that reduction, if any, might be calculated. A recent Health Affairs blog post reviews the evidence and finds that workplace wellness programs, which have grown enormously in recent years, are unlikely to be producing health spending savings. (HA Blog Post) The authors note the widespread growth of wellness activities at employers, which the reform law encourages by allowing companies to tie premium and cost-share reductions to participation in programs. Research on wellness program outcomes has been mixed, and research design issues abound. The authors claim that the programs actually increase costs. One design is to examine the entire worker population, participants and non-participants in wellness programs, for reductions in wellness-sensitive events. The authors cite one study using this design that found dramatic reduction in such events, but the savings were offset by increases in other costs, largely a transfer from inpatient to outpatient spending. The post next reviews randomized trials and meta-analyses, which generally have found no savings. The most common design is comparing participants to non-participants but that design has serious issues about self-selection and participant dropouts. While many of these studies show positive returns, the methodological issues make the results unreliable.
These authors clearly had an axe to grind against corporate wellness efforts, and that has colored their conclusions. We too have often been skeptical about health spending claims associated with wellness programs. It is very hard methodologically to proof such savings in a convincing and rigorous manner. But the presence of design issues doesn’t mean that the programs don’t save money; just that it is hard to proof that they do. And we also believe that it is wrong to judge these programs solely on the basis of return on investment. Helping people eat better, get more exercise, cease smoking, manage stress better and other wellness activities have a value in improving people’s health and quality of life, whether or not they save money. This should be the most important goal of our health system–to make people’s lives better. So lets keep trying to see if wellness saves money, or what components or structures of wellness programs are most cost-efficient, but lets keep our eye on that real objective of better health.