Uncertainty regarding the benefits of wellness programs either in reducing overall costs or improving health outcomes has led to ongoing research regarding the programs. The Employee Benefits Research Institute examined wellness efforts at one large employer, and in particular the effect of incentives on employee participation and results. (EBRI Report) Core aspects of many wellness programs are health risk assessments and biometric screenings, which provide guidance on which conditions a particular employee needs to focus on. The majority of large employers offer these tools. Getting employees to participate can be difficult, so many firms have provided positive or negative incentives. Prior studies had indicated that more employees would participate in HRAs or screenings if the incentive were high enough. This research looked at the impact of significantly enhancing the incentives at this large manufacturing employer, which had been offering HRAs since 2004 and biometric screenings since 2007. The employer had a mix of union and non-union employees. In 2012 and 2013 the non-union employees and some union workers went from a $50 gift card for HRA completion to a $240 dollar a year reduction in premium contributions. In 2013, non-union employees also had to participate in the biometric screenings to get the premium reduction.
The researchers then looked for differences among the various sub-groups in regard to participation in HRAs or screenings and at impact on various categories of utilization. For non-union workers subject to the enhanced incentive completion of an HRA increased from 66% to 95%. For the union employees that received the higher incentive, completion went from 57% to 88%. For unions not participating in the higher incentive, completion only grew from 55% to 61%. When biometric screenings were required for the higher incentives in the non-union population, receipt of those screenings went from 22% to 89%. So the incentive, even though somewhat modest, had a substantial effect on participation rates. In terms of effects on utilization of health services, completion of an HRA appeared to have no effect in the first year after completion of the HRA, but participation in biometric screenings had an effect, although only on drug use, which rose an average of .3 prescription fills per member and $56 in annual drug spending. But effects of both HRA completion and biometric screening on utilization and spending likely need to be evaluated over longer periods of time. The immediate effect on drug spending can be expected and was largely in categories like statins, which were probably prescribed for members with newly discovered high lipid levels. The research validates the utility of incentives in improving employee participation in wellness efforts.