Workplace Wellness Programs: A Re-examination Based on the Literature

Workplace wellness programs reward or penalize employees for changing or not changing health-related behaviors or measurable health outcomes. These programs constitute a multi-billion dollar industry rapidly adopted by employers; more than 90 percent of all large employers report implementing these programs. Promoting this trend, as of January 1, 2014, the Affordable Care Act implements larger incentives for employers to expand wellness programs: employees can be rewarded or charged a premium surcharge (in addition to their employee contribution towards health insurance coverage) of 30% of the full cost of the premium (up to 50% for tobacco users) for participation or outcomes related to certain wellness programs. I will present a review of the published literature, and find evidence suggesting that wellness programs, particularly those that focus on lifestyle management, are not effective at either reducing health costs or improving health. Further, literature suggests that employee discrimination protections and privacy issues related to wellness programs may not be adequate. Moreover, I will present literature suggesting that the incentive structure of wellness programs is concerning, particularly with regard to two factors. First, wellness programs potentially provide a vehicle for employers to shift costs to less healthy employees, who are generally lower-income than healthier employees, thus the redistribution is likely to be regressive. Secondly, these costs have the potential to introduce de facto health rating into employer-sponsored health insurance costs, weakening the pooling of health risk. Overall, evidence suggests that wellness programs need a careful reexamination.