Are wellness programs a waste of money for employers?

Many organizations tout wellness programs as one of the reasons why they are a great employer that truly cares about the health of employees. And many hope this approach will lead to more productive, less costly employees. But are they truly seeing a return on their investment?

Not really, according to the results of a new study out of two American universities.

In analyzing the results of a three-year wellness program that was implemented by BJ’s Wholesale Club, a retailer with about 26,000 workers at 200 sites across the U.S., researchers found only marginally better health outcomes.

At the end of three years, employees at the treatment worksites had better self-reported health behaviours, including a higher rate of actively managing their weight, but there were no significant differences found in: self-reported health; clinical markers of health; health care spending or use; or absenteeism, tenure or job performance.

The study, "Health and Economic Outcomes up to Three Years After a Workplace Wellness Program: A Randomized Controlled Trial" in Health Affairs was conducted by Katherine Baicker, Emmett Dedmon professor at the University of Chicago in Chicago, and Zirui Song, assistant professor of health-care policy and medicine at Harvard Medical School in Boston.

The results were consistent with those of an earlier study, says Song.

“At 18 months, we found improvements in health and no changes in the other outcomes, and then, once again, in three years, we found exactly the same thing,” he says, adding that the study randomized results to remove a bias that many of those participants who enrolled in workplace plans were already interested in achieving healthier outcomes.

“They are healthier, exercising more and looking more favourable in terms of their outcomes than non-participants, but you could incorrectly attribute that difference to the wellness program because the people were different in the first place.”

By adding the randomizing factor, says Song, the results returned a more accurate picture.

“There had been many studies over the years that sought to measure the effect of workplace wellness programs. Most of those studies had methodological limitations and so that motivated us to look for an opportunity to do a more rigorous study to truly discern not only what the effects of the program would be, but also what is the difference when you use a randomized method versus a typical observational study.”

“When we ask the right questions, we get the right information that’s going to help us to design a comprehensive wellness program.”     

This was a very rigorously conducted study, says Duygu Gulseren, assistant professor at the School of Human Resources Management at York University in Toronto.

“I trust the results and it’s published in highly reputable journals,” he says. “These findings are in line with what we already know about creating healthy workplaces in general, and workplace wellness programs and practices.”

Wasted money?

But does this mean that wellness initiatives are not worth the investment? It all comes down to employer goals and who are they trying to help, says a wellness programs expert.

“Sometimes the programs aren’t designed to meet the actual needs of the employees; it’s kind of a generic program that’s put into place,” says Beverly Beuermann-King, founder of Work Smart Live Smart in Lindsay, Ont. “[Employers might say] ‘We’re going to do something on nutrition; we’re going to do a walking program,’ but those might not actually be the strategies that people are needing, so design is certainly an issue and measurement is always an issue.”

Thinking about other goals, rather than increasing employees’ health and reducing health-care costs, is a reasonable use for implementing these programs, according to Song.

“For example, they could be used as a way to attract talent on the labour market. If you believe, as an employer, that it’s important to send a signal that you care about the health of your employees, then you may very well find it worthwhile to invest in a program, even if it did not produce financial returns and so it’s difficult to say whether the money is ‘wasted.’”

While most wellness offerings focus on improving employee health by changing their habits when it comes to nutrition and exercise, employers should also examine their own workplace practices to achieve similar results, says Gulseren.

“Lifestyle programming tends to put the responsibility on the shoulders of employees and give the message that if you perform the right behaviours, you will get to the right result,” she says.

“However, many studies, including this one, show that employees can only do so much, and we need to improve the work and the workplace to improve the worker. We need to eliminate the common reasons for illnesses in the first place; if there is work overload or working in a toxic environment, teaching people how to exercise may not be that helpful.”

Perhaps a better descriptor of programs that don’t work would be that they have “unrealistic” expectations, says Beuermann-King.

“They’re unrealistic thinking that a one-off program is going to make a big impact on their benefits usage or on their absenteeism or on their engagement. It really is about making sure that you understand what are the sources of stress, or what are the issues that they’re trying to address?”

Employers should also shift their targets, says Gulseren, and focus on changing how leaders can help by offering courses on mental health awareness education, for example. This training can teach leaders how to recognize mental health issues among employees and how to respond to them.

“Across multiple studies, they found that employees whose leaders received the training submitted fewer mental health disability claims. Improving leaders’ mental health literacy meant improved work conditions for employees, and that’s why they led to an increase in their mental health outcomes,” she says.

Rigor, creativity lead to better results

So, what should HR be doing when thinking about implementing or trying out a new program for their workforce?

“Before investing substantial resources into a wellness program, I would ask a lot of questions of the wellness vendor regarding the content of the program. I would ask for evidence regarding any prior evidence of evaluations of their programs,” says Song. 

“I would also encourage HR folks to set up some type of evaluation that is as rigorous as possible as opposed to an answer that’s potentially confounded or biased by selection or other forces,” he says.

And don’t hesitate to be creative and open to new areas of wellness, says Gulseren.

“We know from the literature that individualized coaching or mental health supports could be really effective and, unfortunately, many benefits packages still don’t offer psychotherapy. But besides wellness programs, HR departments also have a very important role in developing healthy family policies. They can work to improve personal-leave policies, harassment policies, flexible-work arrangements, and then they can make a huge impact in that.”

Find out from the workforce, through surveys and the like, just what might be helpful, says Beuermann-King.

“Many studies show that employees can only do so much, and we need to improve the work and the workplace to improve the worker.” 

“In doing an assessment, [it’s about] making sure you ask the right questions, like ‘What are the major concerns within your team? What are the things that are causing stress in your home life? What are the things that are making it difficult for you to take care of yourself and put self-care strategies in place?’ When we ask the right questions, we get the right information that’s going to help us to design a comprehensive workplace wellness program.”