New research on views of 2,000 employees on their perceptions and preferences around health and wellness benefits

Americans highly value and depend on their employee benefits — health insurance in particular — but lack the savvy and initiative to ask doctors, “How much will it cost?” That question could mean the difference in thousands of dollars for consumers, and millions for U.S. companies. 

These are among the findings from a recent national survey of more than 2,000 employees, led by Benz Communications, a marketing firm that specializes in employee benefits, and Quantum Workplace, a leading technology firm focused on employee satisfaction and engagement surveys.

The goal was to get clear, actionable data for U.S. companies on how to improve their efforts around managing and communicating health and wellness benefits. Top level findings can be found in the infographic below. A deeper dive into the data, including four topical fact sheets, can be found here.

To view full size click here.

King County’s award-winning wellness program serves as model for other employers

More than four years before the Affordable Care Act was signed into law, a county government in the state of Washington took action on its skyrocketing health care costs, becoming one of the first counties in the country to tie out-of-pocket health care expenses to participation in wellness activities. Today, more than 90% of King County employees have taken ownership of their health through the Healthy Incentives program, and the county serves as a model for other local governments across the nation.

Read more about King County's efforts here.

2014 Consumer Health Mindset study released

For the third straight year, Aon Hewitt, the National Business Group on Health, and The Futures Company surveyed more than 2,700 employees and their dependents covered by large employer-sponsored health plans to determine their perspectives, behaviors, and attitudes toward health and wellness. This year’s report also analyzed the responses of employees who work at organizations with strong cultures of health—or organizations that prioritize and encourage healthy behaviors in the workplace—and compared them to employees’ responses in organizations that do not.

Based on the Consumer Health Mindset analysis, employees who work in strong cultures of health were more likely to say they have control over their health than those who work at companies where it is less of a priority (75 percent versus 63 percent). In addition, they were less likely to report that stress has a negative impact on their work (25 percent versus 49 percent). The report also showed a link between strong health cultures and general happiness. Sixty-six percent of employees in strong health cultures say they are extremely or very happy with their lives compared to just 32 percent of those in weak health cultures.

According to the report, employees in strong cultures of health are more likely to take positive steps to improve their health. Seventy-two percent had an annual physical in the past year and 62 percent exercised at least three days a week, compared to just 64 percent and 49 percent, respectively, of employees at organizations with weak cultures of health. Seventy-seven percent participated in wellness programs, compared to just 46 percent of those employed at companies where health is perceived to be a low priority.

You can download the full report here.

New Survey Finds Employers are Spending More on Wellness Programs

Corporate employers plan to spend an average of $594 per employee on wellness-based incentives within their health care programs this year, a 15-percent increase from the 2013 average, according to an employer survey by Fidelity Investments and the National Business Group on Health.

The survey included 151 companies and found that 95 percent of companies plan to offer some kind of health improvement program for their employees, and the percentage of companies offering incentives to participate in these initiatives has increased from 57 percent in 2009 to 74 percent in 2014, Fidelity and NBGH said in their press release.

Read more about the survey here.

Consensus Statement Offers Guidance on the Use of Biometric Screenings as a Workplace Wellness Tool

Three national health organizations have published new guidance intended to help employers create more successful programs for gathering health-screening information from employees. Known as “biometric screenings,” the gathering of such information — ranging from height and weight to blood pressure and cholesterol levels — can play a key role in an employer’s workplace wellness program.

The Health Enhancement Research Organization (HERO), the American College of Occupational and Environmental Medicine (ACOEM), and the Care Continuum Alliance (CCA) collaborated on a consensus statement titled “Biometric Screening for Employers,” which was published in the October issue of the Journal of Occupational and Environmental Medicine (JOEM), the official publication of ACOEM.

With the growth in the popularity of employer wellness programs, the inclusion of biometric screenings is on the rise. During a biometric screening, factors such as blood pressure, weight, and cholesterol are taken at the worksite and used as a part of a workplace health assessment to benchmark and evaluate changes in employee health status over time. These measurements are often used as an essential component in health management and wellness programs for employees.

But many variables must be taken into account in order for biometric screening programs to succeed, including data collection methods, selection of appropriate populations for screening, operational issues, privacy considerations, budget limitations and others. “Biometric Screening for Employers” offers detailed suggestions on all of these and other variables, organized into four major categories to assist employers when considering biometric screening as part of an overall employee health management approach.

Wellness Experts Caution Against Quick Move to Outcomes-Based Programs

In a new Employee Benefits News story, wellness consultant Dee Edington says companies seeking to make a business case for wellness are too quick to ditch participation-based programs for outcomes-based models and should wait until initiatives have a 70% participation rate and two to three years of data. Consultant Cortney Rowan of Altitude said employers should create wellness incentives with the intent of measuring outcomes to create an initial baseline from which to compare data in the future. Encouraged by the Affordable Care Act's increase in the allowed maximum of wellness incentives - from 20% to 30% of the cost of health coverage - may cause many employers to transition too quickly to outcomes-based wellness programs, before their program has sufficient engagement and maturity.

Lawmaker Asks for Rules on Employers' Use of Health Risk Assessments

The New York Times reports that a federal lawmaker is asking the Equal Employment Opportunity Commission to investigate employer wellness programs that seek detailed health information from employees, and to issue guidelines preventing employers from using such programs to discriminate against workers. The request, by Representative Louise M. Slaughter, Democrat of New York and a staunch advocate for health privacy rights, came a few days after Pennsylvania State University suspended part of its new employee wellness program that had drawn objections from faculty members.

Ms. Slaughter, who made her request in a letter to the commission, is the author of the Genetic Information Nondiscrimination Act, a federal law that protects Americans against discrimination in employment or health insurance based on their genetic information. It is legal for employers to use financial incentives to encourage workers to fill out health risk assessment forms as long as that reward is based on completion of a wellness form and not tied to specific questions related to an employee’s health status.

Employee Benefit News Profiles Three Successful Wellness Programs

Employee Benefit News reports on three different employers whose wellness strategies go beyond basic biometric screening and poorly targeted initiatives to address the whole person, including things like behavioral psychology, physical health, social well-being, and career well-being. EBN profiled three progressive employers - Nationwide Insurance, Heartland Health and Cerner Corporation - who have developed strategic and innovative wellness initiatives that succeed in part because benefits and business leaders have ingrained wellness as a core part of their business strategy and culture.

Penn State Employees Protest New Wellness Program

Reuters reports that Penn State employees are protesting the university's 2014 wellness requirements. More than 2,000 faculty and staff employees at Penn State argue that it is coercive and unethical, and have asked that it be stopped. Matthew Woessner, associate professor of political science at Pennsylvania State University, who doesn't smoke, spends an hour every day on the elliptical trainer and eats (mostly) healthy food, has written an open letter and started a change.org petition.

Penn State has given its covered employees and spouses until October to comply with two key requirements of the new "Take Care of Your Health" wellness program: complete an online wellness profile from WebMD and undergo a preventive physical, including tests of cholesterol and glucose levels, and measurements of height, weight, and waist circumference. Employees who fail to do both will have $100 per month deducted from their paycheck. Studies show this $1,200 annual penalty is one of the most severe to be imposed by a U.S. employer, only 2 percent of which use fines alone, rather than rewards, to push staff to undergo medical testing, provide data on their health and otherwise participate in wellness programs.

CDC Partners With 104 Employers for National Healthy Worksite Program

The Centers for Disease Control and Prevention, through its partner Viridian Health Management, has identified 104 employers in eight counties across the nation that have voluntarily chosen to participate in the National Healthy Worksite Program, a new initiative aimed at reducing chronic disease and building a healthier, more productive U.S. workforce. The initiative primarily focuses on small and mid-sized employers.

CDC’s National Healthy Worksite Program is supported through the Affordable Care Act’s Prevention and Public Health Fund, and is designed to assist employers in building successful workplace wellness programs by implementing science-based disease prevention and wellness strategies to help reduce chronic diseases.

The eight participating communities are Buchanan County, Mo.; Harris County, Texas; Kern County, Calif.; Marion County, Ind.; Philadelphia County, Pa.; Pierce County, Wash.; Shelby County, Tenn.; and Somerset County, Maine. The communities were selected because of their high rates of chronic diseases and health risk behaviors such as smoking and physical inactivity. Also important in the community selection process was the availability of local resources to support a sustainable workplace health program, such as proximity to hospitals and existing community health promotion programs.

A complete listing of the selected employers and more information about the program is located at http://www.cdc.gov/NationalHealthyWorksite.

NBCH CEO Andy Webber Quoted in Forbes Article on Employee Wellness Rules

NBCH's President and CEO, Andy Webber, was quoted in a Forbes article on the recently-published employee wellness program final regulations. Under the Affordable Care Act, employers are allowed to increase the incentives they provide to workers in order to get them into a wellness program, gym or other effort to encourage healthier behaviors. Employers also get clarity on implementing penalties for unhealthy workers.

“This reinforces that employers have been on the right track in using financial incentives as one approach among many to influence health,” Andrew Webber, president and chief executive of the National Business Coalition on Health in a statement to Forbes. “We’re supportive of the wellness rules and increasing the amount of incentives that employers can use in trying to influence employee behavior.”

Wellness Programs Could Factor into Employer Future Insurance Decisions, Expert Says

The Commonwealth Fund reports that the success of workplace wellness programs could have an impact on whether employers decide to move their workers into the new health insurance exchanges, or marketplaces, an official from CVS Caremark suggested at an event last week.

Troy Brennan, executive vice president and chief medical officer of CVS Caremark, said he thinks there is a big chance that many employers will be considering how they can use the exchanges in 2017 or 2018. (The ACA sets 2017 as the date when states have the option of opening up exchanges to employers with more than 50 employees.)  Workplace wellness programs factor into that picture, Brennan argued, "so it's a really critical time" to examine them. "The reason why you offer workplace-based health insurance is because you think you're going to be able to promote better health in your workforce, and as a result of that, have a better operating company," he said. "If these wellness programs don't work or if they turn out to be sort of bankrupt or maybe they're just targeting the wrong people, then I think there's less and less of an argument to maintain employer-based insurance and a lot of employers are going to be looking at sort of, "what should we be doing with the exchanges?'"

Brennan spoke at an event focused on the effectiveness of wellness workplace programs. It was sponsored by the Alliance for Health Reform and The Robert Wood Johnson Foundation.

Final wellness programs rule published

Yesterday HHS and the Department of Labor and the Department of Treasury published the long awaited final rule of requirements for workplace wellness programs, allowing employers to require healthy efforts from employees to qualify for lower premiums.

The final regulations, consistent with the Affordable Care Act, focus on nondiscriminatory wellness programs in group health coverage. Specifically, these final regulations increase the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan (and any related health insurance coverage) from 20 percent to 30 percent of the cost of coverage. The final regulations further increase the maximum permissible reward to 50 percent for wellness programs designed to prevent or reduce tobacco use. These regulations also include other clarifications regarding the reasonable design of health-contingent wellness programs and the reasonable alternatives they must offer in order to avoid prohibited discrimination.

The rule will apply to large employer-sponsored coverage starting next year and most businesses should not have to make more than minor tweaks to existing wellness programs to comply with the new rules.

Employers Need To Be Aware of Potential Legal Challenges to Wellness Programs

According to Human Resource Executive, the Equal Employment Opportunity Commission has not yet decided what the term "voluntary" means for employee wellness programs but companies should still implement plans and reduce their risk of violating discrimination laws, experts said. They suggested including wellness as part of a company benefits program, making sure employees know programs are voluntary, taking steps to avoid discrimination against employees with disabilities or based on age, and ensuring goals can be achieved in a fair way. Employers wishing to take advantage of the larger incentives available under the ACA need to be especially aware of the regulations describing how to create alternative standards for employees who cannot feasibly achieve the health outcome expected under the program.

The article also describes how the EEOC has flip-flopped between positions in recent years, and how there is currently a split among federal appellate circuit courts about interpretation of the laws, so employers - especially multi-state employers - need to be mindful of what the standards are in their specific areas. Potential violations of the Americans with Disabilities Act (ADA) also come into play when designing wellness programs.

Insurers May Include Wellness Programs in Individual Products on Exchanges

Health insurers are gearing up to compete for millions of potential customers who could begin shopping for an individual health plan later this year. And one strategy to win new business from individual health-insurance buyers could be by offering new and unique products.

The Pittsburgh Tribune-Review reports that the University of Pittsburgh Medical Center (UPMC) Health Plan, the health insurance arm of hospital system UPMC, has announced that it will introduce a wellness-program option next month for its Individual Advantage plans. It will include financial rewards for participating.

While fairly common in employer-sponsored health plans, wellness programs are still rare among individual plans. But those programs and other new options could become more widespread. Health insurers will need to differentiate themselves in what's expected to be a highly competitive market for customers who are required under the Affordable Care Act to buy their own coverage because they don't get it from an employer, and wellness programs with incentives could be a relatively easy way to do that.

Health Insurance Exchanges Could Affect Wellness Programs, Experts Say

According to Employee Benefit News, wellness programs could be affected if companies send employees to health insurance exchanges - either public or private - and decide wellness is not their responsibility, or if employees are less engaged. Experts say smaller companies may be most likely to move employees to the exchanges, which could mean they have less access to health data that influence wellness investments and incentives. Employers may lose the ability to work with wellness vendors while developing wellness and health promotion incentives if employees receive coverage through a public or private exchange.

At the same time, a provision in the ACA provides for some stronger incentives for employees who achieve improved health outcomes. This sets up a confusing set of circumstances for employers looking to control health care costs. Employers believe they need a healthy and productive workforce to have an edge in a global economy. But the ACA can have the effect of setting up some competing incentives, and an employer will have to carefully consider its alternatives, taking into account its size, industry, and culture.
  

Companies Plan to Increase Wellness Spending, Survey Shows

A survey of more than 500 employers found that 40% expect to increase wellness budgets and that current top programs include easy-to-implement initiatives such as flu shots, health communications and discount programs. OptumHealth Care Solutions vice president Beena Thomas said 47% of large companies are interested in environmental strategies that influence behavior, such as stocking healthy foods at eye-level in vending machines. Accordingly, 40% of respondents anticipate that their company’s wellness budget will increase in the near future, up from 30% from the group’s 2011 survey.

New Research on Corporate Wellness Programs: Do They Work?

More employers are launching wellness programs to encourge healthy behaviors among their workers and control health care spending. But can these initiatives deliver on their promise?

In the new issue of Health Affairs, Commonwealth Fund–supported researchers led by Gautam Gowrisankaran, Ph.D., report on their study of one wellness program begun in 2005 by a St. Louis hospital system. Their findings show a substantial decrease in hospitalizations for targeted conditions, but they also reveal that the associated cost-savings were counterbalanced by increased spending for prescription drugs and outpatient care, not to mention the costs of the program and incentives themselves. At least in the short term, it appears that while wellness programs may improve employee health and productivity, they're unlikely to lead to substantial reductions in health care spending.

This research is important to learn from as employers move more toward an approach of population health management.  In addition, it remains to be seen whether the new stronger ACA incentives for health-contingent wellness programs have the potential to show substantial reductions in health care spending.

State Legislatures Debate Mandatory Employee Wellness Programs

In both Washington and Maryland, state legislatures are mulling the possibility of taking a more proactive approach to wellness for their state employees. Washington is considering a bill that would require wellness programs be part of health insurance plans offered to state workers starting next year. Legislation in Maryland would require the state to have an employee wellness program with incentives, such as discounted premiums for workers who participate.

States are often one of the largest, if not the largest, employers in any given region, and as such, often have considerable power and influence in their markets. If state employee plans start pushing for stronger wellness programs and incentives, private employers could start to feel pressure to follow suit.

New Report on Wellness Programs: Involve Spouses for Better Results

Employers who have invested in employee wellness programs may be interested in a new report that finds outcomes are most positive when employee spouses are included in the programs.

A new joint report from the Health Enhancement Research Organization (HERO) and Mercer consulting firms finds that employers who follow best practices for workplace wellness programs are more likely to report improvements in medical cost trends, as well as improved employee health status.

The best practice trends that yield higher outcomes are:

• Including spouses in key components of the program.
• Promoting all wellness activities under a single brand name.
• Having a formal, written strategic plan with financial objectives.
• Active participation by senior leadership in wellness programs.

The study found that employers that permit spouses to participate in programs reported an average employee participation rate that was twice as high as the rate among employers that don’t include spouses — 28 percent compared to 14 percent. When spouses were included in key components of the wellness program, employers were also more likely to report improvement in health risk and in medical trends.

Employer interest in health and wellness programs has been growing the past several years, especially since the Affordable Care Act provides companies incentives to promote employee wellness programs and build healthier workforces.