Are Corporate Wellness Programs a Hustle?

Have you heard that wellness programs generate a return on investment (ROI) of $3 for every $1 spent? This sounds like a no-brainer, right? The US corporate wellness market is currently estimated at over 27 Billion⁴ and roughly 4 of 5 large US companies offer a wellness program to their employees.³ Despite large-scale implementation of workplace wellness programs (WWPs), their results remain unclear and controversial in the peer-reviewed literature. In this article I am going to present evidence that WWPs may not live up to the claims for a positive ROI.

Let’s start with a recent randomized clinical trial published in The Journal of the American Medical Association. The authors evaluated a multi-component WWP used at 160 worksites with over 30,000 employees. They found this WWP resulted in significantly greater rates of some positive self-reported health behaviors. However, there were no significant differences in measures of health, healthcare spending and utilization, or employment outcomes after 18 months.⁵ Another randomized trial of 4,834 university employees evaluated the effects of a WWP on employee health, health beliefs, and medical use. They found no significant effects on physical health outcomes, rates of medical diagnoses or the use of health care services after 24 months.⁶

Let’s review a common physical component of WWPs–strategies to reduce sitting time at work. The idea is that reducing worksite sedentary behavior will result in improved employee health. One study retrospectively reviewed 630 employee participants who were enrolled in a randomized trial. The total intervention costs were $206 per person, and $5589 per worksite.⁷ They found an insignificant change in loss of work productivity, which resulted in an estimated $0.34 return for every $1 invested.⁷ While the concept of reducing sedentary behavior is worthwhile, there are two important considerations: 

The first consideration is to understand the expected outcome. 

While reducing sitting time may improve low back pain severity, fatigue and even sleep disturbance, it may not improve productivity, concentration, and presenteeism.¹⁴ In other words, the employer making the investment may not see a ROI, at least not in the short term. Many employers would agree the aforementioned benefits are meaningful; however, gaining context will help understand outcomes and set appropriate expectations.

The second consideration is to understand the current body of research. 

Economic evaluations of WWPs aimed at reducing sitting time are limited and conflicting in the peer-reviewed literature.^7,14 A recent review found that while most of these programs were able to show a reduction in sedentary behavior,  they have uncertain impacts on costs.¹⁴

Some evidence has shown height-adjustable workstations, prompts and behavior change strategies reduce sitting time and can create beneficial cost reductions.¹¹ However, there is a currently insufficient evidence to perform economic evaluations of these interventions.¹¹ This limited evidence prevents firm conclusions of cost-effectiveness, cost-utility and cost-benefit analysis.¹¹

Another common target for WWPs is disease prevention– an impressive claim, indeed! A  recent systematic review assessed 25 studies evaluating the ROI of WWPs for chronic noncommunicable disease prevention. Recall noncommunicable diseases are not passed from person to person.¹ Only 2 of the 25 studies were found to have both high methodological quality and lower risk for selection bias!² This is important and means most of the studies cited as proof of a positive ROI for WWPs were poorly conducted and had a high degree of bias! In this case, the two studies deemed highest quality and lowest risk of bias may be the most useful for investigating. These studies were randomized trials, included a multi-component wellness strategy and found no short term ROI for the WWPs. Whether or not WWPs have a positive ROI in the long term remains controversial with limited evidence.² 

Failing to show a positive ROI doesn’t necessarily mean that a wellness program is ineffective. Reducing sedentary behavior can have a positive impact on many people with chronic conditions. A 2022 umbrella review and meta-analysis¹⁰ included 40 systematic reviews with 136 primary studies suitable for further meta-analyses. This study found that workplace interventions reduced sedentary behavior by 89.83 min/day and cost between €0 to €3587.¹⁰ Unfortunately, with only 22 of the primary studies containing health economic information, a ROI was not available.¹⁰ The key here is communication! Telling employers a wellness strategy offers a positive ROI should not be communicated without sufficient evidence!

Now before I am accused of cherry-picking evidence, allow me to say there are high-quality studies demonstrating a cost savings for some wellness strategies. For example, two previous reviews^8,9 did find a positive ROI for WWPs. However, one of these reviews paid little attention to study quality.⁹ The other based its conclusion on all studies included in the review, despite noting the higher quality studies provided evidence of smaller financial returns.⁹ 

These trends in this evidence are important to understand. Many of the studies noting a positive ROI for wellness programs share a pattern of poor design and a high degree of bias. When these factors are accounted for, financial returns seem to diminish. 

So where should employers spend their dollars? What WWPs have the ability to produce large positive impact on people’s lives, reduce healthcare costs and favor a ROI? A recent review of economic evaluations of WWPs can provide some guidance. This review found wellness strategies with a focus on disease management produced a higher ROI than programs with components of wellness.¹² To clarify, disease management is different than disease prevention. Helping people navigate current conditions represents a meaningful target. One of the top three healthcare costs and a major contributor to lost work time are musculoskeletal (MSK) conditions. This is not new information as the corporate wellness industry does make attempts at targeting MSK pain. However, the vast majority of these interventions are conducted without skilled analysis and without clinical guidance from experts in MSK management. 

With all this conflicting information, poor study methods and high risks of biased data, many companies tend to rely on wellness program representatives or insurance brokers to communicate expected cost savings. This is where the communication tends to veer far from the evidence. Unfortunately, not all programs are created equal and not all people respond the same–even to the same intervention! If you’re analyzing your wellness strategy, be sure the MSK pain and mental health categories are well-developed by experts these areas. Be mindful of any proposed ROI and ask for the evidence! I hope this information and the presented evidence helps provide some clarity. Thank you for your attention and your interest in supporting people to live their best and healthiest lives!

If you are struggling to establish your wellness program or want more detail on evidence-informed wellbeing strategies, I offer free 15 minute consultations. You can contact me at lee@thephysioremedy.com. 

References:

1. https://www.cdc.gov/globalhealth/healthprotection/fetp/training_modules/1/intro-to-epi_ppt__final_09252013.pdf
2. Baid D, Hayles E, Finkelstein EA. Return on investment of workplace wellness programs for chronic disease prevention: a systematic review. American Journal of Preventive Medicine. 2021;61(2):256-266.
3. Kaiser Family Foundation. Employer health benefits 2018 annual survey. http://files.kff.org/ attachment/Report-Employer-Health-Benefits-Annual-Survey-2018. Accessed March 15, 2019.
4. https://www.prnewswire.com/news-releases/global-corporate-wellness-market-report-2022-market-to-reach-90-4-billion-by-2026—ai-emerges-as-the-wellness-expert-in-the-corporate-space-301548242.html
5. Song Z, Baicker K. Effect of a workplace wellness program on employee health and economic outcomes: a randomized clinical trial. JAMA. 2019;321(15):1491.
6. Reif J, Chan D, Jones D, Payne L, Molitor D. Effects of a workplace wellness program on employee health, health beliefs, and medical use: a randomized clinical trial. JAMA Intern Med. 2020;180(7):952-960.
7. Michaud TL, You W, Estabrooks PA, Leonard K, Rydell SA, Mullane SL, Pereira MA, Buman MP. Cost and cost-effectiveness of the ‘Stand and Move at Work’ multicomponent intervention to reduce workplace sedentary time and cardiometabolic risk. Scand J Work Environ Health. 2022 Jul 1;48(5):399-409. 
8. Baicker K, Cutler D, Song Z. Workplace wellness programs can generate savings. Health Aff (Millwood). 2010;29(2):304–311. 
9. Baxter S, Sanderson K, Venn AJ, Blizzard CL, Palmer AJ. The relationship between return on investment and quality of study methodology in workplace health promotion programs. Am J Health Promot. 2014;28(6):347–363. 
10. Lam K, Baurecht H, Pahmeier K, et al. How effective and how expensive are interventions to reduce sedentary behavior? An umbrella review and meta-analysis. Obes Rev. 2022;23(5):e13422.
11. Akhavan Rad S, Kiwanuka F, Korpelainen R, Torkki P. Evidence base of economic evaluations of workplace-based interventions reducing occupational sitting time: an integrative review. BMJ Open. 2022 Jun 30;12(6):e060139.
12. Unsal N, Weaver G, Bray J, Bibeau D. A Scoping Review of Economic Evaluations of Workplace Wellness Programs. Public Health Reports. 2021;136(6):671-684. 
13. Hergenroeder A, Quinn TD, Perdomo SJ, Kline CE, Gibbs BB. Effect of a 6-month sedentary behavior reduction intervention on well-being and workplace health in desk workers with low back pain. Work. 2022;71(4):1145-1155.
14. Lutz N, Clarys P, Koenig I, Deliens T, Taeymans J, Verhaeghe N. Health economic evaluations of interventions to increase physical activity and decrease sedentary behavior at the workplace: a systematic review. Scand J Work Environ Health. 2020 Mar 1;46(2):127-142.