The Real Value of Wellness Programs: A Comprehensive Review of the Literature

Abstract

W ellness and incentives programs continue to be a very important research and policy topic for Care Continuum Alliance (CCA) and stakeholders of the population health management industry. CCA strongly promotes efforts that seek to assess and improve wellness program designs. Recent articles questioning the importance and value of wellness programs led us to update our resources through a comprehensive analysis of case studies and peer-reviewed literature.Some of our findings indicate that the current body of research on wellness programs and incentives supports different conclusions than those expressed in public discussions. We hope future conversations on this topic consider these important results and documented best practices. The findings from our literature analysis follow. On the Relationship Between High-Risk Health Conditions/ Behaviors and Increased Health Care CostsPatients with high risks for tobacco, obesity, and physical inactivity incurred greater annual costs than those with no risks. Health care costs increased with age and were differentially higher for those who used tobacco, were obese, or were physically inactive. Epidemiological Data on the Likelihood of Disease with Healthy LifestylesWhen compared with participants who had no low-risk behaviors, patients who never smoked, had a healthy diet, adequate physical activity, and moderate alcohol consumption experienced reduced all-cause mortality, and mortality from malignant neoplasms, major cardiovascular disease, and other causes. Hence, low-risk lifestyle factors can exert a powerful and beneficial effect on mortality. Research on the Relationship Between Incentives in Wellness Programs and Behavior Change/ Patient EngagementEvaluations of incentive programs indicate that they are likely to have a positive effect, but results vary considerably. The reasons for variation and ways to avoid misguided incentive programs are 2 of the questions that are being researched currently by several organizations and research houses. When using incentives, it is important to emphasize shifting to intrinsic motivation for long-term sustained behavior change. The goal is a balanced approach of extrinsic and intrinsic motivational levers in these programs.Among large employers that provide incentives for health risk assessment (HRA), disease management programs, or behavior modification, cash is the most used incentive type. Other incentives also include lower premium contributions and contributions to an employee's health savings account or flexible spending account. Incentives can impact long-term employee engagement when applied within the context of communications, and the climate and culture of an organization. Workplace culture also is closely connected to the impact of incentives on employee behavior.Specific factors can lead to increased participation in an HRA completion. Incentive value and communications strategy were significantly associated with HRA participation. Multiple factors influenced program enrollment among 98,945 individuals, including ...

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