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Workplace Wellness Programs: Services Offered, Participation, And Research Report Workplace Wellness Programs Services Offered, Participation, and Incentives Soeren Mattke, Kandice Kapinos, John P. Caloyeras, Erin Audrey Taylor, Benjamin Batorsky, Hangsheng Liu, Kristin R. Van Busum, Sydne Newberry Sponsored by the United States Department of Labor C O R P O R A T I O N For more information on this publication, visit www.rand.org/t/rr724 Published by the RAND Corporation, Santa Monica, Calif. © Copyright 2014 RAND Corporation R® is a registered trademark. Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.html. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org Preface This Research Report was sponsored by the Employee Benefits Security Administration (EBSA) of the U.S. Department of Labor. The goal of this report was to leverage existing data to explore patterns of wellness program availability, employers’ use of incentives, and program participation and utilization among employees. This report will be of interest to national and state policymakers, employers and wellness program vendors, employer and employee advocacy organizations, health researchers, and others with responsibilities related to designing, implementing, participating in, and monitoring workplace wellness programs. This research was conducted under contract #DOLJ139335149 with the Department of Labor. The Task Order Officer for the project was Elaine Zimmerman of the EBSA, Department of Labor. We thank her for her guidance and review of the document; however, we note that the material contained in this report is the responsibility of the research team and does not necessarily reflect the beliefs or opinions of the Task Order Officer, EBSA, or the federal government. This research was conducted in RAND Health Advisory Services, the consulting practice of RAND Health. A profile of RAND Health, abstracts of its publications, and ordering information can be found at www.rand.org/health. Comments or inquiries concerning this report should be sent to the lead author, Soeren Mattke, at [email protected] or to his address at RAND: RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116. iii Table of Contents Preface ............................................................................................................................................ iii Figures............................................................................................................................................ vi Tables ........................................................................................................................................... viii Executive Summary ........................................................................................................................ x Analysis of Employer Survey Data ......................................................................................................... xi Which Employer Characteristics Predict Program Availability and Use of Incentives? .................... xi How Are Wellness Programs Configured? ........................................................................................ xii Are Incentives Increasing Program Uptake? ...................................................................................... xii Analysis of Wellness Program Data ...................................................................................................... xiii Which Employee Characteristics Predict Program Uptake? ............................................................. xiv How Do Incentives Alter an Employee’s Decision to (or Not to) Participate? ................................. xiv Do Health Care Utilization Patterns Change Following Program Participation? ............................. xiv Is There a Differential Effect of Selected Program Components on Medical Costs? ........................ xv Is There a Dose-Response Effect on Medical Costs in the Intensity of Program Interventions? ...... xv What Are the Long-Term Effects of Lifestyle Management on Health and Cost? ............................ xv Conclusions ............................................................................................................................................ xv Acknowledgments ...................................................................................................................... xviii Abbreviations ............................................................................................................................... xix 1. Introduction ............................................................................................................................... 1 2. Employer Survey Analysis ....................................................................................................... 3 Introduction .............................................................................................................................................. 3 Methods .................................................................................................................................................... 3 Data Sources ......................................................................................................................................... 3 Analytic Approach ................................................................................................................................ 5 Results ...................................................................................................................................................... 9 Limited Program—Limited Services Across All Components .......................................................... 17 Comprehensive Program—Extensive Services Across All Components .......................................... 17 Screening-Focused Program—Extensive Screening, Limited Other Components ............................ 18 Intervention-Focused Program—Extensive Lifestyle And Disease Management, Limited Screening ...................................................................................................................................... 18 Prevention-Focused Program—Extensive Screening and Lifestyle Management, Limited Disease Management ................................................................................................................... 19 Discussion ............................................................................................................................................... 26 3. Wellness Program Data Analysis .............................................................................................. 29 Introduction ............................................................................................................................................ 29 Methods .................................................................................................................................................. 32 Program Description ........................................................................................................................... 33 iv Data Sources ....................................................................................................................................... 34 Employee Characteristics and Program Participation ........................................................................ 35 Financial Incentives and Program Participation ................................................................................. 37 Health Care Utilization Patterns after Program Participation ............................................................ 37 Differential Effects of Program Components ..................................................................................... 39 Dose Response Effect of Program Participation ................................................................................ 39 Long-Term Gains in Health from Program Participation ................................................................... 40 Results .................................................................................................................................................... 41 Question 3.1: What Employee Characteristics Predict Employee Uptake of Programs? .................. 41 Question 3.2: How Do Incentives Alter an Employee’s Decision to (or Not to) Participate? ........... 53 Question 3.3: Do Health Care Utilization Patterns Change Following Program Participation? ........ 60 Question 3.4: Is There a Differential Effect of Various Programs on Medical Costs? ...................... 63 Question 3.5: Is There a Dose-Response
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