Workplace Wellness Programs Study: Final Report
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Huang, Kristin R. Van Busum, Dmitry Khodyakov, Victoria Shier RAND Health Sponsored by the U.S. Department of Labor and the U.S. Department of Health and Human Services The research described in this report was sponsored by the U.S. Department of Labor and the U.S. Department of Health and Human Services. The work was conducted in RAND Health, a division of the RAND Corporation. The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. R® is a registered trademark. © Copyright 2013 RAND Corporation Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND documents to a non-RAND website is prohibited. RAND documents are protected under copyright law. For information on reprint and linking permissions, please visit the RAND permissions page (http://www.rand.org/publications/ permissions.html). Published 2013 by the RAND Corporation 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 1200 South Hayes Street, Arlington, VA 22202-5050 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665 RAND URL: http://www.rand.org To order RAND documents or to obtain additional information, contact Distribution Services: Telephone: (310) 451-7002; Fax: (310) 451-6915; Email: [email protected] iii Preface This Research Report was sponsored by the U.S. Department of Labor and the U.S. Department of Health and Human Services. It is based on a review of the scientific and trade literature, a national survey of employers with at least 50 employees in the public and private sectors, statistical analyses of health plan claims and wellness program data from several employers, and case studies of five employers with established wellness programs. The report combines existing evidence and original analyses to document composition of wellness programs, describe national patterns of program uptake among employers, analyze the impact of wellness programs on health and cost outcomes, and investigate the use and impact of financial incentives to promote program uptake. 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 #DOLJ089327414 with the Department of Labor, as part of a study of workplace wellness programs that is required by the Section 2705(m)(1) of the Public Health Service Act. The Task Order Officers for the project are Anja Decressin and Keith Bergstresser of the Employee Benefits Security Administration, Department of Labor, and Diane Pilkey of the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services. We thank the Task Order Officers for their guidance and reviews 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 Officers, their respective agencies, or the federal government. This research was conducted in RAND Health, a division of the RAND Corporation. 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. v Contents Preface ............................................................................................................................................... iii Summary ........................................................................................................................................... xiii Acknowledgments ........................................................................................................................... xxix Abbreviations .................................................................................................................................. xxxi Chapter 1: Introduction ........................................................................................................................ 1 1.1. Chronic Disease as a Public Health Issue .......................................................................................... 1 1.2. Growing Interest in Wellness Programs among Employers .............................................................. 1 1.3. Role of the Patient Protection and Affordable Care Act ................................................................... 3 1.4. Overview and Research Questions ................................................................................................... 5 Chapter 2: Methods ............................................................................................................................. 7 2.1. Literature Review .............................................................................................................................. 7 2.2. RAND Employer Survey ..................................................................................................................... 7 2.3. Employer Case Studies .................................................................................................................... 11 2.4. Analysis of Secondary Data from Wellness Programs .................................................................... 13 Chapter 3: Employer-Based Wellness Program Characteristics and Prevalence .................................. 18 3.1. Availability of Employer-Based Wellness Programs ....................................................................... 18 3.2. Wellness Program Components ..................................................................................................... 21 3.3. Wellness Program Operation .......................................................................................................... 25 3.4. Discussion of Program Characteristics and Prevalence .................................................................. 34 Chapter 4: Program Impact ................................................................................................................ 36 4.1. Program Participation ..................................................................................................................... 36 4.2. Effect on Health-Related Behaviors ................................................................................................ 43 4.3. Effect on Health Status ................................................................................................................... 46 4.4. Effect on Health Care Cost and Utilization ...................................................................................... 53 4.5. Discussion of the Evidence on impact ............................................................................................ 57 Chapter 5: The Role of Incentives ....................................................................................................... 66 5.1. Background ....................................................................................................................................