- As a part of the medical industry’s overall shift toward more value-based care, healthcare professionals are focusing on driving patient wellness. For payers, this means implementing wellness programs to promote healthy behavior change among beneficiaries.
According to Healthcare.gov, a wellness program is:
A program intended to improve and promote health and fitness that's usually offered through the work place, although insurance plans can offer them directly to their enrollees. The program allows your employer or plan to offer you premium discounts, cash rewards, gym memberships, and other incentives to participate. Some examples of wellness programs include programs to help you stop smoking, diabetes management programs, weight loss programs, and preventative health screenings.
Wellness programs can be separated into two camps: participatory and health-contingent.
A participatory wellness program is one that does not offer a reward or benefit based on a patient’s ability to meet a certain health metric. Instead, it incentivizes patients to simply engage in the healthy behavior. A gym membership reimbursement is an example of a participatory wellness program.
Health-contingent wellness programs depend upon a patient’s ability to meet a certain health metric or engage in a healthy behavior. A patient could receive a reward for starting a healthy diet plan for some programs. Other programs may require the patient to reach a certain health metric as a result of that diet plan prior to receiving any reward.
Ultimately, a payer and employer’s goal in offering wellness programs is to quell high patient costs. Patients who engage in unhealthy behaviors run the risk of developing a disease down the road, which may be costly for payers. Employers usually want to reduce employee absenteeism and improve the livelihoods of their workers.
Health payers face a number of wellness program regulations, most notably ones that will protect patient health data. Certain HIPAA guidelines aim to promote accountability for the protection of patient wellness data.
Prior to beginning a wellness program, most payers have patients complete a health risk assessment (HRA). HRAs allow employers and payers to identify which wellness program a patient may benefit from the most. Patients with high blood pressure might benefit from a stress reduction program, while those at-risk for diabetes may begin an exercise plan.
In the wake of value- and risk-based care models, wellness programs have gained popularity. In 2017, 70 percent of employers offered wellness programs, according to a UnitedHealthcare survey.
That number increased to 86 percent in 2018, according to a separate report from National Business Group on Health (NBGH).
Are wellness programs effective?
Despite employer and payer enthusiasm, patient participation in wellness programs leaves something to be desired. An oft-cited 2013 report from the RAND Corporation found that very few patients actually take the steps to complete a wellness program and reap program benefits.
Fewer than half of surveyed employees completed the necessary HRA. When beneficiaries did participate, it was likely because of financial incentives. Those incentives were most effective when they totaled more than $50, the report showed.
The UnitedHealthcare survey corroborated that evidence, finding that nearly two-thirds of employees said they wouldn’t spend an hour a day working on a wellness program. More patients expressed interest in participation when they didn’t need to dedicate as much time to their wellness programs.
Despite limited beneficiary participation, there is some evidence that wellness programs work to improve patient health and lower costs. The RAND study found that when beneficiaries completed their wellness programs, payers saw successes in smoking cessation, diet plans, and exercise regimens. Cholesterol levels did not improve as a result of wellness programs.
Participation in a wellness program over five years was also tied to modest reduction in healthcare costs and utilization.
What are the characteristics of a good wellness program?
Like most healthcare services, some wellness programs are more successful than others. Some studies have found that general transparency, patient education, and incentives can drive wellness program efficacy.
The RAND study found that the following yielded program success:
- Patient outreach and effective marketing
- Convenient and accessible wellness activities
- Wellness programs as a prominent organizational priority
- Using resources offered from payers and health plans
- Incorporating patient feedback periodically
The UnitedHealthcare survey showed that use of health IT might increase beneficiary participation. One-quarter of employees own a fitness wearable, the survey showed, and those tools are often used in wellness programs. Sixty-two percent of employee respondents said they would participate in a wellness program if the program was powered by health IT.
Payers and employers that customize wellness programs also often see higher participation rates. Eighty-five percent of employers reported that customized employee communication materials improved engagement. Email (72 percent), employer-branded websites (58 percent), and human resources portals (51 percent) were the most common tools for employee communication.
Employee communication should also include education materials. Specifically, employers and payers should inform patients of both the health and financial benefits of participating in a wellness program.
Currently, patients are vastly underestimating the financial payoff of payer wellness programs. The NBGH survey showed that most patients thought financial benefits totaled at $0 to $300, when realistically payoffs average at $784.
The healthcare industry is increasingly focusing on overall patient wellness as a part of its efforts to cut healthcare costs. When patients maintain a high level of overall health, they are less likely to experience a costly medical event or develop an expensive chronic illness.
Wellness programs are an increasingly popular strategy for payers and employers alike to work toward this goal of overall patient health. Going forward, they will need to make wellness programs engaging and attractive to drive more patient participation.