In the U.S., over 150 million adults go to work daily and spend the majority of their waking hours engaged in some form of employment. Prior to the passage of the Affordable Care Act (ACA), the federal government had not seriously considered the workplace as an appropriate venue for improving population health, although the Centers for Disease Control and Prevention (CDC) had funded a small number of workplace projects dating back to the mid-1980s.
In a bipartisan manner, the federal government can play a significant role to engage the business community in building and sustaining workplace health promotion programs that work by improving employee health, reducing unnecessary spending on health care, and raising worker productivity. Listed below are easy-to-adopt and generally low-cost strategies for delivering wellness programs to public and private sector employees.
Improve the Health and Well-Being of Federal Workers
As the nation’s largest employer, the federal government should lead by example by implementing evidence-based programs across all federal agencies and their worksites. By implementing and evaluating pilot programs, federal agencies can scale up successful models while continuing to explore innovative approaches and discarding programs shown to be ineffective. The government spends more than $40 billion per year on health care for its 4 million employees and annuitants, so there is potential for significant savings by improving employees’ health and well-being and reining in spending.
Support Research of Successful Workplace Health Promotion Programs
This is accomplished by increasing funding to the CDC for applied research performed in “real world” settings, through Prevention Research Centers and other extramural research, and devoting resources to ongoing evaluation of already established and long-standing workplace programs. Such funding would support, for example, companies that have applied for recognition from The Health Project for excellence in health promotion programming but lacked valid and reliable data to support their application.
Funding for evaluation of military wellness programs is also needed. Recently, the Department of Defense concluded the Healthy Base Initiative Pilot designed to test innovative policies and environmental interventions aimed at improving the health, well-being, and force-readiness of military personnel. This and other pilots should be expanded to include additional sites and a longer time horizon to assess the long-term viability of health and wellness initiatives, especially those targeting obesity and tobacco use.
A particular area of need is identification of programs most likely to achieve positive results among small businesses operating in rural communities. Small firms, defined as those with fewer than 500 workers, make up about 99 percent of employers in America and employ more than half of the private sector workforce but many of these smaller employers lack the resources to implement effective worksite health promotion programs. According to the most recent National Worksite Health Promotion survey, fewer than 5 percent of worksites with 50 to 99 employees, compared with 24 percent of sites with more than 750 employees, offered “comprehensive” workplace health promotion programs that included health education, links to related employee services, supportive physical and social environments for health improvement, integration of health promotion into organizational culture, and employee screenings with adequate treatment and follow-up.
Across settings and target populations, applied research studies should focus on health impacts, cost-effectiveness, and potential cost-benefit of wellness programs. The lessons learned from this applied research will guide future employer efforts and curtail wasteful spending on ineffective programs.
Improve Communication and Dissemination of Best and Promising Practices Associated with Workplace Health Promotion
The federal government can accelerate the adoption of wellness programs by highlighting their benefits to the business and consultant communities, promoting best practices, and developing tools and resources to stimulate implementation. While these strategies require upfront investment, they will yield a significant return-on-investment (ROI) to the federal government and the business community.
In a 2013 report prepared for The Bipartisan Policy Center in Washington DC, we projected the ROI resulting from a doubling of the number of employers (both federal and non-federal) who adopt comprehensive health promotion programs. Our analysis found that for large non-federal employers, both at baseline levels and when assuming a doubling of employees exposed to worksite programs, a positive ROI of $1.02 to $1.00 could be achieved through medical savings alone. These savings, when complemented by productivity gains, resulted in a projected ROI of $3.26 to $1.00. Similar results were seen for the federal sector analysis of OPM workers, where a positive ROI of $3.11 to $1.00 was achieved through medical and productivity savings.
While employers generally appreciate the need to promote workers’ health and safety, they often lack the specific skills, knowledge, and “know-how” to do so effectively. The CDC has developed a series of tools and guides for employers and is now building a clearinghouse to maintain these resources in a central virtual location. The aim is to make available a library of credible and vetted public and private resources for establishing and maintaining effective workplace wellness programs.
The CDC is also updating the CDC Worksite Health ScoreCard, a self-scoring “report card” that helps employers determine whether their programs contain the necessary elements for supporting healthy lifestyles. Federal support for the Guide to Community Preventive Services (Community Guide), and similar dissemination outlets will ensure that the right audiences are exposed to, and learn from, the best and most promising practices.
Provide Incentives to Spur Implementation of High-Quality and Innovative Programs
The federal government should provide seed money through its grant processes or low-interest loans to small and medium-sized businesses wishing to implement evidence-based wellness programs. Despite the $200 million authorized by the Affordable Care Act for workplace health promotion pilot efforts, the funds were never appropriated, largely due to Congressional actions restricting the use of federal dollars for prevention and public health initiatives. The limited funding of $10 million per year set aside for CDC-supported workplace health promotion programs and research has been eliminated in the federal budget. These funds should be restored.
Additionally, “smart” incentive programs should be encouraged. Section 2705 of the Affordable Care Act allows employers to charge differential insurance premiums to employees who participate in wellness programs, and, under certain conditions, offer financial incentives for achieving specific health outcomes (for example, quitting smoking, losing weight, managing blood pressure or cholesterol levels, or lowering blood glucose). These incentive programs have come under fire recently (in particular, concerns have been raised that these programs may discriminate against those in poor health) and rules regarding their implementation are now finalized to ensure they are fair, non-discriminatory, and—most importantly—likely to achieve health improvement.
The federal government should ensure through its rules process that when employers put these incentive structures in place, they are embedded within broader comprehensive workplace programs founded on a culture of health.
Finally, employees affected by evolving incentive rules should be included in these programs’ design to avoid the possibility of cost shifting and discrimination based on pre-existing conditions.
Honor and Reward America’s Healthiest Organizations
Employers who have put in place model programs should be recognized and rewarded for their efforts. There are several high quality award programs in the arena of workplace wellness (for example, the C. Everett Koop National Health Award, the National Business Group on Health (NBGH) Award, and the Wellness Councils of America (WELCOA) National Awards) that should be more heavily promoted through press releases and media events. While some award programs are based on self-reports by employers on the extent to which they follow best practices, others like the Koop Prize, require “hard” evidence of program accomplishments in the form of statistics documenting health improvements and cost savings.
Additionally, companies whose senior executives have publicly supported workplace programs should be honored and recognized by a bipartisan coalition of government officials. For example, the Bipartisan Policy Center, American Heart Association, CEO Council on Cancer, Health Enhancement Research Organization (HERO), and other groups have brought together organizational leaders to articulate the business case for increased investment in employee health.
To sum up, employers can and should play an important role in improving the health and well-being of millions of American workers by adopting evidence-based health promotion programs and policies. The federal government can support these efforts in many ways and, by doing so, improve the lives of Americans, and uphold the competitive advantage that U.S. firms now enjoy in a global marketplace.
Dr. Goetzel receives funding from various public and private sources to study workplace health promotion programs. Those sources include the Centers for Disease Control and Prevention. He is also the President and CEO of The Health Project which annually awards the C. Everett Koop Prize to companies that have provided statistical evidence that their programs improve workers’ health and save money for the business.