Germany has more experience with wellness incentives, so researchers affiliated with the Commonwealth Fund looked there for clues about what effect wellness incentive plans could have in the U.S. Considering that federal health reform allows for the expansion of wellness incentive programs and an increasing number of employers are expected to adopt them, the issue of whether they reduce health costs as they typically claim is no small question.
In Germany, public insurers offer members bonuses for participating in health screening, promotion and checkup programs. Participants are rewarded for achieving goals, such as receiving an influenza vaccination, meeting body mass index targets, or exercising in a gym for a certain number of times per week, similar to how U.S. plans are structured.
The researchers examined the results from a wellness program run by one of Germany’s largest insurers and found that participants in the program had “significantly” lower costs than those who didn’t participate. The average difference between the two groups was $251 per year, but that number drops to $143 when wellness program costs are factored in. (Researchers didn’t address whether participating in wellness incentive programs led to better health outcomes. Presumably there was no reliable data.)
While those dollar amounts may not seem like much, a lot more is at stake in the U.S. Starting in 2014, employers can offer wellness incentives of up to 30 percent (and in some cases 50 percent) of the cost of coverage, up from a current 20 percent. That 30 percent figure represents a significant amount — $1,620 of the average cost of coverage in the U.S., according to the report.
And unlike Germany, wellness incentives in the U.S. can act as both a carrot and stick, as seen in an incentive program already put in place by Cleveland Clinic, a pioneer in the wellness field. In the U.S., incentives can go toward reducing health insurance costs for wellness participants, but, importantly, they can also go toward penalizing those who don’t participate by charging them higher fees.
Therein lies the one major drawback with wellness programs identified by the researchers. People with low income or poor health are least likely to participate in wellness incentive programs, so such programs could end up making health coverage even more unaffordable for these people and further intensify income-based health disparities in America.
“Insofar as wellness programs prove to be effective in improving health outcomes, then the relatively low participation rates in such programs by lower-income groups and the chronically ill could have the opposite effect by exacerbating health disparities,” the researchers said.
The researchers recommend that the federal government require employers to provide data not only on the cost savings and productivity gains from their wellness programs, but also on their impact on the health of employees across different income groups, to help ensure that the Affordable Care Act actually makes care more affordable and accessible.