Randy Boss: A Response to the RAND report

Congress mandated analysis of wellness programs as part of the Affordable Care Act and the results were released a few days ago by the U.S. Department of Labor and the Department of Health and Human Services. Some headlines read ‘Workplace Wellness’ fails bottom line. Those who do not support wellness efforts said I told you so. Then why are many Employers reporting positive results from their wellness efforts? Could it be that all wellness is not created equal?

As I read the RAND report I couldn’t help but notice the low participation in HRA’s and then the improvements for wellness program participants. It’s been my experience that many wellness programs fail because of poor execution in getting employees to complete HRA’s and then engaging employees in health improvement which seems to be the case here. This is what was in the RAND report: “Fewer than half of employees (46 percent) undergo clinical screening and/or complete an HRA. In an analysis of the CCA database, when comparing wellness program participants to statistically matched nonparticipants, we find statistically significant and clinically meaningful improvements in exercise frequency, smoking behavior, and weight control, but not cholesterol control.”

If you are not getting results “downstream” look at how you can improve your process “upstream.”  It’s been my experience that a superior process yields superior results. That’s why we use a Benefits Risk Management Process that has 5 steps. They are:

1. Identify Risk – you need at least 90% participation to have credible data for the next step. Most wellness programs fail here.
2. Analyze Data – with the 90% participation in step 1 we have credible “population data” vs. “sample data. You cannot effectively address the next step with sample data.
3. Control Risk – this step is critical because with out “behavior change” you will not be successful in the next step. Just helping employees not get worse is a win here.
4. Finance Risk – this step is where an employer and their employees get rewarded if the first 3 steps are executed effectively. It is critical that the proper insurance plan design is chosen. If not guess who keeps the savings? You’re right…the insurance company.
5. Measure – this is where we evaluate our process, results, make adjustments and start again with step 1.

We have been using this process with our clients since 2005 with phenomenal results. Employers we work with enjoy “total value of health” beyond lower medical and prescription cost like increased productivity through lower absenteeism, fewer disabilities, fewer and less severe work comp claims, lower presenteeism (that’s when someone comes to work sick).

One thing the RAND report did not point out is the huge incentive the Affordable Care Act allows employees that participate in wellness programs. Starting in 2014 is allows a 30% difference in employee contribution between those that participate and those that do not. Employers we work with are very interested in taking advantage, as it’s the only thing in the Affordable Care Act that is actually affordable.

We have been training agents the past 2 years this Benefits Risk Management process and become Certified Benefits and Wellness Advisors. These agents are reporting similar results getting over 90% participation in Health Risk Assessments without pay employees to take them.