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Effects of a Workplace Wellness Program on Employee Health, Health Beliefs, and Medical UseA Randomized Clinical Trial

Educational Objective
To evaluate the effects of a comprehensive workplace wellness program on employee health, health beliefs, and medical use after 12 and 24 months.
1 Credit CME
Key Points

Question  How does a comprehensive workplace wellness program affect health, health beliefs, and medical use among university employees after 24 months?

Findings  In a 2-year randomized clinical trial of 4834 employees at a large US university, employees invited to join a wellness program showed no significant differences in biometrics, medical diagnoses, or medical use relative to the control group. The intervention increased self-reports of having a primary care physician and improved a set of employee health beliefs among the treatment group.

Meaning  The workplace wellness changed health beliefs and increased self-reports of having a primary care physician but did not significantly affect clinical outcomes.

Abstract

Importance  Many employers use workplace wellness programs to improve employee health and reduce medical costs, but randomized evaluations of their efficacy are rare.

Objective  To evaluate the effect of a comprehensive workplace wellness program on employee health, health beliefs, and medical use after 12 and 24 months.

Design, Setting, and Participants  This randomized clinical trial of 4834 employees of the University of Illinois at Urbana-Champaign was conducted from August 9, 2016, to April 26, 2018. Members of the treatment group (n = 3300) received incentives to participate in the workplace wellness program. Members of the control group (n = 1534) did not participate in the wellness program. Statistical analysis was performed on April 9, 2020.

Interventions  The 2-year workplace wellness program included financial incentives and paid time off for annual on-site biometric screenings, annual health risk assessments, and ongoing wellness activities (eg, physical activity, smoking cessation, and disease management).

Main Outcomes and Measures  Measures taken at 12 and 24 months included clinician-collected biometrics (16 outcomes), administrative claims related to medical diagnoses (diabetes, hypertension, and hyperlipidemia) and medical use (office visits, inpatient visits, and emergency department visits), and self-reported health behaviors and health beliefs (14 outcomes).

Results  Among the 4834 participants (2770 women; mean [SD] age, 43.9 [11.3] years), no significant effects of the program on biometrics, medical diagnoses, or medical use were seen after 12 or 24 months. A significantly higher proportion of employees in the treatment group than in the control group reported having a primary care physician after 24 months (1106 of 1200 [92.2%] vs 477 of 554 [86.1%]; adjusted P = .002). The intervention significantly improved a set of employee health beliefs on average: participant beliefs about their chance of having a body mass index greater than 30, high cholesterol, high blood pressure, and impaired glucose level jointly decreased by 0.07 SDs (95% CI, −0.12 to −0.01 SDs; P = .02); however, effects on individual belief measures were not significant.

Conclusions and Relevance  This randomized clinical trial showed that a comprehensive workplace wellness program had no significant effects on measured physical health outcomes, rates of medical diagnoses, or the use of health care services after 24 months, but it increased the proportion of employees reporting that they have a primary care physician and improved employee beliefs about their own health.

Trial Registration  American Economic Association Randomized Controlled Trial Registry number: AEARCTR-0001368

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Article Information

Accepted for Publication: March 23, 2020.

Corresponding Author: David Molitor, PhD, Gies College of Business, University of Illinois at Urbana-Champaign, 31206 S Sixth St, 40 Wohlers Hall, Champaign, IL 61820 (dmolitor@illinois.edu).

Published Online: May 26, 2020. doi:10.1001/jamainternmed.2020.1321

Author Contributions: Drs Reif and Molitor had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Reif, Jones, Payne, Molitor.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Reif, Jones, Molitor.

Obtained funding: Reif, Jones, Payne, Molitor.

Administrative, technical, or material support: All authors.

Supervision: Reif, Jones, Molitor.

Conflict of Interest Disclosures: Drs Reif, Jones, Payne, and Molitor reported receiving grants from the National Institutes of Health, the Abdul Latif Jameel Poverty Action Lab (J-PAL) North America US Health Care Delivery Initiative, the National Science Foundation, the Robert Wood Johnson Foundation, and the W. E. Upjohn Institute for Employment Research during the conduct of the study. No other disclosures were reported.

Funding/Support: This research was supported by award R01AG050701 from the National Institute on Aging of the National Institutes of Health; grant 1730546 from the National Science Foundation; the J-PAL North America US Health Care Delivery Initiative; Evidence for Action (E4A), a program of the Robert Wood Johnson Foundation; and the W. E. Upjohn Institute for Employment Research. Illinois Human Resources provided in-kind logistical support for developing the program.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 4.

Additional Contributions: Lauren Geary, MPH, University of Illinois at Urbana-Champaign, provided project management; she was compensated for her contribution. Michele Guerra, MS, Certificate of Advanced Study, University of Illinois at Urbana-Champaign, provided input into the design of the wellness program and the selection of wellness activities; she was not compensated for her contribution. Illinois Human Resources provided institutional support without financial compensation. Marian Huhman, PhD, University of Illinois at Urbana-Champaign, Mark Stehr, PhD, Drexel University, David Studdert, LLB, ScD, MPH, Stanford University, and seminar participants at the American Society of Health Economists provided comments on this article; they were not compensated for their contributions.

References
1.
Claxton  G , Rae  M , Damico  A , Young  G , McDermott  D , Whitmore  H . The Kaiser Family Foundation employer health benefits 2019 annual survey. Accessed October 14, 2019. http://files.kff.org/attachment/Report-Employer-Health-Benefits-Annual-Survey-2019
2.
Jones  D , Molitor  D , Reif  J .  What do workplace wellness programs do? evidence from the Illinois Workplace Wellness Study.   Q J Econ. 2019;134(4):1747-1791. doi:10.1093/qje/qjz023 PubMedGoogle ScholarCrossref
3.
Volpp  KG , John  LK , Troxel  AB , Norton  L , Fassbender  J , Loewenstein  G .  Financial incentive-based approaches for weight loss: a randomized trial.   JAMA. 2008;300(22):2631-2637. doi:10.1001/jama.2008.804 PubMedGoogle ScholarCrossref
4.
Charness  G , Gneezy  U .  Incentives to exercise.   Econometrica. 2009;77(3):909-931. doi:10.3982/ECTA7416 Google ScholarCrossref
5.
Haisley  E , Volpp  KG , Pellathy  T , Loewenstein  G .  The impact of alternative incentive schemes on completion of health risk assessments.   Am J Health Promot. 2012;26(3):184-188. doi:10.4278/ajhp.100729-ARB-257 PubMedGoogle ScholarCrossref
6.
Royer  H , Stehr  M , Sydnor  J .  Incentives, commitments, and habit formation in exercise: evidence from a field experiment with workers at a Fortune-500 company.   Am Econ J Appl Econ. 2015;7(3):51-84. doi:10.1257/app.20130327 Google ScholarCrossref
7.
Meenan  RT , Vogt  TM , Williams  AE , Stevens  VJ , Albright  CL , Nigg  C .  Economic evaluation of a worksite obesity prevention and intervention trial among hotel workers in Hawaii.   J Occup Environ Med. 2010;52(suppl 1):S8-S13. doi:10.1097/JOM.0b013e3181c81af9 PubMedGoogle ScholarCrossref
8.
Handel  B , Kolstad  J .  Wearable technologies and health behaviors: new data and new methods to understand population health.   Am Econ Rev. 2017;107(5):481-485. doi:10.1257/aer.p20171085 PubMedGoogle ScholarCrossref
9.
Baicker  K , Cutler  D , Song  Z .  Workplace wellness programs can generate savings.   Health Aff (Millwood). 2010;29(2):304-311. doi:10.1377/hlthaff.2009.0626 PubMedGoogle ScholarCrossref
10.
Baxter  S , Sanderson  K , Venn  AJ , Blizzard  CL , Palmer  AJ .  The relationship between return on investment and quality of study methodology in workplace health promotion programs.   Am J Health Promot. 2014;28(6):347-363. doi:10.4278/ajhp.130731-LIT-395 PubMedGoogle ScholarCrossref
11.
Song  Z , Baicker  K .  Effect of a workplace wellness program on employee health and economic outcomes: a randomized clinical trial.   JAMA. 2019;321(15):1491-1501. doi:10.1001/jama.2019.3307 PubMedGoogle ScholarCrossref
12.
Rosenstock  IM , Strecher  VJ , Becker  MH .  Social learning theory and the health belief model.   Health Educ Q. 1988;15(2):175-183. doi:10.1177/109019818801500203 PubMedGoogle ScholarCrossref
13.
Bandura  A .  Health promotion by social cognitive means.   Health Educ Behav. 2004;31(2):143-164. doi:10.1177/1090198104263660 PubMedGoogle ScholarCrossref
14.
Claxton  G , Rae  M , Long  M , Damico  A , Sawyer  B . 2016 Employer health benefits survey. Accessed July 3, 2017. https://www.kff.org/health-costs/report/2016-employer-health-benefits-survey/
15.
Manski  CF .  Measuring expectations.   Econometrica. 2004;72(5):1329-1376. doi:10.1111/j.1468-0262.2004.00537.x Google ScholarCrossref
16.
Hendren  N .  Private information and insurance rejections.   Econometrica. 2013;81(5):1713-1762. doi:10.3982/ECTA10931 PubMedGoogle ScholarCrossref
17.
Ioannidis  JP , Stanley  TD , Doucouliagos  H .  The Power of Bias in Economics Research. Oxford University Press; 2017. doi:10.1111/ecoj.12461
18.
Gerber  A , Green  D .  Field Experiments: Design, Analysis, and Interpretation. W. W. Norton; 2012.
19.
Stata Statistical Software. Release 16 [computer program]. StataCorp LLC; 2019.
20.
Baicker  K , Taubman  SL , Allen  HL ,  et al; Oregon Health Study Group.  The Oregon experiment—effects of Medicaid on clinical outcomes.   N Engl J Med. 2013;368(18):1713-1722. doi:10.1056/NEJMsa1212321 PubMedGoogle ScholarCrossref
21.
Angrist  JD , Imbens  GW , Rubin  DB .  Identification of causal effects using instrumental variables.   J Am Stat Assoc. 1996;91(434):444-455. doi:10.1080/01621459.1996.10476902 Google ScholarCrossref
22.
Finkelstein  A , Taubman  S , Wright  B ,  et al; Oregon Health Study Group.  The Oregon health insurance experiment: evidence from the first year.   Q J Econ. 2012;127(3):1057-1106. doi:10.1093/qje/qjs020 PubMedGoogle ScholarCrossref
23.
Westfall  PH , Young  SS .  Resampling-Based Multiple Testing: Examples and Methods for P Value Adjustment. Vol 279. John Wiley & Sons; 1993.
24.
Abraham  JM .  Employer wellness programs—a work in progress.   JAMA. 2019;321(15):1462-1463. doi:10.1001/jama.2019.3376 PubMedGoogle ScholarCrossref
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