Not all wellness programs are created equally

By Lianne Jacobs

A study at the University of Illinois found that wellness programs—even those with incentives—don’t significantly change employees’ behaviors.  However, many workplace wellness programs are ineffective due to poor design and lack of meaningful evaluation. The behavioral and clinical science techniques shown to be effective in altering behavior and improving health are not always reflected in the development of wellness programs.  When program design does not rely on evidence-based best practices, one should not expect to see favorable outcomes.

The recent study published by the National Bureau of Economic Research garnered significant media attention for its demonstrative conclusion that workplace wellness programs don’t work.  However, several limitations of this workplace wellness program exist, which would make it difficult to have shown significant value in the limited 12-month follow-up period, especially when examining impact on medical cost savings.

Employee engagement is the foundation of any successful wellness program.  According to the study, only slightly more than half of eligible employees participated.  Low engagement may have been due to an inherent barrier to participation in the program design – many wellness activities were in-person 6- or 12-week classes on health topics and employees had to take paid time off to attend them.  However, the authors acknowledged that even a marginal improvement in participation rates could lead to material medical savings.  They stated that “all else equal, reducing the share of non-participating employees by just 4.5 percentage points would lower total medical spending in our setting by an amount sufficient to pay for our entire wellness program.”

Another critical element to a program’s success is the use of technology and mobile devices to engage members, verify activities and track progress.  This study used self-reported online surveys and campus gym records to analyze employees’ activities, which likely did not capture total physical activity levels.  In fact, they found that participants only attended the campus gym about 6 times per year.  One could not have expected that a handful of gym visits is reflective of a well-run wellness program.  This study would have benefited from using fitness trackers to gain a more comprehensive view of verified activity levels.

Financial incentives can also play a big role in workplace wellness program participation.  This study offered monetary rewards for completing a biometric screening, a health risk assessment and participating in at least one wellness activity in the fall and spring.  Participants were informed at the program’s beginning what amount they would receive upon completing the program.  This financial incentive, tied only to the downstream completion of the program, likely did little to incentivize ongoing participation.

This study concludes that wellness programs do not reduce employers’ medical costs.  However, this result is not surprising given the relatively small sample size, short follow-up time, poor use of incentives, and the study’s wellness activities, such as classes on tai chi, healthy workplace habits, and financial wellness, and the program’s provision of a tobacco cessation hotline.  The design of this wellness program was not set up to lead to any meaningful behavior change, let alone lead to medical cost savings.

The study did find that employees who participated in the program were more likely to be screened for various health issues, and they felt their employers placed high value on employee health and well-being.  These are critical factors of a successful wellness program, and these positive findings should not be overlooked.

Another study, published in the Journal of Occupational Medicine, also examined the efficacy of workplace health programs, concluding that “employers seeking a program that works are urged to consider their goals and have a culture that can facilitate success. Employers who choose to adopt a health promotion program should use best practices to maximize the likelihood of achieving positive results.”

We agree.

Vitality – recognized globally as a leader in improving health – uses the best consumer behavioral science, data, technology, and incentives that improve health. Our clients routinely win healthiest employer awards, including a top 5 ranking this past year for Vitality client and partner Baylor College of Medicine.  With more than 150 patents, Vitality has driven and defined the way the world approaches health and wellness for decades.  We have pioneered using financial incentives to encourage healthy behavior, led the integration of wearable and mobile technologies into wellness programs, and created proprietary methodologies linking health plan contributions to participation in wellness.  Our program appeals to individuals across the risk spectrum, and we have found that high-risk individuals exhibit similar improvements in their physical activity profiles as those at lower risk.

Not all wellness programs are effective, but not all are created equally. With great pride, Vitality continues to passionately focus on pairing the right behavioral science strategies and actuarial dynamics with the right incentives and technology to continue helping our members achieve optimal health.


Lianne Jacobs, Product Analyst, has a Master’s in Public Health from Yale University.  She is the only indoor cycling instructor who can’t ride a bike.  She enjoys traveling the world, laughing at her own jokes, and tricking her husband into eating baked goods made with hidden vegetables.

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