Over the last several decades, an epidemic of “lifestyle diseases” has been developing in the United States (Pollard, 2008). The Centers for Disease Control and Prevention (CDC) identified four behaviors—inactivity, poor nutrition, tobacco use, and frequent alcohol consumption—as primary causes of chronic disease in the United States, resulting in increasing prevalence of diabetes, heart disease, and chronic pulmonary conditions (Centers for Disease Control and Prevention, 2010). These chronic conditions have become a major burden in the United States, as they lead to decreased quality of life (Healthy People 2020, 2011) and premature death and disability (Centers for Disease...

We conducted a review of the scientific and trade literature and analyses of survey findings on the characteristics and prevalence of workplace wellness programs. The scientific literature was used primarily to collect evidence on the impact of these programs on health-related behaviors, health outcomes, and cost savings. Before conducting the search, we consulted with experts in government and academia and with representatives of employers, employer organizations, benefits consultancies, and program vendors. A detailed description of the literature review and a full account of our findings have been published in a separate report and a journal article (Mattke, Schnyer and Van...

Chapter 3 examines current program uptake among employers and the composition of currently deployed workplace wellness programs. Using findings from the RAND Employer Survey and our case studies, we describe the availability of worksite wellness benefits, such as wellness screening activities like HRAs or onsite clinical screenings and interventions designed to promote health-related behaviors (lifestyle management) and manage manifest disease (disease management).

The RAND Employer Survey data suggest that nationally, about half (51 percent) of all employers with 50 or more employees offer a wellness program,¹⁴ ranging between 44 percent of heavy industry employers and 66 percent of government employers,...

In Chapter 4, we review the uptake rates of various workplace wellness program components among eligible employees. We then assess evidence of the impacts of workplace wellness programs on health-related behaviors, such as smoking and exercise, and outcomes, such as body weight and blood pressure, as well as the effects on medical costs and health care use. Evidence is drawn from the RAND Employer Survey and CCA database and is supplemented with information from the case studies.

Results from the RAND Employer Survey suggest that about half of employees complete HRAs (46 percent) or participate in clinical screenings (46 percent),...

This chapter begins by summarizing the laws and regulations pertaining to the use of financial incentives for wellness programs. Evidence from the RAND Employer Survey and the CCA database and findings from case study employers are then used to describe the prevalence of incentives, common types of incentives such as cash rewards, novelty items and health care premium differentials, and their role in increasing participation rates or achieving better health outcomes.

Employers have a strong interest in the use of incentives to encourage participation in workplace wellness programs, because of low participation rates and evidence suggesting that incentives can encourage...

To better understand how workplace wellness programs are implemented in practice and how participating employees view such programs, we identified common themes across the five case study employers and the literature. This chapter describes approaches employers used for implementing program interventions and key factors that promote wellness program success.

Interventions under workplace wellness programs can be categorized into two groups, individual-level interventions, which target the specific health risks of individual workers, and public health strategies, which target the entire workforce collectively. Typically, employers use both types of interventions to achieve program goals.

For interventions at the individual level, employers typically...

Our project combined a literature review, a national survey of employers, case studies of workplace wellness programs, and statistical analyses of the CCA database to assess current use of workplace wellness programs in the United States, estimate the effect of programs on employee health and health care costs, and evaluate the role of incentives for program engagement. We find that wellness programs have become a common workplace benefit and that employers remain optimistic about their impact. Well-executed programs appear to improve employee health meaningfully, whereas significant reductions in health care cost may take time to materialize. As employee engagement in...