In certain sectors of the economy, wellness programs are ubiquitous. In others, they remain exceedingly rare.
A new report displays the divide in terms of approach to wellness programs among employers. The likelihood of an employer offering a wellness program corresponds strongly with their location, their industry and, above all else, their size.
The largest employers are by far the most likely to offer wellness programs, according to the recently-released United Benefit Advisors Health Plan Survey, which included responses from 19,557 health plans and 11,524 employers.
Sixty percent of employers with more than 1,000 employees had wellness programs in 2016, compared to 51.1 percent of those with between 500 and 1,000 employees; 35.6 percent of those with 200-500 employees; 25 percent of those with 100-200 employees; 16.7 percent of those with 50-100 employees; 11 percent of those with 25-50 employees; and only 6.1 percent of those with fewer than 25 employees.
Overall, 18.4 percent of employers have wellness programs. It is not clear, however, what percentage of U.S. employees work for an employer that offers a program.
Small employers that do offer such programs usually do it through their insurance carriers (90 percent), while employers with more than 500 workers tend to turn to contract with separate wellness vendors (63 percent) to operate the program.
There are also sharp regional disparities. While a quarter of employers in the Northeast have wellness programs in place, only 10.4 percent of employers in the Central U.S. do.
Wellness programs are most common among employers in the public sector, utilities and education (31 percent). They are least common in agriculture, mining, transportation and construction (13.2 percent).
The design of programs has continued to evolve in response to regulatory changes and changing attitudes.
Health risk assessments remain the most common part of wellness programs. Three-quarters of all employers include HRAs in their programs, compared to 42.4 percent that offer seminars and workshops, 67.5 percent that include blood tests or physical exams, 50 percent that offer coaching and just under 50 percent that offer a web portal of wellness resources.
The survey showed two-thirds of employers offer some type of financial incentive as part of the wellness program — such as lower premiums, contributions to 401(k)s, vacation, discounts at health clubs or gift certificates — up from below 60 percent four years ago.
A plurality of employers (45 percent) favor cash incentives that go towards an employee’s premiums, flexible spending account or 401(k) over gym membership discounts and the like (40 percent). The cash incentives are even more predominant among large employers, with 63 percent of employers with more than 500 workers favoring that approach.
The future of wellness programs remains in flux. While the Obama administration at times appeared conflicted on whether employers should be able to tie major monetary incentives to wellness program participation, presumably the Trump administration will take a more laissez-faire approach. Lawsuits, however, will likely continue.