Carrot, Stick, or Prune Juice: Do Employee Wellness Programs Make Sense?

Department of Population Health Brings Together Diverse Panel to Debate Controversial Issue

Tuesday, February 23 2016

Employers are increasingly offering up wellness programs to incentivize their employees to practice healthy behaviors. Although many of these programs are motivating employees to go to the gym, quit smoking, and get regular checkups, they also raise questions about privacy, the nature of incentives, and whether such efforts even work. On Wednesday, February 3, NYU Langone's Department of Population Health brought together a panel with a wide variety of perspectives on wellness for "Carrot, Stick, or Prune Juice: Do Employee Wellness Programs Make Sense?"

Employee wellness programs can take many different forms. Some provide cash incentives to encourage employees to engage in healthy behaviors. At NYU Langone, staff get discounts on gym memberships and can earn up to $240 a year for meeting certain goals related to quitting smoking, exercising, and diabetes prevention. The Medical Center also offers free yoga and a "relaxation line" for people dealing with anxiety and stress.

MTA (Metropolitan Transit Authority) employees have mental health treatment and education programs available to them, because of the high risk of witnessing traumatic events like a passenger getting injured or killed, said Chris Lightbourne, director of member services at the Transport Workers Union, Local 100. The wellness program, which the MTA recently took over from an outside organization, has reduced the Transit Authority's health costs, according to Lightbourne.

A Radical Choice to Set an Example

Penn Medicine has taken a more controversial approach to wellness: not hiring people who use tobacco. Although he felt morally conflicted about the policy, David Asch, MD, MBA, professor and executive director of the Center for Health Care Innovation at the University of Pennsylvania, said that the organization took this action "in part because we wanted to be a beacon in the community and try to encourage Philadelphia to become smoke-free."

Moderator Arthur Caplan, PhD, director of the Division of Medical Ethics in Population Health, asked the panel whether employees should trust employers to manage their health. Gary Kalkut, MD, MPH, NYU Langone's senior vice president of network integration, responded that employers have to build trust by making privacy a top priority. "I don't think you can go out to your employees . . . without having belt-and-suspenders ways to isolate that information from employers." At NYU Langone, a small group of staff is solely dedicated to employee wellness issues, and they receive special confidentiality training, added Dr. Kalkut.

Driving the Right Changes in Behavior to Improve Health

Dr. Asch wondered whether wellness is the right approach to health challenges. "The concerns I have with wellness activities and employers that focus on wellness activities is that they're focused on things that are much less likely to move the needle." Efforts to get your workforce to quit smoking or reduce hypertension are more impactful than some wellness efforts, he said, adding that "there is no amount of kale—even if you add quinoa to it—that is going to get rid of your diabetes."

Yet Dr. Asch does believe employers should have a role in their employees' health, for the simple fact that people spend a lot more time at work than with their healthcare providers. "We shouldn't just leave it up to the healthcare system. Even if you have a chronic illness, you're spending maybe two hours a year in front of doctors and nurses, but you spend 5,000 waking hours doing everything else in your life," he said. "If you're an employer, why can't we harness some of those behavior change activities in the employment setting?"

Changing people's behavior is one of the toughest nuts to crack. From cash incentives to health apps, wellness programs have tried a variety of different strategies, and there's no clear evidence that any one approach is head and shoulders above the rest. Oral Roberts University, in Tulsa, Oklahoma, even made it mandatory for students to use Fitbits, a policy that has been criticized as authoritarian and coercive.

There's an App for That, But Does it Work?

Technology is being harnessed to influence behavior change, particularly Fitbits and health applications on smartphones. Strategies that rely on technology include the "know your numbers" approach, the "champion" approach that uses positive psychology, and a weaning approach that tries to help people gradually reduce and let go of bad habits.

Natasha Schull, PhD, associate professor of media, culture, and communications at NYU Steinhardt School of Culture, Education, and Human Development, said that while it may feel harmless to throw a "haphazard smorgasbord of incentive structures" at people, "It just seems to me that we're moving so fast without really knowing what we're doing." Rather than focus solely on changing behavior, she suggested, employers should also change what she called "the choice architecture," using "stealth wellness"—for example, offering free water and expensive soda in a vending machine.

NYU Langone’s Reach for Wellness program encourages physical activity with walking and running clubs and through participation in events like the Chase Corporate Challenge. Pictured above, Department of Population Health staff members in the 2015 race.

While NYU Langone's wellness incentive program, called My Wellness Rewards, has been successful for those who participate, the challenge is getting people to enroll, said Dr. Kalkut. The organization is looking to increase participation rates for eligible staff. "The question is, are these the programs that we need? Are there other programs that would be more attractive to our employees?" Dr. Kalkut asked. He also wants to encourage the use of primary care as a wellness value.

Hitting one of the more optimistic notes of the event, Lightbourne said he had seen middle-aged adults change their habits as a result of having a comprehensive wellness program. "If vice is habitual," he concluded, "wellness can be habitual as well."

You can read more about the panel discussion in Crain's New York, and watch the full video on NYU Langone's YouTube channel.

--by Elaine Meyer