Can an employee wellness program impact healthcare utilization?
- A study by Providence CORE drew on ten years of data to assess the impacts of a large employee wellness program.
- The research revealed positive impacts on healthcare utilization, including a 2% increase in primary care visits and a 5% decrease in emergency department visits for every year of enrollment.
- Participants also highlighted opportunities for more targeted programming to fit specific health needs and culturally relevant programs for BIPOC employees.
Employee wellness programs are a popular approach for employers seeking to support employee health and productivity while addressing the rising costs of employer-provided healthcare. But do these programs work? New research from the Providence Center for Outcomes Research & Education (CORE) draws on nearly ten years of data to provide an in-depth look at the impacts of one such program. The research identified several ways that wellness programs can positively impact healthcare utilization while highlighting opportunities for improvement and equitable practices.
Evaluating Oregon’s Health Engagement Model
The Health Engagement Model (HEM) is a wellness initiative offered to employees of the State of Oregon. The program aims to help employees achieve better health and reduce health risks through financial incentives, tools, and social support. Since 2012, thousands of state employees have opted into HEM and an optional subprogram called Healthy Team Healthy U (HTHU). In 2021, the state partnered with CORE to evaluate the HEM’s impacts, focusing on areas including health and healthcare utilization.
Key findings: Positive impacts on utilization with notable differences for some groups
To examine changes in healthcare utilization over time, CORE looked at data from 12,684 health plan members enrolled in both HEM and non-HEM health plans between 2011 and 2020.
Overall, we found that for every year of HEM enrollment, there was a:
- 2% increase in the number of primary care visits
- 4% increase in the number of specialty care visits
- 5% decrease in the number of emergency department (ED) visits
- 2% decrease in the number of inpatient hospitalizations
The research also found notable differences for several subgroups:
- Members with high medical complexity saw the greatest decrease in ED usage, with a 17% decrease in ED visits for every year of HEM enrollment.
- While those aged 50 and older saw no effect on mental health utilization, those less than 50 years of age had 6% more outpatient mental health visits for every year of HEM enrollment.
- While those without any chronic conditions saw no effect on inpatient utilization, those with 1+ chronic conditions had 3% fewer admissions for every year of HEM enrollment.
According to Monique Gill, PhD, MPH, a research scientist at CORE, “When we looked at the HEM data over time, the reduction in the amount of ED and inpatient care was particularly encouraging, suggesting that employees may have avoided unnecessary ED visits by engaging in preventive or chronic care. This assumption is supported by the increased likelihood of primary and specialty care that we also observed.”
In addition, CORE found a decrease in inpatient care for those with high medical complexity, one or more chronic conditions, and aged 50 and older, further supporting that avoidable hospitalizations may be prevented to some extent through additional years of HEM participation.
The evaluation revealed mixed results when the researchers zeroed in on the HTHU program, an optional subprogram within the HEM. Participants expressed high satisfaction with HTHU and said it motivated them to improve their health. However, CORE’s findings on healthcare utilization impacts were inconclusive and showed few direct effects on self-reported health and health behaviors. These findings may be the result of the more medically complex population that chose to enroll in HTHU vs. other health actions to satisfy the requirements of the HEM plan.
Opportunities for more equitable and inclusive wellness programs
The research also revealed opportunities for improvement, especially around offering more equitable and targeted programming to fit individual health needs. Program offerings may be more widely used and have a greater impact by considering accessibility needs such as vision or hearing issues. BIPOC employees, in particular, felt that programs could be more culturally relevant.
Moreover, participants in HTHU were significantly more medically complex than non-participants. They reported poorer physical health, suggesting that members may be self-selecting into programs like HTHU based on specific health needs. Together, these findings underscore the importance of considering unique health needs, goals, and preferences in the programs employers offer for employees.
- Read the evaluation report: PEBB Wellness Programs: HEM & Healthy Team Healthy U
- Blog post: CORE launches study on employee wellness