While a recently proposed rule from the Equal Employment Opportunity Commission aims to clarify how the Americans with Disabilities Act applies to wellness programs that are part of a group health plan — potentially easing fears employers may have about their wellness programs running afoul of the EEOC — many organizations are already re-examining their wellness strategies and even re-defining what they consider to be wellness initiatives.

Traditional wellness programs focused on biometric screenings, health risk assessments and other efforts related to physical health remain popular, but are slowly giving way to more nontraditional wellness benefits such as paid time-off, parenting classes, leadership training and communication and community volunteer projects.

This broadening definition of wellness is reflected in recent research from the International Foundation of Employee Benefits Plans, which surveyed employers about what benefits they consider to fall under the wellness umbrella. Sixty-six percent cited vacation as the top nontraditional wellness initiative, followed by mental health coverage (63%), tuition reimbursement (63%) and community charity drives (57%).

Also see: Scope of wellness programs growing

“Employers are beginning to look at more than just physical wellness when they talk about wellness,” says Julie Stich, director of research with the IFEBP. “They’re starting to take a more holistic view and looking at employee well-being.”

This move from ‘wellness’ to ‘well-being’ is even reflected in the job title of Kim Kent, well-being coordinator at Team Horner, a swimming pool and spa distributor based in Florida. The company has about 430 employees and offers a wide variety of well-being benefits, including parenting classes, onsite coaching, free fruit, stress management classes taught by psychologists, onsite massage, stand-up desks, cooking classes, hula hooping fitness classes and “Take 5” rooms for employees who need a quiet space to recharge. Sales staff who spend a lot of time traveling are even offered coolers that plug in to their cars so they can take healthy snacks and water with them on the road. And while the company offers biometric screenings and a health risk assessment (with discounts on health insurance premiums), these are not the focus of the program.

Also see: States with the highest well-being

The basis of Team Horner’s wellness program, Color Me Healthy, is the True Colors personality workshop, which essentially teaches employees to communicate with people who aren’t like them. It’s a program that’s offered to all new employees and current employees are given refresher courses on a regular basis. When the program was first introduced three years ago, participants were asked to come up with a list of wellness initiatives that would appeal to all types of personalities on the True Colors spectrum. Employees created their own Color Me Healthy teams, and then they implemented the programs and activities they wanted to do.

“It’s not top-down. The leadership and the managers are not telling us what to do with these programs. They don’t micromanage everything; in fact, they don’t even approve everything,” says Kent, adding the company does survey employees every year to better understand what’s working and what’s not.

In fact, company leadership doesn’t even put a budget on its wellness programming, instead trusting employees not to abuse the system. “It’s the most responsible group of people because we’re very careful about how we spend the company’s money,” says Kent. “We know that if we abuse it, that privilege will be taken away.”

Also see: Engagement levels tied to benefits understanding

Holistic well-being programs like the one at Team Horner, which was recognized with a Psychologically Healthy Workplace Award this year by the American Psychological  Association, are also indicative of a growing understanding among employers that wellness programs must take into account the broader context of employees’ lives, including the culture in which they work.

“Workplace culture not only makes or breaks the wellness activities, it also has a huge effect on employees’ perceptions of what it’s like being at work,” says Dr. David Ballard, head of the APA’s Center for Organizational Excellence and Psychologically Healthy Workplace awards program. In other words, wellness slapped over a bad culture won’t do a thing to improve the health of employees.

“Wellness can’t be sustained without a culture,” agrees Stephanie Downs, wellness coordinator at Iowa State University, which has 6,700 employees. The organization doesn’t have a traditional wellness program and is instead focusing, at least for now, on the workplace culture.

Also see: 8 signs your workplace culture needs a reboot

“For us, right now, because it’s a new program in its infancy, that means continuing to partner and collaborate with leadership development, with our EAP, with the supervisory areas and what they’re doing,” she says. “Right now we just don’t have the basic infrastructure tools to support employees, but we are building those too.”

Downs believes the role of employers in wellness is to support employees in becoming good health care consumers. “How can we educate and support our employees to establish that relationship with their physician, to understand their benefit plan so they’re getting the right care by the right provider at the right time? How can we make sure they’re aware of the resources and tools so they can find out financially what’s happening with their benefit plan?” she says. “How can we support their relationship with their pharmacist? To me, that is more the role of the employer, rather than policing the [HRA] numbers.”

Tom Walker, CEO and chief culture officer with Tasty Catering, a Chicago-based catering and events planning company, goes so far as to say HRAs are unnecessary if a company’s culture is strong. And one key component of a good workplace culture, he believes, is psychological health.

“We focus on the psychological well-being first, believing the physical well-being will be a natural consequence of that,” he says.

Also see: Toxic culture overrides wellness efforts

And while Tasty Catering does offer its 49 full-time and 150 seasonal and part-time employees more traditional wellness benefits such as healthy food options, the company is much more focused on nontraditional wellness offerings such as leadership training, flexible work arrangements and paid time-off.

Tasty Catering also offers low-interest rate loans to full-time workers in need of financial help. Loans are repaid through payroll deduction in amounts that are manageable for the employee. The company also provides full-time employees with at least 16 hours per year of paid time to attend a variety of leadership training courses, where topics such as emotional intelligence and ethical behavior are addressed.

Also see: 3 tell-tale signs of an off-target wellness program

Indeed, some wellness industry practitioners say employers who are focused exclusively on using wellness as a way to reduce health care costs — and using incentives and health risk assessments and biometric screenings to do so — are focusing on the wrong issue.

“The bigger issue is the whole concept of punishing people if they don’t participate in a wellness program. [That] is just really an abomination,” says Dr. Jon Robison, founding partner, Salveo Partners LLC, who has been highly critical of studies showing positive ROI for wellness programs.

The Senate and House of Representatives have introduced identical bills (S. 620 and H.R. 1189) to reaffirm laws already in existence that allow for employee wellness programs tied to a financial reward. How these bills will be affected by the EEOC proposed rule remains to be seen, says Tami Simon, managing director for Buck Consultants at Xerox.

Also see: EEOC wellness rule eases employer fears

“If the EEOC is pretty quick to turn around a final version [of the proposed rule] after the public comment period closes, we’ll have to see what the final rule says, then the House and Senate will have to decide if a bill is still needed,” she says.

The proposed rule is a step in the right direction, she says, and the EEOC “appears to understand the need for consistency among the different laws that apply many of the rules that come from HIPAA and the Affordable Care Act. … At the end of the day, though, the question is how is that application going to actually work itself out?”

Approximately half of U.S. employers with 50 or more workers offer wellness promotion activities, and larger employers are more likely to have more complex wellness programs, according to a report conducted by RAND Health on behalf of the Departments of Labor and Health and Human Services.

Poor plan design

Much of the recent emphasis from the EEOC, which has sued at least three employers in the past year over their wellness programs, stems from poor plan design, says Joe Ellis, senior vice president at CBIZ Benefits & Insurance Services. “We have never had an individual at any one of our employers have a negative comment about our wellness programs based on being penalized for something or being discriminated against in any way,” he says.

But even so-called voluntary programs can be problematic, believes Robison. One of the main concerns he has with traditional wellness programs is that they affect employees differentially — higher paid executives can afford higher premiums if they choose not to participate, whereas a lower paid employee might not be able to, and thus feel forced to participate in the program even if it’s deemed voluntary.

“These programs more greatly affect the people who can least afford them, physically and financially,” he says. “If you’re a tenured faculty member and have to pay an extra $1,200 a year because you don’t participate in the wellness program, that’s probably not a big deal. But if you’re one of the secretaries or maintenance people, that’s a huge deal.”

Robison is quick to point out he’s not anti-wellness; he’s against the wellness-or-else mentality he sees dominating the industry. 

“Broccoli in the cafeteria and pedometers are fine, but that’s not what determines whether or not a company has a successful, healthy kind of culture,” he says. “You can’t have a successful, sustainable wellness program in a toxic culture. You can’t do any sustainable change in a toxic culture. That’s my biggest beef with wellness-or-else — the real problem in this country is employee engagement, not participation.”

Giving employees autonomy to think for, and do for, themselves will have a far greater effect on engagement than any kind of pedometer challenge, believes Robison. “What distinguishes a great company from a good or not-so-good company is culture,” he says.

Vik Khanna, a consultant and co-author of the book Surviving Workplace Wellness, is a vociferous critic of the wellness industry. And while he doesn’t see big companies dumping their wellness programs yet, he does sense a “creeping skepticism about whether this stuff actually works.”

Also see: Why paying employees to be healthy doesn’t work

“When you’re giving people value, they’re willing to pay for it,” says Khanna. “That’s why Apple sells phones in the volume that it does. … if people wanted what wellness had to offer, they wouldn’t need to be paid to do it.”

Incentives rising

But employers’ use of wellness incentives shows no signs of slowing down. Employers will spend an average of $693 per employee on wellness-based incentives in 2015, up from $594 in 2014 and $430 five years ago, according to a survey released from Fidelity Investments and the National Business Group on Health.

Of the 79% of employers who offer health improvement programs, larger companies (those with more than 20,000 employees) are spending the most on these programs, where the per-employee average climbed to $878, up from $717 in 2014. The average for companies with between 5,000 and 20,000 workers rose to $661, up from $493 in 2014.

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