There are few signs that American employers have given up on the wellness trend, hoping that workplace-sponsored health and fitness-positive measures will not only produce happier and healthier employees, but also strategically reduce or maintain health care expenditures.

The wellness climate has changed in the last year, however, with a flurry of lawsuits questioning the legality of financial incentives (or penalties) for employees who take part — or fail to meet standards set out in corporate wellness offerings. And benefits decision-makers at companies of all sizes continue to struggle with the notion of financially justifying their wellness dollars, as wellness ROI is still exceptionally elusive, save for hard reductions in insurance premiums.

EBN’s most recent wellness survey, completed in early April, drew responses from 247 benefits decision-makers — 13% of whom were directly responsible for calling the shots on wellness efforts, and the rest involved in the administration and management of wellness plans at their companies. Some 35% work with employee groups between 100 and 1,000, but at least 10% of respondents handle wellness efforts at companies of more than 20,000 employees. And they span the range of business in the U.S. — almost 20% in manufacturing and industry, 12% in health care and everything in between, from banking and education to non-profits and government entities.

Also see: How corporate wellness programs can hurt your health

It’s a wide but representative group with some real hands-on experiences in the challenges and rewards of wellness undertakings — 57% currently have a wellness program, and another 31% are either thinking of or are on their way to implementing a wellness strategy. As a result, they’re well-versed in what works, and also what wellness -related, cost-saving measures might better be avoided among those companies still on the fence about wellness’ overall positives.

“It’s unclear to me that [wellness-driven] consumer-driven health plans and other types of high-deductible health plans sustain better engagement, ownership and improvement in the health status of their enrolled members,” noted one respondent. “It’s simply a mechanism for shifting costs from the employer to the employee. What are the best-in-class employers doing to positively influence their employees’ engagement and sustainment of improved health outcomes?”

Others suggest that the most controversial notions of wellness incentives — both positive and negative, and largely centered on premiums paid by employees, or financial or other rewards offered for successful compliance and participation in wellness programs — do tend to create the most soul-searching when it comes to deciding how to go down the wellness path.

“Past employers have been more aggressive and used both the carrot and the stick approach … more participation in the carrot approach, and less with the stick approach,” notes Wendy Spira, HR benefits coordinator with PathGroup in Brentwood, Tennessee. “But those following the stick approach were generally more engaged. Wellness programs are like thick fog, I think. It’s right there in front of your face, but impossible to grasp.”

Also see: EEOC proposed wellness regs: What employers need to know

According to those survey participants who have maintained their wellness offerings, a series of consistent offerings have emerged. Some 80% of existing wellness programs feature biometric screenings or flu shots as core wellness features, followed by access to health risk assessments (77%). Other popular options include behavioral and lifestyle services and smoking cessation (both 64%), physical fitness classes (58%) and mental health and substance abuse treatment (56%).

Among those respondents who do not yet have a wellness plan in place, their rationale usually comes down to a lack of management support (20%), a lack of resources or information on best wellness practices (23%) — or, more simply, that wellness is just not a company priority right now (39%).

Many survey participants also have moved away from what they describe as failed attempts at wellness at their companies, citing costs and lack of management support (each 25%), administration hassles and growing concerns about employee privacy and anti-discrimination laws (each 13%).

Also see: Progressive companies take fresh look at what wellness really means

Scott Strauss, a Portland, Oregon-based benefits and wellness manager, has had experience in both the good and the less-successful in wellness undertakings. In a previous role with the City of Portland and its 8,000 employees, a well-organized and fully budgeted, dedicated wellness program saw a drop in overall health care cost increases from 15% per year to just 4%, three-and-a-half years into the wellness effort.

“We took a really vast and integrated approach, and it helped that we had a strong mandate from the city, including the support of the mayor,” Strauss says. “Portland’s already healthy stature helped us, but we still needed to get something in front of people, as one bureau demonstrated that many of its workers had pre-diabetes, and others suffered from absentee issues.”

By integrating more traditional efforts such as biometric screenings with walking and cycling groups and even a very popular healthy cooking seminar held at Portland’s Wednesday farmers’ market — or specialized programs such as pre-work stretching exercises for road and maintenance crews — participation levels were very strong and the drop in health care spend was a direct result.

Also see: Scope of wellness programs growing

On the other hand, Strauss spent time attempting to handle a wellness program instituted by a local automotive manufacturing company, and discovered that a short-lived wellness effort with little managerial buy-in and no long-term financial support produced predictably weak results.

“There was no support from the executives, and it just kinda went nowhere — nobody really knew what was going on, and we eventually fired our biometric screening vendor,” he says.

Strauss’ experiences are echoed in the wellness efforts made by other companies who have found that an overly authoritarian approach to guiding employees’ push to health invariably meets strong resistance, or total indifference.

Karen Patno, benefits coordinator with Burlington’s Housing Vermont, says that creating a more open-ended offering helped encourage a wider swath of employees to take part, and has led to deeper involvement in ongoing healthy lifestyles.

“My current organization stopped being the ‘police’ of what wellness is,” she says. “Wellness is something different to everyone and [we found that] letting people know what activities are available in the area for them to participate in seems to spread healthy living more than a formal program. We also gave everyone a flat amount of wellness money in January and asked them to use it for something that promoted their health — home treadmills, ski passes, bicycles, yoga classes. By not locking people into narrow criteria of what the money could be used for, each person chose what made them happy and feel better. Isn’t that what wellness is about?”

Also see: Toxic workplaces override wellness efforts

Rachel Jobin, HR manager with Carlsbad, California-based ViaSat Inc., says her company has been able to successfully utilize the biometric information drawn from her widely spread 3,300-employee base.

“It’s been really helpful — we’ve started to see trends in our cohort population, and we’ve been able to do lots of data mining with our broker, tracking risk and compliance with the program. At the same time, we are also getting very strong employee feedback on what we offer them. The employees love it and [wellness] comes up as the best-loved benefit at our company.”

HumanaVitality was one of the most cited vendors in EBN’s survey, with many respondents listing it as the first wellness provider that comes to mind. That’s not surprising given its rapid expansion. Launched in July 2011, the wellness program surpassed 3 million members in February.

“It’s amazing to see how the program has grown and evolved in just three quick years,” says HumanaVitality CEO Joe Woods. “We’re looking forward to the next million.”

Other top choices, in order of those names that came first to mind, include Aetna, Virgin and Virgin Pulse, United Healthcare, Cigna, Humana, Blue Cross Blue Shield, WebMD and Anthem.

Also see: Engagement levels tied to benefits understanding

In terms of rating a select group of vendors provided by EBN, respondents highlighted Online Health, Medical Mutual of Ohio, Blue Cross Blue Shield of Kansas City, HumanaVitality and WebMD Health Services as providing the best overall wellness services. 

Data generated via wellness programs can have a big impact, such as bringing chronic conditions to the attention of the employer, who can then help the afflicted employees, says Cathy Kenworthy, CEO of Interactive Health, a wellness provider located outside of Chicago.

“Employers that offer wellness programs can obtain important aggregated information on the increasing and high-cost employee segments, and the nature of these health risks, to enable action,” she says. Companies can “tailor preventive care programs, offer resources and incentives, and improve health plan design so that employees take steps to improve their health.”

Also see: A challenging path to wellness

Often times, wellness programs reveal health issues that employees weren’t aware of, Kenworthy says. “We find that more than half the time we are uncovering health risks that were previously unknown to the participant,” she says. “Why? Many health risks are silent, such as high cholesterol.”

Mike Nesper contributed to this report.

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