Health care exchanges and other issues related to the Affordable Care Act have garnered a great deal of attention. However, additional and less well-known ACA regulations went into effect on January 1. One of these impacts wellness programs, including the myriad initiatives employers have put in place to encourage employees to exercise, lose weight and otherwise improve their health to prevent illness, disability and its costs.

With these new regulations, worksite wellness programs are now part of a national public health strategy to address the increase in chronic diseases, which are predicted to cost the U.S. health care system an estimated $4.2 trillion annually by 2023.

Evidence suggests that worksite wellness programs are cost-beneficial, saving companies money in health care expenditures and producing a positive return on investment. Researchers have calculated an average return of $3.27 in medical costs for every dollar spent on worksite wellness programs.

There are essentially two types of wellness programs for employers to choose from: participatory wellness programs and health-contingent wellness programs.

Participatory wellness programs generally are available without regard to an individual's health status. Participants receive incentives for participation in wellness activities with no tie to health or wellness behavior improvements. These activities include programs that reimburse for the cost of membership in a fitness center; provide a reward to employees for attending a monthly, no-cost health education seminar; onsite fitness classes; and many other activities.

Health-contingent wellness programs generally require individuals to meet a specific standard related to their health (decreased body fat, weight loss, smoking cessation, lower cholesterol levels, etc.) to obtain a reward. The reward can be tied to employees’ insurance premiums and employers’ contributions to Health Savings Accounts. Regulations in the ACA keep the program non-discriminatory.

An interesting trend with both types of wellness programs is the effort underway to integrate them with Employee Assistance Programs and other employer initiatives with a health component. This makes sense because common mental health issues like depression manifest themselves physically in overeating, reduced physical activity, alcohol or drug abuse and other actions that harm health—and drive up employer health care costs.

Based on a Behavioral Risk survey conducted by our organization in 2012, fully 97% of employers surveyed had an existing EAP program. But as prevalent as EAPs are, they are woefully underutilized. Employers can do a better job of communicating the services they provide and should continue to emphasize that use is confidential and has no impact on an employee’s work status—just like any other health care.

When HR departments do effectively communicate about EAPs, the results are impressive. Employers can receive a significant ROI from outreach and enhanced treatment of depressed workers for a cost of only $100-$400 for low-to moderate-intensity interventions. While data is still preliminary, integrating EAPs with wellness programs likely produces even higher returns at little if any added cost.

Another example of a wellness/EAP-type innovation is psychotherapy as part of workers compensation. Several workers compensation payers are already using cognitive behavioral therapy for claimants who suffer from depression that hinders their recovery and return-to-work. Cognitive-behavioral therapy is based on the idea that people’s thoughts, rather than external factors such as people, situations or events, cause feelings and behaviors. Cognitive-behavioral therapists encourage their clients to change the way they think in order to feel better even if the situation does not change.

A recent study conducted in the Netherlands and published in the Journal of Occupational Health Psychology found that employees absent due to common mental health disorders returned to the job on average 65 days earlier and saved employers an average of $5,275 when provided work-focused cognitive behavioral therapy. This study shows that integrating return-to-work strategies into therapy leads to less time out of work with little to no compromise in people’s psychological well being over the course of one year.

The ACA is driving significant change well beyond health insurance coverage and exchanges. This includes how employers address mental health issues, especially chronic illnesses like depression. Mitigating depression and similar mental illnesses while gaining control over one’s physical health through wellness programs has been demonstrated to reduce depression and otherwise improve mental health. Wellness programs, EAPs and other workplace initiatives are yet another frontier in the national health care reform effort. We will certainly hear more about them in the years ahead.

Terri L. Rhodes is Executive Director of the Disability Management Employer Coalition.

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