A wellness program nobody uses is not a benefit. It is a line item.
Most wellbeing spend is measured by whether a vendor was purchased and how many employees logged in once. Neither number tells you whether cost moved or whether anyone got healthier. We start from your own population data and work toward outcomes you can see in claims, not participation credits.
Buy the program your claims ask for, not the one in the brochure.
Two employers of the same size in the same industry can have completely different cost drivers. Until you know which of yours is doing the damage, every program is a guess with an invoice attached.
What the claims say
Where spend concentrates, which conditions are driving it, and how much of it is avoidable. Musculoskeletal, metabolic and behavioral health look very different from one another in a claims file and call for different answers.
Gaps in care
Members with a diagnosis and no follow-up, lapsed maintenance medication, missed preventive screening. These are the measurable items where intervention has a defensible return.
Risk, forward-looking
Risk prediction turns a retrospective claims report into something you can act on before next year’s renewal prices it for you.
A wellness program can create a compliance obligation on its own.
The design question and the legal question are the same question, and the answer turns on one distinction most employers have never been told.
Health-contingent or participation-only
A program that pays a reward simply for taking part is treated differently from one that requires an outcome or a standard to be met. Only health-contingent programs carry the disclosure and reasonable-alternative requirements — and the trigger is the design, not the program’s name.
Tobacco surcharges
Tobacco-related programs are the most commonly mis-built design in this area, and they have been the subject of recent federal attention. If you run a surcharge, the alternative standard and the notice matter as much as the surcharge itself.
Data handling
Health information gathered by a program is subject to privacy rules and cannot be used for underwriting employees. Where a vendor sits in that chain needs to be documented before the program launches, not after a question is asked.
A program with a number attached to it.
Vendor vetting
Candidates tested against your population rather than a generic list, and a recommendation to walk away when nothing on offer will move your particular cost.
An engagement plan
Communication and incentive structure designed so the program gets used. Purchase is not participation, and participation is not outcome.
A measurement basis set in advance
What we expect to move, by when, and how we will know. Agreed before launch, because after launch every number is arguable.
What employers ask about wellbeing programs.
How do we know a program is working?
By deciding what working means before it starts. A measurement basis set in advance, against your own claims rather than a vendor’s participation report, is the difference between a program and a line item.
Is participation a good measure?
It is the easiest to report and the weakest to act on. High participation in something that does not touch your cost drivers tells you people like the program, not that it changed anything.
Can we tie it to premium contributions?
You can, within rules. A health-contingent design carries requirements a participation-only design does not, including a reasonable alternative, and getting that structure wrong is a compliance problem rather than a design preference.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
Bloomfield Hills, MI 48304
248.370.8853
Colorado Springs, CO 80921
719.425.2649
Houston, TX 77084
281.404.5670
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