The first article in this series considers the current climate for corporate wellness and how sleep might best fit in this landscape. Sleep specialists will be interested to learn of innovations taking place outside the traditional medical care pathways—and what these changes might foreshadow for the field.
Among self-insured employers, sleep is becoming more and more recognized as a central component of employee health. Medical cost savings, reduced accident risk, enhanced employee productivity, and especially regulatory compliance are each powerful reasons for increased corporate interest in sleep.
Why Sleep in Corporate Health?
The costs of insufficient and disturbed sleep in the workplace are staggering. The two most common sleep disorders, insomnia and obstructive sleep apnea, cost employers well over $100 billion per year, at a cost of thousands of dollars per employee. (Read my recent “Financial Costs of Insomnia” article for additional information.) Further, the risks of sleep disorders as a major contributor to workplace fatigue are well-documented (including in my article “Sleep and Fatigue in the Operational Setting“). Although much work remains, the transportation, energy, and healthcare industries have all responded to regulatory changes by making substantial investments in mitigating sleep-related risks among their employees.
Superimposed on these trends, the Affordable Care Act (ACA) has had an obvious and dramatic impact on the broader healthcare universe–and thus opportunities for the sleep field. One of the most salient involves workplace wellness programs.
(In subsequent installments in this series, we will consider other ways that the ACA impacts corporate sleep health.)
Impact of the ACA
The authors of the ACA correctly recognized the central role of employers in driving a paradigm shift away from fee for service medicine toward population health management. (After all, employees spend a great deal of their waking lives at work!) One way that the ACA seeks to encourage employers in this transition is to financially incentivize workplace wellness programs. It is no coincidence that, while not new, employee wellness programs are more popular than ever since the passage of the ACA.
Under the ACA, employers can be “rewarded” with 30% off insurance premiums for offering workplace wellness programs or otherwise achieving positive health outcomes among their employees. When programs target smoking cessation, up to 50% of premiums can be rewarded.1
The ACA specifies two kinds of wellness programs: participatory wellness programs and contingent wellness programs. In participatory programs, employers reimburse for certain expenses, such as a gym membership, or otherwise reward employees for health-related activities such as completing a nonbinding health risk assessment. Such assessment is an obvious entry point for sleep health.
Alternatively, contingent wellness programs require employees to achieve certain health goals, such as reducing cigarette use or achieving a certain body weight target. Employees who take action but fail to reach the specified goals can still earn rewards by completing alternate tasks. In terms of general wellness, total sleep time could be a feasible contingent outcome. In terms of clinical sleep disorders, PAP or other therapeutic adherence is a likely choice.
Controversies in Corporate Wellness
Not surprisingly, not all are in agreement about the best way to implement wellness programs. In fact, not all are convinced that workplace wellness programs should exist at all.
In its February 2015 issue, the American Journal of Managed Care published a paper assertively titled “Employers Should Disband Employee Weight Control Programs.”2 The piece contends that no large-scale employee wellness program has had any positive effect on weight control to date. Even more strongly, the authors argue that by encouraging crash dieting and other means of meeting contingent health goals, such programs might actually be harmful to workers.
Although we won’t get into the merits of the scientific arguments here, sleep specialists should be particularly interested in this article. The AJMC is a large platform. Corporate decision-makers are readers, and many executives will share the skepticism of the authors regarding the financial return-on-investment of corporate wellness programs.
What This Means—and the Potentially Great News—for Sleep
It’s not surprising that mutual corporate sleep interest has been increasing over the past few years. Indeed, a quick Google search will reveal several conferences of varying quality, including a 2013 event hosted by Harvard Medical School. In light of the evidence regarding the costs of insufficient and disturbed sleep, there is no question that sleep warrants a prominent place as a pillar of corporate wellness initiatives.
Yet in spite of financial incentives and positive momentum, challenges exist. Solving the corporate sleep puzzle will require active engagement and collaboration between industry, government, and academic stakeholders. At the University of Maryland, we are actively exploring the best ways to address these issues. Millions of employed Americans suffer sleep problems–and solutions exist that are healthful for workers and financially advantageous for employers.
In the next installment of this series, we will explore these issues in greater detail, including conversations with stakeholders and examples of successful corporate sleep programs.
Emerson Wickwire, PhD, is director of the Insomnia Program and assistant professor of Psychiatry and Medicine at the University of Maryland School of Medicine. He is a recognized expert in the nondrug treatments of sleep disorders and leveraging technology to improve patient care in medical and organizational settings.
1. http://www.dol.gov/ebsa/pdf/workplacewellnessstudyfinalrule.pdf. Accessed March 7, 2015.
2. Lewis A, Khanna V, Montrose S. Employers should disband employee weight control programs. American Journal of Managed Care. 2015;21(2):e91-e94.