WASHINGTON — Employers overwhelmingly see well-being benefits as part of their overall strategy in the near future, but that doesn't necessarily mean employees feel their own situation is optimal, according to speakers who presented at the National Business Group on Health's (NBGH) Business Health Agenda 2019 conference last week.

"More employees feel they're doing everything they can to live a truly healthy life, but are kind of questioning whether their investments are worth it," Ray Baumruk, employee experience partner at Alight Solutions told attendees. "They're overwhelmed and they're trying to prioritize, but they're struggling, and they see that sense of well-being kind of flat or in some cases declining."

These conclusions, drawn from surveys presented by Baumruk and Robert Kennedy, health and welfare practice leader at Fidelity Investments, paint a challenging picture for employers, some of whom have described pressure to hike wellness benefits in response to the job market. But while employees are having trouble keeping their well-being in check, the speakers concluded most workers still see value in wellness-focused benefits.

#1: Workers aren't feeling great about their finances

Data from a 2019 Alight study of employees showed 40% of employees feel they have control of their financial future, Baumruk said, down from 46% in previous years. Millennials in particular are worried about the impact of debt, and worries about retirement rose across the board, with nearly one-third of respondents saying there's "no way" they would be able to retire at their desired age.

"Retirement fears are re-emerging as more worry they're going to run out of money," Baumruk said. "These aren't dramatic swings but we're starting to see, consistently across each of the data points … this pivot point, where people are starting to re-evaluate and say, is it really worth it? How much investment might I be putting in?"

Compounding the problem is lack of financial literacy: more than half (58%) of employees surveyed scored low on financial literacy indicators, up from 49% from 2017 research. The data weren't all bad, however; more employees are taking action to calculate their retirement needs, with 58% of those in Alight's study having done so. While 8 in 10 respondents held non-mortgage debt, with the average level of debt up $1,000 year-over-year, most employees said it is important to be debt-free, Baumruk said.

#2: Employees choose cost-saving behaviors in healthcare, but not always the right ones

Healthcare consumerism is an oft-discussed trend in the benefits community. Consumerism in this context is generally a loose term for cost-saving behaviors including the use of second opinions, investigating alternative treatments and even just asking one's doctor about different care options. Employees in Alight's study demonstrated a rise in these types of behaviors, Baumruk said, with 73% having asked a provider or insurer for costs or having compared costs between healthcare providers.

But negative cost-saving behaviors were also a highlight of the Alight study — employees stopped taking or took less medication to save money, for example, or refused care for themselves or a family member because they could not meet the out-of-pocket costs required. The incidence of these behaviors was low in some cases (only 16% said they declined benefits for categories like dental or vision to save costs) but still significant, Baumruk said: "They're getting the cost message — costs are rising and it's hard to afford — and they really are taking action around those types of things." Younger consumers were more likely to exhibit such negative behaviors, he noted.

Moreover, fewer workers say they're willing to make the investment required to live a healthy life, Baumruk said, pointing to a 20% rise in employees in the survey who said they weren't sure whether their investments were making a difference.

But the majority of employees (70%) nonetheless said wellness benefits were the "reason I stay at my job," and younger workers were particularly likely to value the programs across health categories. "Well-being programs and their ability to differentiate you and your employment brand is significant in that it really is an opportunity to attract and retain," Baumruk said.

#3: Meanwhile, employers prioritize incentives and changing up communications

Fewer employers cited cost savings as a reason for offering well-being programs, said Kennedy, who presented a separate survey of employers by Fidelity and NBGH. Instead, employers pointed to broader cultural reasons for wellness offerings. "I think we long ago gave up the return on investment conversation and [moved] to value in investment," Kennedy said. "If we can help employees improve their well-being, in the long term, that's got to have an impact on overall cost."

An interesting point in the survey revealed employers' internal approach to well-being. More than half (58%) of employer respondents had more than one full-time employee dedicated to well-being programs, exemplifying the amount of resources being put into the programs, Kennedy said, but only 22% tied well-being to business metrics. "I think this is an area of opportunity," he said. "If these programs are core to our strategy, I think there's some work to be done here in tying these things together in terms of overall strategy."

A majority of employers (82%) offered incentives for participating in a wellness program, with more than half extending incentives to spouses and domestic partners. Incentives took the form of medical plan premium reductions, cash and health savings account contributions, among others.

Kennedy noted a general shift away from outcome-based incentives, but said employers may be hesitant about nixing incentives altogether. "We've found historically they work, but I think if we dig one layer deeper they work maybe not for the reason you want — they work because I want $762, not because I want to engage in the well-being program." That could help employers make a "philosophical" case for reducing their spend on incentives, he said.

Instead, employers could change their well-being approach by changing up communications strategy. Email was still used by the majority of respondents to conduct well-being program messaging, whereas only 1% used text messages. But other avenues picked up strong engagement, Kennedy said. Twenty-one percent of those who used texts said they were "very effective," while 27% of employers said the same of employee meetings.

Communication strategy also can extend to the offerings themselves. One example of this, Baumruk noted, could be investing in comprehensive financial well-being offerings rather than devoting outsized attention just to smaller questions. "What we're seeing from the employee data is that what is effective is that more comprehensive view of financial well-being and having tools, programs and resources available across that spectrum as opposed to just one isolated 'how do you invest your retirement money,'" Baumruk said. "If that's all you're doing today, you're probably not going to make much progress."