Steve Burd, founder and CEO of Alamo, California-based Burd Health, said that company health costs fell by about 40 percent and employees’ cost by about 10 percent even as the level of care improved, thanks to voluntary companywide wellness initiatives that rewarded employees with cash for sticking to healthier ways. With about 85 percent of employees and 75 percent of spouses participating, improvement was obvious: among those who initially failed the blood pressure standard, 72 percent passed it within two years and maintained it through the remainder of the program.

Michael Roizen, MD, chief wellness officer and founding chair of the Wellness Institute at the Cleveland Clinic in Cleveland, Ohio, said that the rise of chronic disease could bankrupt the country’s health care system if costs aren’t reined in; currently chronic disease is growing at a faster rate than that of the U.S. population. Voluntary wellness program participation could cut that by hundreds of billions of dollars over the next several years.

Alexander concurred, saying in a report in The Chattanoogan, “[I]f we really want to focus on improving Americans’ health, why not connect the consensus on wellness to the insurance policies that 178 million Americans get from their job.” He added, “About 60 percent of insured Americans get their health insurance on the job, so it is hard to think of a better way to make a bigger impact on the health of millions of Americans than to connect the consensus about wellness to employer-based insurance for 178 million people.”

David Asch, MD, MBA, a John Morgan professor at the Perelman School of Medicine and the Wharton School, and executive director of the Center for Health Care Innovation at the University of Pennsylvania in Philadelphia, pointed out that people respond more determinedly to negative than positive stimulus—i.e., being financially penalized for failing to engage in healthy behaviors, rather than being financially rewarded for sticking to health improvement steps. Behavioral economics has shown, he said, that people respond more to the potential of loss than of gain.

But Jennifer Mathis, director of policy and legal advocacy at the Judge David L. Bazelon Center for Mental Health Law in Washington, D.C., warned that wellness programs must take into account workplace protections such as the Americans with Disabilities Act so that people are protected and can still keep their health and wellness information private in the workplace.

Alexander said that in light of the popularity and success of offering premium discounts to employees participating in wellness programs (“It was one of the only parts of the ACA on which nearly everyone agreed.") the hearing was focused on “what we can do to make it easier for employers to encourage their employees to lead healthier lives and reduce health care costs.”