Playing Doctor

Playing Doctor

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flying cadeuciiIn a deep dark recess of today’s Federal Register, large corporations just quietly received permission to “play doctor” with their employees. They can now impose even more draconian and counterproductive wellness schemes on their workers than they already do. Their hope is to claw back a big chunk of the insurance premiums paid on behalf of employees who refuse to submit to these programs, or who can’t lose weight.

A Bit of Background on Wellness

The Affordable Care Act (ACA) allowed employers to force employees to submit to wellness under threat of fines. Specifically, the ACA’s “Safeway Amendment” — named after the supermarket chain whose wellness program was highlighted as a shining example of how corporations could help employees become healthier — encouraged corporations to tie 30% to 50% of the total health insurance premium to employee health behaviors and outcomes. (As was revealed while ACA was being debated, Safeway didn’t have a wellness program. The fictional Safeway success was a smokescreen for corporate lobbyists to shoehorn this withhold into the ACA.)

Once this 30% to 50% windfall became apparent, many corporations figured out what this vendor (Bravo Wellness) advertised: there is much more money to be made in clawing back large sums of money from employees who refuse to submit to these programs than in improving the health of employees enough to allegedly reduce spending many years from now. “Allegedly” because–unlike simply collecting fines or withholding incentive payments–improving employee health turns out to be remarkably hard and ridiculously expensive to do, so hard and expensive that:

Most importantly, the complete lack of regulation has allowed the wellness industry and health plans to expose employees to significant potential harms, in order to maximize revenues.

The Federal Government Green-Lights “Wellness-or-Else” Programs

There are no regulations, licensure requirements or oversight boards constraining the conduct of wellness vendors, and only one agency — the Equal Employment Opportunity Commission (EEOC) — providing any employee recourse. The Business Roundtable has taken on the latter at every opportunity. First they threatened President Obama that it would withdraw its support for ACA unless he declawed the EEOC. Then they held sham Senate hearings entitled: “Employer Wellness Programs: Better Health Outcomes and Lower Costs.” Finally, they threatened to push the“Preserving Employee Wellness Programs Act” to eviscerate the EEOC’s protections legislatively.

But it turns out the legislative end-around wasn’t necessary. The EEOC has now caved in. These programs are defined as “voluntary,” and yet as of now, employees can be forced to hand over genetic and family history information, or pay penalties. So, as in 1984, where “war” means “peace,” employees can be required to voluntarily hand over this information.

Let’s be clear. This isn’t about employee wellness programs, which don’t work. It’s all about the penalties. Genetic information is worthless in the prevention of heart disease and diabetes, as Aetna just showed in a failed experiment on its own employees.

Knowing family history does have some predictive value, but it is unclear how employees are going to benefit from employers collecting it. Self-insured employers could either fire the employee or do nothing. Neither is useful for the employee. If the employer is fully insured, this information is akin to a “pre-existing condition” in the old days. The employer’s premiums will increase as long as employees with bad family histories remain on their payroll.

The Good News, Part 1: Corporations Wising Up

The Business Roundtable, and their friends at the US Chamber of Commerce, might want to connect their computers to the internet. It turns out that many companies are finally realizing that compelling employees to submit to medical screens just to claw back some insurance money isn’t worth the morale hit.

Increasingly, employers are learning that what the national data shows is also true for themselves: these programs simply do not work. For example:

And the morale hit? A formerly obscure faculty member who led the successful employee revolt against the Penn State wellness program just got elected president of the Penn State Faculty Senate–largely because employees were so grateful to him for his leadership in that revolt.

The Good News, Part 2: Wellness For Employees

As a result, many companies are deciding that clawing back some insurance money isn’t worth the damage done to their workforces. They are replacing “wellness done to employees” with “wellness done for employees.” These companies are improving the built environment, upgrading their foodservice, encouraging fitness, or simply adding features to the health benefit like paternal leave or financial counseling. They might still hold a “health fair” every now and then, but their medical tests are conducted infrequently–according to actual clinical guidelines–instead of allowing vendors to screen the stuffing out of their employees to find diseases that don’t exist.

Or they are actually focusing efforts where they can make a difference, like steering employees to safer hospitals or educating employees on how to purchase healthcare services wisely. (Disclosure: my own company, Quizzify, is in the business of teaching employees how to do the latter.)

Notwithstanding this disruption and regardless of the harms it has caused, the $7-billion wellness industry has excelled in perpetuating its own existence. Industry “thought leaders” recently proposed a scheme to encourage companies to disclose how fat their employees are –and have even managed to get a few large employers to sign on to it.

The sheer audacity of that scheme and complete disregard for its consequences on overweight employees means the war on “voluntary” wellness-or-else programs is by no means over. Like every other industry threatened by reality but supported by deep-pocketed allies like the Business Roundtable, the wellness industry can rely on the government to delay the inevitable.

Consequently, it might be quite some time before the inevitable course of reality overcomes the wellness-or-else pox on the healthcare system.

Al Lewis is the CEO of Quizzify.com and the author of “Surviving Workplace Wellness”

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5 Comments on "Playing Doctor"


Member
William Palmer MD
May 18, 2016

Although wellness efforts don’t work significantly now, we probably should keep an open mind in the future. Eg aging research is showing that some cells are immortal and do not age. Therefore, we know aging is chemistry….it has to be a technical problem. Aging facilitates hundreds of diseases. Man is good with technical problems. Keep hoping and stay tuned.

We also know that people who are happy and have good social connections are healthier and survive longer. Is anything more certain? Businesses can abet this in a few easy ways that take no imagination.

Business can also tell their workers to not show up with fevers and coughs and not to fear reprisals.

Not much else is needed to know.

Member
May 17, 2016

Jim, when you comment on my stuff or we talk on the phone, it seems like we both agree. Then I read something you wrote in a blog and it seems like we totally disagree. So I am going to agree with this comment you wrote. By setting up a “culture of health” (easier said than done), you should be able to prevent a few people from getting diabetes. The Koop Award-winning programs generally reduce risk on about 2% of the population, albeit at high cost. However, forcing employees to participate in these “voluntary” programs isn’t going to raise that figure.

Member
May 17, 2016

I did ask a pretty straight forward question Al. Are you saying we throw in the towel on changing unhealthy lifestyles that have led us to where we are today? It sounds like you are. But I’d kinda like to pin you down on that one. Because it is there that we disagree.

Member
May 17, 2016

Fair ’nuff. Here goes. Because even the so-called best programs are almost total failures according to their own data (which likely overstates the actual results if dropouts and non-participants were also tracked), as a CEO, which both you and I were, there is no way I invest in a wellness program for my own employees even though they were pretty unhealthy. (You might possibly remember my old company, Peer Review Analysis — BCBSRI was one of our accounts.)

So, yes, I throw in the towel until, to mix cliches, someone invents a better mousetrap.

You had also mentioned people who already have chronic disease. That would be disease management rather than wellness. I am credited by search engines with inventing disease management…and even I am rather lukewarm on it. It should break even and a bit more besides, but overall cost reduction on a $5 PMPY program might be $7 PMPY, not enough to matter.

Meaning, we are in directional agreement on this one, just not magnitudinal.

Member
May 17, 2016

Hi Al,

As we’ve discussed, we agree on many of your points. Such as:
1. Penalties that are thinly veiled ways for employers to reduce their share of insurance premiums won’t work.
2. Incentives are over rated, and only work when they truly motivate people to make lifestyle changes. And incentives are usually short-lived, while lifestyle change should be like forever. Thus, we know the key is finding a way to facilitate decisions by employees to live healthy lifestyles and access the system appropriately.
3. Education on system access is important as you note.
4. Wellness isn’t something you to “to” employees.
5. A great work environment, benefits, and help on the stress, financial management, and mental health side is a good start.

But, if I read you correctly, you are saying to stop (or give up on) trying to find ways that maximize the likelihood of long term lifestyle change. That is where I disagree. I believe we focus on the chronically ill and those at risk of becoming so. I think the real question is how we do that without being insensitive jerks or playing doctor. I realize that the wellness industry has not covered itself in glory on some of its representations of savings. But that doesn’t mean we throw in the towel. Does it?