The Wellness Game: The Employer As the New Parent

Eat your vegetables.  Turn off the TV.  Go outside and play.  Go to bed on time.  These four imperatives were once amongst the core messages delivered to children by their parents and neighbors, a setting of behavioral parameters that people intuitively expected would help to produce healthy, well-balanced kids.  We’re not so good at this anymore.  Like so many other behaviors that animate the phrase “personal responsibility”, in the face of economic and demographic tumult we have decided to pass the buck on them in our homes, neighborhoods, schools, and churches.  We now want employers to handle them, and health-contingent wellness is the final step in the ascendancy of the employer as the new parent.

Employers find themselves teaching employees how to read and write effectively, do math, be polite, how to eat in the presence of others, and even how to sleep better.  Why not throw at their feet the notion that employers should coerce workers into intrusive and dubious health-contingent workplace wellness strategies that are easy as pie for the healthiest, but far more difficult for the less fortunate who are, ostensibly, the ones who need the most help?  This is not why most people start businesses (unless, of course, you’re a wellness vendor).  It certainly is not why people devote themselves to work, which is supposed to be for securing (hopefully) individual and familial prosperity and experiencing the unique contribution to personal dignity that comes from purposeful endeavors.

US employers are not responsible for the chronic disease crisis; truth be told, their sufferance of the costs of many wellness-sensitive events is limited because the majority of the medical catastrophes that health-contingent wellness programs promise to prevent (such as heart attacks, strokes, and many cancers) happen predominantly in older people who have mostly left the work force. Employers have been caught up in the maelstrom of demographic, industrial, and technological changes just like the rest of us.  Yet,  not only do we actively seek their participation in fishing expeditions such as health-contingent workplace wellness programs, some of them jump in with both feet.  This should help to remind you that your CEO might just be the one who graduated at the bottom of his class.

Should employers want everyone to be hale and hearty?  Of course.  I want everyone to be hale and hearty and to live an absurdly long, healthy, prosperous life.  It’s just not clear that the path to health is paved with health risk appraisals, biometrics, and cost-shifting the burden of higher premiums on to the backs of people who, for whatever reason, could not master the four fundamental tasks written at the beginning of this piece.

Organizational cultures should be configured around health centric messaging and tools that help people voluntarily, and by following exemplary health leaders, elevate themselves and change the trajectory of their health lives.  But, the intrusive and coercive nature of health-contingent wellness programs is the most demeaning kind of paternalism.

If you are comfortable today with the notion that your employer should be your parent, consider this: another function of highly engaged parents is to punish when things don’t go as expected.

Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness.  An iconoclast to the core, he is the author of the Khanna On Health Blog.  He is the new Wellness Editor-At-Large for THCB.

52 replies »

  1. That’s a nice read. Overall, everything seems to be trending in the right direction for a change. Permissiveness and technology reigned for well over a decade but now you are seeing the basics make a comeback – the importance of getting outside and exercise, farm-to-table, etc. Definitely good to see.

  2. Living at the worksite would have its advantages. Using moder psychology — peer pressure — every employee’s health statistics (body mass, body mass changes past period, body mass change projected period, ditto for blood pressure and cholesterol, etc could be posted on line (just as the Chinese communes posted birth control data by name at the commuine gate).

  3. Uwe: thank you for your comment. Your characterization of wellness as a Nurse Ratchet intrusion is brilliant, and I plan to borrow it frequently (with due credit, of course).

    After employers have picked our spouses, perhaps they can move into selecting our cars, homes, pets, and even friends. Given the wellness industry’s most recent obsession with leveraging “social media” to help people do whatever it is wellness vendors want them to do, that seems only natural.

    Maybe the real path to wellness is for people to just reside at their workplace, where the wellness-driven command and control function can finally reach its zenith.

  4. Good post, Mr. Khanna. I have deplored this Nurse Ratchet intrusion for a long time as well.

    But hold on. The next frontier undoubtedly will be that employers pick our spouses for us. After all, a well working marriage is good for health and worker productivity. And who else would know better than employers whom we should marry, given all the data they have on us.

    Anyone willing to put some VC money into perfect-mate consulting companies vending their expertise to employers?

  5. Hi Deb, and great to hear from you. You are indeed my kind of parent: you lead by example and expect your people to be responsible adults. What a concept. GE could learn a lot from you.

  6. My only “problem” with the article is the thought that Wellness vendors might be the only people in the world who want to “parent” their employees…I only think its false because my company (I own it) would be considered a “wellness vendor” and I have absolutely NO desire to parent my employees!!! In fact, I do even less wellness for my employees than my clients do for theirs! After all, the people I hire already know (or at a minimum have easy access to) what needs to be done to be healthy and they are grown ups….do it or don’t, but don’t expect me to bribe you or penalize you! Do it and health will be your reward, don’t and sickness will be your penalty. I control what snacks and beverages are available in my office. I take the steps and park out at the far end (lead by example), but beyond that I feel no obligation to do anything to influence my employees behavior…we are at work to do a job for which we are compensatedfairly and which has reasonably generous bbenefits.

  7. Actually, the wellness industry is a creation of that pathetic healthcare system. Consider. for example, that some of the most vociferous proponents of health-contingent wellness program are medical care providers who see them as a feeder system to help create a new stream of patients (many of whom actually benefit from the care provided). Further, if you dig into the background of many of the larger wellness industry players, you will find very strong connections to that same pathetic healthcare system. The healthcare system’s rapacious maw has to be fed. There is a reason that health-contingent wellness is so centrally placed in the Affordable Care Act, which was strongly supported by hospitals, health plans, and wellness vendors.

  8. A mind-opening article. Many employers overlook these important stuffs concerning their employees. Thank you Vik for posting this.

  9. Al, I think the “FOR” vs “TO” distinction is very useful.

    I see a third alternative — employers doing things “WITH” employees — a collaborative approach.

    This whole discussion about wellness has become unnecessarily polarized. Let’s not forget that employers and employees have many COMMON INTERESTS.

  10. Bruce, after we chatted I had a Eureka moment where I came up with an answer with constructive value. It’s very short and would have to be elaborated upon but here is the difference between what Vik (and I and others) criticize and what we support…keeping in mind that “support” does not not equate to “cost savings” but rather well-being and morale.

    (1) Make a list of everything you do in wellness
    (2) Divide them into things you do FOR your employees and things you do TO your employees.
    (3) Refocus from the former to the latter.

    This means the end of screens and anything else that people need penalties to participate in…and redirect that spending to things that people like so much you don’t have to “punish them with rewards” in order to get their to participate as Alfie Kohn would say.

  11. “The wellness industry has been created out of frustration with a pathetic healthcare system–I think we agree on that.”

    No I can’t agree with that. The “wellness industry” has been created out of a pathetic industrial food supply system that has created a culture of illness and treatment.

  12. Vik–not seeking an argument, and I am not a wellness vendor. My point was to say that encouraging people (employees, too!) to understand their health status and act if they desire, is a good thing. HR depts don’t prescribe PSAs–but it may be worthwhile for many to see a doctor every decade or so. The wellness industry has been created out of frustration with a pathetic healthcare system–I think we agree on that. Employers are vulnerable to something that might make intuitive sense, but does not hold up to the evidence. But getting everyone interested in his/her own health status is not a bad thing.

  13. If corporations really wanted to improve the “wellness” of their employees they’d tell them – DON’T USE OUR PRODUCT!

    And if societal change is what they’re after then they’d stop selling their products all together.

  14. Vic, We don’t always agree…but bravo! This was well written and spot on. Key to your last paragraph is the comment on health-centric messaging. So many employers overlook this simple, often times cheap, initiative as a way to create a culture of expectation of personal responsibility.

  15. Vik,

    So you’re the new Wellness Editor at THCB? That seems akin to putting a vegan in charge of reviewing new steak house restaurants. 🙂


  16. I think that an employer should be an employer and just that, but workplace wellness programs are helpful for those who do need the motivation and a little push to get them to a healthier state. The problem seems that parents and teachers in school aren’t teaching the fundamentals.

  17. Bruce — I think pointing out bad ideas, even without suggestions of what would be better, is worthwhile in itself. We should at least stop doing the things that are counter-productive or ineffective. This seems difficult when there’s a culture of “do something, anything”. In Nasim Taleb’s book “Black Swan” he relates a story when he pointed out the fundamental flaws in certain economic models to a group of prominent Fed officials. Their response was, essentially, “Yes, but it’s the only models we have!”. The same attitude seems to be true in employee wellness. But, even if we don’t have better solutions, let’s at least stop doing things that are harmful.

    And of course there are better ideas. But they’re not mainstream today, they’re outside of what is considered best-practices today, they’re different than what is considered to “innovative”. Those people would benefit from more support.

    My own non-mainstream efforts have been focused on *helping* people take care of their well-being in whatever way they themselves feel is best. Not on motivating, gamify-ing, engaging them to do what someone else thinks they should do, but simply helping them to do what they want to do. Unfortunately this approach does not fit into the make-employees-do-the-right-thing world of employee wellness plans. You can read about the thinking in a paper from a few years ago (http://bit.ly/US8DNK) and a recent talk (http://slidesha.re/11g308K).

  18. Great point. This is exactly the reason that it historically proved so difficult to get health plans and self-insured companies to cover preventive clinical services…the downstream financial and health benefit would likely not be theirs and they knew it.

  19. Well, the good news is that selling my book isn’t going to be a problem — the first printing has about 4500 copies, mostly to people who read my last book.

    here are some examples. First, well-being (like Healthways’ program) trumps wellness. If you were a general, which would you rather lead into battle–troops with high morale or troops with low cholesterol? Screens and playing doctor reduce morale, but well-being covers things that increase it.

    Second, coordinated care saves 2-4%, and the best vendor is right in your backyard — not sure why you wouldn’t have all your Ohio accounts using it.

    Third, old-fashioned claims audits can save 2-3%. Don’t take my word for it. Vendors these days do that on a pure satisfaction-guaranteed basis: you only pay for what you agree with, in your own judgment.

    And that’s just for starters…

  20. Median U.S. job tenure as of 2012 (BLS) was less than 5 years (4.6). So, you’re likely to coerce people into “improved health” at significant cost, and their next employer will benefit. Maybe that’s still a worthy goal from a national public health perspective, but there’s some “first mover disadvantage” here, no?

    Where’s JD Kleinke when I need him?

  21. You are a wellness vendor, no?

    I believe you meant “oppressed,” not “repressed”. I would say that the wellness industry suffers from repression because of its inability to deal with ideas that it finds disagreeable.

    As for the contention that medical care providers would not understand a patient’s health status…isn’t that their job? Isn’t that what they do through a thorough history and physical exam and at least attempting to conduct themselves in a manner that is consistent with evidence and expert opinion? Of course it is. As Al notes, it is not the job of employers to delve into medicine.

  22. Good point, Rick. At the end of the day, your parents probably are the people who are most invested in your happiness and success. If you expect your employer to take on that role, you are likely in for a very disappointing surprise.

  23. I am completely in synch with Al. I, too, have no intention of stopping and, indeed, we are just getting started.

    As for people who misunderstand the value of criticism, I direct you to this essay in the NY Times: http://www.nytimes.com/2011/01/02/books/review/LitCritBackPage-t.html?_r=0.

    In fact, I do provide lots of constructive comments, guidance, and full-fledged wellness strategic plans…to clients. And, unlike wellness vendors who have an inherent conflict of interest, I don’t want to run wellness programs. I make very concrete and clear recommendations about steps management should take and direct them to potentially useful partners in the wellness world, when necessary. It’s a short list.

  24. Rajiv, thank you for your note. I am familiar with the Whitehall studies, which are fascinating because researchers are able to follow that cohort of British civil servants longitudinally, which is oh so much more than any wellness vendor can dream of doing. After having read several studies based on the Whitehall cohort, I am most grateful for not being a British civil servant.

    Employers seek expediency, because for most company leaders (even government bureaucrats), for them profitability is the most direct means to an end. It’s easier to have a faulty health culture that keeps people working (and getting sucker punched by a wellness vendor) than it is to have a health culture that requires planning and a serious commitment from management.

  25. I’m with Rajiv Mehta’s comments-

    I’ve studied the impact of job loss and the threat of job loss on health outcomes. Also 1 in 5 American workers are now part-time.

    Would you trust your employer with your health verses your parents? Usually parents don’t fire you!

    Dr. Rick Lippin

  26. Al,
    I appreciate your sentiments – but provide a bit more balance with constructive comments to help those companies “do the best job possible for their employees”. And I get it – you want to sell your book. But provide some helpful morsels for us peons who haven’t had your experience with company leadership.

  27. hmm…a couple of observations. first, of all the people who have posted here, I believe I am the only one who has been Chairman and CEO of a NASDAQ company, one that (in 1995, the last year before we sold) was cited by Modern Healthcare (Febuary 1996) as having the best ere stock performance in the industry. The way we did that was to avoid fads…and manage the company better. This blood-drawing stuff is an expensive, clinically contraindicated, and morale-killing distraction

    Second, my new book, Cracking Health Costs (now orderable on Amazon) provides plenty of solutions to high-cost healthcare, none of which include HR departments playing doctor. I didn’t say that in the earlier comment because I didn’t want to be self-promotional.

    And I have no intention of “stopping” as long as there are client companies (and there are) who are driven not by fads but by wanting to do the best job possible for their employees

  28. And oops – meant to reference Al’s comment as not providing much constructive value for the rest of us.
    My bad.

  29. Everyone,
    I appreciate the frustration with the current system and the seemingly incessant criticism of the way things are. If we were able to devote the corresponding amount of energy to constructive solutions instead of telling the world what’s wrong, we’d all be better off.
    Can everyone that reads this provide some meaningful, constructive feedback? With all due respect to Al, hearing that “the solution is to learn how to manage your company better” provides much value. We have to refocus our attention to what we CAN do, not what’s wrong. And if anyone feels similarly, please let all the “naysayer” blogs know.

  30. The solution is to stop. That’s the constructive feedback. If you want a healhier workplace stop giving people stupid advice like getting a PSA test on HRAs, stop screening them all the time in contravention of government guidelines, and stop overdiagnosing them and stop penalizing them if they don’t like the idea of th HR department playing doctor.

    If someoene comes to you for help in losing weight or smoking cessation, give it to them, but dont bribe them to do things they have no interest in.

  31. Rajiv, I would say that employers are respinsible for an employee”s health and well-being to a large degree. However, the solution is not to draw their blood and make up phony diagnoses. The solution is to learn how to manage your company better.

  32. Vik … I’m with you on the idea that employer wellness programs aren’t particularly useful or wanted. However, your statement that “employers aren’t responsible for the chronic disease crisis” is not so easy to accept. The work environment can be incredibly unhealthy because of the mental and emotional stress it imposes (often unnecessarily) on employees. For many people the most unhealthy thing they do is show up for work. The increased job insecurity and trust-but-verify mindset along with wage stagnation in US companies over the past few decades has worsened the situation. You must be familiar with the Whitehall II studies that show the impact of management policies on health often have a much greater impact than the employee’s diet, exercise or smoking habits. Unfortunately in the US today, as Alex Drane has noted in her “unmentionables” presentations, employer responsibilities are amongst the most unmentionable of the unmentionable issues.

  33. Vik…admirable that you are so protective of the repressed. What are your constructive messages and “health centric” tools to get Americans moving and change how we think about our health? Incidentally, just because one works in a hospital or doctor’s office doesn’t guarantee he or she understands much about individual health status. Give us the benefit of your knowledge—not just withering criticism.

  34. Indeed. Employers have become the default stewards of a system that is largely an historical fluke and they are terrible at running it. No one would be foolish enough to design a health care system to look like ours. The problem is that armies of administrators, executives, managers, and bureaucrats have become incredibly rich and powerful based on the status quo. They have not yet experienced the need to change. If there is a full-on employee revolt against health-contingent wellness as the last straw of health care idiocy and intrusion, they just might.

  35. Linda: thanks for your very thoughtful note. I could not agree more with your characterization of the differences between health and health care/insurance.

  36. Great piece Vik. The path to health is certainly not paved with risk appraisals or other popular wellness program tactics. I like to say that health is created over a lifetime; health insurance is paid for monthly. With such different time horizons, no wonder long-term tactics have no impact on short-term costs (or even long-term costs in many cases).

    Thanks for sharing this.

  37. At least the information that our parents gave us was generally right (except the part about going out to play in the sun). These biometric screens and other wacky employer-playing-doctor schemes are some of the major causes of overdiagnosis in this country.