For those of us who actually think wellness outcomes should be evidence-based, a landmark study was released today: the first evidence provided by a major organization voluntarily (as opposed to being outed by us, like British Petroleum and Nebraska) that wellness doesn’t work. January’s Health Affairs features a case study of PepsiCo, authored by RAND Wellness Referee Soeren Mattke and others, in which a major wellness program was shown to fall far short of breaking even.
The specific highlights of the PepsiCo study are as follows:
- Disease management alone was highly impactful, with an ROI of almost 4-to-1;
- Wellness alone was a money sink, with each dollar invested returning only $0.48 in savings;
- The wellness savings were attributed to an alleged reduction in absenteeism, as self-reported by participants. There was no measurable reduction in health spending due to wellness.
Even though the wellness ROI was far underwater, we suspect that the ROI was nonetheless dramatically overstated, for several reasons. First, the authors acknowledge underestimating the likely costs of these programs, focusing only on the vendor fees without considering lost work time, program staff expense and false positives. Second, no matter how hard one tries to “match” participants with non-participants (the wellness industry’s most utilized measurement scheme), it simply isn’t possible to compare mindsets of the two groups. We learned from one of Health Fitness Corporation’s many missteps that participants always outperform non-participants, simply because they are more motivated. Third, the absenteeism reductions were self-reported, by participants.
Finally, PepsiCo’s human resources department, having made the mistake of accepting Mercer’s advice to implement one of these programs, was already taking some political risk by acknowledging failure. Had they incorporated the adverse morale impact, lost productivity due to workers fretting about false positives, Mercer fees and staff costs, participant bias, and self-reporting bias, the ROI could easily have turned negative (meaning the program would have been a loser even if the vendor had given it away) and the HR staff could have been taking serious career risk.
Therefore we suspect the reason for the nuanced finding lies more in the politics than the economics. It’s to his great credit that Dr. Mattke got PepsiCo to do even a nuanced mea culpa.
This result, of course, will surprise no longtime THCB readers. It might raise the eyebrows of Harvard health economists Katherine Baicker and David Cutler, whose 3.27-to-1-ROI mantra helped turbocharge the current mania, and Emory University’s Ron Goetzel, the wellness industry’s go-to guy for defending the indefensible, or in the case of Nebraska’s program, giving awards to the indefensible. (Expect to hear from Mr. Goetzel in the next few weeks furiously spinning this into something positive, having bet his career on wellness saving money.)
Another surprised party will be the Business Roundtable, whose Health and Wellness Committee has lobbied noisily for more corporate wellness to “empower workers to live longer, healthier lives,” even as Committee Chairman Gary Loveman, CEO of Caesars World, knowingly and purposefully exposes his employees to more second-hand cigarette smoke than all but two or three companies in the country.
But then again, wellness is nothing if not ironic, since employees usually resent and sometimes revolt against programs designed to “help” and “empower” them, so that — in a further irony — corporations can save money through reduced healthcare expenses, though none including PepsiCo ever has.
Al Lewis is the author of Why Nobody Believes the Numbers, co-author of Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care, and president of the Disease Management Purchasing Consortium.
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 also the Wellness Editor-At-Large for THCB.
Vik and Al will be the first authors of THCB’s new e-publishing venture. Their jointly authored book, Surviving Workplace Wellness: With Your Organs, Dignity, and Finances Intact, will be released in the late winter/early Spring 2014. Vik’s solo e-book, Your Personal Affordable Care Act: How To Make Yourself Scarce In The Dysfunctional US Healthcare System will be simultaneously. Pre-orders are being taken now at this link, where you can also sign up to receive additional information.
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It took me a minute but I finally remembered who said that Kate Baicker said that “no expenditure is too large to save even one life.”
It was your buddy Vik Khanna. See his post above.
Also, you still have not answered my question so I will ask it again.
Do you disagree with what you say she said that no expenditure is too large to save even one life?
People turn to comfort in food, alcohol, television and other outlets to avoid and/ or manage stressors on their life. If you don’t manage the mind, the rest is moot.
Part of this comes from engaging with people. People you like and people you don’t. Even in your family. Ever had a boss that sucked where happy hour gave you a bit of respite from the ongoing bullying?
Understanding the way you are hard wired and what your triggers are for stress is the first step, then understanding where people are coming from is the next. We just piloted a new tech that accurately predicts how people will interact on a team. The results were not only stunning, but they also helped minimize stress which will potentially lead to an openness toward lifestyle change. (We are monitoring this now.)
Everybody wishes they were well. But everyone knows that means change. And we know how much everyone loves that!
I never claimed that Kate Baicker never said that “no expenditure is too large to save even one life.” I never asked her this if she believed it or not so I would not have commented on it.
I happen to think that life is valuable and I know that many wellness companies save lives each and every year. That is one of the most rewarding things that we do.
Maybe you can clarify your position on what you say Kate Baicker said. Do you disagree with what you say she said that no expenditure is too large to save even one life?
Haven’t you discredited yourself enough. Now you pretend that the author of the Rand PepsiCo study “specifically asked that you stop misrepresenting it.”? (I am sure you meant “you” to mean us.)
Not sure if you are trying to be funny or are just intentionally looking to annoy people but here is the actual conclusion from this article:
“What are the implications for employers?
We recommend that employers take three lessons from these findings. First, employers need to be clear about their goals for the wellness program. The RAND Wellness Program Study has shown that lifestyle management can reduce health risks such as smoking, obesity, and lack of physical activity. Our analysis of the Fortune 100 employer’s program also shows that lifestyle management can reduce absenteeism. Thus, if an employer wants to improve employee health or productivity, an evidence-based lifestyle management program can achieve this goal. But employers who are seeking a healthy ROI on their programs should target employees who already have chronic diseases.
Second, given the lack of financial return from the lifestyle component, employers need to pay attention to cost. Screening all employees for health risks and offering one-to-one counseling and coaching to those with such risks is expensive, but other interventions, such as offering healthy food choices and launching educational campaigns to use the stairs, are not.
Third, execution really matters. The findings presented here are derived from leading employers with a strong organizational commitment to wellness and substantial experience with running programs. Learning from them how to engage employees and achieve fundamental behavior change would be prudent for employers who want comparable results.”
Oh and the facts still have not changed:
“Disease management drives return on investment from workplace wellness programs.
Overall, the two component programs reduced the employer’s average health care costs by about $30 per member per month (PMPM). But disease management was responsible for 87% of those savings. Employees participating in the disease management program generated savings of $136 PMPM, driven in large measure by a nearly 30% reduction in hospital admissions. Furthermore, only 13% of employees participated in the disease management component, compared with 87% for the lifestyle management component. Put differently, the much higher participation in the lifestyle management component contributed only slightly to the overall savings. (Figure 2)
Our return-on-investment (ROI) calculations bear this out: Considering the ratio of reductions in health care costs to program costs, including the fees of the program vendors and the cost of screening employees for health risks, the overall ROI was $1.50 — that is, a return of $1.50 for every dollar that the employer invested in the program. But the returns for the individual components differ strikingly: $3.80 for disease management but only $0.50 for lifestyle management for every dollar invested. ”
So many of the wellness companies anymore are just subsidiaries of insurance companies and supply a nice avenue to collect and scrape data for sale, the epidemic continues. This is another reason to be a skeptic of what’s out there when you have the likes of Walgreens making about a billion a year or more selling data for one example. In addition you have Blue Cross and United buying your MasterCard and Visa purchase records from the banks, 30 years worth of data about, depending how old you are and when you got your first credit card.
You have Red Brick out there that is basically financed by United Health care running their software with trying to get employees to commit to biometric monitoring to get a discount on their insurance policies on the employee contribution side. Just go out and search Red Brick on the web, not a lot of happy campers as participants and I get them emailing me too, they hate them.
Then we had the Penn state WebMD story a while back to where they were going to penalize all who did not participate in the portal and enter data…all about collecting and selling data. Even the CEO of Mayo seems to be doing commercials to entice all others to give their data to United Labs. Last year Mayo took in almost $9B and had $367 M profit, $300 of that was donations and they want to build a new wing..so bond issue time and look for more money.
Wellness got away from wellness and was quantitated down to profit and thus a lot context and focus changed. Quantified justifications a very dangerous thing..and it’s in media too as reporters now on pay for performance too with the threat of the journobot. So when reading news today and see some really good soap opera type stuff that just jerks your emotional jugular, well that’s what it’s supposed to do, quality or not so the news agencies that are struggling for revenue streams get more ad exposure revenue.
The journobot has another twist to it as Eric from Nanex and I were talking from the stock side of things as stock bots read news so if there’s something you can create and automate to for the stock bots to react with, well the journobot would be it,..it’s at bot bot world..
This is the smartest thing you said so far:
“Maybe you’re right. I guess I need to apologize. We totally lack the qualifications to make these statements.”
The bottom line is you love attacking people who dedicate their life helping others. You misrepresent the facts and when confronted with the facts you do everything in your power to try to change the subject.
I asked you to correct the facts that you are reporting as they are inaccurate and you respond with more attacks. So have at it. I love what I do, I help thousands of people each and every year and have the testimonials to prove it.
We are simply on opposite sides of the same coin. I love helping people and you hate people who help.
RAND just asked that you stop misrepresenting their views on wellness http://www.rand.org/pubs/research_briefs/RB9744/index1.html and, while we’re on the subject, Kate Baicker did indeed clarify that she never said “no expenditure is too large to save even one life.”
So please, please stop misrepresenting people’s statements and positions. When people like you and Ron Goetzel say things that they know not to be true (like Nebraska’s vendor lied by mistakes so they get to keep their award) it makes our whole industry look bad.
Maybe you’re right. I guess I need to apologize. We totally lack the qualifications to make these statements. You’re the one who has written the books, won four awards (3 from Forbes, one from the Center for Healthcare Consumerism), been published in the Wall Street Journal and Harvard Business Review, taught economics at Harvard, been a partner at Bain & Co., and exposed fraud in the C Everett Koop Award and North Carolina Medicaid.
All we do is run a pathetic little company that pokes people with needles in disregard of USPSTF guidelines and are really worried about what happens to our job security if people start reading the literature and give up biometric screens and other worthless and intrusive interventions.
Sorry you get so upset with people who help others.
It is truly a sign of success to see all of the unfounded criticism. Especially when the truth has to be twisted so far from reality in order to criticize something.
I will ask again for Al to retract his inaccurate statements in this article and to show some character that you both are simply looking to point out the deficiencies in the wellness field and that you are not simply rabid critics of something that you really do not understand. There is a big difference between the two. I, and many others, would have respect for you and your work if you did truly report on the actual issues that exist in the wellness industry from the viewpoint of helping to fix it.
The wellness industry does help hundreds of thousands of people each year become healthier, happier and live a more fulfilling lifestyle. No amount of criticism will stop that from happening.
And there lies part of the problem. You make assumptions about the wellness industry that are simply not true of the ENTIRE industry but are true of a small portion of the industry and then draw incorrect conclusions.
You lack any practical experience in this area. If you had any experience running wellness programs you would know that what you just said is not true in the least.
If your precious wellness industry, which was birthed at the same time as the much-heralded managed care industry, had any history at all of beneficial impact, our population health status would not be in its present state. In fact, if wellness had worked — at all, anywhere, anytime, in any way that a rational person could measure — we might even be able to argue that health reform, the wellness industry’s major propellent, would have been unnecssary.
In the last three major papers on national health spending trends, two in Health Affairs and one in the NEJM, the health economists writing them don’t even use the word “wellness” in describing why health care spending has slowed. The fact is that serious people don’t take wellness seriously, but you and your crowd do, which will tell readers of this thread everything they need to know.
Sorry it took me a while to put two plus two together but I have a question.
The whole point of Al’s article is to trash wellness programs based on PepsiCo’s lifestyle management portion of their wellness program only produced a ROI of 48 cents for every dollar spent on that part of the program.
Their lifestyle management program included weight and nutrition management, fitness, stress management and smoking cessation.
So, then why did you brag about the John Hopkins research that shows the four behaviors known to reduce mortality by 80% entails no health care spending? Did you realize that the 4 behaviors are the exact same 4 components of the PepsiCo lifestyle management program?
Yes, and do you know the difference between a program and measuring behaviors and mortality that occur naturally in a population, which is what JHU scientists did and what the AHA has done in establishing its 7 standards of ideal cardiovascular health?
People who are motivated enough to achieve the four standards will pursue them without regard to programs or incentives and people who are disinclined to pursue them won’t. It’s the classic wellness lament: if we just had enough (time, money, incentives, rewards, penalities), we could (control) and change everyone. No, actually, you can’t.
Yes, Johns Hopkins researchers verified that regular exercise, eating a Mediterranean-style diet, keeping a normal weight and, most importantly, not smoking decreases the risk of cardiovascular disease by 80%.
No surprise there for anyone in the wellness industry.
You might be surprised to learn that many well run wellness programs focus on increasing exercise, proper nutrition, weight loss and smoking cessation.
Hey, maybe we are on to something.
Wow, way to not stay on topic.
Maybe I am right, you hate it that people are doing something that just might help someone.
Vik, it is sad.
How do you put a price on the value of someone’s life? Or put a price on creating better quality of life for an entire corporate population?
I fully agree with Mrs. Baicker… “No expenditure is too large to save even one life.”
It is clear that you do not understand and/or value helping others become healthier and helping others live a more productive and rewarding life.
I bet helping others makes you rather upset and you would do anything you can to stop that from happening.
So wellness should be the arbiter of overall health spending and a Quixotic search for disease in mostly healthy people will save money in the long run because we’ll predominantly find things that no one has? This reasoning is why serious health thinkers believe wellness is a joke.
Just in case any other economist is reading this thread, it is NOT the case that everyone who teaches or in my case, taught, economics at Harvard doesn’t understand that the value of a hypothetical life saved is not infinite.
Yep, Vik, Al is misquoting the PepsiCo article. As stated above!
I know your just trying to sell your book that comes from the prospective that prevention is a waste of time and money. You have every right to do so.
There is far more information proving that wellness programs are beneficial to corporations at every level. But you would not know as you have never run any wellness programs to see any of the results.
There is also far more positive information about the success of the wellness industry to deny.
Good luck with your new book!
Prevention is not the same as clinical preventive care. The former is primarily non-clinical while the latter is not only clinical but costly and frequently harmful. Prevention, such as striving for the four behaviors known to reduce mortality by 80% entails no health care spending (you’ll have to research them yourself…hint…Johns Hopkins epidemiologists).
I know wellness people don’t do much in the way of reading or analysis, because doing do would too self injurious, but you certainty have down pat the wellness fantasy of saving money and improving at health at nocost to anyone. Good luck with that.
What I am saying is that when you look at the ENTIRE corporate wellness promotions industry you find hundreds of great examples of programs that work. Just look at the Harvard Wellness Study. (I know you pretend that Katherine Baicker from the Harvard Wellness Study recanted the study. Unfortunately, that simply is not true. I asked her myself no more than a month ago.)
Your attacks can’t hold up to the light of truth. You continue to misquote studies, such as the PepsiCo study that this thread started on. You continue to attack anyone who comes forward with positive results from corporate wellness programs and you won’t listen to reason when people.
When we point out that your “facts” are wrong you change the subject.
The bottom line is you misquoted the PepsiCo study and it would show some character if you publish a retraction instead of attacking anyone who challenges your viewpoint.
How funny. Al is misquoting a bar graph right out of the Pepsi paper, but your addled conflation of disease management and wellness is somehow probative?
How about this misquote, also right out of the Pepsi paper: wellness proponents should “proceed with caution.” Disease management is the plucking of low hanging clinical fruit in people with ongoing ailments for which there are credible clinical algorithms. Once you being them into some kind of rational clinical process, there will be few medical and financial gains to be made, but their problems are by definition chronic and mostly uncurable.
Baicker can deny/ retract her retraction all she wants. Clearly, wellness true believers, who are nothing if not slaves to orthodoxy, have taken up her call. Just today, in front of benefits managers from the largest tech cos in Silicon Valley, Al and heard Baicker’s refrain as though memorized: wellness can be everything to everyone, but it’s too soon to tell, we just need to keep at it becauseI it will work eventually and no expenditure is too large to save even one life.
It appears that employees will have to decide this issue. When our new book comes out and employees learn how they’re being played with and, as Baicke herself encouraged, “experimented on” by their corporate leaders, we’ll see whose message is sustainable and credible.
BTW, in their vaunted healthy lifestyle awards application, the esteemed Helen Darling’s business group explicitly told award applicants to exclude program costs when estimating their ROI. In other words, ignore the cost of hiring vendors, such as your firm, Health Fairs Direct, from their application. Only in wellness does the cost of running something get willfully excluded from the return calculation. In what other business, besides politics, does that kind of financial stupidity go on as a routine practice?
So your view is that, for instance, the state of Nebrasks created a culture of health by lying about all the people their program diagnosed with cancer? Penn State? CVS?
Obviously you need to make a living in this field, but even so I might suggest getting your resume out. I’m just sayin…
Here is some other information about PepsiCo that Mr. Lewis does not want you to know. This is from a New York Times article from January 6, 2014.
“The study also found that savings were greater among people who participated in both the disease management and lifestyle components of the program — $160 a month, with a 66 percent drop in hospital admissions. That suggests that better targeting may improve the financial performance of the lifestyle programs, researchers said.”
I am still looking for more details of their program but this answers my question from my first post. Lifestyle components of their wellness program dis contribute to greater savings overall.
Also, here is an interesting question and answer from the same article.
“■ Could companies stop incentives for people who participate in “lifestyle” programs, or even eliminate such programs, if the programs don’t demonstrate big savings?
That’s unlikely, said Helen Darling, president of the National Business Group on Health. Keeping workers healthy can prevent them from developing high-cost diseases, like diabetes, she said. Plus, “these programs aren’t just there to save money, per se,” she said. Demonstrating a commitment to health helps companies recruit talented workers, providing a competitive advantage. “It sends a message that this company cares about people,” she said. “It will attract people who want to work for a company that demonstrates a culture of health.”
A better strategy could be to insert contractual clauses into the wellness company contract that set improvement measures to be accomplished, or their payment is lowered. Why put this all on the employee when the program isn’t accepted? That means they are not hitting the mark on getting people involved. And please, no more, “the list you gave us is corrupted.” People get their paychecks, so someone actually knows how to reach them.
Are you the Cyncy Nayer from the Center of Health Engagement in Florida?
Not sure what you are referring to with “the list you gave us is corrupted” but the rest of your point is well taken.
If you are from the Center of Health Engagement I am sure you already know that there are many components that go into creating employee engagement. Many of those are from the vendor side while others are from the employer side. I have seen many wellness programs fail because of the vendor and I have seen just as many wellness programs fail because of the company’s lack of commitment to the program. It truly takes a great partner relationship with good planning and execution, on both sides, to make a wellness program work.
I am sure you know that wellness is not a short term “event”. Wellness takes time, it takes handling the resistance that is inherent in every group, it takes creating trust with the employees, it takes dozens of things. But above all else it takes a company and a vendor that are both willing to evaluate their progress, or lack thereof, and adjusting their approach as needed in order to make a wellness program a success.
I am the Cyndy from the Center of Health Engagement. I completely agree that wellness is a lifetime skill, not a once-a-year scenario. And the msg of “list is corrupted” comes from the lack of engagement in DM and wellness efforts, often rebutted from vendors with, “you gave us a list without everyone’s correct address/it’s corrupted/theywouldn’ttakeourcall”, etc. The reality is that if we can’t make personal health management (wellness) a priority, we will lose any attempt at managing health care costs. That’s why I’m highly in favor of everyone having “skin in the game,” including vendors. It’s why I was turning somersaults when CMS adopted “outcomes-based contracting” for avoidable readmissions. Folks who’ve worked with me know that we can burden only the patient/worker, but everyone must be accountable. In short, John, I agree with you.
Wonderful and thanks.
All the best,
Again, truth has to be distilled from the fiction.
The actual article Mr. Lewis is referencing is below. It quotes a $30 reduction in health care costs per member per month (or $360 per year) with the Disease Management portion of their wellness program driving the majority of the cost savings while the lifestyle management portion did not produce a positive ROI.
So HURAH for another successful wellness program. Well Done PepsiCo. I would recommend that PepsiCo look at the effectiveness of their lifestyle management portion to see where they fell short. I would also like to learn a lot more about how their lifestyle management portion supported the disease management portion of their program.
Anyway, here is the exact article from Healthy Affairs. No Spin! No Agenda!
Please read for yourself.
Workplace wellness programs are increasingly popular. Employers expect them to improve employee health and well-being, lower medical costs, increase productivity, and reduce absenteeism. To test whether such expectations are warranted, we evaluated the cost impact of the lifestyle and disease management components of PepsiCo’s wellness program, Healthy Living. We found that seven years of continuous participation in one or both components was associated with an average reduction of $30 in health care cost per member per month. When we looked at each component individually, we found that the disease management component was associated with lower costs and that the lifestyle management component was not. We estimate disease management to reduce health care costs by $136 per member per month, driven by a 29 percent reduction in hospital admissions. Workplace wellness programs may reduce health risks, delay or avoid the onset of chronic diseases, and lower health care costs for employees with manifest chronic disease. But employers and policy makers should not take for granted that the lifestyle management component of such programs can reduce health care costs or even lead to net savings.
Or Go To: http://content.healthaffairs.org/content/33/1/124.abstract
Some of the drive could be because of a desire for actuarial fairness. Not that wellness programs achieve that to any meaningful extent.
The issue is that employers are the unsung single payer plan for close to 60% of US full-time workers. I’ve asked for eons why business is expected to be the pathway to group insurance, and it seems the scales might be tipping to change that.
I can see a hospital or health system being successful in driving wellness engagement in their workforce – it’s the business they’re in. Why on earth is a consumer goods manufacturer expected to become expert at healthcare and wellness? Granted, a healthier workforce would likely deliver better performance, but the incentives are in the wrong place.
Wellness and health need to return to the K-12 curriculum. It’s only in the 30 years since they fell off the classroom agenda that we’ve seen a steep rise in obesity and its sequelae …
Insurance companies are the ones who created the employer based system, not the other way around. Insurance companies wanted to select their risk population: young, healthy, working, fall off the rolls once they get sick and lose their job. Employers benefited by being able to hold their employees hostage for “the benefits” until Medicare/retirement. If Pepsico was serious about wellness, they would ban their employees from using their products. You are correct on wellness, it is something you need to focus on early in life and be led by example.
Well, actually, it was the US War Dept. and WWII defense plants, with an assist from insurers – and that program was only supposed to last the duration of the war, and defense worker wage freezes. But, as so often happens, it got institutionalized.
I get the joke that Pepsi would be best served by banning its workforce from using its products, but that flies in the face of our John Wayne-ness: individual liberty includes the liberty to act like an idiot, unfortunately.
I agree a lot of what we have been doing to support employee/dependent health is not working. Having been in business for 12+ years, we have tried just about everything you can imagine to drive results. The most effective strategy is to get employees to view their health insurance like car insurance. We all know how we pay for car insurance…bad driver, higher premiums. So whether participation or outcomes based, if the employee and their family do not play ball with the program, they pay more for their healthcare. Most employees get this concept and accept it because we all can relate to the consequences of a poor driving record.
Stuart: your car insurance analogy is very apt. But, it may be to late to connect behavior with premiums in the fully insured market because the ACA accounts for only one lifestyle habit in premium setting: smoking. Employees can, however, save on copays and deductibles by taking better care of themselves and using the system less. That’s what my new e-book, Your Personal Affordable Care Act, will teach people.
Thanks for commenting.
I have to say that I agree with this.
“it may be to late to connect behavior with premiums in the fully insured market because the ACA accounts for only one lifestyle habit in premium setting: smoking. Employees can, however, save on copays and deductibles by taking better care of themselves and using the system less.”
This is the ultimate goal of many wellness programs.
I appreciate Mike’s comment. Indeed, why has this industry thrived? I think it has to do with the customer (i.e. HR departments) and their attraction to what-everyone-else-is-doing. Employers do not necessarily care that their health program is science-based. They do care if it is comparable to everyone else’s programs, in order to retain good employees.
If health programs were purchased by CFOs, the world would be a different place.
The vitamin industry continues to go bonkers and make people millions despite little or no evidence. It takes someone doing real science to dispell witchcraft so that people can stop being ripped off on false claims. The wellness industry may continue to do very well financially by taking advantage of employers with promises of cost savings, when there are none. I don’t think anyone is making decisions on where to be employed based on whether or not an employer has a wellness program.
I and others who follow your wellness columns always ask, where’s the defense? What is the argument on the other side? Why don’t we have a wellness debate? If these people were as stupid as you make them out to be this industry would long since have gone away.