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Wellness Puts CEOs on a Collision Course with Obamacare and Common Sense

flying cadeuciiBy now readers of this and many other outlets know that conventional workplace wellness doesn’t work. Period. It’s not that there is no evidence for it. It’s far more compelling: all the evidence is against it. The so-called “evidence” in favor of it is easily disproven as being the result of gross incompetence and/or dishonesty. And occasionally, as in the American Journal of Health Promotion, investigators in this field manage to disprove their own savings claims without intending to, “face invalidity” as it might be termed.  This is not an isolated event: analytic self-immolation happens so often that Surviving Workplace Wellness even has a line about it:  “In wellness, you don’t have to challenge the data to invalidate it.  You merely have to read the data.  It will invalidate itself.”

Just before Thanksgiving, both Health Affairs (with our blog post which, given the events we are about to describe, seems almost prescient) and the often-misquoted author of multiple RAND studies (in a comment to that post) weighed in with the same conclusion, as described in the headline: “Workplace Wellness Produces No Savings.”

The article, Health Affairs most widely read posting of November and one of the most widely read of the year, was described to me as the wellness equivalent of the 1912 Armory Show, as being the seminal event that immediately changed the field forever. No longer could anyone claim with a straight face that “pry, poke, prod and punish” wellness programs saved money, or were even beneficial for employee health.

And yet…

Within one business day of this posting, Reuters’ Sharon Begley reports that on Tuesday, December 2, the Business Roundtable’s (BRT’s) CEO is having a sit-down meeting with President Obama to demand exactly the opposite of what all the evidence shows: more flexibility and less enforcement to do wellness as the ACA empowers them to.  In particular, they want the Administration to call off the EEOC watchdogs, who have recently attacked Honeywell  and others for forcing its employees into medical exams that appear to violate the Americans with Disabilities Act.

The BRT’s goal is to allow companies to punish unhealthy workers to the limits of the Affordable Care Act’s wellness provision.  (Recall from our earlier postings that the ACA wellness provision itself was modeled after the Safeway wellness program, which Safeway later admitted did not even exist during the period for which the company claim it saved money.) In essence, the BRT leadership wants to make their employees love wellness whether they like it or not.

This complete disconnect between the data and the BRT demands can be explained only one of two ways.

(1)   The CEOs who comprise the Business Roundtable have been duped into thinking wellness saves money, because they aren’t bright enough to Google it for themselves and learn that it doesn’t

(2)   The CEOs who comprise the Business Roundtable are VERY bright and have figured out that the only way they can seriously manage their healthcare costs is by fining or shaming employees with chronic disease or obesity into leaving their companies…or at the very least collecting large fines from them.

Let’s examine each possibility in turn. As to the first, these people didn’t get to the C-Suite by simply accepting information that their vendors tell them, especially when the numbers obviously don’t add up: events that can be prevented by wellness programs, like heart attacks, account for only about 8.4% of  hospital spending, or less than 4% of total medical spending in the commercially insured population.   And they also must know that, as with the tobacco industry years ago, when the only people defending an industry are people who make their living from it, wellness is a wholly illegitmate enterprise.  This explanation would therefore need to be termed an impossibility.

The second alternative seems like something only a conspiracy theorist could conjure, but as Sherlock Holmes said: “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.”

These CEOs must know that these “let’s play doctor” programs and fines are expensive, intrusive, ineffective and embarrassing for the employees…and take a major toll on morale. One organization, Penn State University, faced an employee revolt, and backed down. Vik is currently in a wellness program that is eerily Penn State-like, and he is documenting his experiences.

And surely someone has informed the BRT that the heart attack rate is only about 1 in 800 in the commercially insured population, while identifying all the other diseases they hope to prevent or control will merely drive up their drug spending since these nascent conditions wouldn’t become debilitating until years into retirement. Most importantly, these companies’ programs largely disregard screening guidelines promulgated by the United States Preventive Services Task Force (USPSTF). With a few exceptions like blood pressure, the guidelines call for judicious use of clinical screenings in various at-risk subpopulations, whereas wellness screening is done to all employees usually at least once a year. That screening frequency multiplies the odds of false positives, especially in younger populations.

So why go to the mat with the President over these programs? Perhaps because these companies are all self-insured, and they believe that unhealthier people cost them more. This is a reasonable viewpoint strictly as a matter of Scroogian economics. Likewise, they believe that fatter employees have lower productivity, which is also probably the case – if you happen to own a package delivery service or a ballclub. Otherwise, it’s hard to imagine that weight impacts one’s ability to answer to phone, conduct a meeting, or almost any other task commonly required in today’s workplace. And these CEOs own actions contradict their claims: most of the growth in line manufacturing jobs takes place in states with high obesity rates…but lower wages. Obviously the tangible benefit of the latter overwhelms any offset by the former, or they wouldn’t do it.

Unless there is an alternate explanation (or the BRT simply doesn’t understand the data), this BRT demand must be interpreted more cynically: It’s the opening salvo in an old economy jihad against aging and chronically ill employees whom they simply aren’t allowed to fire any more, just because – often due to circumstances beyond these employees’ control – their health care expenses are believed to be higher.

Al Lewis and Vik Khanna are co-authors of THCB’s first e-book,Surviving Workplace Wellness With Your Dignity, Finances, and Major Organs Intact.

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DermafreshCynthiaPerryJay Moore, MDLeoHolmMD Recent comment authors
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Dermafresh
Guest

I agree with the comment, What insurer is willing to cooperate with these discounts?

Al Lewis
Guest
Al Lewis

Almost all of these programs are done on the self-insured. So the insurance company takes no risk and for them it’s a sales thing. In THCB we once gave the example of Aetna offering an obesity program that they refused to subject their own employees (or insured members) to for the simple reason that it was fantastically expensive and likely ineffective. A few new plans targeting young people, like Oscar, will offer discounts and free fitbits etc. to new enrollees. Their goal is to favorably select people who are likely to be healthier. It’s a good idea, probably.

Cynthia
Guest
Cynthia

The hospital where I work has an employee wellness program, and I have little doubt that it does anything to improve the health of its employees. Despite it being a total waste of money, money that could have been used to improve patient care or provide better benefits to employees, e.g., reduced parking fees or lower insurance premiums, I figure the hospital has kept its wellness program merely for PR purposes. The hospital probably figures that if the public sees that it cares about the health of its employees, the public will also think that it cares about the health… Read more »

Michael Turpin
Guest

Post Script… The Penn State program failed in large part because the health risk assessment questionnaire was ridiculously invasive and asked questions that crossed the proverbial Bog Brother Line e.g. Are you having marital problems ( presumably as a leading indicator of stress ) Stupid! BTW, if you have tried to manage benefits for a major university, tenured faculty make the Brotherhood of Electrical Workers look like the yes men. This is a militant constituency that believes no benefits should be cut and that the university has an obligation to maintain benefits irrespective of the rising costs. This also includes… Read more »

Al Lewis
Guest
Al Lewis

Thanks for the comment. I’m all for broccoli, sautéed in a little soy sauce. But alas it doesn’t seem to make much of a difference. Probably just coincidence but the increase in consumption in fresh produce and reduction in consumption of red meat has paralleled the increase in obesity.

And remember, wellness-sensitive medical events are only 4% of an employer’s spending anyway. Reduce those by 10% and you save…0.4% of your total spend, before costs are taken into account.

Perry
Guest
Perry

One problem I see with so-called “Wellness” programs? Many of the companies that promote these programs work their employees outrageous hours and under hugely stressful conditions and wonder why their employees’ health isn’t better.

Jay Moore, MD
Guest
Jay Moore, MD

Two questions: 1. Does a workplace focus on smoking alone make a difference? Smoking causes so many health problems, quitting smoking clearly improves health immediately, and a modest incentive to an employee who quits smoking seems like a no-brainer to me. Thoughts? 2. Employer wellness programs as currently designed may be unhelpful and produce no real ROI. But can employer wellness programs be redesigned to be effective? If these programs focused on USPSTF recommendations only, and perhaps encouraged people to get moderate exercise and eat a few vegetables, and somehow managed to do this in a non-Orwellian way… would that… Read more »

Al Lewis
Guest
Al Lewis

The smoking provision of ACA is the most popular (next to insuring kids) and possibly the most effective. There is a reason we didn’t mention it in this smackdown. Because for some small percentage of smokers it might actually work. That is not the focus of the debate, though, because it doesn’t require a forced medical exam. As to your other question, if you did that you would improve health, but ROI would still be elusive. Companies don’t spend enough money (about 4% of total health spend) that even a successful program would have a noticeable financial benefit. Still, it… Read more »

Michael Turpin
Guest

Well, where to begin: Interesting post painted with a sarcastic broad brush and tinged with bitter truth. 1) There is a big difference between “Wellness” and “Population Health Management”. Wellness involves having a well intentioned health fair where some ex-fitness consultant who looks like the offspring of a POW and a mannequin gives away gift cards and offers to take the blood pressure of employees. The only employees who show up are young single men and employees with resting heart rates under 12 show up to compare how fit they are while 70% of the firm with BMIs over 35… Read more »

Krisna Hanks
Guest

As a self-proclaimed wellness rebel, I have for some time been calling for a Slow Wellness Movement, meaning no more prying, poking and punishing under the disguise of “your wellbeing.” http://www.square1wellness.com/slow-wellness-movement/ However, forces at be (read academic and governmental institutions) are often given roles as “key leaders” or “experts” that advice and dictate how wellness in the workplace should be run. While neither of those fore mentioned camps have really held positions either in a business, corporation or entrepreneurial company. Thus, the common sense understanding of how to run a business and manage employees is non-existent. Therein lies the issue… Read more »

Al Lewis
Guest
Al Lewis

Krisna, I’m sorry. I meant the opposite, that the concept that eating fat caused you to be fat was one of those things, like wellness, where proponents drowned out dissenters, even though the dissenters were right. I’m with you on this. I’m reading Teicholz now with Taubes already downloaded. Kills me to think of all those eggs I’ve passed up through the years in order to eat Cheerios

Krisna Hanks
Guest

Al,
Good to hear, I was worried there for a minute thinking you had succumbed to the latest wellness challenge of eating only egg whites & drinking skim milk followed by get your cholesterol tested! Breakfast is on me if our paths cross beyond virtual sometime in the future.

Al Lewis
Guest
Al Lewis

By the way, has anyone noticed, for the past two years, that the dog never barks in the nighttime? We’ve published about 30 anti-wellness diatribes (and a couple of shout outs to good programs) but never ever get responses from the other side? The one pro-wellness THCB posting in the last 2 years was authored by ShapeUp, and we soon noticed that they too were making up numbers http://theysaidwhat.net/2014/07/23/shapeup001/ . They were never heard from again, and removed the offending slide from their website without apologizing. In the only other response, a company called “Propeller Health” was called out. The… Read more »

Matthew Holt
Editor

Sorry, Al, that must really be pissing you off!

Al Lewis
Guest
Al Lewis

Thanks bro. Now I know how the GIs felt in ‘Nam when the VCs wouldn’t come out and fight

Peter Elias
Guest

Hyperbole, perhaps?

Bill Springer
Guest
Bill Springer

And not coincidentally, it turned out that the Johnson Administration was putting out bogus numbers about what was really going on there, too!

Peter Elias
Guest

Let’s see what a summary of the workplace wellness industry looks like: *They ignore the peer-reviewed literature about how hard it is to change human behavior over the long term and how incentives provide (at best) only small, short term changes, which often result in weakening internal motivation, ultimately changing an impactful social construct into a market construct. *They don’t do math well, and at times claim both health and ROI results that are fantastical. *They don’t understand the basic principles of biostatistics or research, so much of their data is made invalid by things like selection bias, regression to… Read more »

Brad F
Guest

Al The data supports targeted disease management in those with chronic ailments. For sake of question, lets define chronic ailments as those leading to higher costs or absenteeism. If an interested company–for reasons of savings or beneficence–wishes to intervene to find the at risk 5%, a limited screen by contracted outfit might benefit (outside of routine care performed by community providers). The alternative would be to screen claims in those already with chronic conditions or at risk identifiers. Dicey? Comes down to company choosing routine medical care, programs offered by MCO, etc., vs targeted screens through other channels. The scenario… Read more »

Al Lewis
Guest
Al Lewis

In an ideal world I would totally agree. However, it simply isn’t at all easy to find people who are truly at risk. Predicting events is a low-probability proposition. And they can’t even ask about family history, which is key, while they don’t need screens to find smokers, which is also key. The added value of all the other risk factor-finding is way more than offset by the false positives and followups from those. Trying to get smokers to quit is a laudable idea, and would reduce risks, but is also very difficult. Smokers would be disproportionately represented in that… Read more »

Brad F
Guest

AL
My thoughts aligned more identifying folks with diabetes, CKD, inflammatory conditions, or asthma lets say–who incur higher costs. If your back of the envelope company prevalence rate > than 2-3%, may offer ROI. But you dont know unless you look.

Obesity and smoking too ubiquitous, obvious, and beaten to death.

Peter Elias
Guest

Brad and Al ~> As a PCP, I struggle on a daily basis to help patients do better with managing chronic illness and preventing complications. Any PCP will tell you this is a very challenging task. I would love to have help with these patients, and the thing I find most irritating about the wellness initiatives I have seen and experienced (a small number) is that there is no attempt to make contact with the local PCP community to ask what services or resources would help, how best to coordinate efforts and avoid duplication, how to determine appropriate medical goals… Read more »

LeoHolmMD
Guest
LeoHolmMD

Paying Primary Care to address these things breaches the wellness model of the employer doing it. Yes, wellness efforts are redundant and frequently wasteful.

Al Lewis
Guest
Al Lewis

Matthew, that is possible. I have no idea how they measure that, and whether they count the time spent getting these screens and checkups and filling out HRAs in the calculation, or all the time spent at the water cooler talking about what a joke this program is. There is a line that one vendor says “your employees will be 3x as productive,” which of course makes no sense. Can a pilot fly a plane 1500 miles an hour? A checkout clerk ruing up 3x as many groceries? Curly, at NEBGH a week ago Wednesday, someone (who will be willing… Read more »

Curly Harrison, MD
Guest
Curly Harrison, MD

All it takes is one hospitalization for one case of self neglect due to the illusion that the patient is “well”, and any savings (if there ever were any) is gone. Pooof, just like that.

Wellness programs=farce. The employers would be better off paying for their employees’ medications and mental health care.

Al Lewis
Guest
Al Lewis

Curly, it happens that at my 11/19 presentation someone told that exact story. They went to a forced physical –comprehensive, including naturally a lot of tests the person wasn’t indicated for — and was given a clean bill of health. A week later he felt heart attack symptoms. he ignored them for a full day, thinking that he had just gotten a clean bill of health–thus putting his life in danger and damaging extra heart tissue, all because of his company’s wellness program.

Matthew Holt
Editor

For “This complete disconnect between the data and the BRT demands can be explained only one of two ways.” you missed explanation 3 , which is slightly less implausible than the conspiracy theory.

Employers believe wellness programs make their employees more productive. (You dont have numbers disproving that, I believe, although I grant you that the wellness industry may not have numbers proving it).

Vik Khanna
Guest
Vik Khanna

Having actually run wellness programs, and being in one right now that is wasting both my and my wife’s time (it’s her employer), I can truthfully say that the major impact on productivity is negative. As for what employers believe, they also used to believe in Wang computers, that Microsoft would forever be the only game in town (what’s the cloud?), and they currently believe that it makes sense to have wellness programs but sell their employees crap food and deal with none of the issues that stress their people. In business, too many “beliefs” are just the end result… Read more »

Matthew Holt
Editor

Vik. It doesnt matter what you believe (supported by facts or not). It doesn’t matter whether employer CEOs’ beliefs are supported by facts or not.

What matters is what they believe and why, and i think my theory about “CEOs believe in productivity gains” is more plausible than yours about “CEOs using wellness programs as a trojan horse for identifying all the fatties and firing them”

Peter Elias
Guest

I am inclined to agree with Matthew, that they truly believe their programs will make workers more productive and save money. That they have no credible data to support this is irrelevant, because people act on the basis of what they believe and work pretty damn hard to edit and select facts to support what they believe. It is uncommon for people to change what they believe based on new information. “We are slow to believe that which if believed would hurt our feelings.” (Louis Nizer). And ALL of Kahneman, much of Ariely, Margaret Heffernan, Kathryn Schulz and others…

Vik Khanna
Guest
Vik Khanna

True, they do believe in productivity, because productivity = profits. That’s why they automate whenever possible and move their manufacturing plants to right-to-work, lower wage states. You think productivity gains in auto or tech manufacturing or any other major business sector over the past two decades are because of wellness programs. Can you spell t-e-c-h-n-o-l-o-g-y? Their political problem is straightforward: they suppoted a pig in a poke, the ACA. They did what the ACA told them they should do. Now, they’re getting sued, the pig is ugly no matter what kind of lipstick you put on it, and they want… Read more »

Don Levit
Guest

Al
You are correct
We are starting in the self funded market for 2 reasons
Capital and surplus requirements are much lower than fully insured
We can build capital and surplus quite rapidly with self funded employers with 200 employees or more
We plan to enter the fully insured market in 2016 using a commercial insurer as our partner who takes the place of the employer

Al Lewis
Guest
Al Lewis

Chris, this is a head-scratcher indeed. I believe it is one of the many things (like fat in the diet causing people to be fat) that is so intuitive that it doesn’t get challenged at first (I know I didn’t — my first book is pro-screening just on the assumption that prevention has to be a good thing)…and then by the time it gets discredited there is an entire $10B industry that relies on it for a livelihood so the voices supporting it drown out the actual data. Don, from what I can tell from the website National Prosperity serves… Read more »