THCB

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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40 replies »

  1. 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.

  2. 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.

  3. 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 of its patients as well. The public can be pretty stupid sometimes, but they aren’t stupid enough to know when they are being hoodwinked into believing something that is obviously not true. Either that, or there is some sort of tax advantage for keeping a wellness program whose costs far outweighs its benefits.

  4. 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.

  5. 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 no intervention in lifestyles which often drive at least half of all chronic illness.

    After thirty-three years in healthcare, I only know of two ways to lower health care costs : reduce the unit cost per service rendered and better manage consumption. The first is not as easy as one thinks because better doctors ( not the least expensive ) often get better outcomes. You could move to Medicare based peanut butter spread reimbursement but you punish innovation and excellence. Highlighting high value providers over an entire episode of care is tricky business and raises objections from providers who are excluded from first quartile performance designations because they argue that their patients were sicker, irrespective of what age and actuarial adjustments are made to try to correlate treatments and outcomes.

    Second, we can reduce consumption by reducing waste and fraud as well as improving consumer health status to reduce lifestyle based chronic illness. We know Medicare has enormous waste and fraud and saves predominantly by rationing reimbursement to providers. Real consumption reduction comes with promoting better consumerism, transparency: publishing prices for all services, punishing those who defraud the system as consumers or providers and promoting health and well being including a mandatory annual age/gender based physical.

    Wellness is a catch-all term to describe initiatives focused on health improvement. The Supreme Court in their recent Roberts ACA opinion on Obamacare reminded us that it will never be government’s role to tell us to ” eat our broccoli” That leaves employers. If not us, than who? If not now, than when?

  6. 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.

  7. 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 would be good for employees.

  8. 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 be better?

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

  10. 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.

  11. 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

  12. 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 hide in their cubicles eating Butterfingers.

    Population Health is a more strategic basis of managing health risk. It is done rarely and poorly but is effective in laying a foundation for impacting actionable health conditions present in any workforce. It involves inventorying member health status through mandatory biometrics and combines this data with clinical claim reviews to determine the health status of employees and dependents. The ADA protected data is aggregated and used to help employers baseline their health status and target specific conditions — high fasting glucose, hypertension, high BMIs etc… The employer can understand who is well, at risk, chronically ill and unstable ( significant gaps in care ), chronically ill but stable ( compliant ) and catastrophically ill. Dr Dee Eddington on MIchigan did a greta job in his book “Zero Trend” to help us quantify the cost of multiple risk factors among populations and helped us create a framework for quantifying the ROI to reduce the risk factors resident in member populations. Now comes the hard part and why it is failing:

    1) Human Resources has a difficult time driving disruptive programs when their primary job is to smooth ruffled feathers and clean up after CEOs who are achieving productivity gains on the backs of employees by working them harder and longer. Benefits have become the proverbial cultural canary in the coal mine and Big Brother medicine does not sit well with HR who is not rewarded for reducing medical costs. They are rewarded for attracting and retaining talent. Misaligned incentive number 1.

    2) Wellness is not a Trojan Horse for pruning the work force of unhealthy people but most CEOs realize that unhealthy people and smokers are costing them money. If some one was drinking themselves into a stupor at work, an employer can intervene. If someone is socking away twelve Krispy Cremes and two milkshakes, an employer has no means to control the behavior even though it is likely that an obese employee will consume more medical benefits due to multiple co-morobitidites than an employee who jogs every day at linch and eats right. Is it fair to peanut butter spread ( no pun intended ) across an entire population when less than ten percent of the population is consuming 60% of the benefits? At least half of these conditions arise out of lifestyle. Should healthcare not be a bilateral social contract ( either public or private? ). Many employees don’t go to the doctor for two or three years and when they do, the ER is their primary care provider ( a $1200 visit for an upper respiratory infection versus $140 for a PCP visit ) We know that employees that have PCPs are less likely to be readmitted post surgery ( if they see their PCP within 7 days ), more apt to follow a treatment regimen and have fewer gaps in care and less likely to use the ER. Misaligned incentive #2.

    3) Consumerism can help drive market reform and do so much more to eliminate outlier poor value pricing than “wellness”. 40-50% of all consumption is elective or ambulatory; that is, the patient is standing up and can play a more engaged role in making sure they are getting value for money. We are patients when lying on our backs and consumers when standing up. What sickens a CEO is finding out that the cost of MRIs ranged from $800 – $4,800. Assuming a 10% profit margin requires the firm to sell ten times the amount of costs in revenues to cover the cost of the gold standard MRI. Providing concierge services and transparent provider unit cost coupled with forcing consumers to do some comparative shopping on elective and ambulatory services ( radiology, RX, outpatient etc ) can materially help moderate waste and overcharging. One could simply adopt 250% of Medicare as the standard of reimbursement and let the doc and patient battle it out.

    4) Employers want the same ability to direct care as they do in occupational injuries and it won’t happen. They have entrusted the oversight of health to individuals ( HR ) who are under-resourced and shy away from disruption. They have not come to grips yet with behavioral economics — People change only when they have to – usually a pain in their chest or a pain in their pocketbook. Insurers argue that they are a sentinel and that things would be worse if they were dis-intermediated. Today’s insurers are like yesterday’s stock brokers — getting paid whether the client wins or loses in the market. Most employers view their insurer as “the payer”, not themselves. Abdicating oversight to a party that has not proved to be able to truly impact costs and gets rewarded when costs increase, is weak.

    There is a price at which I am willing to quit the Oreos and quit raiding the minibar for M&Ms on business trips. My employer is close to it with its
    “incentives” for better health. BTW, when we went to mandatory biometrics, we had six conditions among about 3000 people where we identified asymptomatically ill members who immediately saw a physician because of dangerous hypertension or an abnormality leading to an early stage cancer diagnoses. Im not ready to wave the white flag and declare the private sector unable to drive loss control programs that are proven to increase compliance to reduce gaps in care, improve health awareness, increase PCP use, drive improved consumerism for elective and ambulatory services and in doing so, reap the dividends of lower trend and a more productive workforce. We have done a weak job as employers and the limited and poor results are more a byproduct of weak execution and a limited will to focus on or disrupt people. We may default into a very different delivery system but it won’t be because the ideas were bad. it will result from poor execution and limited attention span of those responsible for the spend and a poor job of current stakeholders e.g. insurers in moderating anything.

  13. 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 and wellness continues to suffer from that disease.

    However, Al I disagree wholeheartedly on one comment you made. This concerns that eating fat obviously is the cause of fat on the body. Not True! You need to brush up on your food reading. Here are a few ideas for starters:

    1. Denise Minger, Death by Food Pyramid
    2. Nina Teicholz, The Big Fat Surprise: Why Butter, Meat & Cheese Belong in a Healthy
    3. Gary Taubes, Good Calories, Bad Calories & Why We Get Fat
    4. Anything by the Weston A. Price Foundation

    Appreciate your work and here’s to your good health! ☺

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

  15. 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 and processes, how to monitor outcomes in order to improve the program.

    There are some simple and inexpensive things my system could do that would make it easier for my patients and I to do a good job – but they are not interested in hearing about that.

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

  17. 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 the same President who sold them the ACA to call off an independent enforcement agency, which he simply cannot do. Hilarious.

  18. 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…

  19. 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”

  20. 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 principal investigator commented by throwing “Proppeller” under a bus, and neither was ever heard from again.

  21. 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.

  22. 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 5%.

    Sometimes people asked a related question after our Health Affairs posting “The Million-Dollar Heart Attack Screen”: “Isn’t it worth spending a million dollars to avoid an employee’s heart attack?” I can’t answer that except to note that part of the spending of that $1M does to treating clinically non-meaningful findings in many other people. And even if the answer is yes (and many employers would answer yes), it still doesn’t make wellness cost-effective.

  23. 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 the mean, and confusing association with causation. The best results are from the worst studies, and the best studies show a neutral or negative ROI.

    *They ignore data that contradicts their marketing hype, and sometimes use data that is not just poor quality but truly fictional.

    *They claim that prevention can save large amounts of money, despite considerable evidence that this is a myth. (This doesn’t mean that screening and prevention cannot be done well, or that they are not justified based on non-economic criteria.)

    *They don’t understand basic principles of medical care, primary care, prevention and screening, and they ignore recommendations of groups like the USPSTF.

    *They are rife with potential conflicts of interest. They cite data created (sic) by the industry. In at least one instance I have heard about, a chronic disease management program was selected by an institution where the founder of the disease management company is the President of the institution, and the VP of the chronic disease program is the wife of the president of the institution.

    Isn’t the emperor getting cold, being naked and all?

  24. 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 also assumes an all carrot, no stick approach.

    I dont find above objectionable.

    Brad

  25. 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 of sales pitches.

  26. 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 to go on the record) told me exactly that. The company incentivizes people to get a full checkup every year–including a number of tests like EKG that USPSTF says not to get. Hence I obsess with false positivies. But this guy was given a clean bill of health. A week later, he had heart attack symptoms but delayed going to the ER by 6 hours because he didn’t see how he could possibly be having a heart attack, after such a great checkup.

  27. 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.

  28. 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).

  29. 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

  30. 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 self-insured groups. Am I wrong about that?

  31. I’m behind the curve on this issue, but have instinctively resisted my employer’s voluntary wellness initiative. It makes no sense to me that they can give money to participants for no obvious return. What is the business reason for wellness programs to exist? Is the data they gather useful, or even critical for mining? The data is outside of Hippa, correct? Could the data be gathered any other way? I’m missing the big Why question.

  32. Al
    Very astute observation
    I would think self funded employers would have a tinge of benevolence
    But even benevolence has its limit
    Any idea what percentage discounts are actually given
    I have no problem with encouraging people to live more healthy
    But the wellness programs are certainly controversial on the return on investment
    What is indisputable is that actuarial realities can be transformed into mathematical certainties on a group wide basis
    Commercial insurers could have done this but either they were not aware of this maxim or they chose to ignore it
    National Prosperity Life and Health is using this maxim
    To provide significant group savings from
    year one and accelerating thereafter
    To learn more go to nationalprosperity.com
    Don Levit

  33. Peter, it is indeed a mystery. You may be right. I do like the conspiracy theory but I can’t prove it.

    Don, these companies are self-insured. you are right in that no insurer would do anything like this for an insured population, not even close. They have actual actuaries working for them

  34. I understand the ACA wellness provisions to be incentives not punishments
    From the normal rate one can obtain up to 50 percent discounts
    What insurer is willing to cooperate with these discounts?
    Don Levit

  35. I agree fully with most of this.

    I disagree with the assumption that people in the C-suite are competent in biostatistics, principles of medical research, preventive medicine or primary care. It seems utterly believable to me that they truly believe that wellness programs are good for employees and good for their business. (There is little doubt in my mind that workplace wellness programs are quite good for the companies that sell the services, but there is plenty precedent for that in medicine. Numerous testings and treatments are only good for those who sell them, not those who buy them. But I digress.)

    Never ascribe to malevolence what is explainable by ignorance.

    Peter Elias, MD

  36. Hi Steve,

    You are of course correct in that it is theoretically impossible to prove a negative. Wellness outcomes challenge that theory. http://www.theysaidwhat.net has about 25 instances of people making up outcomes. On the other hand, literally no one has shown an outcome in the last 3-4 years that isn’t obvously wrong (assuming they providing the backup data), so it’s made-up numbers 25, legitimate outcomes 0.

    It is also not theoretically possible to save money by reducing wellness-sensitive medical events. There are nowhere near enough of them to cover a modest incentive, let alone program cost. plus there is no real evidence that these events can be preveneted through a “pry, poke, prod and punish” wellness program of the type espoused by the BRT.

    Thanks for your comment and for bringing this up.

  37. I liked this article but it opened up by claiming to have proved a negative which bugged me enough to consider stopping. I only kept going because I trust you guys write stuff worth reading from past experience.

    I gave up on social science when I realized some professors think their research has vast, maybe limitless external validity. Don’t be one of hose guys.

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