The Value of Workplace Health Promotion (Wellness) Programs

flying cadeuciiThe recent Health Affairs Blog post by Al Lewis, Vik Khanna, and Shana Montrose titled, “Workplace Wellness Produces No Savings” has triggered much interest and media attention. It highlights the controversy surrounding the value of workplace health promotion programs that 22 authors addressed in an article published in the September 2014 issue of the Journal of Occupational and Environmental Medicine titled, “Do Workplace Health Promotion (Wellness) Programs Work?”  That article also inspired several follow-up discussions and media reports, including one published by New York Times columnists Frakt and Carroll who answered the above question with: “usually not.”

There are certainly many points of contention and areas for continued discussion on this topic. It turns out that Lewis et al. and I agree on many things, and there are other areas where we see things differently.

Where we agree…

Biometric screenings. Biometric screenings are important for collection of baseline health risk data and are often viewed as an added value by employees participating in workplace health promotion programs. Lewis et al. and I agree that employers should screen their workers for health risks in accordance with guidelines recommended by the U.S. Preventive Services Task Force (USPSTF). These guidelines are clear about the necessity and periodicity of biometric screenings for high blood pressure, obesity, cholesterol, glucose, triglycerides, cervical cancer, colon cancer, breast cancer, and other conditions.

We agree that over-testing people is not a good idea and may lead to false positives, as well as unnecessary medical interventions that are costly and add little value. For readers seeking guidance on biometric screenings in a workplace setting, I refer them to a peer-reviewed article published in the October 2013 issue of the Journal of Occupational and Environmental Medicine.

Incentives. Workplace health promotion programs are not the same as incentive programs. “Smart” incentives are part of a well-designed program, but such programs need to be embedded in healthy company cultures wherein employers encourage and reward healthy behaviors. Comprehensive wellness programs often use financial incentives to attract participation and, in some instances, encourage behaviors that lead to risk reduction.

Most experts in workplace health promotion agree that creating intrinsic motivation for health improvement is an essential component of an effective program. As Daniel Pink points out in his book Drive, people, including workers, are motivated to behave a certain way when they feel a sense of autonomy, when they are able to master certain skills needed to change a behavior, and when they can connect changing that behavior to a larger purpose in life. This applies to individuals wishing to achieve certain health goals such as quitting smoking, being more physically active, and eating a healthier diet.

Paying people to improve their health in an unhealthy work environment is a futile strategy. Workers will expect higher payments each year, will view “non-compliance” as a penalty, and will mistrust their employer for trying to do things to them instead of with them.

To summarize, incentives need to be practical, ethical, and legal. The Affordable Care Act (ACA) legislation should not be used as a vehicle or excuse for “blaming” workers for poor health habits, or to penalize them financially for not achieving certain health outcomes. Employers share responsibility for the health and well-being of workers and can do much to create a healthy company culture.

For readers interested in a more in-depth discussion of health promotion incentive programs, I refer them to a series of Health Affairs Blog posts, and a guidance document prepared by the Health Enhancement Research Organization, American College of Occupational and Environmental Medicine, American Cancer Society and American Cancer Society Cancer Action Network, American Diabetes Association, and American Heart Association.

Culture of health. We also agree that effective workplace health promotion programs need to be embedded within a culture of health that respects workers’ rights to make informed choices about personal health matters. Without question, workplaces need to be safe and employees need to be treated with respect and dignity. Workers also have a right to be in a healthy work environment where positive health behaviors are encouraged and supported. That means making healthy food available in vending machines and cafeterias, encouraging physical activity, prohibiting on-site smoking, offering vaccination programs, and providing health insurance.

The list of programs, policies, and environmental supports for a healthy workplace is long and there are hundreds of environmental and policy interventions available to employers who wish to send a clear message that the company encourages and supports good health. For a more complete discussion of how companies can achieve a healthy culture, see the May 2013 issue of The Art of Health Promotion.

The importance of studying “wellness-sensitive” events…in addition to overall utilization and costs. Lewis et al. highlight the need to focus on “wellness-sensitive” medical events when conducting cost analyses. I agree but ask the authors to address the following questions:  What are these events?  Where have they been published?  Who has reviewed them? Why do they only apply to inpatient claims?  Are there not any “wellness-sensitive” events that would appear in outpatient settings?

The idea of analyzing claims for conditions likely to be most readily influenced by health promotion programs is sensible. In many of our studies, we have analyzed utilization and cost patterns for what we call “lifestyle diagnosis groups” or LDGs. For example, in a 1998 peer-reviewed study, we evaluated Procter and Gamble’s health promotion program and found a 36 percent difference in lifestyle-related costs in the third study year when comparing 3,993 program participants to 4,341 non-participants.

Although it’s important to analyze a subset of diagnoses when evaluating wellness programs, it is equally important to analyze utilization and costs for all conditions. After all, one’s actual well-being and perception of well-being influences health holistically; not just any one particular organ or body system.

Where we disagree…

Whether only randomized trials can determine whether workplace programs are effective. Health services research and the field of epidemiology have had a long track record of studying naturally occurring phenomena and drawing conclusions from observations of those phenomena. That’s how we have learned what causes hospital-acquired infections. We have also learned from long-lasting epidemiological investigations like the Framingham studies that a sedentary lifestyle, smoking, and obesity are causes of heart disease, diabetes, and cancers.

These “natural experiments” inform the scientific community about what happens to individuals or groups “exposed” to a condition whereas others are not. Natural experiments are employed when a randomized controlled trial (RCT) is impractical or unethical.

How does this apply to evaluation of workplace health promotion programs?  Imagine trying to convince the head of human resources of a company to approve a double-blinded randomized trial that would test the effectiveness of a wellness program, over three to five years, by randomly assigning some workers to a comprehensive health promotion program that includes health coaching on smoking cessation, weight management, physical activity, and stress reduction while other workers are denied access to the program. Not only that, the HR executive would be asked to allow the researcher to administer a series of blood tests to participants and non-participants, access their medical claims, and ask workers to complete periodic health surveys. The employer would also be prohibited from instituting organizational policies promoting health while this experiment is underway.

It’s hard to imagine a situation in which a company executive would allow this, never mind an institutional review board at a university.

Alternatively, when health services researchers conduct natural experiments, care is taken to control for as many confounding variables and address alternative hypotheses. In our research, we use statistical techniques such as propensity score matching and multivariate regression to compare the health and cost experience of “treatment” workers (those offered health promotion programs) and “comparison” workers (those not offered the programs). Most often, when comparing participants to non-participants, we match entire populations exposed to a program (whether or not individuals participate in that program) and those not exposed. In that regard, we are investigating program impacts on population health and not only comparing outcomes for motivated participants in programs compared to less motivated non-participants.

We publish our analyses in peer-reviewed journals so that the scientific community can review and critique our methods. We are also transparent about the limitations to our research in these peer-reviewed articles.

By the way, there are experimental studies focused on large populations (not necessarily at the workplace) demonstrating the value of health promotion programs. One such trial was recently concluded by the Centers for Medicare and Medicaid Services (CMS) as part of the Senior Risk Reduction Demonstration (SRRD). Two vendors were involved in the demonstration, which lasted two to three years  Beneficiaries participating in Vendor A’s risk-reduction programs achieved statistically significant improvements in stress, general well-being, and overall risk, and beneficiaries participating in Vendor B’s program achieved statistically significant improvements in back care, nutrition, physical activity, stress, general well-being, and overall risk.

Interestingly, the interventions were determined to be “cost-neutral,” meaning that Medicare spending for participants in the intervention group was not statistically different from spending for participants in the control group. This was a large scale study where about 50,000 beneficiaries were recruited and approximately 20,000 participated in the health promotion program in any given year. The bottom line: Significant health improvements were achieved at no cost to the government.

Interpreting the data. Lewis et al. highlight mistakes and errors in others’ presentation of results. I have no argument with that. That is, after all, what a peer review process is all about:  conduct the study, subject it to peer review, and publish the findings. The problem is that Lewis et al. have not (yet) published any studies in which their interventions are evaluated, nor have their methods been subject to peer review. That is unfortunate because I believe (truly) that all of us can learn from vetted research studies and apply that knowledge to future evaluations.

I am the first to admit that the methods we use to evaluate wellness programs have evolved over time and are still undergoing revisions as we learn from our mistakes. I invite Lewis et al. to reveal their methods for evaluating workplace programs and to publish those methods in peer-reviewed publications — we can all benefit from that intelligence.

One mistake Lewis et al. point to is a study conducted by Health Fitness Corporation (HFC) for Eastman Chemical Company, which earned the company the C. Everett Koop Award. (In the spirit of full disclosure, I am the President and CEO of The Health Project. which annually confers the Koop prize to organizations able to clearly and unambiguously document health improvements and cost savings for their employees.)  Eastman Chemical’s application is online and subject to review.

In their analysis of the Eastman Chemical application, Lewis at al. complain that costs for participants and non-participants diverged in the baseline years of the program and therefore it was not the program that explains cost savings. Here’s the real story. Eastman Chemical’s program has been in place since the early 1990s. The chart found on the website (unfortunately mislabeled) shows participant and non-participant medical costs at baseline (2004), in subsequent years, and the final year of the study (2008).

The study compares medical and drug claims for minimally engaged (non-participant) and engaged (participant) employees matched at baseline (using propensity score matching) on age, gender, employee status, insurance plan, medical costs, and other variables. No significant differences were found between participant and non-participant costs at baseline, but their claims experience differed significantly at follow up. Although not a perfect study, the economic results, coupled with significant and positive health improvements in many of the health behaviors and risk factors examined for a multi-year cohort of employees, convinced The Health Project Board of Directors that Eastman Chemical earned the C. Everett Koop prize in 2011.

Whether return-on-investment (ROI) is the only metric for evaluating workplace health promotion programs. It seems that too much of the debate and controversy surrounding workplace health promotion is focused narrowly on whether these programs save money. If that were the aperture by which we judged medical care in general, we would withhold treatment from almost every patient and for almost every procedure, with the exception of a few preventive services that are either cost-neutral or minimally cost-saving. That makes no sense for a compassionate society.

In a February 2009 Health Affairs article, I argued that prevention should not be held to a higher standard than treatment; both should be evaluated on their relative cost-effectiveness (not cost-benefit) in achieving positive health outcomes and improved quality of life.

Take a simple example of two employees. One has just suffered a heart attack and undergoes a coronary bypass procedure. If the individual is willing, he is then engaged in counseling that encourages him to quit smoking, become more physically active, eat a healthy diet, manage stress, take medications to control blood pressure, and see the doctor for regularly scheduled preventive visits. For that individual, I would be surprised if an employer providing medical coverage would demand a positive ROI.

How about a second employee?  That person is overweight, smokes cigarettes, eats an unhealthy diet, is sedentary, experiences stress at work, and has hypertension. He has not (yet) suffered a heart attack, although most would agree he is at high risk for such an event. To justify a health promotion program for that employee and others in the company, many employers insist on a positive ROI. Why is that a requirement?  If a well-designed program can achieve population health improvement (as demonstrated using valid measures and an appropriate study design), and the program is cost-neutral or relatively inexpensive, why wouldn’t an employer invest in a wellness program, especially if is viewed as high value to both workers and their organization?

It’s time to change the metric for success. Instead of demanding a high ROI, employers should require data supporting high engagement rates by workers, satisfaction with program components, population health improvement, an ability to attract and retain top talent, fewer safety incidents, higher productivity, and perceived organizational support for one’s health and well-being. That’s where program evaluations should be focused, not simply on achieving a positive ROI.

I appreciate the reality that some employers may still require an ROI result. Fortunately, there is evidence, published in peer-reviewed journals, that well-designed and effectively executed programs, founded on best practices and behavior change theory, can achieve a positive ROI. I won’t re-litigate this point, other than to point newcomers to a large body of literature showing significant health improvements and net cost savings from workplace heath promotion programs. (See, for example, studies for Johnson & JohnsonHighmark, and Citibank and several literature reviews on the topic).

I challenge proponents and opponents of workplace wellness to direct their energy away from proving an ROI metric to measuring one or several important outcomes of interest to employers, as listed above. Achievement of these outcomes is only possible when management and labor work toward a mutually beneficial goal — creating a healthy workplace environment. Health promotion programs require time to take root and be self-sustaining, but the benefits to employees and their organizations are worth the effort.

Ron Goetzel is a Research Professor at Emory University and a Vice President of Consulting and Applied Research for Truven Health Analytics. 

27 replies »

  1. Nice and informative article Ron!
    It increase the workplace performance and keep employees healthy. I’d love my workplace to have yoga, meditation and gym exercises…thanks

  2. yes i agree with this, it will be easier for everyone to be more practical and focused and of course leading to better things.

  3. Workplace healthcare, company paid mobile phones and laptops these perks interject work into ones personal life, while these are benefits worth having they also remove the separation of work and personal life.

  4. Although chronic diseases like obesity are among the most common and costly of all health problems, adopting healthy lifestyles can help prevent them. A wellness program aimed at keeping employees healthy is a key long-term human asset management strategy.

  5. Hi, EtAli, thanks for the free plug. However, they are now in the public domain if anyone would like them. (They are listed in the article on WSMEs that Ron seems to have forgotten he reviewed.)

    The support package is still $2000 and makes it much easier to work with them.

  6. FYI: “wellness-sensitive medical events”, brought to you by the Wellness-Sensitive Medical Event Committee (www.dismgmt.com/wsme) with release 1.0 in August of 2013. I will leave it to the reader to determine if the list is free to them as explained on the website or if they need to pay $1,000.00 for them.
    A support package may also be purchased for $2,000.00.

  7. The ability of Ron to parse words once he’s been caught is unsurpassed. For this misstatement in plain view on the smoking-gun slide to not be noticed by HFC, along with the Mercer, Milliman, Staywell and Wellsteps crowd that populates the Koop Committee, there are only one of two explanations: stupidity or dishonesty. The fact that all 4 of those companies have also been caught lying on http://www.theysaidwhat.net leads me to think it’s the latter, but I wouldn’t entertain a defense from the Koop Committee arguing that they are honest but just really stupid.

  8. “Vik’s position is that it’s written in a way that encourages (and will eventually mandate) useless (or worse) overconsumption while giving healthcare consumers a pass on sorely needed personal responsibility.”

    Well, overconsumption without responsibility is what made America great – isn’t it?

    Not sure how, if your quote is the theme of the book, that it justifies the title. Most of “consuming less” in America because it’s the right thing to do is making the other guy consume less so you can consume more.

    How was the law going to at least initially succeed if Obama had also tried to do what Vik says needs to be done – even Vik wouldn’t have be able to do that.

    The law helped more people afford the same out of control “system” we’re all in. Yea it sucks, but don’t deny needed health care to poor people so you can fight the the hard fight.

  9. Interesting point. Vik’s “click-bait” title aside, yes, “ObamaCare” (I call it “AHIPcare”) is really just a huge incumbents-in-place insurance reform law, with a smattering of QI pilots tossed in. Vik’s position is that it’s written in a way that encourages (and will eventually mandate) useless (or worse) overconsumption while giving healthcare consumers a pass on sorely needed personal responsibility.

    “…But, here is the crux of the issue: healthcare done well is predominantly about people, specifically, about helping people, and not doing more to anyone than is absolutely necessary. That is not what Obamacare is about. A patina of benevolence – “I’m with the government, and I’m here to cure you” – wraps around a subversive agenda that is, unfortunately, predominantly about power and controlling individuals to create the illusion of population health management. Obamacare is the fulfillment of an agenda that is singularly anti-individual, anti-liberty, and, most importantly, anti-personal responsibility.

    No President had ever before attempted such an ambitious overhaul of the U.S. healthcare industry. I refuse to use the phrase “healthcare system,” because that implies sensible, ordered relationships between components that work synergistically toward a goal. The wiring and plumbing in my house are systems. My dishwasher operates on the basis of mechanical, electrical, and hydraulic systems. Nothing is more remote from the U.S. healthcare industry than the idea that it is a system.

    The President was not wrong to try, because there was plenty wrong with US healthcare before Obamacare, and there is still plenty wrong afterwards. No, the President’s mistake was much more basic, and it undermines his landmark law. The President wrongly assumed that health is a medical product, and that the government could produce more of it by shoving people into a healthcare industry on steroids. It is the biggest strategic miscalculation and misunderstanding in the history of the concept of health.

    American healthcare has not failed because we don’t have enough technology, or we don’t spend enough money. We have plenty of the former and seemingly can’t stop doing the latter, even though we constantly complain about medical care costs. Our healthcare failed not because managed care plans and disease management companies can’t actually do either; we failed because we are terrible at managing ourselves. The only thing worse than our shameful lack of personal responsibility on health is our shamelessness about it, and our willful disregard of who must be accountable for fixing our national healthcare mess. If you have a mirror handy, now would be a good time to use it…”

    Vik Khanna. Your Personal Affordable Care Act: How To Avoid Obamacare (Kindle Locations 69-86).

    I will be reviewing it in some detail shortly.

  10. Bobby, don’t you find Vik’s book title a little deceitful? The sub text “How To Avoid Obamacare” misleads the potential reader (Obama hater) into thinking thinking Obamacare is a separate health plan and that other health plan policies somehow allow you to “take charge of your health” but Obamacare will not.

    What better way to sell some books than to throw out a little false red meat to the Obama hater wolves.

  11. Ron, as long as you’re answering questions (not), here is another one for you. If peer review is so important to you (the phrase appears nine times in your posting), how come none of the editors of the three wellness promotional journals (AJPH, JOEM, and AJPH) have ever asked either Vik or me to peer review anything, even though we have demonstrating our prowess at peer review by finding three fraudulent claims in your Koop Award winning programs, two of which have subsequently been retracted by the winner? (We haven’t even announced the third yet — we are having too much fun watching you dance around these two.)

    And here is another one: you said the smoking-gun HFC slide “was unfortunately mislabeled”. That is an interesting use of the passive voice, like “the ballgame was unfortunately rained out.” Can you be more specific: did some miscreant hack into HFC’s computers and mislabel the slide, or did HFC lie (again) and none of the eagle eyes of Mercer and Milliman and you on this committee managed to spot the lie even though it was staring you in the face or did you give them a free pass because they are a sponsor?

  12. Propitious Selection.

    I’d love my workplace to have an indoor squash court, a gym, room for yoga and regular bus trips for hiking in the weekends. I’m sure it will really help combat the social determinants of health.

    Well done Ron! Thanks for the financial aid to the middle class!

    The meek shall subsidize the bold and the beautiful.

  13. He’s losing his base too–I get contacted 1-2x/week by people who want to switch sides. By contrast, no one goes the other way.

    Funny thing, I am just this minute reading Good Calories, Bad Calories, which nails exactly what Goetzel’s issue is: “It’s very dangerous to have a fixed idea. A person with a fixed idea will always find some way of convincing himself he is right.”

    I on the other hand used to drink the Kool-Aid big-time, making a great living doing so, and had a lot of respect ofr Mr. Goetzel’s work, before I started looking harder at my own numbers and his. It turned out we were both doing the analysis wrong. I changed my mind — at considerably financial and (originally) reputational expense. Dee Edington, around the same time, did the same thing.

    The irony is that when Penn State’s Susan Basso asked Ron if she should contact me, his major argument against that was: I had changed my mind, as though that was somehow a bad thing. Ms. Basso, Goetzel, Highmark and Penn State proceeded to self-immolate in public view, when a simple phone call to me could have avoided the whole debacle.

    The irony, as Jon points out, is that Ron has now changed his own mind. He now emphasizes employee dignity and USPSTF guidelines–exactly the opposite of the Penn State program features. I am looking forward to how he reconciles these two seemingly opposite points.

  14. transposition – right on the money! – Soeren Mattke had the best explanation for this – he said:

    “The industry went in with promises of 3 to 1 and 6 to 1 based on health care savings alone – then research came out that said that’s not true – then they said ok we are cost neutral – and now as research says maybe not even cost neutral they say but is really about productivity which we can’t really measure but its an enormous return.”

    “What irks me are these aggressive sales tactics that make it a standard benefit based on unrealistic promises and then turning around and saying, but you shouldn’t look at savings in the first place”

    nuff said no?

  15. Hear, hear!

    I have to say, of all of the elements of Prof. Goetzel’s argument, the one that falls flattest (to coin a phrase) is that ROI ought *not* to be a measuring stick for workplace wellness programs.

    For goodness’ sake, how else does a business decide in what to invest? Any business is free to invest however it likes, but the ROI ought to be a significant part of that calculus, or else it will eventually cease to be a business.

  16. OK, Ron, your turn: answer the questions. Jon asks why you are now saying exactly the opposite of what you did at Penn State. Sam asks why every time I blow up one of your friends’ phony slides, you say the slide was a mistake and you really meant something else altogether (as Soeren Mattke predicted you would), I want to know how a company that appears to have defrauded a state by lying about cancer victims can be deemed a “best practice”, and we all want to know how you can say you’ve never heard of wellness-sensitive medical events (that coincidentally rarely show an impact from forced wellness programs) when you just reviewed a paper on that very topic.

  17. Certainly, as Goetzel suggests, workplace HP programs are not the same as incentive programs. However, incentives have become the industry staple in program design. In fact “wellness or else” is one of the major trends in the industry – it is estimated that within another year or so more than 60% of companies will be doing it!

    We are delighted to hear Goetzel state that creating intrinsic motivation is “an essential component of an effective program.” But the idea that incentives can be used to get participation that will then somehow transform into intrinsic motivation is not supported by the literature. Dee Edington nailed the reality quite succinctly recently saying: “the field has been riding the behavioral change horse for 40 years with little to show for it.”

    Goetzel goes on to say that “paying people to improve their health in an unhealthy work environment is a futile strategy.” We ask him how he aligns this conviction with his actions given his intimate involvement with the Penn State Fiasco. There, employees were punished if they did not comply with the directives of the program – including outrageously demanding that women document whether they were planning on getting pregnant in the following year or be punished financially ($1200) if they refused.

    Furthermore, if “intrinsic motivation” is the goal – we would ask Goetzel how his “smart” incentives (extrinsic motivation) would promote that goal given that we have 30 plus years of solid research that consistently shows that aside from not resulting in sustainable change, incentives (extrinsic motivation) actually engender DECREASED not increased intrinsic motivation. And his reference to Pink’s work on intrinsic motivation is additionally confusing given that Pink is clear that the iatrogenesis accompanying the use of extrinsic motivation (for anything that involves the slightest bit of thinking and creativity) which includes decreased intrinsic motivation (as well as cheating, lying, taking short cuts, etc.), occurs regardless of the “culture” or circumstances involved. In fact, we would argue that if the culture of an organization is truly thriving, it would have little need for strong-arming employees with health policies.

    Goetzel goes on to say that: “incentives need to be practical, ethical, and legal” and that “The Affordable Care Act (ACA) legislation should not be used as a vehicle or excuse for ‘blaming’ workers for poor health habits, or to penalize them financially for not achieving certain health outcomes.” So we ask, would be you willing then to take a stand, as we have done and call for an immediate end to all “wellness or else” programs (like Penn State) where that is exactly what happens – employees are punished for not participating or not reaching certain health goals. Whether these programs are “legal” or not is hardly the point. They are clearly unethical, there is not a shred of evidence that they result in sustainable change and they are highly unpopular with employees.

    Finally, regarding the “culture of health” – Goetzel’s description (while typical for the wellness industry) is, to say the least, out of sync with the conceptualization by Organizational experts. His description deals mostly with the environment and mostly with factors related to physical health. But in fact true organizational health – or a “healthy culture” such as defined by Lencioni and others (minimal politics minimal confusion, high morale, high productivity, low turnover) has little to do with broccoli in the cafeteria, fit bits, gym memberships and low cholesterol. While addressing these issues (if done FOR rather than TO employees) can have some benefit, it cannot take the place of and its potential impact pales in comparison to creating a truly “healthy” organizational culture – and it is all but irrelevant if the organizational culture is toxic.

    We invite others to join the discussion – we believe that the distinctions we are making are critical not only for promoting organizational and employee wellbeing, but also for the very survival of our profession. We hope that health and business professionals will see that there are clear differences in the paths being suggested and that – the only way to achieve the goal of having employees act like creative, thinking, responsible, autonomous adults is to treat them as if that is exactly what they are!

  18. I am not the least bit surprised that it is difficult to find cost savings with most wellness programs. As mentioned here, many programs conduct screenings which thrust employees into a costly and chaotic conventional medical system with roots in reactive, emergent treatment versus an environment where health is created and disease is prevented. It is no wonder our system performs so poorly with preventive and chronic care management. Health care as we know it for most situations is the wrong product at the wrong time. Our medical system is uniquely imbalanced towards the suppliers of the industry. If, for example, after the average doctor office visit of 7-10 minutes I am prescribed a statin drug after a review of routine blood tests, I will, in most cases have to take the drug for the rest of my life. When considering documented side effects like increased risk of diabetes, mental decline and muscle dysfunction, who benefits more from the life long use of medical products, the consumer or the supplier? Not to mention that “evidence based medicine” does not support the use of statin drugs to prevent heart disease, only to treat existing heart disease. Try to walk out of your physician’s office with elevated cholesterol, no history of heart disease without a prescription(s). This is only one vignette that is representative of health care transactions that take place every day. What if I walked into a Walmart and spent 10 minutes with a store associate and he told me that I had to buy a bicycle per month for the rest of my life, and then I did it because I thought it was best for me? Who wouldn’t want to be in the business of manufacturing bicycles? There is much opportunity lost in the overconsumption and inappropriate use of health care products and services and employers who self-fund their plans pay for much of it.

    The good news is that employers are uniquely positioned to benefit from an approach which puts the consumer in the driver’s seat, mitigating the effect of the suppliers, to create a situation where products and services are consumed in a more employee-centered, rational manner. Healthcare industry solutions overlook an approach to medicine known as Integrative or Function medicine, whose practitioners disrupt the traditional model of primary care. Integrative medicine is driven by bottom-up consumer demand and is lower cost, effective care that consumers want. Integrative physicians assess the patient as a whole, consider root causes of disease, then develop a treatment plan from all therapies available beginning with modalities that carry the lease risk. The primary emphasis is on disease prevention and achieving levels of optimal health, thereby avoiding more costly medical conditions. Private sector employers can tap into this trend by building access for their employees to an integrative medicine primary care platform, embed cutting edge services and technology, focus on the consumer experience, an operate it with the most qualified human capital that embodies the principles of health optimization.

    Employers who are interesting in exploring these options may write to me at linda.Edwards93@yahoo.com I authored a paper entitled “A Contrarian’s View on Managing Your Most UnManageable Expense: Health Benefits” which I will share with you. I have a unique perspective with a clinical background in addition to experience in Fortune 500 corporate health care with Human Capital Health Management, small business health insurance broker and health policy and insurance regulation.

    Seasons greetings to all. Merry Christmas and Happy Hannakah!

  19. So let me make sure I understand this. Soeren Mattke is quoted on the Lewis-Khanna post as saying that whenever a wellness claim is disproven, the wellness defenders say they didn’t really mean that, but rather they meant something else altogether.

    Didn’t you just do exactly that? Now you’re saying that Health Fitness Corporation didn’t really mean the “smoking gun” slide that invalidates the entire industry by showing participants outperforming non-participants. Your view of events is that they developed the slide, submitted it for review by your committee they sponsor, the whole committee reviewed it, it won the award, they presented the slide all over the industry, and they posted it on their website as an example of how great they are…but then suddenly now that someone has pointed out that it proves the opposite of what they intended, it turns out they didn’t really mean it in the first place? Please comment. Maybe I am misunderstanding.

  20. One background comment. Readers may not be familiar with the Nebraska case, but since that’s the most visible example of the ethical standards (and analytical prowess) of the Koop Committee. Readers can draw their own conclusions from this timeline. https://thehealthcareblog.com/blog/2013/08/08/the-strange-case-of-the-c-everett-koop-national-health-award/

    First, HFC became a sponsor of the Koop Award Committee, a wise move that coincidentally or not netted them and their clients several awards in the years ahead.

    Then, HFC decided to waive all USPSTF screening guidelines for Nebraska and let everyone who wanted a screen get one. To drive home their emphasis on overscreening, they sent around a flyer for colonoscopies featuring a model who was probably 15 years too young to be indicated for a colonoscopy. There is a copy of this flyer in our book Surviving Workplace Wellness.

    Next, they and their clients Nebraska won an award for this “hyperdiagnosis” as we call in in our book caused by the overscreening, plus data that was obviously invalid on its face, that no one on the ironically named Koop Committee noticed. For instance, you can’t save $4.2-million by having 161 people reduce a risk factor, particularly when you aren’t including the costs of overscreening in your savings calculation. Not to mention the likelihood that dropouts and non-participants would increase risk factors, offsetting those 161 people whose risk factors declined.

    Even assuming no dropout or non-participant increased their risk, the state would allegedly be saving $26,000 per person who lost a little weight or temporarily stopped smoking. $26,000 is roughly the equivalent of 161 heart attacks avoided in one year in a population that had fewer than 10 the previous year. Not that HFC would know what happened to the heart attack rate because it never occurred to them to measure actual population-wide wellness-sensitive medical events.

    Next, I wrote to several committee members and pointed out that all this stuff was wrong and that it simply wasn’t possible to find 514 cases of cancer when you were screening a few thousand people, let alone cure them.

    Next, Vik and I ratted them out to the Omaha World Herald. Their reporter got HFC’s medical director to admit lying about saving the lives of cancer victims who didn’t have cancer. No response from the committee.

    Next, Ron Goetzel both in September and November 2014, anointed HFC/Nebraska as a “best practice” in health promotion. I can send the links to anyone who wants them.

  21. My organization OmniMD is promoting health awareness programs at work places like Yoga and Pranayam (Ancient breathing exercise of India). There is strong endorsement from our CEO for implementation. such programs are very well institutionalized in OmniMD. Health promotion programs are work place are not new for OmniMD. it is older more than a decade.

  22. Unfortunately I couldn’t squeeze all the obvious self-invalidating parts of this posting into my Health Affairs comment. http://healthaffairs.org/blog/2014/12/22/the-value-of-workplace-health-promotion-wellness-programs/comment-page-1/#comment-1104199

    Among other things, can you please answer the following questions:

    (1) How can you claim no knowledge of wellness-sensitive medical events, as though this is the first you are hearing of them when you yourself REVIEWED a program, the Barnes program, which measured outcomes based on wellness-sensitive medical events on p 932 in the September 2014 JOEM? And since when do you have to be a rocket scientest to realize that, oh, hey, if we have a program that claims to save money by reducing wellness-sensitive medical events across a population, perhaps we should measure wellness-sensitive medical events across that same population?

    (2) Why is it that none of the people on your committee ever find any “mistakes” until I point them out? I’ve recommended many times that they take and you my course in outcomes measurement and I think the number of glaringly obvious mistakes you and your cabal “overlook” is the best argument for taking that course.

    (3) Why is it that it’s OK for HFC to keep announcing that they are winning your awards without announcing that they are sponsoring your awards?

    (4) How is it that Koop award-winners/sponsors (HFC) can simply lie and then admit lying about saving the lives of cancer victims who as it turned out didn’t have cancer, and the only consequence they face is that you call them a “best practice” twice in the last three months.

    (5) Suppose indeed your spin is accurate and that suddenly HFC and you have realized that in fact the Eastman Chemical wellness program began in 1992 and not 2004 Since there was no separation between participants and non-participants in 2004, according to your own slide, wouldn’t that mean an employer copying this award-winning program starting in 2015 would have nothing to show for it other than program expenses and very annoyed employees until 2027?

    I have any more quetions but I’d like to hear these answers first. Plus, I need to get back to my “day job,” which is booming in large part thanks to the great and very supportive coverage in the mass media that Vik and I have received for eviscerating this fraud of forced wellness “pry, poke, prod and punish” programs” that you have created in order to enrich yourself and your friends, who seem to be the only people who think it has value.