THCB

This Is Your Brain On Wellness

flying cadeuciiAs a CEO of a company in a competitive industry, I cross my fingers that my competitors will implement wellness programs.

Indeed, the more comprehensive their programs, the better it is for me. Those competitors will suffer increased healthcare costs, compounded by declines in productivity. Best of all, these programs’ negative morale impact may lead some employees to quit, thus facilitating our own recruiting efforts. (This is especially true for overweight employees, whom wellness vendors really seem to dislike. We, on the other hand, find employee weight makes no difference in either productivity or health spending.)

So hopefully my competitors will disregard the rest of this posting.

As background for those readers who are mercifully still unfamiliar with workplace wellness programs, they generally consist of four components (called “pry, poke, prod and punish” programs as shorthand):

1. A “health risk assessment,” or HRA, that pries into your employees’ personal lives, often asking about their drinking habits, marriage etc.

2. A “biometric screen” where technicians in white coats come to your workplace and poke your employees with needles to test them for diseases that in many cases, the government’s clinical guidelines say they shouldn’t be tested for. A small but increasing number of programs demand employee DNA, which isn’t in any clinical guideline.

3. Prodding employees to go to the doctor when they aren’t sick, to see if the doctor can find anything wrong with them;

4. Punishing employees who refuse to submit, either in the form of penalties or lost incentives.

Further, more and more programs are “outcomes-based,” meaning money gets tied to weight loss. (To maximize earnings at the expense of their long-term health, employees can binge before the initial weigh-in and then crash-diet before the last. Is this a great country or what?)

There are three reasons I hope my competitors undertake these programs.

First, their healthcare expenses will rise. Even wellness vendors themselves admit — in their official consensus industry guidelines — that wellness loses money. That’s why the Los Angeles Times calls wellness a “scam,” why the New York Times‘ economists say: “workplace wellness programs don’t save money,” and why the steadfastly neutral nonprofit RAND Corporation says it “does not reduce…cost.” Wellness may be the only issue that the right-wing publications we  love to hate – Newsmax and the Federalist – agree with the reviled “liberal media.”

In addition to the considerable cost of wellness itself, there are the extra checkups, lab tests, and the whole “treatment trap” that an employee gets sucked into when a wellness vendor “finds something,” which wellness vendors love to do…and brag about, even making up diagnoses to inflate their findings. We call that hyperdiagnosis.

Second, their productivity will decline. Consider the time spent completing these HRAs, the time wasted in “health fairs,” and the hours lost to forced annual checkups that everyone agrees are worthless, even the doctors themselves. But that’s not the half of it. Now add in the time employees spend telling one another what a stupid idea your wellness program is (and you need only read the comments on other articles about wellness to see how employees feel). And that raises the third point…

…Their corporate morale will suffer. Once again, this is something the industry readily admits, “morale impact” being one of many program costs listed in their consensus document. (Probably never before in history has an entire industry voluntarily admitted its worthlessness as thoroughly as the wellness industry did here. Use this reader’s guide to help interpret this self-immolation.) No need to take the industry’s own word for it. Penn State, CVS, and Honeywell provide excellent case studies.

Better yet is this rant, a typical set of complaints about wellness – the wasted time, stupid and overly personal queries, incompetence, and increased cost. Unfortunately, this organization for whom this person works is not a competitor of mine, or I’d have my recruiters working overtime.

Newsflash: employees want to be left alone to do their jobs. Except at both extremes, it doesn’t matter what they weigh. So don’t “play doctor,” or force employees to get “coaching” for issues they don’t want you involved with.

If you engage your internal wellness staff in a candid moment–which we hope our competitors don’t do–they themselves will likely admit or offer that wellness vendors just make their own jobs harder, make them more unpopular and probably impede them from actually helping to create a healthier culture, which is why you hired wellness experts in the first place. Like all your other employees, they just want to be left alone to do their jobs.

Yes, this is a much different take on wellness than the kumbaya viewpoints that have also been shared. However, those posts are written by the CEO of a wellness vendor and bear no relationship to what that particular vendor (or most others, with a few carefully validated exceptions) want to actually do to your employees to maximize their profits. And these posts lead to another observation about wellness: no one defends it except the vendors and consultants who make money off it. This is a true indication of an industry’s parasitic irrelevance.

Unfortunately, even my densest competitors will figure this out on their own someday.

Al Lewis is the author of “Why Nobody Believes the Numbers” and co-founder of Quizzify.com.

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20 replies »

  1. I am not opposed to these wellness programs at workplaces, but I do not believe forcing people to do “health coaching” is the right answer. Most people do not want to discuss their health problems with a health coach, who they do not know. It would be different if it was his/her primary care physician, but talking to a stranger about weight loss, diseases, alcohol intake…this seems more appropriate to discuss with his/her personal physician whom they have a rapport with.

  2. Hi Al…I know I’m late to this, and am just joining thehealthcareblog, and will be writing on wellness issues. I get your cynicism. I agree that Wellness 1.0 hasn’t done a whole lot although there are exceptions. Those exceptions point out that virtually all worksite wellness programs are poorly designed and hardly led at all. We’re trying to change lifestyle behaviors. As we say in Boston, that’s wicket haad. But nodding to what you wrote, and understanding you may have slightly exaggerated, the fundamental matter is that without changing lifestyles, even the best reformation of our broken delivery system won’t produce much. We have epidemics of diabesity and chronic health issues that are ravaging the system. Do you suggest doing nothing? And where is better than the workplace? At least there you have a CEO to lead (if he or she is willing) and the organizational ability to pay for and implement more sophisticated programs. We simply cannot ignore the rampant claims expense increases caused by unhealthy lifestyles. You suggest we should. To succeed, yes, we must be intrusive. Corporal punishment is old school, and humiliation is tacky. Tell me why I’m wrong.

  3. I’d like to point out that there are companies advocating daily marijuana use as part of their wellness approach — so “fluid” is right!!!

  4. Great minds think alike. We have a THCB posting from a couple of years ago called “Hyperdiagnosis” which says exactly that.

  5. Without question some are better than others. I’ve heard horror stories. It all gets back to doing wellness for employees instead of to them. But just keep in mind that most programs’ cost exceeds addressable wellness-sensitve medical event cost. So you can’t save money even with good vendors.

  6. Literally there is a company that offers manicures as part of wellness. So the definition is very fluid. Programs done TO employees instead of FOR employees are the ones that get our mathematical dander up. If you want to offer your employees manicures, be my guest. http://www.quizzify.com is employee health education. There is no PHI, no HIPAA issue, no overscreening. This country has way too much healthcare and our motto is “Just because it’s healthcare, doesn’t mean it’s good for you.” So we are trying to keep people out of the system instead of pushing them into it. That’s why we can offer a 100% savings guarantee, which is something no wellness vendor can do.

  7. Great question. Some companies are getting out. But the consultants they rely on to tell them whether they are saving money usually play along with the vendors. The best example is Mercer (allegedly working for British Petroleum) and Staywell, which we cataloged on this blog a couple of years ago. Mercer knew that Staywell had already blogged that they could only save $100 per risk factor reduced, but they “validated” about 200 times that amount.

  8. Not at all. The difference is that people are forced to do wellness. You can’t force people to use an EAP.

  9. The difference is that the independent validators (such as myself) would lose their gigs if there is anything but pure integrity. We are held to a very high standard. Not to mention that Intel and GE would shut this down in a heartbeat if it wasn’t stellar for their reputations. You also need to read each validation carefully. There is often some hedging as opposed to a straight endorsement. Quizzify (my other company) is validated and, yes, it is transformative. Since we are a new company, a validated 100% guarantee allows us to have credibility for our outcomes claims we wouldn’t otherwise come close to.

  10. Al – Can you expand on the validity of the Validation Institute designation? It seems like a big deal but it’s also easy to be dubious of yet another certification. This seems like it could be transformative.

  11. If employee wellness programs are such a drag on corporate profitability, I would expect companies to ditch them as fast as possible. So is this happening?

  12. What passion on the subject! I truly appreciate your candid posting.

    I find the value proposition of most wellness offerings to be as simplistic, unrealistic, and unfortunately over-hyped as you, Al! I think the point where we might differ, though, is on what the potential for meeting the purpose of wellness programs is rather than on a disregard for them entirely.

    Your points that only the extremes of the continuum of employees are likely to engage in those outcomes-based program are spot on. The “healthy employees are incentivized intrinsically where the extrinsic motivations from a wellness program may have little to no long-term value” are well-documented. And you’re absolutely right that most of these programs take employees off-line far too often.

    I would love to have a deeper conversation with you about how you intend to expand your offerings at Quizzify to do more than education. From the behavioral health side of things, we know that education alone does very little to impact treatment seeking or adherence to treatment planning. To truly affect long-term change, a social and behavioral approach must be coordinated across the various resources to which someone has access.

    And to your point about employers in your market and competition, let’s be honest: the employer-sponsored element to all of this is rapidly fading as employees are no longer loyal to their employers. We’re not in the 1950’s anymore.

    If you have any questions about where i stand on this “stuff,” feel free to stop by my blog. Would love to catch your thoughts. I’ll try to keep an eye on your org’s continued development!

    Thanks for the post!
    Ryan
    xchangehealth.wordpress.com

  13. Wellness is a healthy lifestyle
    If people need support thru coaches there are vendors out there who actually encourage utilization and contact employers and employees when their services are underutilized
    There are other vendors who operate like gymns and hope people pay without showing up
    There are effective and ineffective vendors
    Don Levit

  14. Being discriminated against ISN”T not qualifying for a gift certificate

    It’s being fired or passed over for a promotion or not hired in the first place

  15. Al,

    Your critique of wellness raises an important question.

    How do you define wellness?

    A lot of people would look at what you’re doing at Quizzify and say “Okay. Hmm. Same creature. Different flavor. ”

    (I think what you’re doing is pretty cool btw and very interesting. More on that later).

    How do we define what is arguably one of the fuzziest concepts there is, encompassing everything from pet spas in Palm Springs to solid evidence-based nutritional advice from respected researchers?

    The fuzziness is the reason that people are putting questionable products on the market.

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