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A Reality Check on Workplace Wellness

flying cadeuciiIn 1971, President Nixon declared a war on drugs, and decades later our country’s efforts to battle drug addiction remains largely a failure. Even here on idyllic Cape Cod, we see deaths by overdose and suicide in numbers that are horrifying, particularly with our youngsters.  This epidemic shows little sign of abating as communities grapple with the scourge of runaway drug addiction and its gut-wrenching consequences.

So, it’s fair to ask: given our societal failure to stop drug abuse, should we throw in the towel because it’s, as we say here in Massachusetts, wicked hard? Is it acceptable to let drug users spiral downward with predictable ruinous consequences, because to intervene and provide programs that might help could be called invasive or ineffective?  Of course not.  Because we cannot and will not abandon people with serious health conditions who, on their own, cannot recover.

The workplace and its wellness are not so very different.  Today’s American workforce is anything but healthy.  Poor health is overwhelmingly the result of unhealthy lifestyles, and it inflicts incredible damage on employers and on employees and their families. It’s a national tragedy, and frankly, it’s a disgrace that we have not had the collective will to do more about it.    

Yet, there are those who suggest that we not only give up on trying to improve unhealthy lifestyles, but also that we give up on workplace wellness altogether. I categorically disagree.

 Just as with our drug policy’s successes and failures, the wellness industry too must learn from its successes and failures, and press forward WITHOUT ABANDONING THE ENTIRE PREMISE THAT GAVE RISE TO WORKPLACE WELLNESS IN THE FIRST PLACE.  

In this, the first of a series of articles, I will outline some fundamental Premises that compel the conclusion that we must double down on workplace wellness.  Subsequent articles will expand on those Premises, explore weaknesses and flaws of some programs, and suggest strategies that can achieve the full benefits of workplace wellness, including lowering coverage costs.

PREMISE 1:  Corporate America has a responsibility to help employees improve their health and wellbeing.  This is not about rampant paternalism. We’ve made access to quality healthcare a fundamental right of every man, woman and child legally in America.  We have compelled businesses to buy healthcare coverage for their employees.  At least 97% of today’s healthcare actually is sick-care, treating already-acquired conditions rather than preventing them.  

Is that where our obligation ends?  If so, employees will keep getting unhealthier, and even the best healthcare system can do little to stem the tide of bad health much less reduce costs.

Unfortunately, the wellness industry is under attack like never before, and an emerging sense of angst over the seeming lack of progress in workplace wellness is palpable. A recent observable trend of commentators and the workplace wellness industry in general is to give up on changing the unhealthy lifestyles of employees and reducing the cost of healthcare coverage (ROI).  “ROI” means per-employee claims expense savings that exceed the cost of a wellness program.  “VOI” (Value of Investment) means any “non-financial” improvements that result from workplace wellness activities, such as boosting productivity, morale, reducing absenteeism, etc.

Two recent articles are symptomatic of how workplace wellness is increasingly viewed as a failed concept and may represent an emerging consensus to give up on efforts to achieve ROI by improving unhealthy employee lifestyles altogether.  

Should Employers Give Up On Wellness ROI?” consists of an interview of Dee Edington, a practitioner in wellness for over 40 years.  Mr. Edington states that, “Yes, [ROI] is dying…”  He conditioned that remark with several “ifs,” but concluded that “[t]he most obvious misconception is that a wellness program will generate a positive ROI, anywhere from 1.0 to 6.0.”  He concludes by saying that corporate wellness has a bright future IF it embraces the shift of focus away from ROI to VOIs.  He was more direct in a 2009 conversation:  “Wellness programs have been focusing on behavior change, and I’ve come to the conclusion that that’s been a waste of time.”  

With respect (and with the realization that Dee has been doing this much longer than I), I emphatically disagree.  Cost of coverage MUST remain the focus.  To reduce cost, we must reduce chronic illness.  According to the US Centers for Disease Control and Prevention (CDC), chronic illness is mostly caused by unhealthy lifestyles and accounts for 75% of US healthcare expenditures.  And chronic disease is the most preventable of diseases.  The CDC states that the key to reducing chronic illness is to address unhealthy lifestyles.  To follow Mr. Edington’s  suggestion means an abandonment of attempts to reduce chronic illness, the most preventable of illnesses, and to reign in costs.

The second article is representative of an even more radical approach, namely, doing away with workplace wellness.

Playing Doctor” is written by Al Lewis, the CEO of Quizzify.com and the author of “Surviving Workplace Wellness,” a title that pretty much sums up his view of workplace wellness. Mr. Lewis’ viewpoint, characterized by militant and high visibility opposition to workplace wellness, reflects the far end of the spectrum of anti-workplace wellness sentiment.  He is oft-cited, and it seems he has not seen a wellness program or a positive ROI computation that he has liked.

“Playing Doctor” focuses on the EEOC’s final rules  regarding wellness program incentives and penalties, which Al uses as a springboard to repeat his mantra that the wellness industry hides data, misrepresents results such as ROI, and not only fails to improve employee health, but actually exposes employees to significant potential harm in order to maximize revenues. His suggestion is to steer employees to safer hospitals and educate employees how to purchase healthcare wisely, something that his company, Quizzify, purports to do.  

Educating people on how to better access our dysfunctional healthcare system should be part of any comprehensive workplace wellness program.  But if that is all we do, it perpetuates smarter purchasing of sick-care by sick people rather than well-care, prevention, and healthier lifestyles.  That, in turn, will only perpetuate an increasingly unhealthy and unproductive workforce, driving costs of coverage higher and higher.

Mr. Lewis and I have commented on each others’ articles in the past, and I commented on this one, asking “[a]re you saying we throw in the towel on changing unhealthy lifestyles…”?  His response was, “…yes, I throw in the towel until, to mix cliches, someone invents a better mousetrap.”  

I believe that commentaries such as these are leading corporate America down the wrong path.  

If followed, this will divert us from the single most important thing that must be accomplished to obtain ROI or VOIs:  healthier employee lifestyles.  We cannot be diverted from this inconvenient fact.  Without improving unhealthy lifestyles, none of these goals is accomplished.

PREMISE 2:  The workplace is not only an appropriate venue, but the best venue to facilitate wellness and wellbeing.

On the issue of appropriateness, the cost of healthcare coverage is one of corporate America’s top concerns, as is an unengaged and unproductive workforce.  It is hard to identify a more appropriate workplace activity than directly addressing those issues.  

Employee engagement is greatly affected by health and wellbeing. A 2012 Gallup State of the American Workplace study confirms how a healthier, more engaged employee population can bring huge returns. Another study by Willis, Towers, Perrin supports this finding that more employers enjoy major financial returns and competitive advantages through higher employee engagement, productivity, and workplace morale. Yet, we cannot significantly improve employee health and wellbeing without long-term improvement of unhealthy lifestyles.  It’s that simple.

As the largest aggregator of adult work-aged Americans today, the workplace is also the best venue to affect and improve employee lifestyle changes. Millions of Americans show up for work each day focused on their work and its environment.  Employers already have their attention. Messages are sent and received.  If employers can link wellness to employees’ personal and work goals, they can create the opportunity for behavior change on a scale that dwarfs any other platform.  

We cannot abandon that opportunity.  Dr. Toby Cosgrove, CEO of Cleveland Clinic said it best:  “only private business…can solve America’s epidemic of obesity, chronic disease, and runaway healthcare costs by investing in the health…of their employees.”

PREMISE 3:  Workplace wellness need not be offensive or inappropriately invasive.  We have interventions in many areas when lifestyle threatens life or good health.  Do we throw up our hands and do nothing about the opioid epidemic that we are experiencing because of some suggestion that recovery is not something you “do” to someone?  Make no mistake about it.  Most of us understand from our own experiences that to facilitate long-term lifestyle change, some method of gentle or firmer intervention is needed to change the status quo.  

Are there poorly designed programs that do more harm than good?  Unfortunately, yes.  Are there incentives that are ill-disguised stratagems to increase employee shares of health coverage costs?  Yes.  Are there examples of invasive use of employee data?   Yes.  Can there be over-testing that some describe as “bad medicine?”  Let’s assume there can be.  And have most wellness programs failed to produce a positive claims ROI ?  That is correct (Rand Study, EBRI Study, and Pepsico), and  claims of Harvard researchers of ROIs of $3.27 from traditional wellness programs have been proven suspect.

But does this imply that we get out of workplace wellness altogether? I suggest that it is quite possible to design and implement programs without being insensitive or downright stupid, nor should we be scared off by strident accusations to the contrary. Accordingly, this is not about whether we do this; it’s about how we engage employees and their families in a supportive, positive way consistent with their life goals.

PREMISE 5: While VOIs are achievable and valuable, the cost of coverage is still the single most critical issue facing corporate America today.  Wellness ROI can be achieved.

While VOIs are indeed valuable “returns” on workplace wellness programs, we are at risk of abandoning ROI. This must drive CEOs and CFOs crazy.  They are in essence being told to abandon precisely what they need most to continue to provide comprehensive employee coverage.  Ignore unhealthy lifestyles??  Other than our dysfunctional healthcare delivery system, unhealthy lifestyles are the biggest cause of our of control costs and an unsustainable trajectory.

Accordingly, it is not time to withdraw.  It is time to  double down on ROI.

America has a tradition of meeting crises head-on. There have been seemingly intractable issues that we’ve overcome by thoughtfulness, persistence, funding, and a will not to give up.  Our environmental legacy has shown that to be true.  Have we reached the finish line on the environment?  No.  We can and will always strive to do better.

I too want “a better mousetrap” for corporate America. Because while we’ve spent a bucket load of money on wellness, we haven’t put in the effort, thought, and leadership that this fundamental issue requires. It’s time to change that, and in my following articles, I will outline how we can do just that.

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William Palmer MDzilaxojamesepurcellKeith McCallinPeter Recent comment authors
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William Palmer MD
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William Palmer MD

If we say workplace wellness programs do not work, aren’t we saying that all wellness programs do not work? And isn’t this the same as saying that wellness is all a passive received gift or self-imposed life style efforts? (eg from parental DNA or epigenetics or passive environmental exposure or endogenous discipline.) Or, in other words: “Everything that makes wellness is a received gift or self imposed life-style discipline. Wellnees cannot be achieved by voluntary effort by others, employers, teachers.” Hmmmm? Too much guessing. I don’t think we have any data to show either conclusion. We are in the Pre-Cambrian… Read more »

zilaxo
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It is useful information, elaborating details which will helpful in near future. Thank you!

Keith McCallin
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Keith McCallin

Just as a matter of good form, it seem a good idea that any health care blog in the U.S. either not make mention of our addiction epidemic or, if so inclined, at least admit that our current health care system created the problem the first place. Second thought that came to mind was a quote from Richard Master at the end of the “Fix It, Health Care at the Tipping Point,” a documentary he produced and which a single payer financing of health care is well argued. One of the benefits of a singe payer system, he points out,… Read more »

Peter
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Peter

Good posting Jim, but I’m on the side that says just tax bad habits to pay for consequences.

I think if we took corn subsidies away and transferred them to fresh fruits and veggies AND taxed calories we’d have a better system – IF congress would not siphon off those taxes for other things as they do for airport fees for TSA security.

However Americans don’t like taxes, even to pay for necessary services, so politically I guess workplace wellness is more acceptable, cause it’s private business.

coloradoexc
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coloradoexc

The problem here is most wellness programs are disingenuous and short-sighted. They focus on weight, exercise, eating, and shaming employees. Even your article harped on “unhealthy lifestyles” which makes you sound judgmental. Managing one’s health is much broader than losing a little weight or walking during the lunch hour. Someone might be a little chunky, but they have excellent dental care, get mammograms, exercise and eat healthily, get lots of sleep, stay hydrated, avoid pesticides, take supplements, maintain good mental health, use their preventative insurance benefits, etc. Wellness programs should encompass all the components of maintaining one’s health and stop… Read more »

jamesepurcell
Member

Short sighted of course doesn’t work. I’m curious why you assumed that my use of “unhealthy lifestyles” necessarily focused on exercise and weight. While it can, it most certainly goes well beyond that. It includes lack of risky lifestyles, regular exams, pharmacy-compliance (taking your meds when and as prescribed), etc. It is changing the activities or lack thereof that WILL cause chronic illness if left unabated. Truth however is, the vast majority of our chronic illness comes from lack of exercise, bad diet, and poor self care. I suppose on some plane or another, that’s judgmental. But we are engaged… Read more »

Peter
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Peter

“shame doesn’t cause long term behavior modification.”

Yes, I’ve tried it on Republicans, no effect.

whynobodybeliev
Member

HI Jim, quite the posting. I think we are largely in agreement on many things. There are a few things we disagree on. The CDC’s 75%-of-costs-are-due-to-chronic-disease thing (they recently jumped it to 86%, by the way, to get more attention) is a complete urban legend. Here– see for yourself: http://www.ajmc.com/contributor/al-lewis-jd/2016/02/chronic-disease-in-the-workplace-are-we-fighting-the-wrong-battle The main thing we disagree on is whether wellness produces an ROI. http://www.quizzify.com does–we 100% guarantee it. No wellness vendor guarantees it because the numbers don’t add up. Rather than debate a he said-she said on whether wellness has produced an ROI, I would simply note that I have a… Read more »

whynobodybeliev
Member

sorry–forgot the septicemia link. Here is an article about what employers SHOULD be doing instead of wellness. It includes noting the septicemia issue http://insurancethoughtleadership.com/employers-stop-paying-for-never-events/

jamesepurcell
Member

Hey Al…Nice photo of you on the reward article. I thought it was Lance Armstrong for a moment. My math abilities are hopelessly poor and I could never do the analysis itself. The lawyer in me, however, recognizes a lot of conditions to your very clever challenge. Let me think on it. I DO agree that much wellness activity in the workplace has not produced ROI as we’ve defined it. It may accomplish other good things, but the typical, push-prod-poke or whatever you call it, is not what I’m into. Moreover, a single program that tries to be all things… Read more »

whynobodybeliev
Member

Jim I never used to object to it either but it simply doesn’t work — that’s my objection. Mine isn’t an objection based on philosophy or politics, just observation.

If the award-winning programs cant achieve risk reduction, who can?

jamesepurcell
Member

Nodding head. Well, I will try my best to articulate strategies, and perhaps even find a couple that do work. We may have to start with disease and care management, focusing on the chronic and at risk populations if ROI is key. The other stuff I agree must revolve around good morale at the workplace. More to come.

whynobodybeliev
Member

For some reason when we chat as in right here, we always seem to agree. I’ve validated positive DM/CM outcomes (including for your old stomping ground) and favor “wellness done FOR employees.”