Suppose a vendor made you this proposal: “Pay us to take your employees off the job for medical tests that the government specifically says are unnecessary, and then send them to the doctor (at your expense) even though the Journal of the American Medical Association (JAMA) says healthy adults don’t benefit from checkups. We also want you to bribe or even fine employees to drive participation. Despite this adverse morale impact and wasted time and money, we promise you’ll reduce your healthcare spending, mostly because we’ll make up the savings numbers.” Here’s a solution.
Think you’d decline this proposal? If you have a wellness program built around screenings, doctor visits, and “incentives,” you’ve actually already accepted it. Because (in addition to free gym memberships and other possibly worthwhile perks) that’s what wellness is for tens of millions of Americans.
There are two possibilities to resolve this incongruity: either the first paragraph is wrong, or else — despite the many wise decisions you’ve made to reach your current position — you blew this one. Let’s break that paragraph down phrase by phrase, so you can decide for yourself. The first phrase is easy: you do pay the vendor. You are also indirectly paying the consultant who brought this vendor to your human resources department — through opaque and unregulated commission arrangements that almost no vendor discloses except by using euphemisms like “trusted advisors need trusted partners.”
The second is also easy: you are taking people off the job to complete forms that tell your employees to quit smoking, lose weight and buckle their seat belts. (If your employees didn’t already know that, you have more profound workforce issues.) They also must participate annually in equally euphemistic “health fairs,” where they are poked with needles and given risk scores based on cholesterol and glucose even though:
- One of the three biggest risk factors is smoking and you don’t need a health fair to know that one, and the second is blood pressure, which can be measured at almost any drug store at no expense;
- Another major risk factor is family history, which wellness vendors aren’t allowed to ask about;
- The United States Preventive Services Task Force recommends cholesterol screens only once every five years and regular glucose screening only for adults with sustained high blood pressure;
- The rate of heart attacks in your employee population is probably only about 1 in 700 to begin with, your likelihood of avoiding one is low anyway, and any other long-term issues you find will cost you more to control than you will save.
The third is equally easy: JAMA says adult checkups have no value. Even if you didn’t have to pay for employee checkups (and lose the work time), the potential harms to your employees exceed the benefits: both overscreening and overdoctoring create huge potential for overdiagnosis. Overdiagnosis begets overtreatment, the cost of which can be considerable both in dollars and potential side effects on employee health.
The fourth is also easy. (Do you see a pattern here?) The way to tell that employees hate these programs is that in two well-known organizations, CVS and Penn State, they have revolted against them. This happened even though walking away required employees to make significant financial forfeitures, because employer incentives to engage have doubled in the last four years.
Finally, all the savings numbers are made up, because it’s simply not possible to save money by doing the opposite of the right thing…especially while paying for that privilege. Consequently vendors transparently make up savings, publicly available examples being British Petroleum, state employees of both Nebraska and Oklahoma, and North Carolina Medicaid. Meanwhile, Aetna and Wellsteps promises that a high-participation wellness program can reduce costs below zero, while Cigna’s “guarantee” pretends to show massive risk reduction without reducing risk at all.
So what’s the solution? Obviously an initiative producing both tangible and intangible negative returns should be terminated. If you want to do something useful instead, here is a rule of thumb: offer programs for your employees instead doing programs to them. The difference should be self-evident between the examples in this article and, for instance, subsidizing gym memberships and ensuring that there is abundant free fruit and water in the office. If not, here are two simple tests: if you need a detailed “communications plan” about your wellness strategy then you don’t really have one. And if the program involves financial forfeitures, it’s a threat.
If, however, you’re doing something employees appreciate and understand intuitively, you’ve got yourself a wellness program. You may not save money or even have much health impact, but if you were a general, you’d be far more successful leading an army with high morale than one with low cholesterol.
Al Lewis, president of the Disease Management Purchasing Consortium, is author of Why Nobody Believes the Numbers (Wiley, 2012) and co-author with healthcare consultant Vik Khanna of the new guidebook for CEOs and employees Surviving Workplace Wellness…with Your Dignity, Finances and (major) Organs Intact (THCB Press, 2014).