Six Reasons Why Your Company’s Medical Screening Program Could Be Counterproductive
Paradoxically, the less savings wellness programs deliver, the more intrusive they subsequently become: these programs now feature not just health risk assessments (HRAs) but also “biometric screens” involving blood draws and other tests formerly the province of physician practices.
Unfortunately, medical intrusiveness in the name of “wellness” is the most counterproductive use of benefits dollars imaginable, with implications far greater than just money wasted. The following are six reasons why CEOs and CFOs should re-examine their company’s commitment to medical intrusiveness immediately:
It costs far more than you think. It’s not just the program cost, the incentives and the time spent lining people up for blood draws. HRAs recommend many very controversial tests that themselves drive up medical spending. One vendor even recommends $2000 lung CT scans … for non-smokers. Most recommend extra doctor visits despite findings published in the Journal of the American Medical Association that those are worthless and even potentially harmful. Biometric screens have a negative ROI even before tallying the cost and potential for harm of the additional testing and procedures caused by ‘false positives” — which is why the National Institutes of Health and most experts recommend screening only about a fifth as frequently as your consultants do.
Even the theoretical savings are trivial, as the risk-related medical events you are seeking to prevent (like heart attacks, already only a 1-in-800 shot) are surprisingly rare in the working population. Overdiagnosis, overtreatment, and overprescribing are far bigger health and cost problems…and all three problems are exacerbated by wellness programs designed to seek out illness by overscreening people to diagnose incipient disease and then treating them.
The premise was mistaken all along. The Affordable Care Act’s embrace of wellness was based on a Safeway experience that never took place, along with an influential peer-reviewed article entitled “Workplace Wellness Programs Can Generate Savings,” whose author just last week reneged and now says <href=”#comments”>”it’s too early to tell” whether there are savings, and that employers need to “experiment” on their employees.
No wellness vendor has ever published savings that weren’t obviously made up. Just last week, the sponsors of Nebraska’s C. Everett Koop-award-winning program now admit they <href=”#nebraska-s-acclaimed-wellness-program-under-fire”>lied about the data, presumably to generate more funding. (Ethics in this field are such that the state is being allowed to keep its award, despite its namesake’s stellar reputation for integrity.)
In larger companies, HR departments delegate responsibility to their consultants, who often “validate” the vendor’s claims, no matter how absurd. Smaller companies use brokers, to whom vendors offer opaquely marketed kickbacks in order to push their programs. These vendors recognize that brokers are interested in “revenue streams ” for themselves, not cost reduction for you.
The negative morale impact likewise cannot be overstated. Resistance to these programs is great enough that “incentives” for participation (viewed by employees as penalties for non-participation) have doubled to $521 in the last four years, prompting protests from CVS hourly workers and Penn State professors. And it’s hard to imagine how telling people they are sick, as happens often with screening, creates a culture of wellness. Likewise, HRA questions like: “How often did you drive while intoxicated last year?” are much more likely to create a culture of deceit than a culture of health.
What to do instead? One specific aspect of wellness makes economic sense — keep the differential employee premium between smokers and non-smokers, and maintain free smoking cessation programs. Breaks make smokers much less productive, and their healthcare spending is also higher. And keep coaching for people who want it, but don’t pay them to pretend to want it. Otherwise, wellness is distracting you from other healthcare issues, like the small number of “outliers” who spend the majority of your budget, and who really could benefit from a fraction of the attention you spend to wellness programs now.
A similarly misplaced belief that wellness increases productivity (nothing like giving people new diagnoses to boost job performance) also distracts you from the real productivity issue, which is morale. If you leading troops into battle, would you rather have soldiers with high morale, or soldiers with low cholesterol?
So workplace medicalization does hurt you in many ways: explicit and hidden costs, distractions from real issues, and employee dissatisfaction. And it can literally hurt you, if you actually take some of the more questionable advice seriously.
President of Emerick Consulting LLC, Emerick has long experience in health benefits design, global healthcare challenges, healthcare economics, evidence-based medicine, and process improvement. He spent fifteen years at Walmart, designing and managing benefits for over 1.6 million employees. In addition, he has held positions with Burger King Corporation, British Petroleum, and American Fidelity Assurance Company. Lewis, President of the Disease Management Purchasing Consortium, is also the author of Why Nobody Believes the Numbers (Wiley). He provides procurement and outcomes consulting to health plans and human resources/benefits departments, and administers the industry certification program in Critical Outcomes Report Analysis. Tom Emerick and Al Lewis are coauthors of Cracking Health Costs, published by Wiley.
