Wednesday, November 26, 2014

Wellness programs are not doing well--or good.

A new article at the Health Affairs Blog by Al Lewis, Vik Khanna, and Shana Montrose evicerates many of the claims of wellness programs offered in the health care marketplace.  Here's how it starts:

During the last decade, workplace wellness programs have become commonplace in corporate America. The majority of US employers with 50 or more employees now offer the programs. A 2010 meta-analysis that was favorable to workplace wellness programs, published in Health Affairs, provided support for their uptake. This meta-analysis, plus a well-publicized “success” story from Safeway, coalesced into the so-called Safeway Amendment in the Affordable Care Act (ACA). That provision allows employers to tie a substantial and increasing share of employee insurance premiums to health status/behaviors, and subsidizes such program implementation by smaller employers. The assumption was that improved employee health would reduce the employer burden of health care costs.

Subsequently, however, Safeway’s story has been discredited

They continue:

Now, more than four years into the ACA, we conclude that these programs increase, rather than decrease employer spending on health care with no net health benefit. The programs also cause overutilization of screening and check-ups in generally healthy working age adult populations, put undue stress on employees, and incentivize unhealthy forms of weight-loss. Through a review of the research literature and primary sources, we have found that wellness programs produce a return-on-investment (ROI) of less than 1-to-1 savings to cost. 

More often than not wellness studies simply compare participants to “matched” non-participants or compare a subset of participants (typically high-risk individuals) to themselves over time. These studies usually show savings; however in the most carefully analyzed case, the savings from wellness activities were exclusively attributable to disease management activities for a small and very ill subset rather than from health promotion for the broader population, which reduced medical spending by only $1 for every $3 spent on the program.

They conclude:

In sum, with tens of millions of employees subjected to these unpopular and expensive programs, it is time to reconfigure workplace wellness. Because today’s conventional programs fail to pay for themselves and confer no proven net health benefit (and may on balance adversely affect health through over-diagnosis and promotion of unhealthy eating patterns), conventional wellness programs may fail the Americans with Disabilities Act’s “business necessity” standard if the financial forfeiture for non-participants is deemed coercive, as is alleged in employee lawsuits, against three companies, including Honeywell.

Especially in light of these lawsuits, a viable course of action—which is also the economically preferable solution for most companies, and won’t unfavorably impact employee health—is simply to pause, demand that their vendors and consultants answer open questions about their programs, and await more guidance from the administration. A standard that “wellness shall do no harm” . . . would be a good starting point.


Anonymous said...

Could there be cost savings for the company through increased productivity and lost workdays?

If staff stop smoking, they're less likely to take smoke breaks (yes, they are still entitled to breaks). However, in my observations, smokers tend to take more breaks and longer breaks (we do not have a clock-in, clock-out system).

If exercise capacity is improved, then stamina for certain jobs (prolonged standing, lifting, etc) should improve, too, and exercise has been shown to improve pain. So, relationships with co-workers that might be strained because of chronic pain issues might improve, too.

Quality of life is important---our lives aren't just about work.

Bob said...

I think it's important to say that "these wellness programs don't seem to save money," because that seems to be the primary conclusion. Emphasis on "these programs," rather than the concept of prevention and health promotion. Also emphasis on "save money," rather than anything about health status. There is also the issue of short term vs. long term; sometimes increased knowledge builds up, and motivation kicks in later after enough exposure, and after the peer effect kicks in. "Health awareness" is pretty important, I think, whatever the studies show, and there are plenty of pediatric studies that show good effects on, say, nutrition, when information and accessibility are improved -- but then, this wouldn't show up as a cost-savings, and it wouldn't show much short term, either.

As always in our system, there are companies in it trying to make money, and they oversell and under-design and lie -- welcome to American corporate life.

Al Lewis said...

Bob, I do say "these programs" but at there is a comprehensive list of programs that don't save money. BAsically all of them. These companies were given every opportunity, plus an honorarium offer, to defend their own claims and didn't.

Does wellness improve health status? The things wellness companies do are much more likely to overdiagnose and overtreat than anything else.

HAving said all that, I would certainly agree that there are things that some companies do to create awareness of health issues (adhering to USPSTF guidelines--most companies overscreen) and to help employees improve their health, like serving healthier food and providing exercise facilities. That I refer to as "doing wellness for employees," vs. this article, describing the more common issue of "doing wellness to employees."

thanks for your comment

Al Lewis said...

Anonymous, thanks for your comment. I think most people, including me, agree that smoking penalties and programs should reduce smoking a little or if not, at least smokers are "paying" for their longer breaks, with higher premiums.

I'm all for improving exercise, but largely employers are about "pry, poke, prod and punish," programs, using risk assessments, biometrics screens, and required checkups--and enforcing those with penalties. Exercise doesn't factor in/ Ron Goetzel's notorious Penn State program is a perfect example. While they were doing "pry, poke, prod and punish," the university was banning faculty spouses from pools and charging them for gyms...and expanding its assortment of pastries and desserts.