Wednesday, July 24, 2013

Doing poorly on wellness

I have the highest regards for Diane Rehm and her radio show, which originates at WAMU and is syndicated nationally.  How disappointing, then, to listen to her recent show, "Wellness Programs in the Workplace."  Much of the show was based on unsupported assertions about the value of wellness programs.  Statistics were bandied about with little plausibility, starting with this particularly meaningless and unprovable one:  "Forty percent of Americans die prematurely."

As radio, too, it was uninteresting, with no one invited to present the other side.  For example, they might have invited Tom Emerick or Al Lewis, whose recent book Cracking Health Costs sets forth the methodological flaws used by those who will try to convince you that prevention and wellness companies will save your company money.

In one segment of the radio show, mention was made of the C. Everett Koop Award, given for promoting better health while cutting medical costs.  But no one mentioned the controversy surrounding one of the awardees, the state of Nebraska.  The Nebraska state employee wellness program had said it saved $4.2 million, caught more than 500 early cancers and improved the health of thousands of employees in its first two years.  But, on July 15, the Omaha World-Herald published a story reporting that Al Lewis had found methodological flaws in their data.  He said,  “The bottom line is their numbers don't add up."

The article noted:

State Auditor Mike Foley also has been skeptical of the savings reported for Nebraska's wellness program.  In an audit last year, he called for the state to analyze whether the program's financial benefits outweigh the added administrative costs. 

Lewis and his colleagues believe the Koop award committee should rescind the award.  They state:

The state of Nebraska and their vendor, Health Fitness Corporation, lied about their cancer incidence late, claiming 514 "life-saving catches" of people with cancer, that were also "cost-saving," in order to get more state funding and public support. It turns out that almost all of these people did not have cancer, but only benign polyps that many adults of a certain age get. A few turn into cancer, just like a few people with high cholesterol get heart attacks, but to call these cases cancers and take credit for "life-saving catches" is a lie, equivalent to saying that people with high cholesterol had heart attacks.

They point out that the state claimed $4.2 million in savings even though only 186 people's risk declined, and claimed a 3% reduction in use of chronic disease medications even though they diagnosed an extra 40% of the population with a chronic disease needing medication.

Here's hoping Diane Rehm will revisit the issue on her radio show and that other commentators, too, will offer a more balanced view of these matters.


G. B. Miller said...

Wow. Sounds like something to look forward to in my state of Connecticut where they recently introduced the exact same thing for their state employees and are trying to tout potential "savings" just like Nebraska.

Hilary said...

Couple of thoughts and questions:
1. How do we support wellness for medical professionals? Do you have any good resources that you've come across?

2. How do you measure savings? Programmatic effectiveness is crucial, but the outcomes are so multifactorial.

If we all agree that wellness is important, how do we move forward in an effective way?

One lens by which to look at this is Tina Rosenberg's book "Join the Club: How Peer Pressure Can Transform the World". It's all about behavioral change and seeing people that have influence over you doing positive things, as opposed to negative. She highlights fascinating case studies from around the globe.

Anonymous said...

@Hilary "If we all agree that wellness important, how do we move forward in an effective way?"

I think you're on to something with the Rosenberg book. Simply encouraging and endorsing healthy behaviors in the workplace will often produce results.

A company can always do simple things, like eliminate junk food dispensers (vending machines), to give healthier behaviors a jump start...

...but having that 'peer pressure' of your influencers doing good things is huge. That's a big reason why having top-level enthusiasm for, and adoption of, healthy behaviors is inextricably linked to better measures of health across the entire enterprise.

Unknown said...


Under the premise of 17.37% of most media outlet statistics are generally true, it can't be all bad. Right? =/

Holy smokes! As a quality director in the electronics industry, if I "positioned" data like you cite, I would be out of a job.

Great post!

Linda Riddell said...

I think we do not all agree that wellness is important, at least not wellness as it is packaged and sold to employers. Good health is cerainly important to individual people for many other reasons, but even that is not widely embraced. If it were, we would not be so receptive to the latest treatments for the latest illness.

Anonymous said...

Linda, your observation about our receptivity to the latest treatments is right on point, and illuminates the fact that we patients as well as we medical professionals have been conditioned to do so, often by those selling those treatments. Also, of course it is always easier to gamble that you can do what you want and not get sick, then it is to exert the self-discipline to remain healthy, particularly in our self-gratifying society.

What bothers me most about Paul's post is how, once again in our profit-oriented health care industry, a well-meaning and entirely laudable initiative (wellness) has been co-opted by profit seekers and political manipulators - giving it a bad name and discouraging the original effort. Can anyone really disagree that wellness is something we should strive for instead of sick care? No. It's how we get there that is the point of contention.

nonlocal MD

David Joyce MD said...

As a physician my clinical practice was based on data driven truth. Yet most physicians make process decisions based on perception. It is a perception that wellness programs work. Yet my MBA training reinforces the fact that perception is the enemy of reality. Reality can only be established with data. When there is data there is truth.

Barry Carol said...

There isn’t any question that wellness initiatives like smoking cessation and encouraging people to exercise more and make healthier food choices and to get high value preventive healthcare services can help them to live longer and healthier lives. That doesn’t mean that they save money for the healthcare system. In all likelihood, they don’t, especially on a lifetime cost basis. Politicians and private for profit vendors who try to sell wellness and preventive care as cost savers for the healthcare system are doing us all a disservice in my opinion.

Mitch said...

Excellent post, I am big fans of Tom and Al. Would love to see you keep wellness front and center, there are so many ridiculous claims and outright lies it is embarrassing. Or should be.

Blake said...

It is regrettable that vendors need to stretch and sometimes misrepresent data on wellness programs when we have so many highly effective, brief and practical approaches for engaging people and supporting health and health behavior change. In too many of these wellness programs the wellness intervention is not sufficiently defined or operationalized to draw conclusions. While I will leave the matter of long-term cost savings to the experts in program ROI, I can assure you (having evaluated thousands of these encounters) that the manner in which most telephonic vendors and corporate wellness coaches engage people in wellness programs and facilitate health behavior change does not reflect the best science. And, like any practice that lacks fidelity to the evidence, we see wide variation and suboptimal results. Wellness, like medical care, could be an evidence-based practice, but today it is not.