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Business is booming for the workplace wellness industry. Thanks largely to the Wellness Provisions in the Affordable Care Act, initiatives aimed at improving the health of employees and the organizations in which they work have become almost ubiquitous. Unfortunately, as one healthcare expert recently wrote in “Forbes”:
“This rapid escalation in employer investment has spawned a ‘Wild West’ kind of market for wellness and disease management, with thousands of vendors overwhelming employers, often touting exaggerated claims of effectiveness.”
As a result of relentless lobbying and lots of “creative” marketing, the folks who provide these programs have managed to convince human resource executives and business leaders that turning the workplace into a doctor’s office and forcing people to participate in behavior-change programs will reduce healthcare costs and improve employee engagement.
Unfortunately, there is a huge disconnect between
the rhetoric above and the reality.
In our upcoming book: “How To Build a Thriving Culture at Work, Featuring The 7 Points of Transformation,” Dr. Rosie Ward and I expose the rhetoric in detail. By way of introduction, we offer here a brief reality check of five major claims made by the Industry.
- American healthcare is a disaster because people don’t take care of themselves. If people would just change their behaviors (exercise, nutrition, stress management, etc.) it would fix the system.
This is, of course, a hugely complicated issue far beyond the scope of this blog or even our book. But as an underlying healthcare principle in America, it is fundamentally misguided. In fact, our healthcare system is neither broken nor bloated primarily as a result of people’s “unhealthy” behaviors. Dr. Otis Brawley, author of “How We Do Harm” and chief medical officer of the American Cancer Society, nailed the reality when he said:
“The system is not failing. It’s functioning exactly as designed. It’s designed to run up health-care costs.”
Respected physician Dr. Nortin M. Hadler echoed a similar sentiment in his powerful 2013 book “The Citizen Patient,” when he said:
“The per capita expenditure of every other resource-advantaged country is half that of the United States or less without disadvantaging their patients by even an iota. In the United States, the ‘system’ and its myriad stakeholders are no longer the infrastructure; they are the raison d’etre.”
- The second claim is that employees’ bad (unhealthy) behaviors are costing business huge sums of money and making it very difficult for companies to thrive.
Again, there is little evidence that this is true. As two lawyers and an economics professor recently wrote for the National Institutes of Health:
“Research results raise doubts that employees with health risk factors, such as obesity and tobacco use, spend more on medical care than others.”
Further, no workplace wellness study has ever attempted to show that a population’s health-risk-sensitive medical events (such as heart attacks) outperformed non-risk-sensitive medical events over time, because no one has even created such a list. So, all such claims are made up and/or likely to be highly exaggerated.
As Al Lewis, author of “Surviving Workplace Wellness” and widely acknowledged as having invented disease management, commented:
“Large chunks of America’s healthcare cost aren’t sitting there waiting to be reduced by employees eating more broccoli. And yet, that’s what wellness is all about — generating the appearance of massive cost reduction by making employees promise to change a few health habits.”
- The third claim is that “medicalizing” the workplace and shuffling employees into behavior-change programs will save money and make employees healthier.
This belief has unfortunately set the stage for the 4P (pry, poke, prod, punish) “wellness or else” program explosion that we have seen in the past few years. And again, the research tells quite a different story. No respectable study has shown that these programs even pay for themselves and they may well be responsible for increasing costs and potentially harming employees through overdiagnosis and overtreatment and cost shifting to the most vulnerable employees.As Tom Emerick, author of “Cracking Health Costs” and formerly designer and manager of benefits for over 1.6 million employees at Walmart, put it:
“There is not one shred of evidence that a corporate wellness program can reduce the costs of your health benefit at all, let alone by more than the cost of the program.”
And as far as the efficacy of these programs to change health behaviors, one of the pioneers of workplace wellness, Dr. Dee Edington, summed up the reality recently saying:
“The field has been riding the behavioral change horse for 40 years with little to show for it.”
- The fourth claim is that employees won’t do the right things unless they are rewarded for doing them and/or punished if they don’t.
Anyone with even a rudimentary knowledge of the literature knows that more than 30 years of consistent, definitive evidence demonstrates that extrinsic motivation does not result in sustainable change for behaviors that involve even a modicum of thought and creativity (exactly the kind of cognition that is most desirable for employees).Those who choose to ignore this reality, likely also choose to ignore the reality that extrinsic motivation in the form of rewards and punishments diminishes performance and creativity, fosters short-term thinking, cheating, lying and taking shortcuts; reduces intrinsic motivation and becomes habit forming, which is why the cost of incentives at the worksite has more than doubled in the last few years and is continuing to increase.
- The final claim is that increased participation in workplace wellness programs will translate into improved employee engagement.It is extremely common for health and business professionals alike to use the terms participation and engagement as if they were interchangeable. Of course, they have entirely different meanings. Participation is simply the act of taking part in something, such as an HRA, while engagement refers to how employees feel about their work.
“When a person is engaged, they are attracted to, inspired by, committed to and even fascinated by their work or their input to the work relationship.”
Historically, workplace wellness programs have suffered from poor participation. In response, companies offered rewards, monetary and otherwise, to increase participation. When participation improved, some as a result, the claim was made that engagement improved. Of course, this makes no sense as:
“Bribing employees to participate may increase the numbers who do. But it says nothing about engagement: how they feel about their work.”
With participation still less than desired, more and more organizations are now punishing employees who don’t participate by making them pay more for their health insurance. It really should not take a rocket scientist to add up why this approach is counterproductive.
• Fully 70% of workers in this country are not engaged in their work.
• This costs business hundreds of billions of dollars every year.
• One of (if not the) key factor determining the level of employee engagement is the autonomy they have at work.
• Autonomy derives from the ability to direct one’s own life.
• Clearly, forcing participation and punishing non-compliance (“wellness or else”) is the antithesis of autonomy.
And, the proof, as they say, is in the pudding, or at least in the latest research, that tells us exactly how employees feel about these approaches:
• 62% believe it is inappropriate to require workers to pay higher health insurance premiums if they do not participate in wellness programs.
• 75% believe it is inappropriate to require workers to pay higher premiums if they are unable to meet certain health goals.
So much for supporting autonomy and nurturing employee engagement!
In closing, we suggest it is time for our industry to come back down to earth; stop making promises it can’t keep and claims it cannot validate. Interestingly, Dr. Soeren Mattke, perhaps the industry’s leading researcher, without an ax to grind either for or against workplace wellness, summed up the rhetoric and the reality perfectly in a recent radio interview:
“The industry went in with promises of 3-to-1 and 6-to-1 based on health care savings alone — then research came out that said that’s not true — then they said ok we are cost neutral — and now as research says maybe not even cost neutral they say but it is really about productivity, which we can’t really measure but it’s an enormous return… What irks me are these aggressive sales tactics that make it a standard benefit based on unrealistic promises and then turning around and saying, but you shouldn’t look at savings in the first place.”
Or as Uwe Reinhardt, one of the nation’s leading healthcare economists, put it on a recent episode of Managed Care TV:
“I think American employers stumbled into this by default. But I think it’s sad, it’s very sad. Employers should not be doing that.”
Because, in terms of the rhetoric, as Dr. Dennis Angellis, medical director of Presbyterian Healthcare Services, commented in “Surviving Workplace Wellness“:
“If every vendor got me the ROI they say they’re getting me, I’d have negative medical spending.”
Time for a serious reality check, don’t you think?