There has been a tremendous amount of discussion lately about whether employee wellness programs actually save money. Not surprisingly, the people who sell and promote these programs emphatically claim they do. One such purveyor recently commented to me on a LinkedIn® group discussion,
“I don’t think I have ever read a research article on a workplace wellness program that did not show savings.”
Unfortunately, outside the literature published by those with a vested interest in showing these programs save money, there is very little, if any, reasonably well-conducted research to support that statement. Growing evidence concludes just the opposite. In 2013, in his groundbreaking book, “Cracking Health Costs,” Tom Emerick (who designed and managed health benefits for over 1.6 million employees at Walmart) summarizes the state of the literature:
“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.”
Earlier this year, the RAND Corp. released the results from the long-awaited study from Pepsico, which has been doing wellness for a very long time. The study findings echoed Emerick’s sentiment:
“Participation in lifestyle management interventions,” conclude the PepsiCo researchers, “… has no statistically significant effect on healthcare costs,” and employers considering adopting such a program “should proceed with caution.”
In fact, even what appears to be the only published research outside of the profession supporting the claim of savings (ROI 3.27) from wellness programs has now been outed by none other than its lead author. Harvard health economics professor, Katherine Baicker, stated in a recent interview with “Marketplace” that it was actually “too early to tell” whether these programs save money, saying:
“We’ll find out the answer better as more employers experiment with these programs, and we see what happens to the participants’ weight [and] blood pressure.”
The concept of “experimenting” on employees is worrisome at best. The fact that it is “too early to tell” whether programs work does not bode well for our profession — especially considering that wellness professionals have been attempting to improve health and health risks for decades. As Dr. Dee Edington recently commented in his blog:
“The field has been riding the behavior change horse for 40 years with little to show for it.”
The gap between what wellness program promoters and independent researchers believe about the money saving issue is likely based on how the research is conducted and evaluated. The many serious pitfalls of the industry-conducted research have been examined in detail elsewhere. The purpose here is to point out that these serious limitations may actually be overshadowed by another factor rarely, if ever, discussed or included in this research. The elephant in the room in this case is iatrogenesis, which Wikipedia defines as:
“Preventable harm resulting from medical treatment or advice to patients.”
Professionals who may sometimes cause harm to patients include physicians, pharmacists, nurses, dentists, psychiatrists, psychologists and therapists as well as alternative and complementary medicine practitioners. It also makes sense to include wellness vendors, coaches, managers, CEOs, and other business leaders as well — in fact, anyone involved in promoting change on an organizational or individual level. In these cases, the individuals suffering as a result are employees. Iatrogenesis is often a negative consequence of the Law of Unintended Consequences that states that almost any initiative likely has “outcomes that are not the ones intended by a purposeful action.”
Any action, from smallest to largest, in any context, can have unforeseen results. For instance, you might decide to watch a movie with your kids. Suddenly, your five-year-old gets frightened by something in the movie that you viewed as innocent; you were unaware of the possible negative consequences occurring from watching the film.
How does this relate to workplace wellness programs? For the purposes of this blog, I picked four of the most common interventions: biometric screens, health risk assessments (HRAs), weight-loss programs, and incentives. Let’s briefly see how each of these might engender significant iatrogenic effects that could overturn any savings – if, indeed any really do exist.
We are not saying that knowing your blood pressure, cholesterol, glucose, and triglyceride levels doesn’t have value on an individual level. However, mass screenings, particularly when done at the worksite, are fraught with potential increased costs from overdiagnosis and overtreatment.1 These screenings frequently result in employees seeking further costly, and sometimes dangerous, medical tests and treatment —even when no real evidence of illness exists. Furthermore, vendors offering workplace screenings frequently recommend tests for employees that are either 1) not recommended by preventive medicine specialists at all, and/or 2) implemented at different frequencies (usually more often for obvious reasons) than recommended by the preventive medical establishment.2
Health Risk Assessments (HRAs):
Most HRA data indicate employees need to lose weight, eat more fruits and vegetables, exercise more, quit smoking, and perhaps reduce stress. There, we just saved you thousands of dollars. HRAs are highly unlikely to save money and more often may actually waste money because:2
- They regularly recommend preventative actions (including both type and frequency) that are not medically valued.
- They often result in having employees seek additional and often unnecessary medical help that can be costly.
- They often ask for highly personal information that employees may not want their employers to know — so HRAs promote lying and giving false information.
- They are available for free online for anyone who wants to take them.
Oh yes, and before I forget, there is the highly significant additional issue that HRAs are taken and reported anonymously so it is actually impossible to assess savings anyway.
Weight-Loss Programs, Competitions, Contests
There is not a shred of evidence over the last three or four decades that any weight-loss intervention results in long-term weight loss for all but a small handful of people. Therefore, most participants end up losing and gaining substantial amounts of weight over and over again.
The ongoing claims of weight-loss promoters about the financial (and health) success of their programs are based on short-term results that mean very little in either case. As a result of built-in recidivism (which, of course plays into the hands and wallets of those providing weight-loss services), the typical dieter gains and loses weight, on average, four times a year.3 So, the next time a worksite claims to have saved x numbers of dollars from x number of pounds lost in the year-long program, the organization should be challenged to follow up and see what happens a year or two after the program ends if we are to take the savings claims seriously.
Finally, with respect to the ubiquitous use of rewards and punishments to produce change at the workplace, no published evidence shows anything but short-term behavior changes. In fact, scores of studies clearly demonstrate the lack of efficacy of these approaches. Even when incentives increase short-term behavior, substantial evidence suggests incentives:4
- Diminish performance and creativity.
- Foster short-term thinking.
- Encourage cheating and lying.
- Become habit forming.
Of course, these can result in additional costs never considered when “savings” are being claimed. With respect to just the last bullet, research shows the costs of incentives being used to pressure employees to participate in workplace wellness activities has more than doubled from $260 to $521 per employee in just the last four years, and is projected to increase another 15% to almost $600 per employee in 2014.5
Hopefully, those of us in the wellness industry will begin to pay more attention to all of the intervention details rather than grabbing on to the first (and usually short-term) data that come along before we claim our programs save money. If we don’t pay more attention, we are doing a disservice to the employees and organizations we serve — and we are jeopardizing the credibility of our profession. As Dr. Soeren Mattke, the senior scientist who led the much-heralded RAND Report stated in a recent 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’s 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.’”
When you combine the potential costs of iatrogenesis with the dismal likelihood of saving money from traditional “pry, poke, prod and punish” wellness programs, the appropriate conclusions seem fairly obvious: If the employer’s role is to create the conditions within which people can thrive in their wellbeing, medicalizing the workplace makes little economic sense. Instead of wasting money playing doctor, employers might apply those monies toward providing quality tools and resources to help employees better partner with their healthcare providers for quality and cost-effective prevention to meet their specific health needs.
- Welch, H.G., “Overdiagnosed: Making People Sick in the Pursuit of Health”; Brawley, O.W. & Goldberg, P., “How We Do Harm”
- Khann, V. & Lewis, A., “Surviving Workplace Wellness…with Your Dignity, Finances and Major Organs Intact”
- The U.S Weight Loss & Diet Control Market. Marketdata Enterprises, Inc. March 9, 2011.
- Pink, D.H., “Drive”; Kohn, A, “Punished by Rewards”