Next to facts, integrity is the wellness industry’s worst nightmare. Like if one of their brethren were to actually say something honest. Tom Parry of the Integrated Benefits Institute just did exactly that. And unlike the HERO Report, where the self-immolating honesty was accidental (and at odds with the propaganda in the text itself), this slide might actually have been honest on purpose.
***Please read this post all the way through including the new postscript***
I also checked with him, and he is quite clear that you can’t get an ROI on health savings from spending money on “pry, poke, and prod” wellness programs. His exact words are: “It is difficult to spend medical dollars to save medical dollars, particularly in the short term.” (This is at odds with Ron Goetzel’s giving out awards to Eastman Chemical and Health Fitness Corporation, for a program that “saved medical dollars” two years before it started. Mr. Goetzel, unlike Mr. Parry, does not appear to be constrained by self-evident facts.)
And Tom Parry is indeed right. But — as we’ll see — his valid insights don’t stop with healthcare ROI. His slide makes excellent points about absenteeism, “presenteeism” and wellness — even if perhaps they weren’t the points he intended to make.
First, let’s look at the actual slide, the top ten health-related drivers of expense.
Only two “wellness-sensitive” items make it into the top-ten drivers of ill health: obesity and hypertension. Estimating off the y-axis (and dividing by 1000 to come up with costs per employee), it appears that the cost of each of those two is about $10 per employee per year. We already know that employers can’t reduce obesity–that’s in our peer-reviewed article. And let’s say you could reduce hypertension by 10%. That’s a $1 savings per employee per year–before adding back the (much higher) cost of the hypertension drugs. (Presumably extending this top-ten list would eventually reach the other diseases that wellness vendors love to hyperdiagnose, so add a couple of dollars of potential savings there, for a total of maybe $3 per employee per year in savings before adding back costs.)
This being the wellness industry, even the “honest” slides are full of head-scratchers. For instance, how can there be so much absenteeism due to hypertension, which has no symptoms in 99.9% of cases? Do you even know anyone who doesn’t go into work because their hypertension is acting up? And how can HR even track absences due to hypertension, assuming there are any? Absences aren’t coded by ICD-9s (and are rarely even coded by sickness vs. vacation).
Back to the top of the slide, if your biggest problem is depression, why would you institute a wellness program which — according to the HERO report which Tom Parry co-authored — is bad for morale? We don’t mean to make trouble here. We’re just askin’…
And this slide is actually the best argument against “pry, poke, prod and punish” wellness I have ever seen: the nine most expensive items either have nothing to do with screening or HRAs, or in the case of obesity, aren’t fixable by wellness.
We look forward to many more presentations in “support” of wellness. In the immortal words of the great philosopher George W. Bush, bring ’em on.
POSTSCRIPT: Explanation from Tom Parry. We, as you know, are unlike wellness vendors in that we are in the “integrity segment” of the market, which means we print all responses. (We used to seek responses prior to publication but never got any, so we gave that up.) Tom explains below. Albeit not as funny as the “insights” we gleaned, it is the right answer, so here it is. (It doesn’t change the overall narrative or conclusions about the money — and it doesn’t address Nicole’s comment — but it does describe how the findings on the slide can be accurate and can logically have come out of IBI’s research.)
Al – one clarifying point on the research graph (and I’d be happy to send you a copy of the research paper if you like). It is a person-centric analysis rather than an analysis of the marginal impact of individual diseases (parsing out the marginal impact in this kind of data is extraordinarily difficult). We wanted to look at the experience of PEOPLE with different conditions (and because of the prevalence of co-morbidities tend to have other conditions as well). So as you point out, you don’t miss work because of high-cholesterol but those with high cholesterol often have other conditions that together cause them to miss work. Tom
So how many does that make who’ve come clean? Altarum, IBI. I recall you wrote about a journal that said wellness lost money but it was an accident
Yes, the American Journal of Health Promotion did indeed admit that high-quality studies showed wellness loses money. But they “weighted” that result with low-quality studies showing huge savings, to conclude that wellness overall saves money. I pointed out that’s like averaging Ptolemy and Copernicus to conclude that the earth revolves halfway around the sun.
And the lowest rate of Absence is in cancer?? And virtually no “presenteeism”? Hmm. If I was dealing with a cancer diagnosis, I’d be a little distracted at work, but maybe that’s just me.
Yikes! You sound more like me than I do. I can’t believe I missed that one. Thanks for finding it. Please don’t go into competition with me–you’re too good.
The vast majority of employers cant even track their medical spend accurately, that said, you dont need an exact measurement of the hole to know the boat is sinking and you should start bailing.
Not sure quite what you’re saying here but (1) we appreciate your comments and (2) as someone who has actually climbed around on the original Orca, which was beached years ago on the channel to Menemsha Pond but has since been scavenged by souvenir hunters, I especially like your name. Did you know that line was ad-libbed?
Regarding the comments in the article on absence from hypertension, based on my past experience working with individuals, I’d venture a guess that it isn’t the hypertension itself, but the side effects of the prescribed medication to treat it (which is a whole ‘nother issue).
Or maybe they call in sick because the dog ate their diuretics. (That is actually funny on multiple levels, if you don’t mind my saying so — especially if you are a dog-owner) In all seriousness, though, Tom Parry sent me a thoughtful explanation that I am about to put up as a postscript.