A truly Orwellian wellness program would:

1. Force employees to do something that they shouldn’t do;
2. Fine them if they don’t do it; and
3. Make the whole thing so complex that employees won’t be able to figure out what you’re talking about and employers won’t be able to administer it.

And that is indeed exactly what Hodges-Mace is proposing in this week’s Employee Benefit Advisor.  Even though I’ve visited the Hodges-Mace website, I can’t figure out what they’re selling, but whatever it is, this article isn’t exactly a ringing endorsement for buying it.

Hodges-Mace wants employees to all get annual physicals, even though Choosing Wisely, the New England Journal of Medicine and everyone else says not to, because the potential harms of overtreatment exceed the benefits. (The list of harms doesn’t even include the cost of those visits themselves.)

Hodges-Mace’s exact words: “Use financial penalties to sway employees to see their PCP. If they don’t, charge them a surcharge.”  Going into detail:

If the employee fails to comply, she must pay the surcharge, and it is this practice that encourages higher participation rates than traditional wellness programs and generally results in a positive ROI for these programs during their first year.

I had to read this multiple times to figure it out.  The more employees who get useless checkups, the higher the ROI? Or is it the reverse? The more employees who pay the fines, the higher the ROI?  Or, using wellness math, is it both?  In 1984, War is Peace and Ignorance is Knowledge. In this wellness program, spending is savings, and…

…Complexity is Simplicity

The author, Hodges-Mace’s Eric Helman, says: “Employers are moving to simpler programs with tangible results and nearly immediate cost savings,” like this wellness-or-else program Hodges-Mace is advocating.  How “simple” is this program?

On average, 8 to 12% of employees will opt out and elect to pay the surcharge, which is based on complex rate tables for both the employee and her dependents…

If the employee chooses to participate in the program, the system has to verify her compliance, a process that typically entails multiple reminders, follow-up communications and documentation from the PCP.

So far this is a piece o’ cake, right? Complex rate tables, compliance verification, multiple reminders, pestering the PCP.  Not so fast — here is the rest of the cake:

The benefit system must be able to seamlessly accept information from the verification process, calculate and apply surcharges, and then communicate the appropriate information to the payroll system. These actions and the rules they are based on must also be integrated into the process of handling qualified life events.

In other words, it takes a lot of complexity to make a program simple, a lot of spending to save money, and a lot of harms to benefit employees.

One is reminded of the immortal words of the great philosopher Major Chester Brown, as told to the AP’s Vietnam correspondent Peter Arnett: “We had to destroy the village in order to save it.”

Hey, I know it isn’t always about Quizzify, but we try to un-teach exactly what Hodges-Mace and other wellness companies teach:  Astronomy is not a health issue. Don’t schedule a checkup just because the earth completes a revolution of the sun.  We educate employees on when and when not to visit the doctor. Avoiding useless checkups–now that’s something that really will save money right away.  

But we should caution: even though the science is overwhelming and the economics are transparent, it still takes months for us to get this message across. Unlearning incorrect information is not easy…and it doesn’t help that wellness vendors are teaching the opposite.