Workplace “pry, poke and prod” programs are like pennies, Communism, baseball and Microsoft Outlook, in the sense that if they didn’t already exist, nobody would invent them.
This observation does not apply to workplace screening according to actual clinical guidelines, and next-generation programs like the Wellness 401W Savings Plan, which are good ideas that should get traction. It doesn’t apply to wellness done for employees instead of to them. It doesn’t apply to the Sterlings, It Starts with Me’s, USPMs, ImpactHealths, Redbricks, and Limeades of the world, who are doing the right things. (If you think I am leaving anyone out, let me know!) And of course it doesn’t apply to health literacy, a la Quizzify. There is no argument in favor of ignorance.
There is no better evidence for this observation than the current issue of the Case Western Reserve Law-Medicine Journal, which devotes almost its entire current issue to the problems with these first-generation wellness programs.
The lead article, “The Outcomes, Economics and Ethics of the Workplace Wellness Industry,” shows how vendors cover up their losses and harms to employees with lies that would make a White House press secretary blush. When they get caught blatantly lying and harming employees (and kudos to Sharon Begley for her expose on Wellsteps), they simply give each other awards. To paraphrase the immortal words of the great philosopher Ryan O’Neal, being a Koop Award winner means never having to say you’re sorry.
Next up is The Incidental Economist (TIE) team, weighing in on the “Dubious Empirical and Legal Foundations of Wellness Programs.” Kudos to TIE for outing this scam (the LA Times’ word, not mine) years ago. I did too, but the difference is that they have “day jobs” dissecting all the other frauds in healthcare, whereas I have altogether too much free time on my hands.
Samuel Bagenstos then piles on with “growing…evidence that reliance on workplace wellness to reduce disease is bad and likely futile health policy,” before deconstructing the questionable legality of these programs, featuring a definition of “voluntary wellness programs” that would make George Orwell blush.
Next up is Leah Fowler, pointing out that one reason wellness programs fail is they assume you can basically “give [employees] the opportunity” to lose weight, and they will. Fowler and her co-author Jessica Roberts point out that social determinants of health rather than employee indifference are vastly disproportionately the cause of poor health. “Nudges” won’t help. The evidence overwhelmingly supports their thesis. (And kudos to our own Tom Emerick for being first out of the box with this insight.)
Finally, Penn State’s resident health policy experts, Professors Scanlon and Shea, review the debacle of Penn State’s own wellness program and the (many) lessons that can be learned from it. The combination of their policy expertise and having been in the belly of the beast makes for a compelling read.
The bottom line? Wellness in its current form is such a sham (Slate’s word, not mine) that I can offer a $2-million reward for showing it works, knowing my money is safe from the Wellness Ignorati, who for all their bluster apparently either know their programs fail, or don’t have any use for $2-million. (They hate me so much you’d think that even if they didn’t need the money, they’d claim the reward just to keep me from having it instead.)
It’s up to us to create a next-generation offering that benefits employees, and that they like. I see some good things out there on the http://www.ethicalwellness.org website — Sterling Wellness, It Starts with Me, and many other vendors have endorsed it. (You know it’s a good start because none of the Wellness Ignorati want anything to do with it.)
They Said What? 
Excellent.
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You’ve gone from pariah to prophet in a few short years. I always knew your stuff was right. I was a security analyst. We know how to read numbers.
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Very good summary of all the items you have “uncovered” from these vendors. I have worked 28 years in healthcare cost control and it’s unfortunate that most employers believe what someone else tells them (so you have the blind leading the blind). These points tell about the industry from your article and other items I have learned from you and my experience:
1) We all want to feel like there is an answer to cost control/help our employees and management looks to HR for the answers: On its surface, who can argue with the concept of workplace wellness? How could there be anything wrong with corporations helping their employees reduce their risk of disease while saving money in the process?
2) As a culture, we have convinced ourselves “more is better”. So vendors have an easy sell—let’s do more testing, more HRAs, more surveys…because it will give better results.
3) People don’t ask questions, they don’t take the time to understand or study the facts as outlined in your overview of ACA/Safeway, Harvard Study, HERO, etc.
4) For years no new studies show savings that can be independently verified. You’ve pointed this out before and no vendor wants to claim your $2M reward. You also noted…For the last seven years, no peer-reviewed article in a major journal has found that wellness programs lead to substantial risk reduction.
5) No vendor ROI savings/metric methodology standard. Vendors don’t want to be held accountable and most employers don’t care/don’t understand or just want to put a program in place to feel good. Similar to your experiences with vendors, I have felt others view me as an obstructionist or negative because I ask too many questions or point out their program doesn’t/didn’t provide savings. Unfortunately, I don’t see the industry changing because wellness is an easy product to sell to employers that don’t ask hard questions. Maybe we’ll see some type of regulations to help in this area.
6) I hope the good vendors mentioned at the end of your article/Validation Institute members begin publishing their results that demonstrate an independent verified ROI that the industry will want to follow (become the standard). I would suggest you explore more discussion on these vendors so employers might look to them for help.
Al, I appreciate your insight and oversight in this industry. Thanks for sharing your time and expertise.
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