The Commonwealth Fund recently released a comprehensive report comparing employer healthcare spending with various outcomes measures. The result — and you’re way ahead of me here, I’m sure — is bad news for the wellness industry. It shows basically no correlation between employer spending and outcomes. Examples:
- No correlation between doctor office visits and prevention of avoidable ER visits
- No correlation between total employer spending and prevention of avoidable ER vistis
Let’s see how all those diabetes programs are doing…
- A slightly negative correlation between employer spending and people getting their HbA1cs checked.
And of course, the holy grail: how are employers doing in preventing hospitalizations?
- Spending more doesn’t get better results. It’s in how wisely the money is spent. Iowa scores way ahead in preventing hospitalizations while spending less than average, perhaps due to Bill Appelgate’s Iowa Chronic Care Consortium. Nebraska, right next door, shows the opposite, spending somewhat more and preventing somewhat less. As you recall, Nebraska put their very stable genius wellness vendors on the case and ended up on the front page of the Omaha World Herald. Not to mention ongoing color commentary from They Said What, featuring — you guessed it — Ron Goetzel, trying to explain how Nebraska’s state program got an award for lying about saving the lives of cancer patients who didn’t have cancer in the first place. Not to mention the rest of program simply threw money away: of 20,000 state employees, only 180 reduced a risk factor.
Curiously, the loser states in these analyses are not the usual loser states in health status. Mississippi scores high. Not because the outcomes are great. They are around the average. However, very few employers in Mississippi spend anything on prevention or workplace wellness to achieve those outcomes. Other states spend tons of money on vendors and doctor visits…with basically the same results as Mississippi.
The displays don’t lend themselves to cut-and-pasting, since they are interactive (by state) and for some reason the axes are rather shy when you try to copy them. Nonetheless, worth noting is the slightly negative correlation between spending and quality in the employer population. (Quality on the left axis, spending on the bottom.) After a point, more healthcare only makes things worse. Or, as Quizzify says, “Just because it’s healthcare doesn’t mean it’s good for you.” Exhibit A being Interactive Health, of course. They are the most expensive wellness vendor, do the most tests, and send the most employees (45%!) to the doctor with “newly discovered conditions.” And yet they haven’t actually accomplished anything, other than getting exposed in the Wall Street Journal.
The conclusion? Like everything else in life, there can be too much prevention. Annual screenings plus annual doctor visits for asymptomatic and younger employees is simply way too much…and as this graph shows, too much healthcare can be hazardous to your health.
Too much healthcare and not enough healthcare education is a recipe for lots of excess costs.
Great post. Great information. Thank you.