CEOs, Obamacare, and Workplace Wellness

By now readers of this and many other outlets know that conventional workplace wellness doesn’t work. Period. It’s not that there is no evidence for it. It’s far more compelling. All the evidence is against it. The so-called “evidence” in favor of it is easily disproven as being the result of gross incompetence and/or dishonesty. And occasionally, as in the American Journal of Health Promotion, investigators in this field manage to disprove their own savings claims without intending to, “face invalidity” as it might be termed. This is not an isolated event: Analytic self-immolation happens so often that Surviving Workplace Wellness even has a line about it:

“In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”

Workplace Wellness Produces No Savings

Just before Thanksgiving, both Health Affairs (with our blog post which, given the events we are about to describe, seems almost prescient) and the often-misquoted author of multiple RAND studies (in a comment to that post) weighed in with the same conclusion, as described in the headline: “Workplace Wellness Produces No Savings.”

The article, Health Affairs most widely read posting of November and one of the most widely read of the year, was described to me as the wellness equivalent of the 1912 Armory Show, as being the seminal event that immediately changed the field forever. No longer could anyone claim with a straight face that “pry, poke, prod and punish” wellness programs saved money, or were even beneficial for employee health.

And yet…

Within one business day of this posting, Reuters’ Sharon Begley reports that on Tuesday, December 2, the Business Roundtable’s (BRT’s) CEO is having a sit-down meeting with President Obama to demand exactly the opposite of what all the evidence shows: more flexibility and less enforcement, in order to do wellness as the ACA empowers them to. In particular, they want the Administration to call off the EEOC watchdogs, who have recently attacked Honeywell and others for forcing its employees into medical exams that appear to violate the Americans with Disabilities Act.

The BRT’s goal is to allow companies to punish unhealthy workers to the limits of the Affordable Care Act’s wellness provision. (Recall from our earlier postings that the ACA wellness provision itself was modeled after the Safeway wellness program, which Safeway later admitted did not even exist during the period for which the company claim it saved money.) In essence, the BRT leadership wants to make their employees love wellness whether they like it or not.

 

Why the Disconnect?

This complete disconnect between the data and the BRT demands can be explained only one of two ways.

  • The CEOs who comprise the Business Roundtable have been duped into thinking wellness saves money, because they aren’t bright enough to Google it for themselves and learn that it doesn’t
  • The CEOs who comprise the Business Roundtable are VERY bright and have figured out that the only way they can seriously manage their healthcare costs is by fining or shaming employees with chronic disease or obesity into leaving their companies…or at the very least collecting large fines from them.

Surviving Workplace WellnessLet’s examine each possibility in turn. As to the first, these people didn’t get to the C-Suite by simply accepting information that their vendors tell them, especially when the numbers obviously don’t add up: events that can be prevented by wellness programs, like heart attacks, account for only about 8.4% of hospital spending, or less than 4% of total medical spending in the commercially insured population.   And they also must know that, as with the tobacco industry years ago, when the only people defending an industry are people who make their living from it, wellness is a wholly illegitimate enterprise. This explanation would therefore need to be termed an impossibility.

The second alternative seems like something only a conspiracy theorist could conjure, but as Sherlock Holmes said: “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.”

These CEOs must know that these “let’s play doctor” programs and fines are expensive, intrusive, ineffective and embarrassing for the employees…and take a major toll on morale. One organization, Penn State University, faced an employee revolt, and backed down. Vik is currently in a wellness program that is eerily Penn State-like, and he is documenting his experiences.

And surely someone has informed the BRT that the heart attack rate is only about 1 in 800 in the commercially insured population, while identifying all the other diseases they hope to prevent or control will merely drive up their drug spending since these nascent conditions wouldn’t become debilitating until years into retirement. Most importantly, these companies’ programs largely disregard screening guidelines promulgated by the United States Preventive Services Task Force (USPSTF). With a few exceptions like blood pressure, the guidelines call for judicious use of clinical screenings in various at-risk subpopulations, whereas wellness screening is done to all employees usually at least once a year. That screening frequency multiplies the odds of false positives, especially in younger populations.

 

Why Go to the Mat?

Unless there is an alternate explanation (or the BRT simply doesn’t understand the data), this BRT demand must be interpreted more cynically:It’s the opening salvo in an old economy jihad against aging and chronically ill employees whom they simply aren’t allowed to fire any more, just because—often due to circumstances beyond these employees’ control—their health care expenses are believed to be higher.


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