A post-mortem for wellness programs: What went wrong?
Commentary: The obituary for traditional wellness programs has been widely published (see National Public Radio, Health Affairs, and Kaiser Health News) though perhaps not universally acknowledged. Perhaps an autopsy is in order. What indeed went wrong?
Here are some suspects for the kill shot:
1. Assuming there was a straight line between behaviors and costs. The idea was that if the group had fewer couch-potato people, it would have lower costs for heart disease. In truth, a working-age population has relatively low costs for heart disease to begin with. Even in smokers, it takes many years for a cancer to develop.
2. Hoping that screening tests would lower long-term costs. Finding a small tumor or treating pre-hypertension was supposed to make medical costs lower. The reality is, early treatment is more treatment, and can also be over-treatment. All that treatment is costly – more costly than treating the illnesses that were being avoided.
3. Banking on “avoided” costs or projected trends. Estimating costs that would have been paid or cost increases that would have happened does not put cash in an employer’s pocket. Employers have still paid more every year than they did the previous year.
4. Taking credit for trends that are bigger than the employer’s group. Health costs have slowed down in recent years, likely because of the overall economic slowdown. It’s unlikely that an employer’s lower rate increases are from their health risk assessment, no matter how well designed it is.
5. Focusing on after-hours, lifestyle choices instead of the work environment. Considering that a person spends much more time with his boss than with his doctor, it makes sense that having a bully for a boss is a bigger health hazard than being a sofa spud. Indeed, studies show that people’s blood pressure goes down when they get a fair and respectful boss, even if they don’t get off the couch after work.
6. Changing superficial things in the work environment. Putting more fresh fruit in the cafeteria or eliminating junk food from the vending machines does do something, but not much. For example, a person who has control over her workday will have less hyperlipidemia (high cholesterol) than her time-clock-punching subordinate even if they both eat the same junk food. Actual health, in other words, is affected only indirectly by the food we eat. It is more shaped by a person’s whole life experience.
7. Using extrinsic incentives to motivate behavior change. Paying people to stop smoking, lose weight, or go to the gym works as long as the incentive keeps flowing, and goes up every year. Few employers would want to keep up the game at higher and higher cost every year. Besides, behavioral economists have long known that external rewards do not create lasting behavior change.
Employers who are ready to start the post-wellness era will look at how employees are treated in the workplace. Are they treated respectfully? Are they rewarded and acknowledged for their efforts? Are they informed about the company’s future plans? Improving these aspects will improve everyone’s health, and no programs, vendors, or assessments required.
Linda K. Riddell is principal consultant with Health Economy, LLC in Cape Elizabeth, Maine.