March 9, 2014
‘Surviving Workplace Wellness’: an Excerpt
by Al Lewis
"We aren't doctors, and you're not sick, and you never asked for our help and probably never would, but we've got the solution for you anyway."
The caveat for brokers: Be careful what you sell. Your commission checks may come from the seller, but your business value comes from retaining your clients. As your clients grow more skeptical of wellness vendor claims, you need to be a step ahead, anticipating their skepticism rather than being blindsided by it.
Dr. Aetna Is In
Imagine how you’d feel if you got a letter saying basically:
Dear Fat Person,
We aren’t doctors, and you’re not sick, and you never asked for our help and probably never would, but we’ve got the solution for you anyway: Arena’s Belviq and Vivus’s Qsymia, obesity drugs made by companies we’re partnering with. True, these drugs are expensive, have side effects that you may not tolerate (the nasty outcomes in clinical trials included a 20% incidence rate of paresthesia, a 5% incidence of high blood pressure and a 12% incidence of back pain) and lack a generally accepted treatment protocol, but nonetheless we’d like you to give them a try.
This is basically what Aetna has in mind. They essentially made a list of all the things wrong with wellness programs — unwanted interference in people’s lives, playing doctor, unproven therapies, opaque relationships with “recommended” suppliers, high expense and “diagnosing” people who aren’t sick — and packaged them all into one press release (1/14/14).
This release came out after our e-book, and we considered holding our two cents for Surviving Workplace Wellness: The Sequel. Yet naïve optimists that we are, we decided that by the time any sequel would be published, wellness will have gone the way of the Edsel, pet rocks, Netscape, colon cleanses (we hope) and Sarah Palin (see “colon cleanses”), thus rendering us obsolete along with the rest of the industry. Hence we are squeezing them into an epilogue now.
To summarize, Aetna is pitching specific name-brand drugs — not just any name-brand drugs but name-brand prescription drugs that consumers have rejected (Arena’s Belviq and Vivus’s Qysmia) to the point where one Wall Street analyst described them as ”flailing” — to “selected Aetna members” who aren’t even sick, just obese. So this is a wellness first two different ways. No health plan has ever pitched name-brand drugs to its members before, let alone to members who aren’t sick.
But wait…there’s more. Because it’s likely that not a lot of obese people would ever call Aetna to ask: “What specific flailing drugs from manufacturers you’ve made side deals with would you recommend for me even though I’m not sick?” Aetna isn’t taking any chances by just sitting by the phone. Instead, it is providing “outreach” to those members (maybe not using that exact letter above but not far from it) — combined with an incentive that is really hard to come by, a totally free app — to convince people to take these drugs.
In your eagerness to get this free app and lots of drugs that don’t work, you’re probably asking: “How do I get to be a ‘selected Aetna member’? I bought a policy from them.” Haha, good one. You didn’t seriously think Aetna would actually spend its own money covering its own insured members for its own program covering its own partners’ drugs endorsed in its own press release, did you? Hello? Have you actually read this book? Obviously, Aetna executives don’t believe this program can save money any more than you and I do, so participation is a privilege they reserve for their self-insured employer customers who want to follow Harvard Professor Katherine Baicker’s advice in Chapter 3 to ”experiment” on their employees, taking the advice a step farther by using flailing drugs.
After you’re done wondering how something could be good enough to sell to Aetna’s customers but not for Aetna’s insured members themselves, you may also be excused for then wondering whether Aetna knows anything about weight control in the first place, as the release demonstrates a failure to understand the difference between short-term weight loss and long-term weight loss maintenance, an overreliance on anecdotal outcomes and an insufficient disclosure of product side effects.
However, the misunderstanding of the basics of study design and weight control — along with the ignoring of any consequences of Aetna’s actions such as any potential liability if these drugs turn out to be another fen-phen (phentermine of fen-phen fame is one of the two active ingredients in Qsymia) — is not the lead here. The lead here is that Aetna is playing doctor with a license it doesn’t have, pushing drugs that no one seems to want on people who aren’t actually sick, without even taking the financial consequences of its own actions but rather foisting those consequences on the very same employer customers whose financial risks and whose employees’ health it is supposed to be protecting.
Now you see why we couldn’t wait for the sequel even if there is one, and why there’s likely to be one.