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What Trump Means for Workplace Wellness

Assume, reasonably, that voters chose Donald Trump to be the next president because they feel big business and government are in bed together. If indeed they are, workplace wellness is their sex toy.

There is nothing, certainly in healthcare and possibly anywhere, that more embodies the complete disdain for the average worker than the joined-at-the-hip partnership between big business and government known as workplace wellness.

That claim might seem extreme, but put yourself in the shoes of the average worker. You used to have a good health benefit. But then, following the passage of the Affordable Care Act, your benefits were reduced, and you were put in a high-deductible plan. True, your benefits might have been reduced anyway due to the increasing cost of healthcare, but coincidence to the average person smells like causality.

See also: The Value of Workplace Wellness  

A benefits reduction sounds like a wage cut. However, you are told you can earn some or all of it back. All you have to do is allow your employer (and, yes, it isn’t really your employer, but it smells like your employer) to pry into your personal life with a questionnaire; poke you with needles to do blood tests that over a 15-year period have proved useless at reducing the country’s heart attack and diabetes event rates; and prod you, in violation of all guidelines, to go to the doctor when you aren’t sick.

You (remember, “you” are still the worker) are then left with this Hobson’s choice: You must throw yourself at the mercy of an unregulated wellness vendor that – if last month’s C. Everett Koop award to Wellsteps for being the “best wellness program in the country” is any indication – is more likely to harm you than benefit you, while invading your privacy and sucking up your time.

As an employee, what recourse do you have? Basically none. The Equal Employment Opportunity Commission has no provisions against “voluntary” workplace wellness programs, and the word “voluntary” has now been defined to include even programs with non-compliance penalties that might exceed $2,000. The net result: You can be forced to pay a large fine for refusing to participate in a voluntary program, and there’s nothing you can do about it.

You can’t sue for malpractice because wellness vendors aren’t clinical professionals, and you can’t complain to the licensing authority because wellness vendors aren’t licensed. You can’t claim they violate the industry code of conduct because – unlike everything else, including war — wellness has no code of conduct: The wellness trade association has stonewalled on the code of conduct, which embraces only the simple notion that wellness should respect the dignity of workers and not harm them.

Should you opt to maintain your dignity and not violate clinical guidelines, by declining to be part of a wellness program, you may lose four figures in compensation just by wanting to be left alone to do your job.

Don’t take my word that this is how employees feel. Simply read the comments by employees to any article on wellness.

Meanwhile, what is the government doing? Simple. The government is carrying the Business Roundtable’s (BRT) water. The Senate is in the BRT’s pocket, holding “hearings” that are basically just ads for the BRT. And the president put the EEOC on a short leash after the BRT threatened him.

As members of the BRT, and their like-minded compadres at the U.S. Chamber of Commerce, corporations are gleeful. They can cut benefits and “offer” employees the opportunity to earn them back, or just fine employees directly. One vendor, Bravo Wellness, even dogwhistled to employers that they could get immediate “savings” by fining employees.

What happens now, and what should you do?

Wellness is likely to become a touchstone for all that is wrong with the Affordable Care Act, because, almost uniquely in the ACA, the wellness provision has basically no upside. (Disagree? Show I’m wrong, and claim the $1 million reward I’ve offered to anyone who can show wellness has broken even this century.) The American Association of Retired People (AARP) is already shining a light on wellness via a lawsuit, and the effort may make it much more difficult for the wellness industry, the BRT and the Chamber to hide behind the EEOC.

As representatives of the employers who may very well be abusing employees (and not knowing it, any more than the Boise School District realized it was being snookered by Wellsteps until the problem was exposed by a leading healthcare journalist — even though the invalidity and ineffectiveness of the district’s wellness program was perfectly obvious to Wellsteps’ colleagues on the award committee), you should get ahead of this curve. Drop punitive wellness programs, or programs with low participation (which reflects low satisfaction). Or swap out programs that “do wellness to employees” for programs that “do wellness for employees.” The difference is fairly self-evident. Are employees lining up, or do they need to be coaxed? Are there big bribes or fines involved? Is the program something you yourself would do without an incentive?

See also: ‘Surviving Workplace Wellness’: an Excerpt  

You shouldn’t need to wait for the law to change to make changes yourself now. “Pry, poke and prod” programs were a bad idea to begin with, and the passage of time and rise of populism hasn’t made them any better.

Disclosure

The editorial viewpoint in this article, though reflecting my opinion, is colored by my leadership of Quizzify. Quizzify does not “pry, poke and prod” employees, but rather just enhances their knowledge base in an entertaining way. Not just theirs – even yours. Play the sample game on the site and see for yourself. We hope to benefit from the likely retreat from government support for intrusive and ineffective wellness programs in the new administration. On the other hand, you are free to publish opposing comments or viewpoints. Join the conversation, even if it means hollering at me by quoting people who know they are wrong claiming savings they know are fabricated.

Wellness Industry’s Terrible, Horrible, No-Good, Very Bad Week

Just as the Bear Stearns implosion presaged the 2008 financial crisis, the events of the last few days, building on earlier events, are presaging the collapse of the “pry, poke, prod and punish” wellness industry.

For those readers still living in Biosphere 2, here is a brief review of how we got here:

First was Honeywell’s self-immolation with the Equal Employment Opportunity Commission (EEOC). We’re not sure how Honeywell’s benefits consultants failed to advise that all the company needed to do was offer a simple wellness program alternative that didn’t require medical exams, and there would be no way Honeywell would get hit with an  EEOC lawsuit. But they didn’t.

Second, the Business Roundtable (BRT) decided to go to the mat with the president over this EEOC-wellness issue. It is possible that there is some conspiracy at work here, where large companies really want to retain the ability to shame and fine overweight employees into quitting (because you can’t fire people for being overweight). But we lean toward a less sensationalistic interpretation: that the BRT is simply getting lousy advice, likely from consultants whose business model depends on more companies doing wellness. Because the BRT’s member CEOs have actual day jobs, they can be excused for taking the BRT’s word for the benefits of wellness and not investigating this industry on their own; if they did, they would find that the wellness industry attracts more than its share of well-intentioned innumerates and outright scoundrels, perhaps because the industry lacks adult supervision.

Third was our popular Health Affairs posting, which spurred see-we-told-you-so pickups by the Incidental Economist and Los Angeles Times, the latter of which helpfully added the word “scam” to the discussion.

Thus, we bore witness to a perfect storm, the first-ever lay media feeding frenzy on wellness, from both the right-leaning Federalist and the, uh, non-right-leaning All Things Considered. Those would be the first times wellness in general (as opposed to specific programs like, for instance, the Truven/Highmark Penn State debacle or Nebraska’s falsified outcomes) has attracted the lay media. Additionally, the comments, even on the typically erudite All Things Considered, were merciless. Skeptics that we are, we still underestimated employee resentment of forced screenings and risk assessments.

The wellness true believers’ rebuttals were quite in character. As we say in Surviving Workplace Wellness, in this field you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself. Because most of the true believers’ “A Team” are ethically compromised, they had to go to their bench to find a rebutter. Against all those eviscerations in the major national media, they countered with: Siyan Baxter, a graduate student at the University of Tasmania, who claimed a positive return on investment (ROI) for wellness. She wrote in a journal that contains the words “health promotion” in its very title and has never once published a negative article about wellness savings. Publication bias, anyone? That isn’t even the punchline. The punchline is that, as our book predicted, Ms. Baxter self-invalidated. She says, right in the article: “Randomized controlled trials show negative ROIs.”

How did she still come up with a positive assessment of wellness? Because she “averaged” those ROIs with studies she herself describes as low quality, to get a positive ROI. (These 5- to 30-year-old studies were conducted in an era when, as the award-winning book The Big Fat Surprise observes, the American Heart Association bestowed a “heart-healthy” endorsement on every box of Kellogg’s Frosted Flakes.)

Her approach is, of course, is like averaging Ptolemy and Copernicus to conclude that the earth revolves halfway around the sun.

The other rebuttal was from Professor Katherine Baicker, who is considered a deity in this field because she basically launched it with a claim, published five years ago in Health Affairs, that wellness achieves a very precise 3.27-to-1 ROI. (As with Baxter, the wellness programs where Baicker found savings were conducted during the era when the AHA apparently conflated Tony the Tiger with Dean Ornish). Having recently stated she no longer had interest in wellness and having more recently blamed readers for relying on the headline “Workplace Wellness Can Generate Savings” and not reading the fine print, she nonetheless decided to defend her legacy.

Her defense on NPR is worth reviewing. Baicker said: “There are very few studies that have reliable data on the costs and benefits.” That, of course, is not the case – the wellness true believers’ own meta-analysis above shows that in well-designed assessments, the programs lose money. Baicker also said: “It could be that when the full set of evidence comes in, it will have huge returns on investment, and the billions we’re spending on it are warranted.”

This all sounds a little different from the three significant digits of: “Wellness achieves a 3.27-to-1 ROI.” And it is invalid because, as any epidemiologist knows – and as Dr. Gilbert Welch elegantly explained in Overdiagnosed — if an impact is truly meaningful, it would show up in a small or medium-sized sample. This means that, if indeed there were “billions” to be saved, we’d know it based on the hundreds of millions of employee-years that have been subjected to wellness in the last 10 years.

The “full set of evidence” is already in….and it’s game, set and match to the skeptics.

CEOs Defy Common Sense on 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 that all the evidence is against it. The “evidence” in favor of conventional wellness is easily disproven as being the result of gross incompetence or dishonesty. Occasionally, as in the American Journal of Health Promotion, investigators even manage to disprove their own savings claims without intending to. As we say in Surviving Workplace Wellness: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”

Just before Thanksgiving, both Health Affairs (with our blog post) and Soeren Mattke, 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.”

No longer can 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 the posting, Reuters’ Sharon Begley reported that on Tuesday, Dec. 2, the Business Roundtable’s (BRT) CEO is having a sit-down meeting with President Obama to demand exactly the opposite of what all the evidence shows: He wants more flexibility on wellness. In particular, the BRT wants the administration to call off the EEOC watchdogs, who have recently attacked Honeywell  and others for forcing 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 was modeled after the Safeway wellness program, which Safeway later admitted did not even exist during the period for which the company claimed it saved money.) In essence, the BRT leadership wants to make their employees love wellness whether they like it or not.

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

(1)    The CEOs who compose 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.

(2)    The CEOs who compose 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.

Let’s examine each possibility in turn.

As to the first, people don’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. The C-suite 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, then the industry is a wholly illegitimate enterprise. The first possible 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 annually in the commercially insured population, while using wellness programs to identify all the other diseases they hope to prevent or control will merely drive up employers’ drug spending; these nascent conditions wouldn’t become debilitating until years into retirement. Guidelines promulgated by the U.S. Preventive Services Task Force (USPSTF) call for judicious use of clinical screenings in various at-risk subpopulations, (with a few exceptions, such as blood pressure). By contrast, 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.

So why go to the mat with the president over these programs? Perhaps CEOs believe that fatter employees have lower productivity, which is probably the case – if you happen to own a package delivery service or a ballclub. Otherwise, it’s hard to imagine that weight affects one’s ability to answer the phone, conduct a meeting or handle almost any other task commonly required in today’s workplace. And these CEOs’ own actions contradict any claims about how weight loss leads to greater productivity: Most of the growth in line manufacturing jobs takes place in states with high obesity rates…but lower wages. Obviously, the tangible benefit of the latter overwhelms any offset by the former, or hiring practices would be different.

Unless there is an alternate explanation (or the BRT simply doesn’t understand the data), this BRT demand of the president must be interpreted more cynically: It’s the opening salvo in an attack against aging and chronically ill employees whom employers simply aren’t allowed to fire any more. Employers want to get rid of these employees because – often due to circumstances beyond these employees’ control – their healthcare expenses are believed to be higher.