February 11, 2014
Three Surprising Hazards of Worksite Wellness Programs
by Leah Binder
Many of us may be reluctant to question the design of our company's wellness program because it sounds like we are challenging Mom and apple pie. But poorly designed wellness programs can do much more harm than good.
Here's a proposal for the plot of a new comic book.
Perry White summons Clark Kent and Lois Lane into his office one day in Metropolis.
“I have bad news,” White barks. “Health costs at the Daily Planet are through the roof. And it's all your fault. You're unhealthy!”
White tells Clark and Lois to fill out a questionnaire, which he assures them will be kept “private.” Once they complete it, they will receive free advice on running their personal lives better. “And we're docking your pay $1,200 if you don't fill it out and see a doctor,” White warns.
The questionnaire asks about smoking, exercise, weight, feelings of depression, financial problems, marital problems and stress. Clark's questionnaire asks whether he examines his testicles regularly. Lois must answer whether she plans to get pregnant. And they get lots of valuable guidance on their misguided lifestyles. Eat your vegetables. Cheer up. Calm down. Don't smoke. Pay your bills on time.
Though he can leap tall buildings in a single bound, Clark, according to the questionnaire, needs a number of tests and screenings to rule out serious health problems.
I probably couldn't sell this comic book proposal because the scenario sounds too preposterous, even for a guy with X-ray vision who flies. Surely, in real life it would be illegal or at least politically incorrect for your boss to demand to know your most private information, obtained under the threat of a pay cut.
Sorry to say, this plot isn't entirely fictional for thousands (if not millions) of Americans. Not only is it actually legal for your employer to require you to answer intrusive personal questions, it's encouraged by a little-known provision in Obamacare, which is embraced by a surprising mix of people and interests on both sides of the aisle. That provision allows employers to promote “worksite wellness” programs and require their employees to pay up if they don't participate.
A multibillion-dollar industry has grown up overnight, selling wellness programs to well-meaning employers. More than 90% of all large employers report offering one for employees. Some of these programs are excellent and welcomed by employees. It's nice for an employer to support exercising and quitting smoking.
But badly designed programs are not so nice, as Matthew Woessner learned. He received an email from his employer on July 17, 2013, instructing him to take the online questionnaire called a “Health Risk Assessment,” reporting on his personal life and habits akin to Perry White's grilling of Clark and Lois. Like the Daily Planet employees, if Woessner refused, he would lose $1,200.
This could happen to you, according to Al Lewis and Vik Khanna in a disturbing new book, “Surviving Workplace Wellness…with Your Dignity, Finances, and (Major) Organs Intact.” The book is so laugh-out-loud funny you may wonder if it's really serious, but actually it's a sobering exposé of hazards in the worksite wellness trend in American business. Think of the book as Dave Barry meets Rachel Carson.
The authors agree that the worksite wellness movement is not only a privacy hazard, but a health hazard and business hazard to boot. While some of us might be willing to tolerate a certain amount of privacy loss if we thought it would improve our health and save some money, Lewis and Khanna make a compelling case that poorly designed wellness programs don't help at all. In fact, these programs in the wellness business: 1) dismay and alienate employees, 2) fail to reduce health costs and 3) harm employee health.
How is this possible? Let's look at each in turn.
1. Dismaying and Alienating Employees
Bad wellness programs send the message that your boss thinks you're an idiot. This typically isn't a good strategy for improving morale, though it does improve motivation to update your resume.
Woessner's employer is a good example. That employer tells employees who smoke that tobacco use is not healthy. This implies that employee smokers are not educated enough to recall the Surgeon General's warnings or the mountains of studies over the past 50 years. Woessner's employer also believes that a good number of workers are too simple-minded to understand they should eat their vegetables and get some exercise.
What kind of company employs such a dim workforce? In Woessner's case, it is Penn State, which employs some of the world's leading researchers in science, technology, social sciences, humanities and health care. Despite their apparent stunning lack of knowledge about the most fundamental aspects of their health, a disproportionate number of them managed to earn PhDs.
Of course, the reality is that public health is a complex enterprise for which it is very easy to condescend and coerce when you mean to encourage. Bad wellness programs focus on the former.
2. Bad Programs Don't Save Money
Lewis and Khanna show examples of wellness vendors inventing savings numbers to sell their services to your employer. (I dare anyone to get through this section of the book without laughing.) Wellness marketers make claims that literally don't add up, such as proclaiming savings exceeding 100% (mathematically impossible) or, similarly, suggesting an employer saved more money than he spent in the first place.
Fundamentally, Lewis and Khanna make a compelling case that bad wellness programs don't save money because the programs themselves cost money, and the added cost of screenings and education and other services aren't free, either.
3. Potential Harm to Employee Health
Even if wellness programs may cost a bit more money in the short run, surely they improve health in the long run…right? Unfortunately, that's not evident either, the book argues.
Lewis and Khanna give us a case study of the state of Nebraska, which touts the success of an employee wellness program that won the national C. Everett Koop Award. The book shows convincingly that, not only are the proclaimed savings numbers impossible, but Nebraska's employees may have been exposed to hundreds of unnecessary and invasive tests. Many resulted in false positives that demanded even more invasive tests and treatments, which can scare patients for no reason and even lead to additional risk and harm.
I recommend this book because your employers – and the vendors and consultants that sell to them – aren't going to change without your input. Employees and business leaders need to do what the Penn State staff did and push back on poorly designed programs. In the process, they will be supporting, not undermining, the economic wellbeing of their employer.
Many of us may be reluctant to question the design of our company's wellness program because it sounds like we are challenging Mom and apple pie. How can you oppose something as pure-sounding as employee wellness? But what this book warns is that poorly designed wellness programs can violate the very essence of good management practice: namely, that management should focus on employee performance, not employees' personal lives. The latter can do much more harm than good.
A well-designed wellness program does not threaten to dock Superman's pay if he doesn't get a cholesterol test. A good one might instead add a salad bar to the Daily Planet cafeteria. The latter doesn't sound like something Perry White would do, but after all the Chief has never been the model of a good boss.
I don't come to this conclusion about the problems with wellness programs lightly. I worked in public health and dedicated much of my career to promoting prevention. My belief in the importance and the difficulty of prevention is precisely why I believe we must call out poorly designed programs that prey on well-meaning employers and other purchasers. Those programs apply equal measures of coercion and disparagement toward the people they are supposed to help. That discredits employer benefits programs and undermines employee loyalty and trust. Employers deserve better for the investment they make in the wellbeing of their employees.
This article first appeared on Forbes.com.