Health Economist Blasts Wellness Programs

Disease management expert and author Al Lewis lays out his case against health-contingent wellness programs: The concept of health risk assessments "is advice opposite of what doctors tell you to do. The arithmetic can't save money. Every vendor who reports savings lies."

Al Lewis, a disease management expert and health economist, and Tom Emerick, a health benefits consultant and former benefits VP at Wal-Mart, believe that spending more on wellness programs increases healthcare costs. In their book, Cracking Health Costs: How to Cut Your Company's Costs and Provide Employees Better Care, they say human resources departments lack the focus and data analysis skill to adequately evaluate their company wellness programs, and instead they rely on vendors to take care of their employees.  

In a phone conversation, Lewis explained what's wrong with the wellness system:  

HLM: What are we talking about with workplace wellness?

Lewis: I'm completely in line with the vast majority of your readers in thinking that the culture of health is something that a company should really want to achieve.  

Then there's health-contingent wellness, where a wellness company is essentially playing doctor. They're getting involved in things they know less than nothing about. They are as likely to cause harm as to help people. The issue is that there's a reason you have to go to medical school to be a doctor. The reason is it's not that easy.  

The health risk assessments and the screenings are on such high levels with these programs that your own doctor would find them unnecessary. HRAs create problems of their own with advice that isn't medically accepted.

HLM: What advice isn't medically accepted?

Lewis: The government very clearly says that screening should be done less frequently, but benefits consultants and vendor communities are saying precisely the opposite. And we're penalizing people for not showing up for the screenings.  

Or when they do go to the screenings, it can be a false positive, which is why you're not supposed to get screened as often. You can tell hundreds they have diseases they don't. In an attempt to create a culture of health with HRAs, you create a culture of deceit. Instead of a culture of wellness, it's a culture of sickness, designed to tell people how sick they are.

If a doctor told you to do these things, and they did scans with no cause, they'd lose their license. If a screening company does it, they aren't MDs, so they can give you all the advice they want and they aren't regulated.

HLM: So you're saying that the wellness industry business is essentially a scam? How has the industry responded to you?

Lewis: The MO of the wellness industry, when they are faced with these issues is to ignore them. Everything I and others have ever written, with exception of [one] RAND report, they've ignored. No response to my Wall Street Journal article, and the last book I wrote [Why Nobody Believes the Numbers] is a trade best seller, but from the wellness industry, [there's been] no review or acknowledgment that the book even existed. If [they thought the wellness industry] was defensible then [they] would acknowledge and defend it.

To summarize the case against industry: Epidemiology is all wrong; the concept of HRAs is advice opposite of what doctors tell you to do. The arithmetic can't save money. Every vendor lies.  

HLM: How do you explain the reports where wellness companies show savings?

Lewis: Participants will always out-perform non-participants because they are motivated. Even without a program, participants do better and wellness programs split people into actively motivated participants and non-participants.  

Throughout the industry, every study, except for a couple, compares active participants with people who are so unwilling that they are willing to forgo an incentive not to be involved in a program. You can't compare these two groups to determine savings.

HLM: Why don't incentives work to change behavior?  

Most behavioral economists will tell you [that] you can't pay someone at work to make changes to behaviors that developed where they do not work. Think about 'stop smoking' incentives. You pay someone $300 to stop smoking, but mentally it costs them $3,000 to not smoke.  

You can't pay someone to overcome an addiction. With weight management, think about the junk food industry and how they are spending billions on brain science to figure out how to addict people more. Meanwhile the wellness industry is countering this highly sophisticated, molecular level science—and spending more is the only tool they have, so incentives keep going up and up and up.

More money doesn't help incentives, yet incentives doubled in last four years. The incentive payment itself is greater than the amount being spent on the bad habit.  

HLM: How does an employer redeem an existing program to make sure it's serving employees appropriately?

Lewis: Let go of the large consulting firms. If they are supporting wellness, they want to generate more activity. When you get independent consultants, they won't have any stake in the outcome.  

Make a two-by-two matrix and put in one column, 'These are things we do to our employees in the name of wellness.' Then the second column, 'These are things we do for our employees in the name of wellness.'  

Then take as many things as possible out of the first category, and realize these things are such bad ideas that we have to pay people to do them. Instead, examine what you can do for your population so that they will like your program so much they will voluntarily sign up.

You can subsidize healthier food in cafeteria. Build fitness centers. Make it easier to ride a bike to work, have a walking path. Essentially, allowing people to pursue their own interests is a very valuable way to do a wellness program. Instead of penalizing employees if they don't do things, replace that philosophy with 'If you build them they will come.'

HLM: So making it easier to exercise and eat healthfully at work is enough? What about those workers who are so stressed they still don't think they have time to participate?

Lewis: You still have to push the concept of wellbeing. It's like wellness, but it's also looking at the quality of management to make sure it's trickling down that the company cares. Telling somebody they're sick won't reduce [their] stress. A company should want employees to think that the employer cares about them. You have to expand it to things that involve more than just building the physical environment.  

People don't quit companies, they quit managers. Want to change wellbeing at the workplace, look to see if people are regularly quitting underneath certain people, and then change the manager. Wellbeing requires fundamental changes to the workplace structure.