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.