Corporate wellness programs fail both companies and patients

This column was published in USA Today on September 9, 2013.

More patients are coming to my primary care clinic with forms from their employer, asking me to measure their blood pressure, or check their sugar and cholesterol levels. Companies requesting medical data drive employee wellness programs, a booming $6 billion business, with approximately half of large employers offering such plans.

Coaching and financial incentives are often offered to help employees meet certain health metrics, such as losing weight, lowering cholesterol or quitting smoking. The results of these tests are often tied to the cost of health insurance, with less healthy workers paying more. Under the Affordable Care Act, up to 30% of an employee’s premium in 2014 can be influenced by these programs, an average of$1,620 annually per worker.

Wellness programs are designed to lower costs for employers and keep workers healthy, but do they accomplish either goal?

True health cost savings?

Wellness plans are often promoted as saving $3 or more for every dollar invested. But a recent RAND Corporation analysis found that fewer than half of companies took the time to calculate whether these programs saved them money. If they did, the numbers might have startled them. That same study also concluded that wellness programs did not significantly reduce employer health costs.

Why? Health screenings generally promote more doctor visits, prescription medications or further tests. While this might benefit workers’ health, it doesn’t necessarily save money.

If there are no measurable savings, employers pass on the cost of these programs, as much as $500,000 per year, to workers by raising their insurance premiums.

Whether wellness programs improve health is also dubious. This year, the California Health Benefits Review Program, which advises the state’s legislature, found that employees’ blood pressure, blood sugar or cholesterol did not improve by participating in a corporate wellness plan. Weight loss was minimal, with the RAND researchers finding that workers lost about 1 pound annually for three years.

Furthermore, there was no improvement in the rate of hospitalizations and emergency room visits.

Some short-term benefits

While there was a short-term gain in the rate of smokers quitting, it came with a qualification. Fewer than half of employees participate in wellness programs, which are mostly voluntary. Those who participate are often the most motivated, making it hard to tell whether their smoking cessation was due to the wellness program or the employees’ motivation.

Wellness programs also require tests more frequently. For instance, many require blood sugar and cholesterol screens every year in healthy adults, far in excess of recommended guidelines, which call for checking these levels once every three and five years, respectively. Such over-testing doesn’t necessarily make patients any healthier and contributes to the $210 billion our health system spends annually in unnecessary care.

Because I want my patients to save money on their insurance premiums, I dutifully fill out their wellness forms and order the requested screening tests that might not be needed. But it’s doubtful I’m saving these companies money or making my patients healthier by doing so.

Corporate wellness programs fail both companies and patientsKevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor, KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • NPPCP

    I agree. In my clinic, we fill this out all the time for state employees. It is an administrative burden. AND, the customer wants it completed because they “get cash for doing it”.

  • karen3

    Awesome post.

  • Dr. Drake Ramoray

    One of my partners patients stopped taking his insulin last week to meet his employers weight loss goal. A1c 13.5. He got his incentive money through his employer though.

    • NPPCP

      Wow. That is impressive. Amazing. I can only imagine what you told him.

    • buzzkillerjsmith

      Beautiful. I like the way that guy thinks.

  • elizabeth52

    This is becoming a real problem in Australia too. My husband’s firm had the breast screening authority come into the office to “talk” to women, in my opinion, it was a biased sales pitch for screening. Women here are finally hearing about uncertainty of benefit and over-diagnosis in breast screening and so the screening authority is frantically trying to achieve the govt-set target of 70% of eligible women. (aged 50 to 70)
    They won’t make it, the cat is out of the bag. Even using some celebrities in a new “Get Screened” campaign won’t get them over the line…to reach their political goal.

    Some firms/companies also, offer free flu shots and a wellness check every year, not the American examine-the-lot type annual exam, but basic checks. (BMI, blood pressure, cholesterol, Vitamin D etc.)

    I personally think people should be left to make their own healthcare decisions/arrangements, and even though these talks and exams are voluntary, there may be people who feel they must or should agree or feel pressured/questioned by workmates. (especially with breast screening) Sadly, some women still don’t feel they can admit they’ve chosen not to have cancer screening, it’s always been promoted as something we must do, so some feel guilty, embarrassed etc. if others find out they’ve opted out.
    I tell people very clearly that I’ve opted out, we need to hear that more so more women understand these tests/exams are a choice we can reasonably refuse.

    In my opinion, almost all routine exams and screening tests are a waste of time and far more likely to harm us. We need to be cautious and protect our asymptomatic body from excess and non-evidence based testing/exams….informed decisions are the best decisions.

    • buzzkillerjsmith

      Glad to hear they’re nuts down under as well. Less lonely that way.

    • Disqus_37216b4O

      But in Australia, it’s the government driving those sales pitches for screening, not employers. Employers don’t pick up your health tab, the government does.

  • Steven Reznick

    Bloomberg News ran a similar story today about a different firm with similar issues. Ultimately the responsibility is our own. Holding you financially responsible to take care of yourself may dissuade some people from an unhealthy habit, activity or lifestyle but ultimately it is an individual responsibility. No degree of badgering will work. When individuals decide to make a lifestyle change they are successful

  • Disqus_37216b4O

    Another reason why we need to decouple health insurance from peoples’ jobs.

    If your boss were expected to provide your home & contents insurance, they’d probably pop around with snap inspections making sure your gutters were clean, your smoke detectors all had working batteries and you didn’t leave your garage door cracked open for your cat to come in and out.

    If your boss were expected to provide your car insurance, they’d be out every morning inspecting your tire tread, and probably give you a bonus for having a speed limiter and breathalyzer-interlock installed, and dock your pay if you ever got caught texting while driving.

    People need to start taking out their own individual health insurance policies, the way they do for home & auto. The situation as it stands is really quite ridiculous.

  • Dorothygreen

    I read how this “incentive program” came about in John
    McDonough’s book – Inside Health Reform. There was little evidence to show this approach was cost effective. I think one company was used to make that decision. Recently, I heard on PBS – “Walgreens will shift 160,000 employees into private exchanges with company subsidies; Time warner, Sears and Trader Joe’s doing the same”. Health Insurance exchanges are a good thing. Even Medicaid as we know it could come to an end by subsidizing insurance premiums for more. It is not a new concept – this is the only way to purchase health insurance in Switzerland – employers can contribute but not mandated. Other countries also have exchanges. Insurance companies reinsure so they all share risk. It would be a step in the right direction but overall health care costs and insurance premiums still have to be reduced for folks to buy in. And the sad state of health care costs is changing too slowly especially the SAD (standard American Diet) impact on American Health.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    A hospital system I work with has periodic screenings onsite to check BP, cholesterol, & blood sugar. I would think it would be cost effective to do these screening onsite? Maybe not?

  • http://www.themovementonline.net/ The Movement Online

    This is exactly why companies need to implement a combined wellness AND risk management program in order to achieve the results they are looking for. The types of wellness programs mentioned in this article are typically voluntary and focus on individual behaviors that are difficult to change. However, wellness programs with a risk management component become a mandatory part of the job, they focus on mitigating the risks associated with jobs, they becomes a part of corporate culture, and have been found to make immediate and lasting change.

    It’s easier to change the job than it is to change the person doing it, so it’s important to implement a program with a risk management component. That way both your employees and your bottom line will be reaping the benefits.

  • katerinahurd

    It is not an issue that I haven’t raised in a submission to your post while you were on vacation July 2013. In my article I had explained why a health manages the financial health of a company by managing the healthcare costs of employees. The incorporation of a health coach into the management team of a company individualizes the health needs of the employees by taking into consideration the work environment. The wellness programs fail because they lack an individuality and operate independently of the work environment. It would be an investment to hire a health coach without adapting carrot and stick method toward employees. In my article I had given examples of companies such as Apple, Microsoft and Johnson and Johnson that incorporated a health coach into their human resources team. I would be grateful if my article could be retrieved and reviewed by you.

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