Over the last decade–and especially since the enshrinement of wellness in the Affordable Care Act–American workers have found themselves subjected in ever-increasing numbers to workplace wellness programs. While originally these programs were confined to large organizations, that market is now saturated. Consequently, the thousand or so wellness vendors in the marketplace are turning their sights on companies like yours.
These vendors pay your company’s own benefits brokers (whom they ironically refer to as “trusted advisors”) to convince your human resources department that weighing you, lecturing you, and poking you with needles will save them money. Since almost no employee would actively request their company to do these things, employers use bribes and fines, now averaging $521 per program, to drive participation.
Your instincts to steer clear of these programs–or do the minimum necessary to collect your “incentive” or avoid your fine–is well-founded for several reasons, as we amply demonstrate in our new book, Surviving Workplace Wellness with Your Dignity, Finances and (Major) Organs Intact:
Wellness programs generally require annual biometric screens and/or annual physician checkups, to allegedly detect early problems in order to prevent later ones. However, too much prevention is hazardous to your health, due to false positives and subsequent overtreatment. The United States Preventive Services Task Force (USPSTF) concludes that the harms of all annual cardiometabolic screens (except blood pressure) exceed the benefits, while all the medical literature recommends against annual checkups.
In their quest for relevance now that cholesterol has been discredited as a major predictor of heart attacks, wellness vendors are offering dozens more tests, almost none of which are recommended to be performed annually on generally healthy adults by the USPSTF or any other responsible medical organization. Some of the recommended tests, such as the prostate-specific antibody test, are recommended not to be done at all, because of the strong likelihood of false positives.
The result of rampant overscreening is a massive increase in the number of false positives. The Nebraska state program won an award for achieving a 10% diagnosis rate for colon cancer and a 40% diagnosis rate of cardiometabolic illness. In each case the figures, inflated by false positives, are many multiples greater than the actual rate of illness, and in the case of colon cancers the vendor later admitted lying to boost their numbers.
Suppose there is some kind of “silent” condition with a 1% prevalence in the general population. And suppose that the wellness vendor’s test is 96% accurate. The chance of a potentially harmful false positive would then be 4%, right? Wrong. If 100 employees are tested, assume the one employee (a “1% prevalence”) who actually has the problem tests positive, but because this test is 4% inaccurate so will four other people. Hence only one of the five people–20%–who test positive actually has the problem. And that’s just on one test. Vendors want to administer a dozen or more.
With your company’s financial health in mind, you may also want to knock on the door of the benefits administrator and point out that–in addition to potentially harming some employees–wellness won’t reduce corporate health spending either. A leading health policy journal has exposed vendor “get well quick” schemes, and published studies with negative returns at Barnes Hospital and PepsiCo. RAND weighed in with a study showing only minor health improvements and no cost savings. The author of the only major journal article ever to claim savings walked it back last summer, and even the informal leader of the wellness field acknowledged that “90% to 95%” of programs lack the proper incentives or systems to make them work.
Like everyone with a big budget, your benefits administrator wants to spend it, presumably wisely. If you are successful in talking this person out of wellness, you might be asked for your opinion on what to do instead. You can suggest putting that money towards improving the quality of the food in company cafes, subsidizing gym memberships, and developing family-friendly policies and procedures that help people manage the stress of their work lives more effectively. Recommend that they consider two questions when allocating wellness money:
1: Are they doing wellness to employees or for employees? (The distinction is easy enough–if a program requires fines or incentives, and/or a detailed “communications plan,” it’s a threat, not an offer.)
2: Would a general leading an army prefer troops with high morale or troops with low cholesterol?
That should be all the benefits administrator needs to reallocate resources, albeit over the protestations of their broker or prospective wellness vendor. If not, then make plans to protect yourself. You have a right to keep private health information private. You cannot be upbraided for failing to answer health risk appraisal questions truthfully, and you have no obligation to follow up on any questionable clinical recommendations.
Clinically based workplace wellness was a bad idea whose time has come and gone. Employees who care about their dignity, finances, and major organs can help ensure that, like any successfully treated disease, there is no recurrence.