Wellness programs and the West Virginia Teacher’s strike

Earlier this week, John explained the wellness program that the West Virginia PEIA pushes called Go365:

Whoever came up with the idea for Go365 is a special kind of asshole…. I will give you a brief explainer. For decades now, as health insurance costs increase, corporations and organizations have been implementing wellness initiatives to try to encourage workers to engage in healthier lifestyles, which will lower health costs for the company, and in return there is usually a small reward- a small reduction in worker contribution, etc….

Go365 was like that, in the sense that it tried encourage employees to engage in healthier behaviors, but while normal wellness initiatives are all carrot, this was a gigantic stick up your ass and if you didn’t do it, they were going to charge you 500 bucks more a year. And it was invasive- biometric screenings, tracking your fitbit, etc. Apparently they tried to soften it a touch by letting you earn points for crap like free movie tickets….

There is very little quality evidence that shows broad employee wellness programs save money or increase health. Austin Frakt at the Incidental Economist had a good summary from late 2014 on this topic:

We’ve said it before, many times and in many ways: workplace wellness programs don’t save money.

Last week, on the Health Affairs blog, Al Lewis, Vik Khanna, and Shana Montrose said so too, adding some nuance we have not included in our posts on TIE. You should read the whole thing. Here are a few of my favorite passages:

It is beyond the scope of this posting to question non-peer-reviewed vendor savings claims that do not use any recognized study design.

I just love this phrasing of “we’re not reviewing crap.”

There is a recent NBER working paper that conducted a large randomized trial of wellness programs in Illinois:

we do not find significant causal effects of treatment on total medical expenditures, health behaviors, employee productivity, or self-reported health status in the first year. Our 95% confidence intervals rule out 78 percent of previous estimates on medical spending and absenteeism. Our selection results suggest these programs may act as a screening mechanism: even in the absence of any direct savings, differential recruitment or retention of lower-cost participants could result in net savings for employers.

It changed no behaviors. Instead it rewarded or punished previous behaviors. Now if you are an HR rep for a small self-insured, setting up a wellness program that is very attractive to low actuarial risk individuals and ugly to people with a high likelihood of needing expensive care, there is a certain amount of logic to run people away. That works until it does not and it begins to fail miserably when the insurer is also a monopsonistic buyer of a particular type of skills and services as they are going to get everyone in the pool anyways.

Broad wellness programs are intrusive, expensive and ineffective at actually achieving what they claim they want to achieve: improved health and lower costs. And yet we keep on doing them.

36 replies
  1. 1
    Phylllis says:

    Our wellness program with the state insurance program kept pushing a thing last year where you’d get your maintenance prescriptions with no co-pay. Which is great, except for the monthly conversations you were required to have with a ‘wellness coach’ regarding health habits, etc. I take a beta blocker for irregular heartbeat, and they would.not.leave.me.alone about it last year. Nope, rather pay the 9 bux. They’ve changed it this year to a quarterly thing where if you finish all the challenges each quarter, you get ‘no pay co-pay’ the next quarter. I did it, but I’m still uneasy about it. It’s just another way for big corporate/pharma/boss to weasel into your personal business.

  2. 2
    NorthLeft12 says:

    I was very surprised to hear about the punitive nature of some of the wellness plans in the US. The two wellness plans that I have been involved in are/were both reward based.
    The new plan [Virgin Pulse] is very intrusive and time consuming, especially since I don’t have a cel phone or Fitbit. Fortunately my financial condition is good enough that I don’t need to bother myself with participating in it. I still workout, walk, and generally eat healthily, but I’ll be damned if I am going to detail that for them.

  3. 3
    Betsy says:

    It’s like drug testing for social welfare benefits. Driven by an impulse to.punish and judge, something that *some* Americans love to do to other Americans.

    I’m so over Calvinism.

  4. 4
    ArchTeryx says:

    @Betsy: Or simply yet another way employers can impose their will on workers. When the “reserve army of the unemployed” is small enough, these things start disappearing like magic. The moment employers in a given sector get market power over their workers, these things start *popping up* like magic.

    Their end goal is indentured servitude.

  5. 5
    NorthLeft12 says:

    @ArchTeryx: Yes, I love how businesses will screw around with their personnel wrt hours of work, benefits, safety, training, and their general security when they have the upper hand, then whine and moan about the lack of loyalty when those same employees leave when they get a better opportunity.
    I have told many youngsters that I have worked with that they don’t owe the company anything, and if it is in the company’s best interest they will kick your ass down the road or even close entire departments or facilities.
    And I have worked for some decent companies too.

  6. 6
    Elizabelle says:

    What a Big Brother system. Something else the MBAs stick the rest of us with. Jebus.

    I am all for encouraging better habits, and preventative care. But this is bizarre.

  7. 7
    gvg says:

    huh, here at my employer of over 20 years, they seem more like a perk. If you want to get healthier, they offer some help. A lot of people are kind of social and like company when exercising or dieting. we get news letters, we can contact this person if interested. I do want to exercise and eat better but I am not social so I don’t care. claims of less employee sick time etc. strike me as justifying to bean counters what they want to do anyway. Also helping people quit smoking helps those who don’t smoke suffer less though thank goodness Florida banned smoking on public places years ago. My early work experiences were less pleasant because of smokers.

  8. 8
    RSA says:

    Likewise, most literature finds that annual checkups confer no net health benefit for the asymptomatic non-diagnosed population.

    I did not know this. In fact, I suspect very few Americans know this; the concept of an annual physical has been drummed into us for decades.

  9. 9
    Luthe says:

    @NorthLeft12: Yep, as a young(ish), my personal metric is quality of life, not company loyalty. Now, if it is a company where my quality of life is high and my bosses are not assholes I will feel more loyalty, but as soon as conditions begin to change I start looking for the exit.

  10. 10
    Sister Rail Gun of Warm Humanitarianism says:

    I’m sure NC’s SHP is taking notes, but so far their wellness stuff has been limited to an annual certification of no tobacco use and getting an annual physical. They have the health coaches but don’t offer incentives to use them.

  11. 11
    DHD says:

    @NorthLeft12: Yeah, I don’t think we get the really dystopian ones in Canada, for what should be pretty obvious reasons. I get to choose to fill out a questionnaire that is clearly fishing for risk adjustment information once a year, and in return I get $150 towards a new pair of skis … taxable, so actually it’s $75. At this point I’m just doing it out of good will to save the company money on our insurance premiums thanks to my excellent blood pressure and cholesterol numbers :)

  12. 12
    dr. bloor says:

    @RSA: If you think about it, it’s not at all surprising. An annual health check up is probably best suited to catch conditions that involve “quiet” symptoms like hypertension, glucose issues, etc., that become very expensive and dangerous when not addressed.

  13. 13
    Barbara says:

    There is nothing wrong with adopting a wellness program to help people try to achieve healthier habits. The amount of disinformation surrounding nutrition and exercise is just astounding. The problem is that the wellness vendor wants to get paid, so the employer wants to know why they should pay even more for something they are already paying too much for. Wellness programs oversell their benefits or else no one at all would buy them. And of course, that assumes the employer is operating in good faith and not just using the wellness initiative as a way to impose greater costs on employees or just drive away the higher risks. Honestly, you might as well pay for someone’s gym membership, or even better, build out a gym in the workplace and fund a trainer to help those who want to use it.

  14. 14
    RSA says:

    @dr. bloor:

    If you think about it, it’s not at all surprising. An annual health check up is probably best suited to catch conditions that involve “quiet” symptoms like hypertension, glucose issues, etc., that become very expensive and dangerous when not addressed.

    Good point. I probably never would have realized I have high cholesterol otherwise.

  15. 15
    gene108 says:

    Without wellness programs it is just surrender to the inevitable 10% annual rate hike, if you are lucky or the dreaded 20% to thirty percent hike if you are unlucky or the one hundred percent, we really don’t want to insure you anymore, hike because your employees got brain tumors and premature triplets.

    All I am trying to say is wellness programs may offer a feeling of control over costs, when they are always escalating and so out of control of anything the employer can do to control costs.

  16. 16
    MomSense says:

    Do any of these wellness programs pay your gym membership or pay for consultations with a trainer?

  17. 17
    Kristine says:

    My former company had a wellness program where you received a discount on your health insurance if you enrolled and answered all the questions, including exercise habits, weight, lipid levels, etc. IIRC I would’ve saved about $300/year, which wasn’t enough for me to give them that info. I feared they would use it against me at some point and jack up my rates.

  18. 18

    @RSA: Wouldn’t somebody with high cholesterol who didn’t know it fall into the “asymptomatic non-diagnosed” category though?

  19. 19
    Ukko says:

    @MomSense my previous employer would cover like $40 of a gym membership. Not enough for the nice gym but plenty for a Planet Fitness or the like. I still paid for the nice one since we could take the kids swimming there. ;-)

  20. 20
    Gex says:

    I would have to assume that employers realize the savings aren’t there. I guess they go to the effort of implementing these *precisely* because it allows them to be more intrusive into employees lives, exert unnecessary control over them, and adds various exciting new ways to punish or discriminate against workers they don’t like.

  21. 21
    RSA says:

    @Major Major Major Major:

    Wouldn’t somebody with high cholesterol who didn’t know it fall into the “asymptomatic non-diagnosed” category though?

    True! I guess I’m commenting here without thinking things through. (Not surprising.) Here’s the abstract:

    Clinical Question What are the benefits and harms of general health checks for adult populations?

    Bottom Line Compared with usual care, offers of health checks were not associated with lower rates of all-cause mortality, mortality from cardiovascular disease, or mortality from cancer. Health checks may be associated with more diagnoses and more drug treatment. Morbidity was infrequently reported, as were most harms, such as use of diagnostic procedures.

    Now I don’t know. If a “physical” is a “general health check”, as seems to be the case, the argument here is that it’s not actually helpful. I need to read more–like most people, I guess, I rely to much on anecdotal evidence from my own experience.

  22. 22
    SWMBO says:

    My husband’s company has switched insurance carriers every 2-4 years. The last couple of times, they have had the wellness coaches and assorted other bullshit. (Fitbit with targeted number of steps per day, biometric screening in a single room where everyone knows how much you weigh, bp, etc. A direct violation of HIPAA. Calls to remind you to get your flu shot. etc) They transfer your data from one carrier to the next. For years, they called me every year to get my flu and pneumonia shot. I had a bad reaction to a vaccine years ago and the doc at the time said not to do this again. I finally got pissed (they would call every week to remind me) and I started asking for their name, employee number, social security number, and bank account number. If I took the shot as they recommended, not only would I sue the insurance company, I would sue them personally for giving me bad medical advice. They haven’t called me in years.

  23. 23
    gvg says:

    @MomSense: My employer is a huge state University and they have to have gyms and trainers for the modern student anyway so employees get the same access. I believe it also helps recruiting desirable professors etc. But mainly it’s just the college way of life when a school is huge…around 50,000. Clearly that isn’t going to apply to most employers…but maybe in large ones who need to sell themselves to a workforce. Actually their are nursing, a med school, nutritionist degrees…that need trainees and people like the town and often want jobs to stay here so i think it would be hard not to provide coaches. but no need for being obnoxious.
    I can’t see people sticking to a program if it’s too pushy.

  24. 24
    JPL says:

    The teachers got their raise. WaHoo!!!!!

    The governor announced a deal was reached for a 5% increase.

  25. 25

    @RSA: from my perusal of the literature and talking with my public health friend, both of which are amateur, my understanding is that there are only a few things we know that prevent early death (which appears to be what that study looked at). Don’t smoke, that sort of thing. Sort of like the only thing we seem to rigorously know about food is that refined carbs are bad.

  26. 26
    MomSense says:


    I had to drop the nice gym because it was just too expensive. We do miss the swimming.

    ETA I’d like to convince my employer to buy me a leaf. It probably won’t help me get more fit but I like the way it looks.

  27. 27
    Blue Galangal says:

    @Kristine: I feel the same way. My company is smart enough to get one of the nicest women in the world, who survived cancer, to promote this program to make us feel even guiltier for saying no. But I keep saying no.

  28. 28
    Mnemosyne says:


    I feared they would use it against me at some point and jack up my rates.

    Check your state laws — here in CA, it’s illegal for them to do that. That’s also probably why our wellness program is all carrots and no sticks — our state law doesn’t allow the punitive actions that other states do.

    The other thing I’ve heard people say is that the wellness program is doing a pretty good job at helping people with diabetes and similar chronic issues keep up on their maintenance. For people without a chronic illness, it’s a lot more meh.

  29. 29
    gene108 says:


    I’d like to convince my employer to buy me a leaf.

    Can’t you just pick them up off the ground for free? Especially in the fall.

  30. 30
    proudgradofcatladyacademy says:


    This is based on employer plan design. Having worked at a major health insurance company that managed wellness plans, most large employers do not, while perversely, since they get a tax break, smaller employers do.

    I don’t participate in mine beyond taking the survey to get six bucks knocked off my premium tab. Some things though are automatic, for example when I go from my mammogram this year, that claim will feed over to my wellness program and it will be marked as complete and I will get another fifty bucks knocked off my premium. They really don’t work for weight loss, I saw the same employees year after year enroll in weightloss/smoking cessation coaching to meet the “hey, I have to show at least I tried to save 300 bucks on my yearly premium. ” The employees never changed their unhealthy habits and just the fact they completed the program unsuccessfully earned them their reward of a lower premium. Before I left this department, employers discovered this flaw and were designing programs that required not only doing the smoking cessation/weightloss coaching programs, but also that you had to demonstrate that you were successful at them.

    Plus, I have real issues with what I consider off the clock work for a proffered work reward/benefit. If my employer requires me to call in to the weightloss coaching line to earn a reward/benefitwell that work and I should either be allowed to do on during my scheduled work hours, or I should be compensated for that time.

  31. 31
    catclub says:


    I am all for encouraging better habits, and preventative care. But this is bizarre.

    I think it is bizarre for a different reason. Health insurance companies typically don’t like to spend on things that will benefit the next insurer, when clients move on for whatever reason. But in this case, any benefits to changing habits will likely accrue to the next insurer.

    So I am puzzled why they are doing it, at all.

  32. 32
    Arclite says:

    I bet sin taxing the shit out of chips and soda would have a positive effect on people’s health.

  33. 33
    NorthLeft12 says:

    @MomSense: My company’s first plan reimbursed us $350 per adult [includes my spouse] towards any physical activity related membership [curling and gym] or even purchase of equipment [running shoes, bicycle, etc.] every year. The new plan does not. We can collect some kind of points to redeem for generally worthless bric-a-brac.

  34. 34
    Roger Moore says:

    @Major Major Major Major:

    Sort of like the only thing we seem to rigorously know about food is that refined carbs are bad.

    We know more than that. For example, we know quite rigorously what happens if we fail to get enough of different vitamins, essential amino acids, essential fatty acids, etc. My gut feeling is that the reason we have trouble getting much beyond those very basic points is because there are literally no consistent rules past that point. Different people have different metabolisms, so they need different diets to be optimally healthy. The biggest rule of nutrition is that you need to find what works for you and not worry too much about what works for other people.

  35. 35
    RSA says:

    @Roger Moore:

    The biggest rule of nutrition is that you need to find what works for you and not worry too much about what works for other people.

    In contrast, the biggest rule of talking about nutrition seems to be that whatever works for you will work for all other people, and if it doesn’t it’s because they’re weak and lazy.

    At least, that’s the impression I get when the topic comes up elsewhere. :-)

  36. 36

    @catclub: usually sold by a different division or different insurer and it is usually sold to self-insured plans so the insurer is mainly doing admin work with little financial risk.

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