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.