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Protecting Employees From Harmful Vendored Wellness Programs: A Wake-Up Call

Al Lewis wears multiple hats, both professionally and also to cover his bald spot. As founder of Quizzify, he has married his extensive background in trivia with his 30 years experience in healthcare to create an engaging, educational, fully guaranteed and validated, question-and-answer game to teach employees how to spend their money and your money wisely. As an author, his critically acclaimed category-bestselling Why Nobody Believes the Numbers, exposing the innumeracy of the wellness field, was named healthcare book of the year in Forbes. As a consultant, he is widely acclaimed for his expertise in population health outcomes, and is credited by search engines with inventing disease management. As a validator of outcomes, he consults to the Validation Institute, part of an Intel-GE joint venture.
Second, in addition to the general overscreening creating this tendency, a specific example of the “nocebo effect” from this program would be moralizing about alcohol consumption in any quantity. In the chart above, note the average self-reported consumption of alcohol is 1.1 to 1.3 ounces per day, well below the 15 ounces/week considered problematic. However, Wellsteps calls any consumption of alcohol a “high level” and a “worst health behavior.” As noted in the chart below, everyone admitting to any amount of alcohol consumption (meaning the same group as in the chart above) is found to have this worst health behavior.

Third, paying people to change behaviors (or in the case of self-reported health habits, paying people to say they changed behaviors) is very controversial and may be counterproductive. It is also possible that the incentive-based program design itself created iatrogenic consequences due to the very high ($830) incentive payments.
Between the overscreening, misunderstanding of the risks of alcohol, use of powerful but possibly counterproductive incentives, and Wellsteps’ own claims of causation, it is possible, if not likely, that the program caused the deterioration in health. Even if it didn’t and this was just pure coincidence, no program should be given an award for this performance, and no vendor should be allowed to claim it improved outcomes, based on this performance.
Wellsteps’ award application revealed other issues as well. Examples would include misattribution of savings to the program and mathematically incompatible savings figures. Wellsteps’ CEO, Steve Aldana, and the head of the Koop Award Committee, Ron Goetzel, also appear to contradict themselves, and or admit error, in attempting to defend this program.
While these flaws don’t involve the specific question of harms to employees addressed in this posting, they do further confirm that this industry needs to address major issues of credibility, mathematical competence, and cost-effectiveness, as Slate quite dramatically posited.
Putting Harms to Employees in Context
While the Hippocratic oath calls for doctors to “do no harm,” an excellent argument may be made that the standard for wellness programs should be much higher due to the financial coercion that organizations use to drive employee engagement. Specifically, virtually everything else in ambulatory healthcare requires “opting in” to actively seek medical assistance. By contrast, wellness requires employees to “opt out” in order to avoid a clinical intervention. In the Boise example, opting out costs $830 in higher deductibles and contribution.
To put this in perspective, other specific health-related activities for which people are or can be penalized for “opting out” include: wearing helmets/life jackets/seat belts and getting kids vaccinated. In each case, the clinical evidence/science allows government paternalism to overwhelm considerations of personal choice. Wellness, as the Wellsteps example shows, does not remotely approach the level of evidentiary certainty of these other de facto personal health requirements.

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