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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.
Further, in the case of wellness, the government has abdicated design, implementation and day-to-day enforcement to the employer. The other major workplace area where the government cedes those to the employer is worker safety. However, safety requirements differ from wellness in 3 key ways:
 
  1. Safety is overseen by government agencies in many, if not most, cases—it is not an abdication. No government agency oversees wellness vendors;
  2. There is clear recourse for employees—and possible criminal sanctions—if employers violate safety rules. By contrast, while an employee can bring a suit for certain process violations of the law, they can’t sue wellness vendors for malpractice because there is no license requirement or minimum standard of care;
  3. Safety requirements have worked, reducing on-the-job fatalities by about two-thirds. There is overwhelming evidence that wellness has not produced measurable savings to date, and even acknowledgement by industry leaders that—to quote STAT—“vanishingly few” programs work.
 
A Regulatory Proposal 
The fact that Wellsteps is considered award-worthy raises the question of what harms are being done by non–award-worthy vendors, which are presumably worse than Wellsteps. To protect employees from harms caused by such vendors—especially the ones embracing programs rated “D” by the United States Preventive Services Task Force—a model Employee Health Program Code of Conduct has been proffered. It basically urges wellness companies to aim to do no harm:
Our organization will recommend doing programs with/for employees rather than to them, and will focus on promoting well-being and avoiding bad health outcomes. Our choices and frequencies of screenings are consistent with United States Preventive Services Task Force (USPSTF), CDC guidelines, and Choosing Wisely.
 
This Code could be the basis for a regulation. It might be too politically difficult to require wellness vendors to adhere to guidelines, owing to the support for wellness by politically powerful entities such as the Business Roundtable. Instead, a requirement of disclosure might be sufficient.
 
So perhaps vendors should be required to either adhere to this or a similar “do no harm” standard, or else explain to employees why they aren’t adhering to it—and get releases from the employees saying they understand the risks of overscreening but would like to participate in wellness anyway. If they decline, they would be offered a “reasonable alternative” to the wellness program, such as healthcare education or an exercise program. While there is no guarantee the alternatives would save money or generate a positive impact on health, the likelihood that exercise or education would harm employees is far lower than the demonstrated chance of overscreeninng, moralizing, or large financial penalties would do exactly that.

 
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