September 13, 2016

WELL, THEY ARE RUN BY H.R.:

Workplace wellness programs are a total sham (L.V. Anderson, 13 September 2016, Dallas Morning News)

You might think of Al Lewis, Vik Khanna and Tom Emerick as the Three Musketeers in the fight against wellness programs. Lewis is a health care consultant. Khanna worked as a consumer health advocate for the Maryland state attorney general before running wellness programs for various companies. Emerick managed health benefits for Wal-Mart for 15 years. 

Individually, they all came to realize that wellness programs alienated employees and wasted money. After Khanna accepted a job running a wellness program for a nonprofit health system, he says, "I had a light bulb moment when I realized that these people who want these wellness programs and are running them really, literally have no idea what they're doing."

Their criticisms of the industry start with two of the most common tools in the wellness program's toolbox: the health risk assessment and the biometric screening. HRAs typically offer advice that any moderately educated adult has already heard hundreds of times: Eat lots of fruits and vegetables. Exercise. Don't smoke. Get enough sleep.

HRAs can contain misinformation, too. The HRA I completed last year grouped full-fat dairy and eggs in the same category as cold cuts, fried foods and cake, even though the evidence against saturated fat is nowhere near as conclusive as the evidence against processed meats and sweets. 

In an HRA he completed to save money on his wife's health care plan last year, Khanna reports: "They tell me that I'm slightly overweight with a BMI of over 25, and that's because I'm very muscular. I'm short, but as one of my workout mates says, I'm built like a fire hydrant." 

Khanna, now 58, took up bodybuilding at the age of 17 and describes himself as "a fitness and wellness fanatic."

As Khanna's experience shows, BMI is a crude tool. It can't necessarily tell the difference between someone who's ripped and someone who's chubby; it also can't tell the difference between someone who's chubby and someone who's pregnant. 

What's more, a 2013 meta-analysis of more than 7,000 studies found that a BMI in the overweight category was associated with lower mortality than a BMI in the "normal" range; only morbid obesity was associated with higher mortality.

The other measurements taken in a typical biometric screening are a little better. Blood pressure tests are very useful for detecting hypertension, but blood pressure isn't consistent from one moment to the next. As for cholesterol tests, the United States Preventive Services Task Force (USPSTF) recommends that otherwise healthy adults get screened for lipid disorders every five years unless they have other factors that put them at risk for heart disease, and recommends glucose screenings only for people over age 40 who are overweight or obese.

The upshot is that wellness programs often recommend screenings for otherwise healthy people far more often than their doctors would. As Gilbert Welch, a professor at Dartmouth College's Geisel School of Medicine, argues in his book Less Medicine, More Health, biometric data collection can lead "people to feel more vulnerable, to be terrorized by false alarms, and to be overdiagnosed and overtreated."

Moreover, most health conditions simply aren't wellness-sensitive. They can't be prevented via lifestyle interventions. Think about multiple sclerosis, or asthma, or schizophrenia, or Crohn's disease. These conditions require ongoing treatment, sometimes in the form of expensive medications.

Further, wellness-sensitive diseases like cancer, heart attacks, stroke and diabetes usually don't hit until retirement, even among people who have had bad habits all along. 

"Most of the diseases they say they are going to prevent are diseases of aging," Khanna says. 

Lewis and Emerick's Cracking Health Costs estimates that "only about 7 percent of your total spending -- at the very most -- pays for medical events like heart attacks that are preventable through wellness."

A government-sponsored 2013 analysis of large employers' medical and wellness data by the nonprofit RAND Corporation was unable to detect a statistically significant reduction in health care costs as a result of wellness program implementation. RAND also challenged the notion that financial incentives produce thinner employees: according to their analysis, $10 in incentives is associated with 0.03 pounds of weight loss. At that rate, a company would need to spend $10,000 to get an overweight employee to lose 30 pounds.

Posted by at September 13, 2016 4:51 PM

  

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