The Darker Side of Workplace Wellness Programs

Corporate wellness programs aren’t new, but their popularity is growing as companies seek ways to minimize spending on health care. But a lot of people within and outside of the health-care system question many of these programs in terms of their real health value, their financial benefit and their potential to invade employee privacy.

One recent commentary on the topic was penned by Al Lewis on the Huffington Post and repurposed on Lewis is the author of “Why Nobody Believes the Numbers,” a critique of workplace wellness programs, and the CEO of a company he says is in a competitive industry. He wants his competitors to implement wellness programs because it will hurt them. As he wrote, “Those competitors will suffer increased healthcare costs, compounded by declines in productivity.”

“Best of all for me, these programs often have a negative impact on employee morale that may lead some of them to quit, thus facilitating our own recruiting efforts. This is especially true for overweight employees, whom wellness vendors really seem to dislike. We, on the other hand, find employee weight makes no difference in either productivity or health spending.”

Workplace wellness programs, Lewis said, are places where employees are subject to “pry, poke, prod and punish.”

The prying is about undergoing a “health risk assessment” (HRA) that identifies personal information about drinking/smoking/eating habits, marital relations and other things you should tell your primary care doctor but maybe not even a close relative.

Poking involves a “biometric screen.” That’s when technicians come to the workplace and administer tests, possibly involving needles, to identify diseases employees might have and that in many cases, according to Lewis, “the government’s clinical guidelines say they shouldn’t be tested for,” including, at some companies, DNA.

Prodding occurs when employees visit the doctor when they not sick “to see if the doctor can find anything wrong with them.”

The punishment, Lewis said, is for employees who refuse to submit. It might amount to financial penalties (they pay more from their paycheck for insurance coverage) or lost incentives.

A lot of these programs are “outcomes-based,” which means, for example, you get paid if you lose weight.

How much does Lewis object to this? “To maximize earnings at the expense of their long-term health,” he suggested, “employees can binge before the initial weigh-in and then crash-diet before the last. Is this a great country or what?”

More to the point here are Lewis’ three reasons why nobody should support company wellness programs:

  1. Health-care expenses will rise.

After investigating some programs, one major metropolitan newspaper called wellness programs a “scam,” and another wrote that they don’t save money. The nonprofit think tank RAND Corporation agreed that they don’t reduce costs.

Half of large employers offering health benefits, according to (KHN), have wellness programs that ask workers to submit to medical tests, involve a trip to a doctor’s office, lab or workplace health fair.

Although RAND said most programs don’t save money for employers, the think tank did conclude that some can help employees to quit smoking, get more exercise and lose weight.

Lewis refers to the “treatment trap,” or additional costs for extra checkups, lab tests and anything the employee must endure when a wellness vendor “finds something.” Anyone receiving health care in this country knows well that vendors and providers love to find things. Our blogs regularly refer to the U.S. habit of overdiagnosing and overtreating.

  1. Productivity will decline.

Wellness programs are a time suck. On company time, workers must complete an HRA, and have a checkup; often, programs involve “health fairs” and other sounded-like-a-good-idea-at-the-time events that really only serve to separate people from their work.

“But that’s not the half of it,” Lewis reported. “Now add in the time employees spend telling one another what a stupid idea your wellness program is …”

  1. Morale will suffer.

In fact, Lewis said, the corporate wellness industry cops to this. “Morale impact,” he said, actually is a program cost listed in their consensus document. “Probably never before in history has an entire industry voluntarily admitted its worthlessness as thoroughly as the wellness industry did in this report,” he wrote.

As amusing and possibly as biased as Lewis is on the topic, KHN also looked at the efficacy of workplace wellness programs, and found that although asking employees about smoking or checking their blood pressure is not controversial among medical experts, making everyone submit to the same tests isn’t good medicine, because it’s a one-size-fits-all approach.

That never works for patients who might be 25 years old with no risk factors versus those who are 35 with a family history, say, of heart trouble. That’s where the overtesting comes in. “All screening tests carry the potential to give a false positive result,” according to KHN and many, many of our blogs. A false positive suggests someone has a problem who actually doesn’t. And what about a false negative, which provides reassurance that all’s well when it’s not?

Cholesterol screening is common in workplace wellness programs, and KHN said it’s probably the most contentious of these tests. It measures the levels of particular types of fats in the blood. But there’s no consensus among medical groups (the American Heart Association and the U.S. Preventive Services Task Force, to name two), on the best age to test people for cholesterol and the frequency of doing it. So it’s silly to think this test is a good idea for every employee in the company. (See Patrick’s newsletter on the topic of statins.)

That’s just one example of a common screening at a wellness program that is less about function than form. And it’s only one component — health — that might be important to workers. Privacy concerns loom large. Should any third party affiliated with your employer that isn’t your insurer know those details about you?

As patient advocates, we strongly recommend that people develop a strong, transparent relationship with their health-care provider. But that’s not their employer.

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