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Tuesday, October 18, 2011

The Wellness Industrial Complex

My place of employment (no not this blog, luckily I have a real job), required us employees to do a biometric screening this year. They drew blood to measure our cholesterol and lipids, took our blood pressure, and weighed us. Opinions varied. I listened to one coworker ask what our insurance company was going to do when they got her results. She was assured that her results were just for her to better understand her health. Another coworker commented on how this screening was a great idea and she was really interested in seeing if behavior changed.

The coworker who was nervous about the insurance company probably got results that indicated she wasn't so healthy. The coworker who thought this was a great idea probably was perfectly healthy, knew it, and was acting smug about it. The coworker who was nervous about the insurance company was told a half truth. This first year, the results would be just for us to see if we improve our health on our own. However, in future years, our employer and insurance company will slowly but surely get more active. The first year is voluntary and a free service to show they care. Next year, a nurse will probably call us about our high BMI. The following year, it will be outcomes focused and there will be rewards for improving health. The next year, the carrot will be replaced by a stick and we will be beaten with it until we lose that weight.

I know that some of my coworkers who work for insurance companies refuse the reward to take biometric screenings for fear that their insurance company will no longer cover them if they have poor results. That's not true. The insurance company will just give them lesser coverage until they show improvement and have nurses harass them.

I am being a little apocalyptic since the scenarios above are probably unlikely. However, they are unlikely because of employers and insurance companies ability to make these hard decisions about when to start the more punative measures for poor employee decisions about their health. Employers don't really want to be in the health insurance business let alone run weight loss centers. These more draconian measures of hiring companies to make employees give them their candy in exchange for fruit (a company really does this) will result in hard conversations and distraction. Most employers don't want to deal this. However, their desperation to reduce medical costs have resulted in the Wellness Industrial Complex.

We have an endless choice of Health Risk Assessments from all kinds of company that ask about our health based on the theory that we will take these tests and suddenly discover that we have unhealthy behaviors and stop them. For example, "Oh I thought it was 5 servings of bacon a day not 5 servings of vegetables!" or "I will certainly stop snorting cocaine off my Iphone while driving in traffic and go back to snorting it off stripper's chests. That is much less risky." Thanks Health Risk Assessment for showing me the light.

The Health Risk Assessments are followed up by Health Coaches which are often non-clinical, non-licensed staff who talk with you on the phone about your bacon consumption. These Health Coaches are coupled with Incentive management programs who are solely dedicated to mailing gift cards or horse's heads for those who do well or do poorly on their health scores. This is all complemented with Wellness in a Box campaigns that include some lovely marketing material such as vegetable of the month of how to start a walking club at your work.

That sucking noise that you hear is the cost of the Health Risk Assessments, Health Coaches, Incentive programs, and material to celebrate National Pedometer Day. What's the ROI on that readers are probably all shouting like the Timbers Army at a Portland MISL soccer game.

The ROI in terms of medical costs saved is as elusive as a moderate Republican. It isn't really there and hard to find even it is. That's because the whole implementation of the Wellness Industrial Complex was foisted on health insurance companies. For insurance companies, the ROI is based on medical cost savings. Their business model does not reward them for improving wellness, productivity, or making employees happy. For an insurance company, the ideal customer is the one who dies in their sleep of a massive undetected heart attack after using no medical services for the year and not the client who manages their diabetes with monthly doctor visits and 3 prescription medications.

Provider groups or even unions are more logical candidates for hosting Wellness programs because they have different interests and are looking for different results. Both get rewarded for keeping workers happy and productive. That's where there is potential for ROI as opposed to the very indirect connection with medical costs.

Employers, in their insatiable desire for vendor consolidation, assigned Wellness programs to their health insurance companies because they thought incentives would be aligned and because they could. Insurance companies saw a market differentiation and revenue opportunity and grabbed it. However, the marriage of insurance companies and Wellness is proving to be as awkward as Bristol Palin on Dancing with the Stars. It's proving to be an added expense for insurance companies and the medical cost savings aren't there.

Since I like to offer solutions on this blog, I am pleased to say that I have one that should help all parties. Since employers are interested in vendor consolidation, they should have their Waste Management vendors run their Wellness programs. Given that most Waste Management companies can tell what employees are eating at work by going through their trash, they have the information. No need for a Health Risk Assessment. More importantly, since most Waste Management companies are mob run, they should be very successful in this endeavor. Their loan sharking and enforcement arms can easily handle the health coaching and incentive programs. The medical costs may rise in the first year due to some broken knee caps but I am confident, they would show a better ROI then health insurance companies.

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