If President-elect Trump would like to do something useful to reform healthcare, he could start with workplace wellness, truly the "swamp" of the Affordable Care Act. What follows is a story of how wellness vendors routinely lie about savings and even harm employees.
I'm not the only one who has noticed this. Many leading economists and publications (of the left and right) have observed that so-called "pry, poke and prod" workplace wellness programs are scams or shams. That these programs are worthless is not news to anyone except the Business Roundtable and the US Chamber of Commerce, which use their bountiful resources to purchase Congressional support, and even self-promoting Senate Committee hearings. Their agenda, of course, is to allow employers to collect fines from employees who don't (for example) lose weight. Those fines can then flow directly to the employer's bottom line.
By way of background, "Pry, poke, and prod" programs differ from, for example, Ariana Huffington's wellness program, in that non-participants face a financial consequences, like a four-figure fine or foregone incentive, for refusing to submit. These programs pry into your lives by making you disclose your diets, drinking and drug use habits, poke you with needles at an oxymoronic "health fair" and prod you to get annual checkups you don't need and may harm you.
Worthless? Of course. As a whole, wellness programs have not reduced heart attacks or related events, and improve risk factors only trivially. In 2015's award-winning program, done by a group of vendors led by United Health Care for McKesson, all this intrusiveness was wasted: the company's employees were almost every bit as unhealthy after the program as before it, according to the company's own data. One of McKesson's cabal of vendors, an outfit called Vitality, admitted they couldn't even get their own employees to lose weight.
Crossing a Bright Red Line
Ineffectiveness is one thing. Actually allowing a vendor to harm your employees is something else altogether, and that's exactly what the Boise School District did. Apparently lacking an internet connection, Boise chose Wellsteps to do wellness to its employees, without realizing that Wellsteps is a vendor known both for fabricating savings and for fat-shaming. Wellsteps' exact words re the latter? "It's fun to get fat. It's fun to be lazy."
They published a report showing a dramatic increase in risk factors (cholesterol, weight, blood pressure) for Boise's employees over the period when they were retained. Along with those objective risk increases, employees reported feeling worse too.
Wellsteps and Boise Face the Consequences
Of course, Wellsteps blatantly suppressed their own data showing cost increases and lied about their savings, but -- along with being worthless -- lying and cheating are part of the wellness industry's DNA. The way I prove that isn't just by quoting their own words against them (backed up with screenshots) but by simply offering a $1-million reward (plus a $1-million contribution to the Boise School District, for a total of $2-million) if they can simply show they aren't lying. Let's just say I'm not expecting to mortgage the house anytime soon. I've been offering a similar reward for a year, with no takers. The $100,000 entry fee is a dissuader, though they would recoup that times ten if they aren't lying.
Fortunately, there is an industry watchdog group to complain to. And while this group is perfectly fine with lying (indeed, it is one of their core competencies), the harming-employees thing was too much for them to stomach. Consequently, Wellsteps faced a strong rebuke from the authorities in the wellness industry.
Quite the contrary, last month this program won something called the C. Everett Koop Award. You might think, it must be OK, then. After all, Dr. Koop was a renowned Surgeon General. And he was...but that was before he left office and starting basically auctioning off his naming rights, and his soul. Most famously, he received a large sum from the latex glove industry to testify before Congress that latex gloves were great, without disclosing his conflict of interest. Likewise, he licensed his name to a group of wellness industry promoters, led now by Johns Hopkins School of Public Health employee Ron Goetzel, to give these awards to their friends and clients. For instance, the aforementioned McKesson was a client of Mr. Goetzel's other company, while Wellsteps' CEO was also on the awards committee, until he recently stepped down due to the obvious Nero-type optics of voting yourself an award, so he let his friends do it instead.
Needless to say, when Johns Hopkins found out their employee was using their good name to reward a company that made employees sicker, they were outraged.
And how hard is it to answer softball questions like: "Do you think this sets a good example for your students?" Or: "Should a wellness program in which employee health deteriorates win an award for health improvement?" They refused to answer.
Mr. Goetzel and the rest of the committee knew Wellsteps had harmed employees. The story had been broken the day before the awards ceremony by Sharon Begley, winner of many (legitimate) awards for her health/science reporting. Nor could they pretend they hadn't seen the article, because they were quoted in it. As one attendee at the ceremony told me: "It was like being in an alternate universe. I was on my phone reading how harmful and dishonest this program was, while the award was being bestowed."
Wellsteps' CEO, Steve Aldana, didn't defend himself, other than to call Ms. Begley a "lier." He didn't provide any evidence of this, nor did he contact her or her editor directly.
Needless to say, an investigation has been opened by the Office of the Inspector General, the government agency charged with fraud detection and prevention in healthcare.
Actually, the wellness industry is subject to no regulations, or even licensing, educational or continuing education requirements. The United States Preventive Services Task Force establishes clinical guidelines for optimal screenings and prevention. They also recommend strongly against certain screens due to the potential for harm, giving them "D" grades. However, employers may force employees to get D-rated screens or face fines. One vendor even admits their entire program is D-rated, while the Huffpost blogger who defends wellness as basically a kumbaya moment ("show employees the value and excitement" of wellness events) himself runs the company that does more D-rated screens than any other.
So wellness is the Wild West of healthcare, and speaking of Wild West, let's circle back to the Boise School District. They were originally thrilled to be part of this award, back when Wellsteps "explained" to them how well they did. Now that the District's management finally got an internet connection, a calculator, and a pair of reading glasses, and/or found a smart person to re-explain Wellsteps' report to them, they no longer comment, or show any interest in their potential $1-million contribution.
My suspicion is that they are not too pleased with Wellsteps these days. And Wellsteps' CEO, Steve Aldana -- whose linkedin profile now claims his program is the "best" -- didn't exactly enhance his standing with the Boise authorities by using the Nuremberg Defense in Begley's article, blaming them for making Wellsteps flout clinical guidelines to (very profitably!) screen the stuffing out of their employees.
So what? We don't live in Boise
This Boise scandal is only the tip of the iceberg. 60 million employees are threatened or bribed into these programs. (Once again, a distinction for loyal Huffpost power users: this is not about Thrive, Arianna Huffington's new venture. That company is in the emerging segment of "wellness done for employees," where employees participate voluntarily because they see value. The Wellsteps/Boise segment is "wellness done to employees," where refusal to submit carries significant financial consequences.) These 60-million employees have essentially no recourse against vendors like Wellsteps. It's not just that vendors are allowed to do harmful, D-rated screens. They need not even disclose that the screens carry the "not recommended" imprimatur from the USPSTF.
Further, while health plans who "do wellness" for their members are subject to privacy regulations, independent vendors like wellness are completely unregulated. Wellness vendors don't even need to be licensed. Consequently, vendors can claim to save the lives of cancer victims who didn't have cancer...and win a Koop Award for it, as long as they sponsor the award and/or are friends with the Johns Hopkins employee in charge of giving them out. Health plans can even collect your DNA, if your employer lets them.
Vendors can even sell worthless nutritional supplements on their website...and get insurance to pay for them. Sound like a great business? You too can become a wellness vendor -- for only $67,000 and 5 days of classroom training.
What Comes Next?
And there it is, the ideal place to start "repealing and replacing" the Affordable Care Act. Simply requiring vendors to adhere to a "do no harm" Code of Conduct would drive most of them out of the market. Yet I suspect that in a year from now, wellness programs will be more entrenched than ever, with employees getting "pried, poked and prodded," paying fines, and being harmed. If only America had elected a populist...
Disclosure: While this posting represents my own opinion and findings, I am CEO of Quizzify, which is an employee-education alternative to wellness ("Wiser employees make healthier choices"), involving no prying, poking or prodding. And, yes, Quizzify endorses the Code of Conduct and can't understand why other vendors are stonewalling it. Really, if you're in the wellness industry and can't promise not to harm employees, you need to find a new line of work. You'd be doing employees everywhere a huge favor.