It’s a good idea to not have blind faith in wellness vendors, but to have a healthy dose of skepticism. For one thing, there are probably leaders and employees at your organization who are skeptical, so you need to anticipate their questions rather than coming across as naïve. More importantly, you should review actual data on the outcomes and think critically about them. Depending on your specific goals for your organization, your wellness program may not actually be meeting your goals.
Pitfalls of “Pry, Poke, Prod” Wellness
Al Lewis and Vik Khanna’s book Surviving Workplace Wellness…: With Your Dignity, Finances and (Major) Organs Intact sounds the alarm on what they call the “pry, poke, prod” model of corporate wellness … using financial incentives to drive employees to get a health risk assessment (pry), biometric screening (poke), and treatment based on the assessment/screening results (prod). Due to a high risk of false positives, they say, the “pry, poke, prod” model can lead to “hyper-diagnosis” and unnecessary tests and treatment, which is dangerous for patients and drives up health care costs.
I think that’s a valid concern. Many large employers have “plugged in” a wellness program promoted by a vendor, and they are “acting on faith” that what seems like common sense (early diagnosis and management of health risks and especially diseases should lead to improved long-term health and reduced costs) will really come to pass. But rather than analyzing the data to evaluate whether they’re achieving their desired outcomes, they are trusting the wellness vendor to tell them whether it’s working (letting the fox guard the henhouse).
Worse, the “pry, poke, prod” approach seems to promote an overly invasive approach to health care that may be harmful for your workforce. It’s a little like investing … the average “actively managed” mutual fund performs significantly worse than an index fund. If you run to the doctor for every little thing, the average doctor (who typically feels compelled to provide some sort of treatment) may at times write a prescription, order an invasive test, or recommend a surgery that you don’t really need, that isn’t the best next step to try, or that actually does more harm than good.
On the other hand, done right, “pry, poke, prod” may be exactly what your workforce needs right now. For example, at one company we work with at Aspendale Communications, the workforce is predominantly male (who typically place a low priority on health care), located in rural areas (where health care is not convenient), with low turnover (likely to stay with the company for many years). Several years ago, the company retained an epidemiologist to study their medical claims data, and discovered signs that the workforce had abnormally high levels of undiagnosed early-stage cardiovascular disease and diabetes. The company took a thoughtful approach to promoting screening and early treatment; as a result, over time the number of serious conditions (and expensive hospital admissions) was significantly reduced.
Another pitfall stressed in the book is “pry, poke, prod” can hurt employee morale. No one wants to feel forced to do something they don’t want to do. And no one wants an employer they don’t trust to have their private health information and give them medical advice. This is a valid concern too, but it depends on each organization’s situation and climate of trust. Business leaders should thoughtfully consider:
- Whether their current and/or planned health strategy is helping or hurting organizational trust and employee engagement,
- Whether the cultural risks of “pry, poke, prod” are worth the potential return, and
- How the program design, the specific health professionals involved, and the supporting communications and education will affect the organization’s culture and employer brand.
Other Types of Workforce Health Engagement
It’s important to note that Lewis and Khanna are much less critical of health initiatives outside of the “pry, poke, prod” model. But they do make you stop and think about whether each initiative will truly be worth what you spend on it. I was reminded of one of the conclusions from this year’s study by the non-profit research group RAND Corporation.
Screening all employees for health risks and offering one-to-one counseling and coaching to those with such risks is expensive, but other interventions, such as offering healthy food choices and launching educational campaigns to use the stairs, are not.
The book echoes this sentiment. In addition, Lewis and Khanna agree that better follow-up programs for people who have known risk factors (“follow-up for the few instead of screening the many”) can be useful. And they praise companies like Healthways who offer employees an integrated blend of health-engagement initiatives that create an overall culture of health.
Should Business Leaders Read This Book?
In a word, yes. This book is a fun read that asks challenging questions … questions that business leaders should seriously consider … questions that CEOs and HR leaders can anticipate from their employees … questions that benefit directors can anticipate from their CFOs.
I do have three criticisms of the book, however…
First, some of the authors’ arguments just didn’t convince me. Some parts of the book hit me like a politician’s ad rather than an intellectually honest search for the truth. Perhaps it’s because it’s written for a lay audience rather than for business leaders, but the book is heavy on sound bites and humor (which I really enjoyed, by the way), and light on logical arguments. Often they would criticize a blog post or article, and I would follow the link to read the blog or article and find that (in my opinion) Lewis and Khanna had quoted them out of context or misrepresented their data or argument. Other times, they would make claims that sound alarming and might be true, but aren’t fully supported in the book or the links provided. Here’s an example:
[Safeway’s] healthcare savings, by the way, were due [not to their wellness program but] completely to an overhaul of medical benefits that put more of the financial burden on employees.
That’s a great one-liner that will tick off employees, but I wasn’t convinced that Safeway is a poster-child of cost-shifting, rather than wellness. So I’m skeptical of some of the book’s conclusions, but my interest is definitely piqued. I have not yet read Al Lewis’ previous book Why Nobody Believes the Numbers (a more technical book written for business leaders), but now it’s on my wish list.
Second, the book reads more like a blog, often using a link to hint at a logical argument (like this) rather than clearly laying out the argument right in the book. Often the book provides links that promise evidence for various claims made by the book. It was a pain to follow those links from my Kindle Paperwhite (a great device for reading, a crummy device for surfing). But even if read on my iPad, it makes for a dissatisfied book-reading experience. When I read a book, I want an in-depth, long read … a different type of experience than surfing the web. Beyond just a personal preference (which I would guess is shared by most book readers, which is why they are reading a book rather than blogs), this is an expectation that the book author will lay out a cohesive argument, including quotes of the specific passages of other literature that they are commenting on. Too often I would follow a link, read the entire article being referenced, and then wonder why Lewis and Khanna believed that article truly backed up their claim.
Third, and perhaps most importantly, I detect in the book an underlying philosophy that suggests employers have no business attempting to manage the health of their employees. This philosophy also comes out loud and clear in one of the closing sentences of Cracking Health Costs, a book that Al Lewis recently wrote with co-author Tom Emerick
[This book has] shown you that there is so much broken in your health benefit, so many self-interested providers, vendors, and consultants feeding at your trough, and so much angst among your employees, that it might simply be a better idea to focus on your base business – and let the health insurers handle the health insurance.
If it’s truly the authors’ philosophy that employers should mind their own business and let doctors, insurers, and perhaps the government mind health care, I think that sounds good on the surface but is flat-out wrong. Here are two reasons:
- Right and responsibility of large employers. In the U.S. today, the expectation is that large employers pay the majority of the cost for their employees’ health care. As long as that’s true, employers have the right (and responsibility to shareholders) to be wise stewards of how their health care dollars are being spent. No, they shouldn’t blindly spend money on programs that don’t work. Yes, they should look for solutions that truly make a positive difference on health outcomes and expenses.
- Influence of large employers. Historically doctors, insurers, and the government have not been effective in controlling medical inflation, which is spiraling upward much faster than general inflation. Large employers are in a unique position to analyze aggregate claims and screening data to make data-driven decisions, influence employees to adopt healthier lifestyles, and help employees choose the providers and treatment options that are most likely to lead to optimal outcomes for a fair price. Do people fully trust employers in the area of health? Nope, but they don’t trust hospitals or the government to have their best interests at heart, either. At many companies, employees reasonably believe they and their company have long-term interests that are aligned, which is more than can be said for their beliefs about politicians, insurance companies, and hospital executives.
Whether you or not you like or agree with the book’s message, Lewis and Khanna are asking some important questions. You owe it to yourself to look into them, and also to be prepared to answer these kinds of questions.
Being proactive about potential tough questions from employees, your CFO, and other areas of your organization is just one implication regarding how you communicate your health programs. My colleagues and I at Aspendale Communications can help you audit how you’re currently communicating and develop a strategy that will help you meet your objectives.
Jesse Lahey, SPHR, is the host of the Engaging Leader podcast and managing principal of Aspendale Communications. Connect with him on Twitter, Facebook, or LinkedIn. If you know anyone who would benefit from this information, please share it!