Imagine a scenario in which potentially hazardous over diagnosis and over-treatment were rising because companies made their employees either undergo highly unpopular and intrusive healthcare screens, or else pay much more for health insurance. Further, imagine that the unregulated vendors running and interpreting these screens usually ignored accepted guidelines and sometimes gave clinical advice not taught in any medical school. These are exactly the kind of practices the Affordable Care Act (ACA), with its emphasis on evidence-based medicine and cost reduction, should have ended by now.
But instead of ending these practices, ACA has encouraged them, to the point where most major employers embrace exactly these practices — all in the unintentionally ironic name of “workplace wellness.” Some wellness programs also involve (for example) employees working out on company time in company facilities, a laudatory activity which doesn’t depend on legislation. But most also entail “workplace medicalization,” in which employees are subject to blood draws, mandatory checkups and other similar intrusive requirements, under the ACA-sanctioned threat of much higher insurance premiums for those who don’t comply.
Conventional wisdom says that employee engagement in these programs will improve health and save money, but simple demographics and economics say the reverse: most wellness-related health problems occur after retirement. And like too much of anything else, too much prevention can be harmful: employees routinely receive feedback from online health risk assessments (HRAs) with no basis in medicine, such as recommending a prostate cancer test that the federal government strongly advises against, and perpetuating the myth that all women under 50 should get regular mammographies.
Workplace biometric screens pose an even greater risk to health than health risk assessments. Although medical societies and the federal government are urging fewer screens to avoid over diagnosis and over-treatment, employer human resource departments can’t get enough of them, thanks to incentives created by ACA. The inevitable consequence: more people are identified for “early intervention” to treat clinically insignificant conditions. For instance, a Nebraska screen revealed that state employees had 40 to 100 times the cancer rate of former residents of Love Canal. Yet instead of calling for an investigation, the state promoted this result successfully enough to win their program the C. Everett Koop wellness award, even while its employees were undergoing expensive, painful, hazardous and, for probably 99% of them, futile follow-up.
Biometric screens usually include weigh-ins, which are perhaps the most hazardous of all workplace medicalization issues. Shaming people into losing weight is unhealthy and unproductive, and body image issues reinforced by workplace “biggest loser contests” affect 20-million women and can be fatal. Meanwhile, weight has only a slight effect on health spending during the working years, and if economic incentives could generate sustained weight loss, Oprah Winfrey would have kept her weight off instead of giving up her lucrative Optifast endorsement contract and renouncing formula diets.
Perhaps the most curious and expensive wellness requirement of all is paying employees to go to the doctor when they aren’t sick, or charging them if they refuse. The clinical literature is quite clear about the futility of this custom, which may do more harm than good.
These hazards (and employee resentment) might be acceptable if money was being saved, but it isn’t. No vendor has ever shown savings that weren’t obviously made up. Even Nebraska somehow “found” huge savings despite all these unnecessary cancer treatments and no meaningful change in employee health.
Consequently, it is time to de-medicalize the workplace, simply by requiring wellness programs to be in compliance with accepted clinical guidelines. In other words, wellness must do no harm. Employers whose programs failed this clear and logical standard would have to automatically waive all employee penalties or pay all incentives. Faced with this sanction, human resources departments would almost immediately cut way back on screenings, HRAs, forced checkups, and biggest-loser programs. Many employers might start actually trying to make their workplaces healthier, a clear “safe harbor” under any do-no-harm standard for wellness programs. So instead of doing wellness to their employees, this sanction might encourage employers to do wellness for their employees and actually improve their health…exactly as the ACA’s authors had intended.
By Al Lewis
Award-winning author of 3 books on measuring population health outcomes and President of the Disease Management Purchasing Consortium.
Al Lewis, an outcomes measurement consultant who works with the Validation Institute, is co-author of Surviving Workplace Wellness…with Your Dignity, Finances and (major) Organs Intact and Cracking Health Costs, and author of Why Nobody Believes the Numbers: Separating Fact from Fiction in Population Health Management.