Wellness programs don't need to have positive outcomes to make sense for insurers. Instead, they need to use enough superfluous technology to discourage older people from signing up for them.
Hence, from a linked point in the article:
> AARP, the consumer advocacy group for older Americans, sued the federal government in 2016, arguing that the rules governing the [wellness programs] violated anti-discrimination laws aimed at protecting workers’ medical information.
That lawsuit against Kaiser was over individual coverage. Kaiser realizes all its savings by carefully maintaining very health (i.e., young) pools. The medical information stuff is the legal argument, but it was really a lawsuit about making people do stuff that disproportionately negatively affects old people.
If you try the wellness program for people whose enrollment is through their employer, and your employees are disproportionately not college educated or young, the wellness program of the kind you and I are familiar with will not be effective at either lowering costs or improving health outcomes. That's why this program was sort of doomed to fail.
There exists an as-of-yet unobserved program that gives people money in exchange for behavior modification with positive health and cost savings outcomes. It will probably look more consuming entertainment--stuff that has evidence people will do over long periods of time. We're a long ways off from finding the appropriate design of such a program.
I've seen it done in a much more brutal (if less discriminatory) fashion - everyone who doesn't get a full fluids screening in done 2 months sees their premium jump.
Employees are responsible for booking their lab appointment, receiving the lab sample, and then submitting it manually. So that's 2-3 weeks to schedule and make an appointment, followed by at least 4 weeks for the lab's turnaround, followed by time to submit the paperwork from the lab.
4 weeks??? Aside from a handful of tests which need cultures to be performed, I would be shocked if tests took more than 4 days. When I have my HbA1c, TSH, lipids, CBC, and electrolytes checked, I normally have results within 12 hours.
That is pretty harsh. I'm personally scared of the future liability and privacy implications of deep screens, especially if it's employment related. Is that irrational or justified?
On the other hand, my life insurance company asked for an update on my health, and after I had a blood test, they came back and said I was so healthy they were going to have to cut my rates, and they did massively, by like half. They weren't threatening to raise rates or offering to reduce them, so I guess it felt like a very positive thing. Still worried that somehow the data will be used against me to reject claims when I get old.
That's pretty crazy because outside of cholesterol and A1C using blood tests for screening in asymptomatic populations has little proven benefit.
EDIT: And there's no benefit in testing cholesterol or A1C every two months unless you're actively tinkering with medication doses for people with high cholesterol or diabetes respectively.
Yep. My employer lowers my premium and awards us with Amazon gift cards if we earn a certain amount of points each year. You earn points by completing a full blood test, visiting the dentist, etc. It's a significant enough amount that everyone is motivated to do it.
Hang on, so the clock ticks until the lab sends it back, rather than the time submitted to the lab? And the lab is associated with the insurer/health provider? So all they have to do is delay everything for 3 months?
Collecting behavior data is important to insurers as they can profile customers based on public data.
For example, if you work out 4 days a week, and have back pain diagnosis, you might be a different risk for recovery complications than a guy who doesn’t work out.
There are folks looking at using consumer behavior and habits to predict health outcomes.
I really don't want another game in my life to micromanage my behavior. Diet and exercise are their own rewards.
I got a rewards program for everywhere I eat. A miles program got every airline I fly. A tax code with a million subsidies and loopholes. Auto insurance companies who want to stick telematics in my car. Now I have health insurance companies gamifying literally what I eat and how I spend my free time.
Totally agree, it's gotten out of hand. We have too many people with too little to do. And too much money to pay them to do useless things. So they come up with more programs.
On the other hand I look after my health reasonably well. I take very few sick days as a result. It would be nice if my employer showed some sort of recognition of that.
You don't need a participation medal in taking care of yourself. Right now you aren't earning more money or being directly rewarded by being healthy but this is a personal investment in your own future, why should anyone else show any form of recognition to a very personal life choice?
I do the same, I'm healthy, I go to the gym, I bike to work, my reward is getting older fit while I see people on my age group having more and more issues.
Yup, you might be more productive than someone that is unhealthy and taking sick days, etc., at the same time you don't use your paid time off (or have days discounted from your salary, such as here in Sweden) for when you got sick.
Yeah they'll give you recognition alright - for saving them money by allowing them to pry into your personal life.
Maybe it's just working for an international megacorp, but I can tell you with absolute certainty they don't give a shit about my health - except to the extent it affects the bottom line. I'll get my positive recognition from my doctor because it means something from them.
Unfortunately, we don't have a good way to measure the difference between "few sick days due to good health" and "few sick days because came into office sick".
Or, for that matter, "many sick days due to unsolvable chronic illness but doing their best" and "many sick days due to eating an entire bag of Doritos during lunch and feeling ill".
You cannot even pay people to do them because the first remark back among my coworkers is, they //the company// aren't giving us enough to participate. There were even prizes for some categories for wellness categories, like the steps counting programs for which they gave up counters to weight loss.
of course there are other self defeating attitudes available too, from those who won't contribute more than the match for 401k, again the company's fault, to those who take more smoke breaks because of the extra cost on their premiums.
I am not sure if its a product of the education system or television. I think schools should focus a bit more on instructing students to better themselves for no other purpose than to improve themselves. that waiting for someone to make you improve yourself is the first step in failing
> from those who won't contribute more than the match for 401k,
This can be an entirely rational choice. Contributing less than the match is irrational because it's giving up on additional compensation, but often 401K choices are terrible and the tax deduction isn't worth it in many circumstances.
Plus 401(k) fees are usually higher than if you just opened your own IRA with Vanguard and bought some no-load index funds. Rational order to do it is: fund 401(k) to the match, fund your own IRA to the max, then fund the 401(k) to the max.
You can, though. Our company did up to ten bucks a day for a walking program and participation was quite high. It promptly fell off a cliff when the value went down to up to $4 a day.
I've seen the same thing. The perception is that the reward doesn't match the amount of effort required, and/or that the programs offered aren't going to do much for serious preexisting health issues (may or may not be true). And people who already like to exercise and like fitness aren't going to be motivated by what they might view as "newbie" programs.
And then you get into the tangled mess of workplace interpersonal interactions and privacy issues. Does anyone want to spend even more time with their coworkers, if the program is hosted on premises? Does HR need to know that Employee #4752 wants to lose 10 pounds? Or that a different employee wants a stress reduction class?
I like the idea mentioned elsewhere in the comments re: giving people a discount or other reward for proven gym attendance. That's easy enough. In my case, I'd be going to the gym, anyway, link my gym barcode to the plan and it's a done deal.
> There were even prizes for some categories for wellness categories, like the steps counting programs for which they gave up counters to weight loss.
What were the rewards like? I’ve seen those usually in the range of a fraction of a percent of salary, which isn’t going to motivate anyone. Things which would help involve spending money because most people need time and lifestyle support more than some drone nagging them about something they already knew: provide solid bike-to-work support (showers, storage, etc.), high-quality nearby childcare so parents have time to workout, ending a culture of overtime, flexible scheduling & showers so people can workout in the middle of the day, make sure that healthy and tasty food is readily available so it’s not “5 minutes to the vending machines or 30 to get non-junk”, etc.
>> What were the rewards like? I’ve seen those usually in the range of a
>> fraction of a percent of salary, which isn’t going to motivate anyone.
I worked in this space for a while (the company used Rails to do their apps!), so I'll give some input.
It varied from company to company, but most of our customers gave out tiered rewards. Everyone who participated got a step counter of some sort. Everyone who logged X amount of days recieved a t-shirt or water bottle. And the 'winning' teams would get wellness-related gift cards ($50-$250, again depending on the company). The cards were usually for sporting goods stores or 'healthy' items but sometimes they were for chain restaurants.
Now, when I say winning, there were often many teams that tied for first place. The reason was, for whatever activity you had to log (healthy foods, exercise minutes, steps), there was a daily cap. And we'd find obvious cheaters who would log all their activity on the last day of the program (or even for their whole team). People would call/email with support issues asking why they don't have the amount of points they should have, it's always a big ordeal. Teams accusing others of cheating...
You couldn't pay me to participate because I categorise it as BS. It's way overstepping the jurisdiction of the employer. FWIW I don't have a problem with weight, diet or exercise.
Maybe paying more is something that should be explored...
I think for $500-$1,000 a month per person you would have widespread behavior change in most companies, and it wouldn't really even be that expensive in the context of total healthcare+wellness program spending.
Some interesting bits to counter the title's face value:
> Researchers followed thousands of BJ’s Wholesale Club employees for a year
> Nearly all the studies to date had been observational and have largely concluded that the programs save some money for employers. But this study randomly assigned employees to a wellness program and compared their results with those of employees who were not enrolled in such efforts.
> Employers looking for a quick reduction in their health care spending will be disappointed
It makes sense to me that benefits come on a longer time scale and when employees join the specific programs that interest/apply to them (rather than random assignment).
Yes. Following people for just a year is ~meaningless. If someone quits smoking, for example, the benefit of reduced lung cancer incidence will show up on decade scale.
I’m sure the biggest intervention they are hoping for is weight loss. The reduction in insulin/metformin prescriptions would be evident if the program was effective.
> when employees join the specific programs that interest/apply to them (rather than random assignment)
The problem with this from a study standpoint is that it introduces self-selection bias. A complication for exercise programs in particular is that avoidance of exercise can be caused by cardiovascular and metabolic dysfunction.
the only people i know who take advantage of wellness programs are people who are already doing things well beyond the wellness program requirements. They participate in a variety of sports in all seasons, run 5ks or marathons, ski, bike hike or play organized sports. For them it's just a way to subsidize things they are already doing, maybe get a free fitness tracker or gym membership.
I don't think wellness program alone won't be able to make people change their lifestyle. To me, thing that made big difference was access and motivation; particularly for me, easy access to on-site gym (especially with a group class)
I transitioned from hating-to-workout to doing 5 days a week in gym, engaging in activities ranging from Yoga to HIIT.
Not to mention that these programs are notoriously difficult to actually use as an employee. Some require getting monthly receipts from your gym, then faxing to your healthcare provider, waiting for a check to come in the mail, etc. Look for companies like https://myleon.co/ to disrupt this space and make these programs more effective.
It's not particularly convincing to track people for only one year on behavior changes that are known from many other studies to yield long term health benefits. And the researchers in this study would know that.
Readit News
Hence, from a linked point in the article:
> AARP, the consumer advocacy group for older Americans, sued the federal government in 2016, arguing that the rules governing the [wellness programs] violated anti-discrimination laws aimed at protecting workers’ medical information.
That lawsuit against Kaiser was over individual coverage. Kaiser realizes all its savings by carefully maintaining very health (i.e., young) pools. The medical information stuff is the legal argument, but it was really a lawsuit about making people do stuff that disproportionately negatively affects old people.
If you try the wellness program for people whose enrollment is through their employer, and your employees are disproportionately not college educated or young, the wellness program of the kind you and I are familiar with will not be effective at either lowering costs or improving health outcomes. That's why this program was sort of doomed to fail.
There exists an as-of-yet unobserved program that gives people money in exchange for behavior modification with positive health and cost savings outcomes. It will probably look more consuming entertainment--stuff that has evidence people will do over long periods of time. We're a long ways off from finding the appropriate design of such a program.
Employees are responsible for booking their lab appointment, receiving the lab sample, and then submitting it manually. So that's 2-3 weeks to schedule and make an appointment, followed by at least 4 weeks for the lab's turnaround, followed by time to submit the paperwork from the lab.
Great way to raise some rates.
4 weeks??? Aside from a handful of tests which need cultures to be performed, I would be shocked if tests took more than 4 days. When I have my HbA1c, TSH, lipids, CBC, and electrolytes checked, I normally have results within 12 hours.
On the other hand, my life insurance company asked for an update on my health, and after I had a blood test, they came back and said I was so healthy they were going to have to cut my rates, and they did massively, by like half. They weren't threatening to raise rates or offering to reduce them, so I guess it felt like a very positive thing. Still worried that somehow the data will be used against me to reject claims when I get old.
EDIT: And there's no benefit in testing cholesterol or A1C every two months unless you're actively tinkering with medication doses for people with high cholesterol or diabetes respectively.
For example, if you work out 4 days a week, and have back pain diagnosis, you might be a different risk for recovery complications than a guy who doesn’t work out.
There are folks looking at using consumer behavior and habits to predict health outcomes.
I got a rewards program for everywhere I eat. A miles program got every airline I fly. A tax code with a million subsidies and loopholes. Auto insurance companies who want to stick telematics in my car. Now I have health insurance companies gamifying literally what I eat and how I spend my free time.
Just fuck off already.
I do the same, I'm healthy, I go to the gym, I bike to work, my reward is getting older fit while I see people on my age group having more and more issues.
Yup, you might be more productive than someone that is unhealthy and taking sick days, etc., at the same time you don't use your paid time off (or have days discounted from your salary, such as here in Sweden) for when you got sick.
Maybe it's just working for an international megacorp, but I can tell you with absolute certainty they don't give a shit about my health - except to the extent it affects the bottom line. I'll get my positive recognition from my doctor because it means something from them.
Or, for that matter, "many sick days due to unsolvable chronic illness but doing their best" and "many sick days due to eating an entire bag of Doritos during lunch and feeling ill".
of course there are other self defeating attitudes available too, from those who won't contribute more than the match for 401k, again the company's fault, to those who take more smoke breaks because of the extra cost on their premiums.
I am not sure if its a product of the education system or television. I think schools should focus a bit more on instructing students to better themselves for no other purpose than to improve themselves. that waiting for someone to make you improve yourself is the first step in failing
This can be an entirely rational choice. Contributing less than the match is irrational because it's giving up on additional compensation, but often 401K choices are terrible and the tax deduction isn't worth it in many circumstances.
You can, though. Our company did up to ten bucks a day for a walking program and participation was quite high. It promptly fell off a cliff when the value went down to up to $4 a day.
And then you get into the tangled mess of workplace interpersonal interactions and privacy issues. Does anyone want to spend even more time with their coworkers, if the program is hosted on premises? Does HR need to know that Employee #4752 wants to lose 10 pounds? Or that a different employee wants a stress reduction class?
I like the idea mentioned elsewhere in the comments re: giving people a discount or other reward for proven gym attendance. That's easy enough. In my case, I'd be going to the gym, anyway, link my gym barcode to the plan and it's a done deal.
And cut out the people who exercise elsewhere. Let the corner case chase begin!
What were the rewards like? I’ve seen those usually in the range of a fraction of a percent of salary, which isn’t going to motivate anyone. Things which would help involve spending money because most people need time and lifestyle support more than some drone nagging them about something they already knew: provide solid bike-to-work support (showers, storage, etc.), high-quality nearby childcare so parents have time to workout, ending a culture of overtime, flexible scheduling & showers so people can workout in the middle of the day, make sure that healthy and tasty food is readily available so it’s not “5 minutes to the vending machines or 30 to get non-junk”, etc.
I worked in this space for a while (the company used Rails to do their apps!), so I'll give some input.
It varied from company to company, but most of our customers gave out tiered rewards. Everyone who participated got a step counter of some sort. Everyone who logged X amount of days recieved a t-shirt or water bottle. And the 'winning' teams would get wellness-related gift cards ($50-$250, again depending on the company). The cards were usually for sporting goods stores or 'healthy' items but sometimes they were for chain restaurants.
Now, when I say winning, there were often many teams that tied for first place. The reason was, for whatever activity you had to log (healthy foods, exercise minutes, steps), there was a daily cap. And we'd find obvious cheaters who would log all their activity on the last day of the program (or even for their whole team). People would call/email with support issues asking why they don't have the amount of points they should have, it's always a big ordeal. Teams accusing others of cheating...
I want the "Bruce Industries LTD Competitive Meditation Champion Quarter 2 2016-17" t-shirt.
I think for $500-$1,000 a month per person you would have widespread behavior change in most companies, and it wouldn't really even be that expensive in the context of total healthcare+wellness program spending.
> Researchers followed thousands of BJ’s Wholesale Club employees for a year
> Nearly all the studies to date had been observational and have largely concluded that the programs save some money for employers. But this study randomly assigned employees to a wellness program and compared their results with those of employees who were not enrolled in such efforts.
> Employers looking for a quick reduction in their health care spending will be disappointed
It makes sense to me that benefits come on a longer time scale and when employees join the specific programs that interest/apply to them (rather than random assignment).
The problem with this from a study standpoint is that it introduces self-selection bias. A complication for exercise programs in particular is that avoidance of exercise can be caused by cardiovascular and metabolic dysfunction.
I transitioned from hating-to-workout to doing 5 days a week in gym, engaging in activities ranging from Yoga to HIIT.
I don't know how typical I am, though...