
Employee Wellness Programs Yield Little Benefit, Study Shows - mlthoughts2018
https://www.nytimes.com/2019/04/16/health/employee-wellness-programs.html
======
doctorpangloss
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.

~~~
awkward
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.

Great way to raise some rates.

~~~
dahart
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.

~~~
JamesBarney
I think it's justified. I felt lethargic so I got my testosterone tested. Came
back low. But now that's a pre-existing condition so if the ACA is overturned
I'm SOL.

~~~
firebird84
It will probably return to the pre-ACA regime where maintaining continuous
coverage of SOME sort will preclude an insurer from using "pre-existing
conditions" to deny coverage. COBRA is useful for this especially for those
who lose their jobs, albeit at immense cost.

I'm not saying everything's fine, but you do have some options.

~~~
JamesBarney
I've never been without health insurance and I was rejected from several
insurance carriers pre-ACA. I was on cobra at the time but trying to switch
because it was so expensive. But luckily Cobra got me through until the ACA
kicked in.

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currry
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.

Just fuck off already.

~~~
collyw
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.

~~~
piva00
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.

~~~
collyw
I live in a country where our taxes pay for healthcare. Its in everyone's
interest to have more people healthy.

~~~
piva00
I'm on the same boat, my taxes pay for healthcare which I hope I won't ever
need.

I just don't believe in strictly direct incentives to motivate people to
change behaviour, even less for a whole society. People aren't motivated just
by a dangling carrot, making people healthier is much more systemic than
awarding who takes care of themselves.

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Shivetya
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

~~~
zrail
> 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.

~~~
tvanantwerp
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.

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bariswheel
3 day weekends. Solved. 50% longer, 100% better. Treat the disease, not the
symptoms.

~~~
tonyedgecombe
As long as it doesn’t come with 12 hour days.

~~~
collyw
I Honestly think 3 x 12 hour days would be better than 5 * 7.5.

~~~
cheschire
The amount of creative work that can be accomplished in a day is finite,
regardless of the length of the workday. The only way you could shift a work
schedule that much is if you substantially change the type of work being done,
and accept that you would get less creative work per week while gaining more
resources in other areas such as rote tasks or physical labor.

~~~
xfitm3
Not everyone can produce creative work every day, either.

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hombre_fatal
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).

~~~
mirimir
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.

~~~
jnwatson
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.

~~~
tomjen3
If they need to lose 30-40 pounds (or more) that might not happen in the 1
year time frame.

And don't bother replying and telling me you lost that much weight in less
time, I am aware that can be done, but not by small tweaks which these
incentives normally give.

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iamthepieman
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.

~~~
unsignedint
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.

I don't know how typical I am, though...

~~~
tlarkworthy
Blood pressure and stamina bump is within days of giving up (I switched to
vaping, the feeling of increased vitality was noticable).

------
homerhomer
I'm pretty certain most would benefit from working less, but that's not what
these programs offer.

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droithomme
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.

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RobertRoberts
I really like the idea of encouraging health in any form.

But it seems that when the health care systems feed you green jello, white
bread and skippy peanut butter sandwiches when you are sick isn't a system
worth solely relying upon to guide us.

Also, it seems percentage wise, the best results for the investment should be
on extreme health risk areas. (like help people quit smoking)

~~~
mises
I'm also not sure hospitals serving cheap calories when better options are
available ought to disqualify the entire medical system. The people who make
the decision to do that are corporate types and nurses, whereas the people who
do medical research are doctors and those who do things of the sort mentioned
in the article may be data scientists. It's not fair to disqualify the entire
system based on one bad choice, and were it the greatest flaw of the medical
system, we ought to thank God.

~~~
FiddlyPack
Not sure where “and nurses” is coming from in your comment. Nursing research
is predominately on long-term patient outcome, whereas MD education is
predominately on the disease / underlying cause. The nurses I know are more
focused on and better educated on how holistic care serves the long-term
outcomes of the patients, while docs are better educated to attend to the
acute problems.

I would expect a change to quality of calories provided in a hospital to
originate from a DNP before a MD.

~~~
mises
It is coming from exactly what you said, I would also expect a change to
nutrition to originate from a DNP. My point is they have more control over
day-to-day intake.

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kadendogthing
What if we just had less stress and less overall working hours. Which is
totally doable given our economic productivity?

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matt_s
If employers want to reduce US health care spending, why don't they band
together and lobby Congress to introduce legislation to reduce health care
costs?

I have a gut feeling it is the insurance companies that set ever increasing
rates which drive up costs overall. And then they cover less forcing patients
to pay out of pocket for anything more than a flu shot.

There are other countries with the same quality services for much cheaper
costs. Maybe even better quality.

Employers would save more money getting the insurance companies to lower rates
(via legislation likely) than trying wellness programs.

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knightofmars
The only employee wellness program that works is one that actually has a time
slot (not lunch) during work hours for an employee to exercise. Where the
employee is literally being paid to exercise. Be it cycling, weights, walking,
etc.

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xfitm3
I've never worked for an employer that had a program which required you to
share data. I have always been able to expense things like gym, mattresses,
copays, whatever as part of TC but never data collection.

~~~
kaikai
You’ve been able to expense things like mattresses at multiple companies?
Where are you based?

~~~
xfitm3
Yes, a good nights rest is related to health and wellness. US.

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jamisteven
The people who conducted this study should be embarrassed. First off they
chose BJ's wholesale, which I would venture to say doesnt have the healthiest
of employees on the planet and doesnt represent a good sample. Second, they
didnt actually track what the individuals were actually doing, were they
eating a diet high in greens and low in processed foods? Were they getting
cardio in daily? Were they smoking, drinking excessively? How anyone serious
about health, nutrition, or even cost spending could take this study
seriously, beyond me.

~~~
coleca
Why would the study want to target "the healthiest employees on the planet"?
That would bias the study. Seems to me they chose a random company (that would
agree to participate) with average workers. The whole point would be to see if
these programs improve healthcare. Honestly, the majority of BJ's workers work
in a giant warehouse store and get a lot of walking in daily as part of their
job. (*Source: I'm a former BJ's Wholesale 'team member' although I worked in
the office in IT)

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gwern
The most interesting thing about this is not that wellness programs don't work
(this is the null hypothesis for all interventions, behavioral interventions
particularly, and diet/exercise interventions _especially_ ) but that it
offers a direct examination of 'correlation!=causation': they did the cluster
randomized trial, but they _also_ did the naive correlational analysis
ignoring the randomization to see how misleading the estimates would be.

They compare the estimates side by side in the supplement
[https://www.gwern.net/docs/statistics/causality/2019-song-
su...](https://www.gwern.net/docs/statistics/causality/2019-song-
supplement2.pdf#page=45) You can see that the estimates are... different.
Frequently, the point estimates aren't even the same sign. Self-selection and
'healthy user bias' are very much things.

\---

This parallels an earlier workplace wellness randomized experiment:
[https://www.gwern.net/docs/statistics/causality/2018-jones.p...](https://www.gwern.net/docs/statistics/causality/2018-jones.pdf)
which comes with nice graphs/tables comparing & contrasting the correlational
vs actual causal effects:

[https://www.gwern.net/images/causality/2018-jones-
table5-nyt...](https://www.gwern.net/images/causality/2018-jones-table5-nyt-
randomizedvscorrelation.png)

[https://www.gwern.net/images/causality/2018-jones-
figure8-ra...](https://www.gwern.net/images/causality/2018-jones-
figure8-randomizedvscorrelationliterature.png)

[https://www.gwern.net/images/causality/2018-jones-
supplement...](https://www.gwern.net/images/causality/2018-jones-supplement-
randomizedvscorrelation-tablea3-ac.png)

[https://www.gwern.net/images/causality/2018-jones-
supplement...](https://www.gwern.net/images/causality/2018-jones-supplement-
randomizedvscorrelation-tablea3-de.png)

[https://www.gwern.net/images/causality/2018-jones-
supplement...](https://www.gwern.net/images/causality/2018-jones-supplement-
randomizedvscorrelation-tablea3-fg.png)

[https://www.gwern.net/images/causality/2018-jones-
table5-cor...](https://www.gwern.net/images/causality/2018-jones-
table5-correlationvsrandomized.png)

(I collate a bunch more of these kinds of correlation!=causation results in
[https://www.gwern.net/Correlation](https://www.gwern.net/Correlation) as a
way of making the point that, empirically and especially when it comes to
humans, correlation frequently is not causation, and this is not merely some
carping pedantic statistician's complaint, but normal.)

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sonnyblarney
Wellness is incorporated into the daily grind, not some 'other' thing.

So decent stress levels, the right kinds of breaks, proper vacays, good
managers, not worrying about stuff all the time.

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diogenescynic
Just give employees more time off. Wellness starts with having work-life
balance.

~~~
tomjen3
Wellness is a corp-term for losing weight, exercising and stop smoking.

~~~
collyw
All three of these are considered to be part of a healthy lifestyle.

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C1sc0cat
I thought it was to improve peoples health and catch conditions earlier -
though I suspect given US health care only healthy people would apply.

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WalterBright
Place the employee parking lot a mile away from the office.

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loblollyboy
No shit

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Krasnol
Oh you mean "do some yoga" (F500) won't help?

Paint me surprised!

~~~
derrida
Look at the faces of people that have dedicated their life to yoga (or
christian monk, or sufism or whatever), and then people who have dedicated
their life to the profit motive & been successful (billionares).

Who's happier?

~~~
Krasnol
I'm sure it's quite nice if you can make a living giving yoga courses to
office slaves who work their asses off in open office cubicals in fear of
being fired tomorrow for shitty money and so on....Yoga won't help them.

~~~
derrida
There's a lot of livelihoods that do not involve offices or even working for a
company out there in the world today. But I can understand how it seems that
if you were raised in the United States and aren't either really poor or
wealthy.

~~~
Krasnol
I was not and it doesn't touch the issue at hand.

Those employee wellness programs are being used as cheap place holder to cover
up anti-social working conditions. Unpaid overtime and unhealthy working
environment won't go away with Yoga. Even if it helps some to forget the
actual issues, it doesn't solve them.

~~~
derrida
> Those employee wellness programs are being used as cheap place holder to
> cover up anti-social working conditions. Unpaid overtime and unhealthy
> working environment won't go away with Yoga. Even if it helps some to forget
> the actual issues, it doesn't solve them.

Absolutely. We need unions (or if that's a dirty word, some
organization/democracy at the point of production) in order to ensure
equitable society and also that people's contribution to society through their
work & their productivity is adequately valued - that people are working
because they see their place in the whole & on a voluntary basis - what's
occuring right now is work based on fear and necessity, the false scarcity
means people have to chose to put up with injustice at work in order to
survive & the hours mean the working poor are mostly silent.

Look at Finland, look at Norway.

------
psds2
I think a lot of factors come in to play, and this finding does not surprise
me for an employer such as BJs wholesale. Compare that workforce vs IBM, where
employees remain with the company longer and have much more sedimentary jobs,
and wellness programs are probably providing better ROI.

