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Friday, February 14, 2014

“In wellness, you don’t have to challenge the data to invalidate it. You just have to read it. It will invalidate itself.”

Above: the headline of this post (from page 24) pretty much sums up the authors' assessment of workplace wellness programs. (Though, pedantically, get me Rewrite: “In wellness, you don’t have to challenge the data to invalidate them. You just have to read them. They will invalidate themselves.”)

This is the first e-book release by THCB (The Health Care Blog). They gave me a press review copy.

Al Lewis and Vik Khanna give me some reassurance that my own snarky, curmudgeonly inclinations are not too over the top. Their book is the Kindle version of The Daily Show for the increasingly intrusive Dilbert Zone Pseudo-Science authoritarian fad of "Workplace Wellness." Some excerpts:
Why Friends Don’t Let Friends Do Wellness
Summer, when most faculty are scattered to the four winds, is typically the time that university administrators send out bad news to their employees.  July 17, 2013 was no exception. Penn State Professor Matthew Woessner opened his email and learned that he was going to be fined $1200 if he didn’t disclose his drinking habits, any feelings of depression, whether he was having problems as a result of divorce/separation or financial problems, and whether he regularly examined his testicles. Further, he needed to have blood drawn and visit a doctor even though he was quite healthy, exercised regularly, drank only recreationally and wasn’t depressed (at least until opening this email).

He also learned all this information was going to be shared with WebMD, which promised privacy even as they were about to be ”outed”  by Bloomberg (“Your Medical Records Are For Sale,” August 8, 2013) for selling other allegedly private healthcare data that could readily be matched to individual patients.

About 100 miles away, Professor Maria Truglio opened the same email, making the same demands of her—and adding the requirement, to avoid the $1200, fine that she disclose whether she intended to become pregnant...

Welcome to the world of “workplace wellness.”

What is workplace wellness?  It’s the right question to the Jeopardy answer: “With a big assist from the federal government, this is the dumbest idea your employer’s human resources department has ever come up with.”

Maybe trying to get you and your colleagues to be healthier, to hold healthcare costs down for everybody, doesn’t immediately strike you as a dumb idea. What’s wrong with making the fat guy in the next cubicle go to Weight Watchers? Plenty, as it turns out.  First, that guy doesn’t want to be fat any more than you do, and fining him if he doesn’t lose weight isn’t going to make his fat go away, though it may embarrass him into leaving the company. Second, his health expenses probably aren’t much higher than yours during his working-age years, so there is nothing to be gained by fining him, bribing him, making him fill out forms, drawing his blood, or making him go to the doctor when he’s not sick.

Third, it isn’t just about him. Everybody is victimized by these schemes, just like at Penn State. Fourth, it is a massive invasion of privacy and, assuming you’re getting your job done, it’s not clear how it’s any of your boss’s business what goes on in your personal life. These intrusive programs benefit no one except the vendors and consultants who make their livings off them, at your expense...

It is possible that, unlike a Coke, there is a chance that a wellness program — for all its forfeitures, invasions of privacy, inconveniences, and false diagnoses—will result in a slight reduction in your cholesterol. In turn this reduction that might even more slightly reduce your (already slight) risk of a heart attack, but at what cost in the relationship between you and your employer? If your boss were a general, would he prefer an army with high morale or an army with low cholesterol? To put it mildly, morale is unlikely to receive a boost from the three most common things done to you in a wellness program:
  1. Prying into your personal life to ask you about your drinking, drug,
  2. and sexual habits, as well as general health issues, through a “health risk assessment”;
  3. Poking you with a needle to test up to fifty different lab values for a “biometric screen”; and,
  4. Prodding you to go to the doctor when you aren’t sick...
The most expensive benefit—and also historically the fastest growing—is healthcare. You have, no doubt, heard how paychecks for most people, possibly including you, have “stagnated.” But total compensation is far from stagnant—mostly because of the increase in health benefits. (These days, it’s popular to simply make you pick up more of the tab directly for your own healthcare expenses. In that case, your paycheck could rise, but so will your health expenses.)

If your company could actually control its benefit costs, it could pay you more and/or make you pay less of your health benefit, without changing the total compensation it pays out. Unfortunately, its wellness “solution” will do exactly the reverse, and raise the cost of benefits, thus squeezing your paycheck.
Surviving Workplace Wellness will prove this assertion two completely different ways:
  1. The ideas are wrong: Much, if not most, of what is recommended by these programs is either self-evident or the other extreme—controversial or even the opposite of what actual experts recommend, and likely to increase your health spending, usually for diagnostics you don’t need or shouldn’t get. Hence medical experts who actually understand prevention recommend less testing, fewer screens, and fewer checkups. Yet wellness vendors recommend more testing, more screens, and more checkups. And, as you’ll see in Chapter 3, they themselves can’t coherently explain why they recommend these things despite overwhelming evidence to the contrary.
  2. The outcomes are bad. As a result of doing the opposite of what should be done, no conventional wellness vendor has ever saved any company money. Eighty percent of pry-poke-and-prod wellness vendors don’t even pretend to. They just siphon money from the total compensation equation; but at least they’re honest about it. The other 20 percent simply lie, usually transparently, in order to separate your employer from your money...
Dr. Aetna Is In
Imagine how you’d feel if you got a letter saying basically:
Dear Fat Person,
We aren’t doctors and you’re not sick and you never asked for our help and probably never would, but we’ve got the solution for you anyway: obesity drugs made by companies we’re partnering with.  True, these drugs are expensive, have side effects that you may not tolerate (the nasty outcomes in clinical trials included a 20% incidence rate of paresthesia, a 5% incidence of high blood pressure and a 12% incidence of back pain) and lack a generally accepted treatment protocol, but nonetheless we’d like you to give them a try.


Dr. Aetna

This is pretty much what Aetna has in mind. They essentially made a list of all the things wrong with wellness programs – unwanted interference in people’s lives, playing doctor, unproven therapies, opaque relationships with “recommended” suppliers, high expense, and “diagnosing” people who aren’t sick – and packaged them all into one press release (1/14/14).
A joy to read. Vik and Al and I exchange comments episodically in THCB post comments. I always find their observations spot-on.

My only lament goes to a paucity of positive recommendations for a broader and more rational definition of "workplace wellness," one that includes things like addressing and abating organizational psychosocial toxicity -- e.g., the "bully culture" that is all too prevalent, particularly in the healthcare space.

Search this book for the word "stress" and you get 13 hits, not all of them relevant to the problem of toxic stress in the workplace (e.g., "cannot stress enough..."). The word "morale" shows up 15 times. It's the better choice. Nonetheless, the book does not give enough attention to it, in my view.

Recall a post of mine during last December's IHI 25th Anniversary Forum:
Below, from a tweet during the Forum:

Indeed. I've been having some email discussions of late with some national nursing leaders about the patient safety implications of the adversarial, dysfunctional management cultures far too prevalent in healthcare, where one speaks truth to power at one's peril.

I've worked in about seven or eight different organizational settings across the span of my white collar career. Only one of them could be considered a "safe," non-toxic culture (somewhat ironically, a hardhat clientele digital industrial diagnostics company in West Knoxville, TN, where I was a writer and our Technical Editor). The rest were burdened by differing degrees of authoritarianism, back-stabbing, and org chart climbing machinations.

It remains a problem. One all the more ironic in the "health" domain. If you work in healthcare, you know exactly to what I'm referring.
I can see that I have two more expensive, apparently authoritative Kindle reads to buy: "Employee Morale: driving performance in challenging times," and "The High Engagement Work Culture: balancing Me and We." I'll let you know about my take-aways.

What, you might ask, does any of this have to do with Health IT?

Plenty. EHRs are necessarily highly complex applications requiring constant focus for consistent accuracy and efficiency of use amid high-stress, severely time-constrained settings, optimally via high-performance teams. Dysfunctional work environments are indisputably inimical to the cultivation and operation of high-performance teams. It behooves us to improve the health of healthcare operations themselves; a necessity every bit as important as improving the physical health of healthcare workers.

Buy a copy of Surviving Workplace Wellness at, decide for yourself. Read the reviews first if you like. Straight up 5.0.

I recognize a few of those names.

THCB: VIK and AL UPDATE (Feb 19th)
What If Your Employer Gets Access to Your Medical Records?

T was never a star service tech at the auto dealership where he worked for more than a decade. If you lined up all the techs, he wouldn’t stand out: medium height, late-middle age, pudgy, he was as middle-of-the-pack as a guy could get.

He was exactly the type of employee that his employer’s wellness vendor said was their ideal customer. They could fix him.

A genial sort, T thought nothing of sitting with a “health coach” to have his blood pressure and blood taken, get weighed, and then use the coach’s notebook computer to answer, for the first time in his life, a health risk appraisal.

He found many of the questions oddly personal: how much did he drink, how often did he have (unprotected) sex, did he use sleeping pills or pain relievers, was he depressed, did he have many friends, did he drive faster than the speed limit? But, not wanting to rock the boat, and anxious to the $100/month bonus that came with being in the wellness program, he coughed up this personal information.

The feedback T got, in the form of a letter sent to both his home and his company mailbox, was that he should lose weight, lower his cholesterol and blood pressure, and keep an eye on his blood sugar. Then, came the perfect storm that T never saw developing.

His dealership started cutting employees a month later. In the blink of an eye, a decade of service ended with a “thanks, it’s been nice to know you” letter and a few months of severance.

T found the timing of dismissal to be strangely coincidental with the incentivized disclosure of his health information.

An HHS investigation months later showed that T’s employer got access to health data it had no right to see and the service manager, with a wink and a nod from the dealership’s finance office, fingered T as expendable. It was a nice bonus — literally — that T departure lowered the dealership’s medical costs both immediately and over the long term, which is what every wellness vendor promises.

This data breach story is fictional. But, it’s coming...



More to come...

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