When Wellness Worlds Collide: Wellness Critics Respond to Attacks

uestions & nswers

if your message is a

if your message is a

– Include presenters so your question

will be directed toward the appropriate person

( )

Al Lewis Agenda

• Qualifications

• Brief Response to August 29 Goetzel/Aldana Attack

– Review the Wellsteps/Aldana “science” …and make him an offer

– Fill in some “blanks” Mr. Goetzel might have left out

• How to Measure Outcomes

My Own Metrics Qualifications

• Outcomes evaluation and procurement consulting for DM and wellness, and now litigation support (JD from Harvard Law School)

• The popular course/certification in Critical Outcomes Report Analysis so you don’t have to rely on vendor/consultant ROIs

• “Unsung Hero Changing Healthcare Forever,” Leah Binder, Forbes

6

Most Importantly, I’ve Written award-winning trade bestsellers on Wellness Outcomes

Honest vendors and consultants will recommend these very well-reviewed books even if don’t agree with everything in them

Today We Will Test This Line…

• “In wellness, you don’t have to challenge the data to invalidate it. You simply have to read the data. It will invalidate itself” – Cracking Health Costs

Al Lewis Agenda

• Qualifications

• Brief Response to August 29 Goetzel/Aldana Attack

– Review the Wellsteps science …and make them an offer

– Fill in some “blanks” Mr. Goetzel might have left out

• How to Measure Outcomes

Oops—Spending Goes Below Zero

The Bialystock Rule

1. You cannot reduce a number by more than 100% no matter how hard you try

2. This is not one of those things that’s the opposite in the Southern hemisphere

11 (c) 2013 DMPC www.dismgmt.com

Let’s Use More Reasonable Assumptions

Another way to save money is to INCREASE smokers and obesity

No “confusion” being created here…

Next Steps for Dr. Aldana

• The “open mike” gives you a chance to apologize for pretending to offer a model

• This lack of regard for facts, data and simple arithmetic is typical in this field, especially the Bialystock Rule

…More Bialystock Rule violations

In Childrens’ Admissions for North Carolina, Milliman “validated” savings for 2007-2010 > amount spent in 2006

Aggregate costs of discharges Medicare Medicaid Total number of discharges 1,106,005 423,602 226,190

######## ######## ########

Age group <1 136,849 19 69,019

390,703,783 68,228 227,790,451

1-17 44,546 117 22,394

250,617,666 1,365,939 114,620,426

18-44 289,755 21,669 97,859

######## 178,553,996 487,584,960

45-64 265,992 72,447 36,442

######## 729,137,435 369,788,731

65-84 299,251 264,785 429

######## ######## 4,874,779

85+ 69,595 64,563 39

531,179,285 495,677,349 335,288

2006 baseline spending

(c) 2013 DMPC www.dismgmt.com 17

Mercer/Staywell can reduce BP’s events by more than 100%...and get 100x the savings Staywell says is possible

Al Lewis Agenda

• Qualifications

• Brief Response to August 29 Goetzel/Aldana Attack

– Review the Wellsteps “science” …and make them an offer

– Fill in some “blanks” Mr. Goetzel might have left out

• How to Measure Outcomes

Lots of Ironies in 8/29 Presentation…he presented this slide—and did exactly that

Example #1: “Selective Citation of Literature”

Failed to Mention the Author Walked It Back

4 years ago: “Workplace Wellness Can Generate Savings” of 3.27-to-1 July 2013: “It’s too early to tell” whether these programs save money

Selective Citation #2: Nebraska

• Claimed $4.2-million in savings even though risk factors only declined for 186 participants and other costs “spiked”

• Claimed 40% of screened people were diagnosed with cardiometabolic disorders

– but drug use for cardiometabolic disorders declined 3%

• Claimed cancer rates 40-60x that of Love Canal (514 cases)

Goetzel’s Koop Committee Did Not Notice and/or Care about Any of This

But People Are Becoming Aware that the Koop Committee Didn’t Notice or Care

514 Cancer Cases Were Made Up to Win an Award named for C. Everett Koop

• 2012 Claim: Nebraska/HFC program made “life saving, cost saving catches [of ] 514 early-stage cancer cases”

• 2013 Admission of Guilt: HFC’s Dr. Richling admitted that these 514 cases “technically were not cancer”

• Goetzel Committee lets HFC cronies keep their Koop Award despite admitted lies

• LinkedIn groups and blogosphere: What would Koop say?

Selective Omission #3: Penn State (See Harvard Business Review)

Highmark-Penn State-Goetzel Program: The Worst Wellness Program Ever?

• Rep. Louise Slaughter: “What happened at Penn State was appalling”

Lots of Ironies in 8/29 Presentation…he presented this slide—and did exactly that

You Can’t Match Participants to Non-Participants

• You can “match” demographics all you want but you can’t compare the mindset of participants and non-participants

• “Match” 50 smokers who want to quit against 50 other smokers with identical demographics who don’t want to quit – and the quit rate will be higher among the people who want to quit, program or no program.

The Most Eloquent Participants-vs.-Non-Participants Smackdown

• “Self-improvers are likely to be drawn to self-improvement programs, and self-improvers are more likely to improve.”

– Henry Albrecht, Limeade

Costs fall before the program starts just by separating participants from non-participants

What have we learned so far?

• Wellness vendor/consultant data indeed invalidates itself

What have we learned so far?

• Wellness data indeed invalidates itself

• We also learned why I am not very popular in some circles…

“My greatest achievement is being on Nixon’s enemies list”

How Cool is Being on the Enemies List?

Al Lewis Agenda

• Brief Response to August 29 Goetzel/Aldana Attack

– Review the “qualifications” of Wellsteps’ Steve Aldana …and make him an offer

– Fill in some “blanks” Truven’s Mr. Goetzel might have left out

• How to Measure Outcomes: Caveat Emptor and do-it-yourself opportunities

• Example: Cigna

Cigna Guarantees that 30% of High and Medium Risk will decline in risk:

37 (c) 2013 DMPC www.dismgmt.com

What about people whose risk factors should go up? Shouldn’t they be counted too?

38 (c) 2013 DMPC www.dismgmt.com

Should Cigna have drawn the 670-person low-risk segment larger than the 200 and 130?

39 (c) 2013 DMPC www.dismgmt.com

Example from Wellness using Cigna methodology: Smoking Cessation

40 (c) 2013 DMPC www.dismgmt.com

Smoking hypothetical

• Suppose everyone in your organization smokes and quits in alternate years, and that smoking is the only risk factor

• So the 50% of the workforce smokes every year but it’s a different 50% each year

41 (c) 2013 DMPC www.dismgmt.com

Smoking hypothetical

• Suppose everyone in your organization smokes and quits in alternate years, and that smoking is the only risk factor – Only smokers are high-risk

• So the 50% of the workforce smokes every year but it’s different 50%

This methodology would find a 100% reduction Every year even though the smoking rate remains unchanged There is, however, one undeniably true statement in Cigna’s brochure…

42 (c) 2013 DMPC www.dismgmt.com

43 (c) 2013 DMPC www.dismgmt.com

Significance of Cigna Example

• Shows how little respect vendors and health plans have for your advisors’ ability – or willingness -- to find fallacies

– Many advisors to HR departments are also getting directly or indirectly paid by vendors (from Wellnet website)

So What Do You Do Instead?

• Use honest vendors and consultants

– They will ask the question: “What should improve as a result of wellness?” by saying “Wellness –sensitive medical events”

• Do It Yourself

– The “Wellness-Sensitive Medical Event Committee” is making its work product available to self-insured employers, Leapfrog Group and IHPM members free from www.dismgmt.com

What is this group and How does Release 1.0 work?

• Inter-corporate committee developed list of medical events most likely to be avoided through wellness

• There will be other things that go up (MD visits) and maybe other events that decline but this is a “plausibility test”

• We will be expanding the list in future releases of other impacts

• You can ask to join the committee

Screen Shot of Release 1.0 and Instructions

Example of Output: ER and IP Event Rates per 1000 covered people

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

asthma

cad

chf

copd

diabetes

49

CAD vs. national averages (events per 1000 commercial members)

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

Employer A

National Averages

50

Here’s what you can learn

• Whether you are reducing wellness-sensitive medical events through your wellness program

• Whether your wellness-sensitive medical event rate is higher or lower than average for the US (or your segment), and whether it is decreasing faster or slower than average

• With the real ROI calculator (not free) you can see if you saved money.

Take-Aways

• Test models – they usually don’t work

• Track records (Nebraska, Penn State) aren’t always disclosed but are relevant

• Vendors and consultants fabricate numbers and selectively cite literature

• Measure wellness-sensitive medical events to see if your wellness program “moves the needle”

The Key Difference between What You Saw in August and Today

“Who are you gonna believe, me or your own eyes?”

53 (c) 2013 DMPC www.dismgmt.com

You decide which you’d like to do

How wellness subverts essential medical principles and drives hyper-diagnosis by giving us what we’ve already had

Vik Khanna Vikram Khanna Health Consulting Chesterfield, MO October 2013

10/02/2013 Wellness as managed care; No use without permission and attribution 55

Wellness as managed care; No use without permission and attribution 56

http://www.imdb.com/title/tt0107048/

10/02/2013

Wellness as managed care; No use without permission and attribution 57

• Overdiagnosis

• Encouragement of the sick role

Intentional

• Reliance on discrete data points

Inaccurate • Belief in the

clinic as the locus of health

Deceptive

10/02/2013

Control of the

individual

“Incentives”

“Comprehensive solutions”

“Cost containment”

Wellness as managed care; No use without permission and attribution 58 10/02/2013

2.40 2.50

2.89 3.00

1.73 1.65

1.48 1.14

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

2.00

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

1994 1997 2003 2009

Miles driven (trillion) Death rate (per 100M miles driven)

Source: http://www-fars.nhtsa.dot.gov/Main/index.aspx

Wellness as managed care; No use without permission and attribution 59 10/02/2013

Wellness as managed care; No use without permission and attribution 60 10/02/2013

Fortune 1000 Company

State 1 State 2

Younger population

75% greater ED use

50% higher hosp admit rate

10% higher per capita med care spending

Longer lifespan

30% lower death rate

55% higher rate of vigorous exercise

44% higher rate of fruit/veg consumption

10/02/2013 Wellness as managed care; No use without permission and attribution 61

Source: Kaiser Family Foundation, State Health Facts

Colorado Mississippi

Younger population

75% greater ED use

50% higher hosp admit rate

10% higher per capita med care spending

Longer lifespan

30% lower death rate

55% higher rate of vigorous exercise

44% higher rate of fruit/veg consumption

10/02/2013 Wellness as managed care; No use without permission and attribution 62

Source: Kaiser Family Foundation, State Health Facts

Uwe Reinhardt, commenting at The Health

Care Blog

• “I have deplored this Nurse Ratched intrusion [corporate wellness] for a long time as well.”

Donald Lloyd-Jones, MD, Chair of Preventive

Medicine, Northwestern University

• “Treatment can never restore you to the baseline risk factors of someone who has never had them.”

10/02/2013 Wellness as managed care; No use without permission and attribution 63

10/02/2013 Wellness as managed care; No use without permission and attribution 64

Health economists don’t even use the word “wellness” when talking about the slowing rate of growth in medical care spending, which is nearly all due to macro-economic trends that conventional wellness vendors don’t even understand let alone affect.

RE-FRAMING THE WELL-BEING VALUE PROPOSITION HP Live

Rosie Ward, Ph.D., MPH, MCHES, BCC, Certified Intrinsic Coach®

Health Management Services Manager

Marsh & McLennan Agency

Minneapolis, MN

October 2, 2013

MARSH & McLENNAN AGENCY LLC

WHO IS THIS CHIC???

• 20 Years in the Health & Wellness Industry

– B.S. in Kinesiology

– MPH in Community Health Education

• 2001: realization that published “best practices” weren’t reality for us in

the field; disheartened with worksite wellness but still a believer…

• 2003-2004: Light Bulb moment

– Broadened scope and earned Ph.D. in Organization and

Management

• 2004 – Present: Trying to change the world and elevate well-being to a

different level of understanding and focus within organizations and our

field

66 October 2, 2013

MARSH & McLENNAN AGENCY LLC 67 October 2, 2013

MARSH & McLENNAN AGENCY LLC

Section 1

CHANGING THE PARADIGM From Health Risk Reduction to Total Well-Being

MARSH & McLENNAN AGENCY LLC

INDIVIDUAL WELL-BEING

5 Universal, Interconnected

Elements:

• Career Well-Being

• Social Well-Being

• Financial Well-Being

• Physical Well-Being

• Community Well-Being

MARSH & McLENNAN AGENCY LLC

ENGAGEMENT & PHYSICAL HEALTH

Source: Crabtree, Gallup Management Journal (2005)

22% 54

%

23%

Engaged Not Engaged Actively Disengaged

39%

30%

30%

62%

12%

25%

2% 1% 1%

Effect of Work Life on Health

ENGAGEMENT & PHYSICAL HEALTH

MARSH & McLENNAN AGENCY LLC

DISENGAGEMENT & MENTAL WELL-BEING

4.6%

6.4% 6%

7.6%8.8%

10.4%

Engaged Not Engaged Actively Disengaged

% Dx with Depression Over the Next Year

% Dx with Anxiety Over the Next Year

Source: Robison, Gallup Management Journal (2010)

1.7x Increase for Disengaged EEs compared to Engaged EEs

MARSH & McLENNAN AGENCY LLC

THE REALITIES OF WORKPLACE STRESS IN AMERICA

• 69% of adults with high stress report increased stress over past year; 35% report increased stress overall. (APA, Feb. 2013) ­ Main sources of stress: Money (69%) , Work (65%)

• 80% of workers feel stress on the job. (American Institute of Stress, 2011)

• Workplace stress is as bad for the heart as smoking & high cholesterol. (JAMA, Oct. 2007)

• 90% of all visits to primary care doctors are related to stress. (JOEM, Oct. 1998)

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MARSH & McLENNAN AGENCY LLC

WORKPLACE OVERLOAD Indicators of Poor Career Well-Being

73 October 2, 2013

MARSH & McLENNAN AGENCY LLC

Section 3

WHY CULTURE MATTERS The Link to Well-Being & Sustainability

MARSH & McLENNAN AGENCY LLC

ORGANIZATIONAL CULTURE

MARSH & McLENNAN AGENCY LLC

A HIGH-PERFORMING CULTURE: Beyond Engagement

76

Engaged

Enabled

Energized

A work environment that supports productivity & performance

Attachment to the company & willingness to

give extra effort

Individual physical, social

& emotional well-being at

work

Source: Adrian Gostick & Chester Elton, All In: How the Best Managers Create a Culture of Belief and Drive Big Results (2012)

MARSH & McLENNAN AGENCY LLC

COMPETITIVE ADVANTAGE OF E + E + E

9.9%

14.3%

27.4%

Companies with Low

Engagement

Companies with High

Engagement

Companies with High Levels of E+E+E

Operating Margin

77 Source: Adrian Gostick & Chester Elton, All In: How the Best

Managers Create a Culture of Belief and Drive Big Results (2012)

3x Higher

MARSH & McLENNAN AGENCY LLC

LEADERSHIP CREATES CULTURE

50-70% of employee’s

perception of the

organization’s climate

can be traced to the

actions of the leaders.

78

Sources: Consortium for Research on Emotional Intelligence in Organizations (2001); Adrian Gostick & Chester Elton, All In: How the Best Managers Create a Culture of

Belief and Drive Big Results (2012)

MARSH & McLENNAN AGENCY LLC

79

LEADERS’ ROLE IN WELL-BEING

• Leaders shouldn’t ignore well-being as if it’s beyond the scope of their jobs.

• People who agree their manager cares about them as a person:

– Are more likely to be top performers

– Produce higher quality work

– Are less likely to be sick

– Are less likely to change jobs

– Are less likely to get injured on the job

Source: Rath & Harter (2010), Wellbeing: The Five Essential Elements

MARSH & McLENNAN AGENCY LLC

SHIFTING FROM BEHAVIOR CHANGE TO CULTURE

“Behavior change is really the mantra of wellness,

but if a person achieves a lifestyle behavior

change, only to return to the same unhealthy

environment, what can we expect will happen?

We set up wellness for failure if we don’t work

on improving the environment and culture

before we work on individual behavior

change.”

(Dee Edington, Ph.D., The Art of Health Promotion, Sept./Oct. 2012)

80

MARSH & McLENNAN AGENCY LLC

IF YOU DON’T MANAGE CULTURE, IT WILL MANAGE YOU

81

MARSH & McLENNAN AGENCY LLC

WELL-BEING VALUE PROPOSITION 6 Components to Effective Well-Being

1. Data Collection / Analysis

2. Strategic and Annual Planning

3. Establish Foundation for Ongoing Support

4. Quality Coaching and Support

5. Environmental Support

6. Resource Allocation

82 October 2, 2013

MARSH & McLENNAN AGENCY LLC

CONTACT INFORMATION

Rosie Ward, Ph.D., MPH, MCHES, BCC Certified Intrinsic Coach®, Certified Valuations Specialist

Health Management Services Manager

Marsh & McLennan Agency

[email protected], (763) 548-8861

www.rjfagencies.com

www.DrRosieWard.com

© Copyright 2013. RJF, a Marsh & McLennan Agency LLC company. All Rights Reserved.

The content provided in this presentation is proprietary and confidential and not for distribution without written consent from MMA.

Jon Robison holds a doctorate in health education/exercise physiology and a master of science in human nutrition from Michigan State University where he has been teaching for 20 years in the Nutrition and Physiology Departments as an Adjunct Assistant Professor. Dr. Robison is also adjunct Associate Professor at Western Michigan University where he teaches in the Holistic Health Care Program. He has authored numerous articles and book chapters and is a frequent presenter at conferences throughout North America. Dr. Robison specializes in health promotion and human behavior, with a particular interest in why people do what they do and don’t do what they don’t do. His book: The Spirit and Science of Holistic Health …More than broccoli, jogging and bottled water …More than yoga, herbs and meditation presents a radically new direction for health education and promotion. Dr. Robison’s work served as the foundation for the award-winning KAILO - one of the first truly holistic employee-wellness programs in North America. He continues to work with organizations to help promote non-coercive, relationship-based personal and organizational health. Dr. Robison has served as co-editor of the journal Health At Every SizeTM – and is one of the featured health professionals in the powerful Documentary - America the Beautiful II - The Thin Commandments. Aside from his work, Dr. Robison’s passions include his wife Jerilyn, music, humor, and arranging sports schedules for his 18-year old son, Joshua.

EVIDENCE BELIEF

Worksite Wellness At a Crossroads

Evidence vs. Belief

Evidence-Based

“Evidence-Based Medicine”

“The integration of best research

evidence with clinical expertise and

patient values.”

Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. 2000, p.1

“Evidence-Based” Worksite Wellness?

Programming

Process

Weight Loss

Motivation

Weight Loss at The Workplace

Types of Wellness Coaching Offered: Exercise 85% Weight 83% Nutrition 81% Stress 78% Heart Health 73% Diabetes Health 65% Pregnancy 38% Sleep Management 29%

Wellne

ss in the W

orkplace 2

012

: An O

ptum®

Rese

arch U

pdate

– N=15

6

The Legacy of Failure Medicare’s Search for

Effective Obesity Treatments

“In sum, there is little support for

the notion that diets lead to

lasting weight loss or health

benefits.”

American Psychologist, April, 2007

The Legacy of Failure At The Workplace

17 worksites - 2,407 employees

Year-long, incentive programs

Weight loss – 1.4 to 3.6 pounds

Dropout – as high as 76.4%

Cawley, National Bureau Of Economic Research, Inc. Working Papers, No. 14987, 2009

The Legacy of Failure At The Workplace

“Weight loss money is money down the toilet.

Every diet program gets results, but none works beyond two years.”

Dee Eddington, HR Magazine, Countering a Weight Crisis, March 1, 2004

Sound Business Investment ?

1.2 lbs.

.31 lbs. 5 oz.

To Reward?... Or Not To Reward?:

Questioning the Wisdom of Using External Reinforcement in Health Promotion Programs

Jonathan I. Robison

American Journal of Health Promotion:

September/October 1998

Vol. 13, No. 1, pp. 1-3.

Motivation

doing something due to pressure or tangible rewards rather than for the fun or interest of it - because someone is trying to get you to do it.

doing something because it provides spontaneous satisfaction - doing it because you want to do it.

Gagne & Deci, Self-determination Theory & Work Motivation, J.Org.Beh.2005;26:331-362

Extrinsic-

Intrinsic-

Incentives: Evidence-Base ??

Curry, Wagner., J.Consult Clin Psych. 1991;59(2):318-323)

Windsor, 1988, J.Behav.Medicine;11:407-21

Matson et al., AJHP 1993;7(4):270-80, 295

Koffman DM , et al., AJHP 1998;13:105-111

Redmond et al., Center on Budget and Priority Policies, June 2007

Cochrane Database of Reviews,Cahill & Perera, 2008, Issue 3

Kevin Volpp et al., Randomized Controlled Trial of Financial

Incentives, JAMA 2009;360:699-709

Kramer et al., Behavior Therapy 1986:295-301

Obesity Reviews 2007;9, 355-367

Volpp, Financial Incentive-Based Approaches for Weight Loss,

JAMA 2008;300, 2631

Geller, Rudd, et. al. Journal of Safety Research 1987;18:1-17.

Gingerich SB, et al. Impact of financial incentives on behavior change participation and risk

reduction in worksite health promotion, American Journal of Health Promotion 2012;27(2)

25 years of

workplace

research:

Top 13

Reasons Not

To Use

Incentives Competitions & Incentives for Smoking Cessation, Kate Cahill and Rafael Perera -

April, 2011

Extrinsic Motivation

Does not produce long-term behavior change

Can diminish performance

Can diminish creativity

Can foster short-term thinking

Can encourage cheating, shortcuts, etc.

Can become habit forming

Can reduce or extinguish intrinsic motivation

Motivation “There are literally hundreds and hundreds

and hundreds now of scientific investigations that have shown when you’re

autonomously motivated you’re behavior will be more creative, you’ll be a better

problem solver, when you encounter obstacles you’ll be able to think outside the box and figure out what to do about

them.

Dr. Edward Deci - http://www.youtube.com/watch?v=VGrcets0E6I

Motivation

your performance will be better particularly at heuristic activities, and

your emotions will be much more positive. And very importantly, autonomous motivation is associated with both

physical and psychological health.”

Dr. Edward Deci - http://www.youtube.com/watch?v=VGrcets0E6I

The Safeway Debacle

or…

“We all drank

the Kool-Aid”

The “Safeway Amendment”

“Safeway designed such a plan in 2005 and has made continuous improvement

each year.

The results have been remarkable, our health care costs for four years have

been held constant.”

The Rhetoric

Steven A Burd, Safeway CEO, Wall Street Journal, June 12, 2009

The “Safeway Amendment”

“Safeway designed such a plan in 2005 and has made continuous

improvement each year.

The results have been remarkable, our health care costs for four years

have been held constant.”

The Rhetoric

Steven A Burd, Safeway CEO, Wall Street Journal, June 12, 2009

The “Safeway Amendment”

“Safeway figured out how to incentivize

people to take better care of themselves,

and they have flat-lined their health care

costs for 200,000 employees in the last

four years.”

The Rhetoric

Sen. Thomas R. Carper, Democrat, Delaware, Senate Finance Committee, September, 2009

The “Safeway Amendment”

“You know, there’s a guy who has become

pretty famous lately, and he’s the CEO of

Safeway… Safeway’s health-care costs

have gone down. Why can’t we adopt that

on a national scale.”

The Rhetoric

Sen. John McCain, Republican, Arizona, Town Hall Meeting, August, 2009

The “Safeway Amendment”

“It’s a program that has helped Safeway

cut health-care spending by 13 percent

and workers save over 20 percent on

their premiums... And we’re open to help

employers adopt and expand programs

like these.”

The Rhetoric

President Barack Obama – June – American Medical Association speech

David S. Hilzenrath, Washington Post

“Misleading claims about Safeway

wellness incentives

shape health-care bill”

Washington Post

Sunday, January 17, 2010

The “Safeway Amendment” The Reality

Costs declined by 12.5 % in 2006

Program was not implemented until 2009

(only 11,000 out of

200,000 employees eligible)

http://ilovebenefits.healthcarebenefitsnetwork.com/?p=3284

The “Safeway Amendment” The Reality

“Although it may seem obvious that charging higher premiums for smoking (body mass index, cholesterol, or blood pressure) would encourage

people to modify their habits to lower their premiums, evidence that differential premiums

change health-related behavior is scant. Indeed, we’re unaware of any insurance data that convincingly demonstrate such effects.”

Volpp, et. Al, Redesigning Employee Health Incentives, NEJM 2011;365:388-390

The “Safeway Amendment” The Reality

“We also have a pretty good idea of what doesn’t

work, and heading the list are strategies that tie

individual employees’ share of health insurance

premiums to health-related behaviors and/or

meeting benchmarks.”

Workplace wellness regulations:First do no harm.The Prevention Institute, The Greenlining Institute, 2013

The “Safeway Amendment” Why Not?

Workplace wellness regulations:First do no harm.The Prevention Institute, The Greenlining Institute, 2013

Punitive measures have not been linked to improved health outcomes

May instill resentment in employees

Shift health costs to the least healthy

Most damaging effect on people of color

and low-income workers

Take Home

The field has been riding the behavioral change horse for 40 years with little to

show for it…

Paying individuals for forced participation is a step in the wrong direction

Motivation

Dr. Dee Edington – August 21, 2013 – Edington Associates

Take Home

“Don’t ask how you can motivate others.

That’s the wrong question.”

Ask how you can create the conditions within which others will motivate

themselves.”

Motivation

Dr. Edward Deci - http://www.youtube.com/watch?v=VGrcets0E6I

Take Home

Addressing the issues that have the greatest impact on employee health ?

Addressing the issues that have the greatest impact on organizational health ?

Promoting engagement? Inhibiting it ?

Are Our Programs:

EVIDENCE BELIEF

Worksite Wellness At a Crossroads

How successful do we want to be ? How seriously do we want to be taken?

uestions & nswers

if your message is a

if your message is a

– Include presenters so your

question will be directed toward the

appropriate person

( )