When the Harvard Business Review publishes an essay called "The Cure for the Common Corporate Wellness Program," you know the backlash is real.
"No major and widely embraced employee productivity enhancement initiative has veered farther off course than wellness," argue consultants Al Lewis and Vim Khanna in a post on Harvard Business Review website.
Some 50 million American workers participate in wellness programs of some sort. And as more employers adopt health risk assessment and intervention programs -- with about 15 percent of American companies using incentives for workers to complete HRAs -- some employees have resisted (most recently at Penn State University) and skeptics have sharpened their critique, chief among them Lewis and Khanna, authors of the new book Surviving Workplace Wellness With Your Dignity, Finances and (Major) Organs Intact.
Lewis and Khanna see four "fundamental flaws" in the current employee wellness paradigm: coercion of workers rather than empowerment, marketing hype, lack of evidence, and unnecessary use of healthcare.
To start, they take the Business Roundtable to task for aggressively lobbying of Congress for more flexible employer-based insurance wellness rules, and specifically the Roundtable's chair of health and retirement, Gary Loveman, the CEO of Caesars Entertainment.
"How can one be sure their position is not driven by genuine health concerns but rather by a desire for more control," Lewis and Khanna ask, when the Roundtable's wellness lobbying "is led by a CEO in the casino industry who exposes his employees to more second-hand smoke than virtually any CEO in the country"?
They also lob a critique at Aetna, which recently started a personalized weight-loss pilot available to self-insured customers that offers two drugs sold under the brand names Qsymia and Belviq. Qsymia, paring an appetite-suppressing stimulant with an anti-seizure compound, and Belviq, a serotonin receptor-based appetite suppressant, have had mixed sales success since being approved in 2012 -- "likely due to unacceptable side-effect profiles," Lewis and Khanna argue.
They continued: "In a tacit acknowledgement that it is not possible to save money by putting people who aren't sick on drugs that the marketplace has largely rejected, Aetna is offering this program only to self-insured employers, not to its own fully insured members."
They also criticize wellness programs, such as one for Nebraska's state employees, as prone to overdiagnosis by targeting age groups and risk profiles that even the U.S. Preventive Services Task Force deem unlikely to benefit. And they argue that the annual checkups wellness programs typically require "can do more harm than good" for adults without chronic disease.
As for solutions, Lewis and Khanna suggest a revamp of wellness programs by urging company leaders to ask themselves two questions: "If you're a general leading an army into battle, would you rather have troops with high morale or troops with low cholesterol? Are you doing wellness to your employees or for your employees?"
Specifically, they think wellness programs should abide by only USPSTF screening guidelines, not subject employees to weight measurement, and only encourage checkups for those likely to benefit.
"By cutting spending on failed wellness conventions, organizations will find room in the budget for wellness innovations that will raise morale by doing things for employees instead of to them," they argue. "Rather than offer a laundry list of possibilities for offers, we suggest a new approach: ask employees what they want. You are far more likely to increase morale by responding to employee interests and concerns than by trying to manipulate health behaviors that are largely unrelated to enterprise success."
Health plans have seen a good deal of business from wellness plans, and many employers may very well see results in lowering their costs while improving the health of their workers, even if only marginally. And the fact that health plans and employers are even trying to tackle the problem of unhealthy lifestyles may suggest some failure on the part of primary care doctors for not holistically addressing their patients' diet and exercise habits.
But if backlash does persist against top-down health benefit and wellness programs, insurers could take the opportunity to help redesign other aspects of American work that may have connections to health and productivity.