4. uestions & nswers
if your message is a
if your message is a
– Include presenters so your question
will be directed toward the appropriate person
( )

5. 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

6. 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

7. 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

8. 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

9. 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

10. Oops—Spending Goes Below Zero

11. 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

12. Let’s Use More Reasonable Assumptions

13. Another way to save money is to
INCREASE smokers and obesity

14. No “confusion” being created here…

15. 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

16. …More Bialystock Rule violations

17. 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.com17

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

19. 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

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

21. Example #1: “Selective Citation of Literature”

22. 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

23. 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

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

25. 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?

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

27. Highmark-Penn State-Goetzel Program:
The Worst Wellness Program Ever?
• Rep. Louise Slaughter: “What happened at
Penn State was appalling”

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

30. 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.

31. 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

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

33. What have we learned so far?
• Wellness vendor/consultant data indeed
invalidates itself

34. 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”

35. How Cool is Being on the Enemies List?

36. 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

37. Cigna Guarantees that 30% of High and Medium Risk will decline
in risk:
37 (c) 2013 DMPC www.dismgmt.com

38. What about people whose risk factors should go up? Shouldn’t
they be counted too?
38 (c) 2013 DMPC www.dismgmt.com

39. Should Cigna have drawn the 670-person low-risk segment larger
than the 200 and 130?
39 (c) 2013 DMPC www.dismgmt.com

40. Example from Wellness using Cigna
methodology: Smoking Cessation
40 (c) 2013 DMPC www.dismgmt.com

41. 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

42. 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. 43 (c) 2013 DMPC www.dismgmt.com

44. 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)

45. 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

47. 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

48. Screen Shot of Release 1.0 and
Instructions

49. 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

50. 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

51. 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.

52. 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”

53. 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

54. 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

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

56. Wellness as managed care; No use without permission and attribution 56
http://www.imdb.com/title/tt010
7048/
10/02/2013

57. 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

58. Control
of the
individual
“Incentives”
“Comprehensive
solutions”
“Cost containment”
Wellness as managed care; No use without permission and attribution 5810/02/2013

59. 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 5910/02/2013

60. Wellness as managed care; No use without permission and attribution 6010/02/2013
Fortune 1000 Company

61. 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

62. 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

63. Uwe Reinhardt,
commenting atThe 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

64. 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.

65. 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

66. 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
66October 2, 2013

67. MARSH & McLENNAN AGENCY LLC 67October 2, 2013

68. MARSH & McLENNAN AGENCY LLC
Section 1
CHANGING THE PARADIGM
From Health Risk Reduction to Total Well-
Being

69. 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

70. 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

71. 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

72. 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)
72

73. MARSH & McLENNAN AGENCY LLC
WORKPLACE OVERLOAD
Indicators of Poor Career Well-Being
73October 2, 2013

74. MARSH & McLENNAN AGENCY LLC
Section 3
WHY CULTURE MATTERS
The Link to Well-Being & Sustainability

75. MARSH & McLENNAN AGENCY LLC
ORGANIZATIONAL CULTURE

76. 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)

77. 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

78. 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)

79. 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

80. 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

81. MARSH & McLENNAN AGENCY LLC
IF YOU DON’T MANAGE CULTURE,
IT WILL MANAGE YOU
81

82. 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
82October 2, 2013

83. 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
wardr@rjfagencies.com, (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.

84. on Robison holds a doctorate in health education/exercise physiology and a mas
science in human nutrition from Michigan State University where he has been
aching for 20 years in the Nutrition and Physiology Departments as an Adjunc
ssistant Professor. Dr. Robison is also adjunct Associate Professor at Western
ichigan University where he teaches in the Holistic Health Care Program. He h
thored numerous articles and book chapters and is a frequent presenter at
nferences throughout North America.
Dr. Robison specializes in health promotion and human behavior, with a particu
terest in why people do what they do and don’t do what they don’t do. His book
he Spirit and Science of Holistic Health
More than broccoli, jogging and bottled water
More than yoga, herbs and meditation
esents a radically new direction for health education and promotion. Dr. Robis
ork served as the foundation for the award-winning KAILO - one of the first t
listic employee-wellness programs in North America. He continues to work wit
ganizations to help promote non-coercive, relationship-based personal and
ganizational health.
Dr. Robison has served as co-editor of the journal Health At Every SizeTM – a
one of the featured health professionals in the powerful Documentary - Amer
e Beautiful II - The Thin Commandments.
Aside from his work, Dr. Robison’s passions include his wife Jerilyn, music, hu
d arranging sports schedules for his 18-year old son, Joshua.

85. EVIDENCE BELIEF
Worksite Wellness
At a Crossroads

86. Evidence vs. Belief

87. Evidence-Based

88. “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

89. “Evidence-Based”
Worksite Wellness?
Programming
Process
Weight Loss
Motivation

90. 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%
WellnessintheWorkplace2012:AnOptum®ResearchUpdate–N=156

91. 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

92. 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

93. 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
Sound Business Investment ?

94. 1.2 lbs.
.31 lbs.
5 oz.

95. 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.

96. 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-

97. 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

98. 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

99. 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

100. 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

101. The Safeway Debacle
or…
“We all drank
the Kool-Aid”

102. 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

103. 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

104. 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

105. 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

106. 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

107. David S. Hilzenrath, Washington Post
“Misleading claims about Safeway
wellness incentives
shape health-care bill”
Washington Post
Sunday, January 17, 2010

108. 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

109. 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

110. 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

111. 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

112. 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

113. 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

114. 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:

115. EVIDENCE BELIEF
Worksite Wellness
At a Crossroads
How successful do we want to be ?
How seriously do we want to be take

116. uestions & nswers
if your message is a
if your message is a
– Include presenters so your
question will be directed toward the
appropriate person
( )