Wednesday, January 8, 2014

The Useful and Not so Much of Wellness Programs

A friend and reader referred me to this New York Times article that discusses a DOL-commissioned study performed by the RAND Corporation and PepsiCo. The study looked at wellness programs to determine the relative values of disease management components and lifestyle management components.

I was surprised that the results were so glaring. I'll get into that difference in just a minute.

First, for readers who don't deal in this area every day, it's useful to explain what we are talking about here. Disease management programs target people with chronic illnesses by educating them about their risks, reminding them to see their physicians, and reminding them to take medications. Lifestyle management programs focus on things such as stress management and weight loss.

The study found that disease management produces very meaningful cost savings, but lifestyle management results in virtually no savings at all. First and foremost, the PepsiCo disease management program has reduced hospital admissions significantly, and hospital admissions are one of the leading contributors to high medical claims costs.

Personally, I think there is more to the difference than what appears in the NYT article. Consider a patient with hypertension (high blood pressure). That blood pressure can be measured. There are prescription drugs whose primary purpose is to get a patient's blood pressure under control. Taking that medication once a day is easy as long as you can remember to do it. For most people, since the medications usually don't have severe side effects, there is nothing discomforting about doing this. Patients see the improvements and they are happy. Statistically speaking, a person with normal blood pressure is less likely to be admitted to the hospital than a hypertensive person. And, blood pressure medication is not among the more expensive ones.

How about lifestyle management? How exactly would I measure stress? How exactly would I control my stress? How would I know that my stress was reduced?

To my mind, these are all largely indeterminable elements. I know when I feel less stressed, but it's usually not something that can be controlled. If I think I will have trouble paying my bills, I will be stressed. If I think I will lose my job, I will be stressed. If a family member is ill, I will be stressed. No stress management program can change this.

Looking at the numbers cited in the study, the disease management program saved nearly $4 for every dollar spent on it while the lifestyle management program saved only about 50 cents for every dollar spent. In total, the program saved nearly $1.50 for each dollar spent.

One could look at this in several ways. We could say that the program in total is working. We could say that PepsiCo should eliminate the lifestyle management component. What we can't say is that disease management doesn't work.

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