A Message to Self-Insured Employers: Just Say No to the Disease Management Sales Pitch

A few posts ago I warned readers about the perils of offering up their personal health information to a nurse calling from their insurance company or some organization affiliated with their employer’s health plan initiative. At the end of this post, I promised a future discussion of how self-insured employers pay lip service to the health promotion paradigm by implementing these so-called health promotion programs that are usually provided by the insurance company in tandem with claims management services or are outsourced to stand-alone disease management companies. These programs usually entail regular telephonic outreach to at-risk members (identified by claims data and contact with the system through preauthorization) where nurses or other health professionals educate plan members on their benefits and encourage them to get preventative care and remain compliant with cost-effective treatment regimens. There is also a big emphasis on smoking cessation, weight loss, exercise, and stress management—all laudable goals. By purchasing these disease management/health promotion programs, the self-insured employer’s expectations are that they will enjoy decreased healthcare costs overall and greater presenteeism from a well workforce. At least, this is the sales pitch they’ve swallowed without question.

Here’s the truth from someone who actually worked in disease management and telephonic outreach: these programs don’t work. Why? Well, for one, employees are far too busy with work and family issues to talk on the telephone to random persons, even nurses, especially about their sensitive medical information. The ones we do reach are often rightfully wary of speaking with someone from their insurance company who is also pushing wellness initiatives from their employer. They get the suspicious connection and are unreceptive to our wellness cheerleading tactics. Moreover, stressed-out workers suffer from the same illness paradigm that infects the entire healthcare system, and they often don’t seek care until their condition is urgent due to costly deductibles and co-pays, concerns about missing work, and cultural considerations, such as language barriers. So, here we have a situation in which the employer has paid, perhaps, millions of dollars to an insurance company to provide ineffective disease management services, money that could have easily gone into reserve for future spikes in healthcare costs are better yet, used to implement sweeping organizational changes on an internal level that would have far greater impact on long-term workforce health. What type of changes?

How about a sound investment in employee health through the widespread provision of onsite clinics where members can seek routine care without leaving work, including regular blood pressure checks, blood sugar monitoring, and pap smears? How about working with executives to implement a wellness paradigm that encompasses all aspects of the organization, including nutrition services? Yes, this means ridding the cafeteria and vending machines of all junk for staff and visitors. How about investing in onsite exercise facilities or subsidies for local gyms, yoga and exercise studios, or home equipment vouchers? How about instituting your own disease management program in which your own employees advertise wellness initiatives to their colleagues? How about mandating top-down involvement where your top brass actively participate in the programs and promote them to employees, instead of hiding out in their executive suites stuffing dingdongs into their already expansive waistlines and wringing their hands over spiraling healthcare costs? There’s nothing like modeling the behavior you want to see in others.

Are these radical propositions? Absolutely, but true transformation never comes from half-ass changes. And, that’s what I’ve seen time and again from the self-insured employer community. They all want to jump on the health promotion bandwagon, so they lap up the delusional “we-can-make-it-all-better” Kool-Aid served by the insurance companies who dazzle administrators with charts and figures that promise a huge ROI if only they purchase additional disease management services along with claims administration. With visions of saved dollar signs dancing in their eyes, employers sign on the dotted line and offer up the cash that will find its way into insurance executives’ deep pockets while their workforce grows sicker.

Self-insured employers, I’m surprised and appalled by your failure to see through this expensive, yet worthless charade. I know you’re desperate to control your healthcare costs and stay competitive. I know your own bosses are breathing down your necks to get this issue under control, but come on! Do you actually believe a bunch of nurses or other health professionals calling and borderline harassing your employees is going to bring your long-term costs down in any meaningful way? Puuhhlease. If I could get people to stop smoking, lose weight, exercise, and go to therapy just by calling them and praising the benefits of wellness, I wouldn’t be working for an insurance company. I’d be the next Tony Robbins or certainly a wealthy, healthy televangelist. Moreover, do you really think a bunch of overweight, stressed out, heavily medicated nurses can motivate your overweight, stressed out, heavily medicated employees to turn their lives around in a few phone chats? If so, then please pass that Kool-Aid.

Employers, I implore you to resist the insurance companies’ tantalizing sales pitch that they can help control costs even more if you pony up mega cash for their disease management programs. Trust me, the insurance sales posse is clueless about the logistical nightmares associated with implementing such a program, and since it won’t be their problem once the deal is done, they won’t be accountable. They’ll simply blame the nurse team for not doing their job, you know the job of magically changing human behavior with the snap of our just-as-fat fingers. Ridiculous!

Please, employers, when you go into contract negotiations with your insurance carrier, don’t fall for the “disease management-will-solve-all-your-problems” presentation. I guarantee it’ll be one slick performance you’ll have to resist. After all, everyone else is doing it, and all Gods forbid, you buck convention and do something truly transformative, like investing directly in your employees’ health instead of relying on a middleman who’s ultimate motive is shoring up his bottom line. Leave your rose-colored glasses at home, use the brain that actually got you in the position of negotiating insurance coverage for your company, and just say no to this useless frill. Oh, and it helps to bring your own drink.