Just because it's "healthcare" doesn't mean it's good for you
Must be great to live and work in Colorado, where one of the state’s largest employers and its namesake university, will pay Coloradans to do what they already do. See the report by the Boulder Daily Camera here. Colorado is already one of the fittest states in the nation, having the lowest prevalence of obesity, a full 15 percentage points lower than the national rate. It is a state where people are far more physically active than elsewhere in the US. Coloradans also spend 12% less on medical care each year (per capita) than the national average (maybe the result of the first two factors? Hmmm…). So, in other words, Colorado residents are already national leaders in terms of taking responsibility for their health, and Boulder is probably one of the fittest places in the state.
Why, then, would a large employer pay people $300 per year to do something that they already (mostly) do? According to MetroDenver.org, the University of CO system employs over 16,000 people. Applying the data above, half of them (8,000) already exercise “sufficiently”. Who amongst them wouldn’t happily sign up to take their employer’s money; I would if I worked there. But let’s say just half do so; this puts the University on the hook for $1.2M, with the University absurdly estimating savings of $1.65 to $6 for every dollar spent. This means that they will have to see a reduction in health care spending of between $1.98M and $7.2M and somehow be able to tie those savings specifically to this program. By being diligently active and more-likely-than-not normal weight, these people have already reduced their risk of a wellness-sensitive problem as much as they can (remember, risk is not endlessly reducible). These estimates do not even take into account how much it will cost the University when their exercise underachievers also start to sign up.
The focus on moderate to vigorous exercise is both strange and problematic. No doubt this threshold was pushed by the creator of the fitness app favored (and likely paid for) by the University, which people must use to get this benefit. People who are deconditioned cannot do moderate or vigorous exercise. Because they must start with low intensity exercise, which won’t count, this will effectively exclude from the benefit a large proportion of those who are not physically active now, but actually need the most help. It also invites an unhealthy unintended effect: if the money entices some lower paid employees (who also are likely to be less well-educated, less healthy, and the most at risk), they may actually hurt themselves. I wonder if the University estimated the cost of health care claims for injuries and illnesses in this population or the long-term impact of someone becoming permanently dissuaded from exercise. And speaking of injuries, the ultimate irony, as anyone who frequents Boulder knows (and a chapter in Al Lewis’s book was set there, as he visits annually), is that many Boulderites are far more likely to end up in the hospital as a result of activity than inactivity. Maybe the state of Colorado should pay these people to chill. Just getting them to stop tubing down Boulder Canyon — which is full of (you guessed it) boulders — would be a great start.
The use of a GPS-based fitness app to affirm participation is inane because it requires outdoor linear movement. This means that the app will not record or report any kind of suitably intense indoor exercise (treadmill, stationary or recumbent bike [often important for overweight or obese people], elliptical, or rower); water exercise (also very useful for people who are very heavy or unfit); group exercise classes (where novices can get crucial social support and encouragement); dance (which many newbies like because it’s fun for them); kickboxing; and, strength training. Indeed, the list of exercises ignored is potentially endless.
Here is what University officials did not tell us they did: reformed their food services and vending operations (it’s a university…think they serve much lousy food?); expanded the accessibility of fitness centers and trainers and nutritionists employed in them; sent all these trainers and nutritionists on missions to educate employees in every nook and cranny of the university about how and why to exercise more and eat better; marked every footpath and trail with distance markers and ensured that they are well lighted and safe, so that employees can know how far they are walking each day; estimated how many medical events occur in their employee population each year that this kind of wellness initiative might impact; and, last but not least, that they modified their personnel policies and practices to give everyone at least 30 min every single day to either exercise or get nutrition education.
The wellness space is chock full of bright-eyed and bushy-tailed app creators who have all the answers in their handy-dandy little bit of disruptive technology. Well, the thing that most employers need to disrupt are mindsets (their own and their employees’) about evidence, distinctions between different kinds of prevention, and the difference between strolling the easy, conventional path to nowhere versus doing some real heavy lifting to change the culture and make people who need the most help feel like they belong in your strategy. For this, no one needs a discriminatory app and an ROI fairy tale.