A Wellness Program That Isn’t Working
In 2006, West Virginia started rewarding Medicaid patients who signed a pledge to enroll in a wellness plan and to follow their doctors’ orders with special benefits, including unlimited prescription-drug coverage, programs to help them quit smoking and nutrition counseling. Those who did not sign up were enrolled in a more restrictive plan that, among other things, limited drug coverage to only four prescriptions a month.
The program, by many accounts, is failing. As of August 2009, only 15 percent of 160,000 eligible patients had signed up. Patients with limited transportation options were having a hard time committing to regular office visits. And experts say there is no evidence that restricting benefits for noncompliant patients has promoted healthy behaviors.
I’m supposed to be surprised that wellness programs don’t work? Can you point to one that does work?
The primary problem with wellness programs is you have to efficiently identify those few people who are: 1) willing to change their behavior; and 2) would not have adopted a healthy behavior absent the incentive.
Any money spent on people already pursuing healthy lifestyles; or spent on those unwilling to pursue healthy lifestyles is essentially wasted.
Another problem is that when you do nudge people adopt healthy behaviors the cost of the nudge should not exceed the benefits from healthy behaviors.
From an economic standpoint, a better option is to internalize the cost and benefits of whatever behavior people choose.
When you are dealing with Medicaid enrollees, it’s hard to internalize any cost.
I think it’s fascinating that anyone thinks that type of program will work since the savings don’t accrue to the individual. If someone only needs 4 prescriptions a month, the plans are basically identical, so why bother joining the wellness program?
I agree with C. Lewis. No real incentive, no behavioral payoff.
It makes me wonder: What type of incentives would I need to lead a healthier life? (assuming they are supplied from an external source like the government)
Money? Fame?
Yep. That’s about all I can think of. Other than those two, the only other reason I have for eating healthier/exercising/going to my doctor is for my own self satisfaction.
I suppose that free prescriptions (if I were a Medicaid patient) might lure me to join the program, but I agree with C. Lewis. And Devon makes a great point. What’s the benefit of all of this spending?
The primary problem is that, as Devon points out, the whole wellness meme suffers from massive internal contraditions.
What do we know about wellness? Pretty much what your Mom knew: get important immunizations, don’t inhale or ingest pathogens and other stuff that are bad for you, eat a variety of foods, get enough sleep, take reasonable safety precautions when driving or working with dangerous materials, and stay physically active. We don’t even really know how people quit smoking as most who have quit have done it on their own.
Once a problem develops, wellness is out the window. Then we’re talking about medical care to manage or cure a particular condition.
So programs like this are trying to influence medical care which, as Devon points out, has almost nothing to do with wellness.