If, indeed, wellness reduces hospital admissions, Healthcare Cost and Utilization Project (HCUP) data over a sufficiently long period should reveal gradually increasing separation-mirroring the dramatically increasing spending on wellness over that period-between the rate of WSMAs in the exposed population versus the nonexposed population of similar age, which was not insured privately. This plethora of “micro” case evidence, combined with the unpopularity, intrusiveness, equity concerns, and (in some cases) documented harms of workplace wellness, calls for a “macro” review to determine whether wellness has indeed saved money for the United States through reducing hospital admissions attributable to events such as heart attacks, diabetes, stroke, and hypertensive events-wellness-sensitive medical admissions, or WSMAs, that the industry claims to address-that should theoretically be avoidable through these programs. Subsequent to ACA enactment, small-scale findings by researchers and practitioners outside the industry have universally found financial benefits or health improvements to be trivial at best. The second was a meta-analysis showing that programs at large companies had averaged more than $3 in savings for every $1 invested, a finding later invalidated by one of the principal investigator’s own subordinates. The first was Safeway’s claim that wellness reduced its health spending 40%, a claim that garnered so much publicity that the wellness provision of ACA became known as the “ Safeway Amendment.” It was later revealed that Safeway didn’t have a wellness program during the period in which the savings from it were claimed. This consensus assumption was based on 2 pieces of evidence. It was “ the one part of ACA that everyone agreed on”, as Senator Lamar Alexander, R-Tennessee, quite accurately stated.
Prior to 2010, it had been widely assumed that the health and financial benefits of workplace wellness (risk assessments, biometric screening, and coaching) were so substantial that the Affordable Care Act (ACA) provision allowing employers to tie large proportions of insurance coverage to wellness program participation, or to measured improvements in health outcomes, was not even debated before being passed into law.
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