Indeed, we could focus employer efforts and budgets on doing exactly that if vendors and consultants weren’t (very profitably) convincing HR departments to do precisely the opposite: bribe people to complete forms, take unnecessary blood tests, and talk to coaches. If perpetual individual incentives are the price of workplace wellness, then the model is unsustainable.

We have much respect for Ron Goetzel, but the rest of the wellness industry is not Ron Goetzel. It’s people who routinely design studies incorporating three blatant violations of basic study design principles. First, they compare voluntary, motivated, incentivized participants to non-participants to evaluate interventions whose success depends on motivation.

Second, risk factors ebb and flow on their own. The best research shows that fully half of high-risk people will migrate to lower risk categories without an employer-based wellness intervention. Therefore, a cohort of people who start with multiple risk factors will always migrate downward, but the wellness industry assiduously ignores upward migration of people with low or no risk factors, failing to count them as an offset. Preventing this upward migration should be the grail quest for wellness because that is the largest pool of modifiable population attributable risk.

Finally, without having predicted which wellness-sensitive events would decline and then seeing if the savings were in those events, it’s not enough to just say that wellness programs produce savings. This would be like a drug company saying “whatever diseases you had were cured by taking our pills.”