Monday, September 24, 2007

Illness vs. Wellness

What is "wellness?"

I could not find a reference to the word "wellness" before 1995. (It is interesting that this correlates to the time when managed care took hold in medicine.) Could this word have been born of pure marketing fluff? It is described as a noun on We used to speak of one's "well-being," or "fitness" maybe, but not "wellness." After all, we don't say "I have wellness," do we?

I hear everyone using this word now, but I'm not sure any of us really knows what it means. Most people tell me it's the opposite of "illness," but is it really? Wikipedia suggests it's "a balance of mind, body and spirit" which implies one can be very ill and still have wellness. Others have noted that it's really a pet food.

If one looks closely at how "wellness" is used by some insurers, we see a very different definition (and I suspect motive) for the word. Could it be that insurers have concocted these programs to save their skins in the eyes of the gullible consumers by providing a "feel good" aire to themselves while reaping ridiculous profits and making our patients pay increasingly more of their own health care costs? After all, insurers should be about insuring illness, not providing healthcare in "wellness" clinics.

Take for instance, the wellness initiatives from UnitedHealth. We find that "wellness" means they want to store your health information online through an online database called a "Personal Health Manager". Any shread of evidence this promotes "wellness (whatever that is)?" Nope. Or how about well "wellness" endeavors of a "Healthy Pregnancy Program." Are insurers making housecalls in these programs? Or just calling the house? Where are their performance measures? I mean, doctors have to supply our performance measures to insurers - why can't we see the effects of the insurers' "wellness" measures? Could it be that "wellness" is intangible (and therefore non-existent)?

Public health initiatives like smoking cessation is also commonly promoted in "wellness" clinics. To be fair, smoking bans appear to have had a huge impact on the health of societies worldwide. But while insurers offer some tips on smoking cessation to many of their members, their efforts fall flat compared to the efforts of grass-roots organizations enacting legislation. And now, nicotine blood levels are being used to discriminate between insurance rates for smokers and non-smokers. Where's the "wellness" love here?

And then comes “health screenings” by "wellness" initiatives. Mammograms. Glucose and cholesterol levels. Colonoscopies. But do these really prevent disease, or provide “early detection” of disease for the insurer? You see, early detection helps insurers know who’s going to be “naughty and nice” regarding costs to their system - it's another way to weed out "high risk" members of your insured population under the guise of "wellness." What happens when insurers find you have coronary disease or hyperlipidemia? Your premiums rise. In the case of mammograms and colonoscopies, early detection with these tests certainly can save lives – but importantly, it does nothing to prevent disease. Many of these maladies are genetically predetermined. The public dissembling by insurers when they encourage people to “live a healthy lifestyle” is ludicrous. People still socialize, people still drink, people still drive, people still age, people are fallible, and yes, despite such smoke-screens, people get sick, and people still need someone to provide insurance when they're ill, not when they have "wellness."

But when studies and procedures are needed for people who are sick, it has almost become the norm for insurers to deny payment to doctors for at least some services required for their management. The sad fact is insurers' denials have become so commonplace, that now a new layer of bureaucracy has come to our collections industry - companies to help doctors collect the claims that are denied by insurers. Making doctors and hospitals jump through administrative hoops has become the de facto standard of care in the healthcare industry today. One only needs to look to the much ballyhooed IPO of AthenaHealth this week – a company who initial stock price shot up 97% on Wall Street on its first day - and a company who develops web-based software to facilitate physician collections. It reminds me of the $435 hammers that the military was purchasing years ago. Too much bureaucracy, too much overhead. Unfortunately, when doctors don't receive payment from insurers, guess who gets billed? The patient.

That really promotes patients' psychological well-being (not "wellness") doesn't it?

I'd suggest from now on, that the noun "Wellness" be left to the dogs.



Richard A Schoor MD FACS said...

Terrific post!
BTW, chiropracters seem to have embraced the whole wellness thing, and my friend Scott, a chiropracter, actually claims that a chiropracter coimned the word and created the concept.
The definition of wellness is simple: it is a percieved sense of being that creates money for someone else.
Good post.

Medical Quack said...

Being I used to be on the programming side of medical records in the early days, spent a lot of time looking at data, integrating billing software, taught me a lot as numbers don't lie, people do to quote a famous professor at NYU.

We are getting away from what we set out to do here and help people get better and a lot of it revolves around the data selling epidemic we have going on. You can't see it on the surface but its there and wellness ends up being a store front for more data or data profile to sell. Not supposed to be that way but we have too many in the US, banks and companies "flipping algorithms" for profit and no regulation.

Dr. Wes made some good points so instead of using segmentation to work on specific groups with problems we are creating more inequality..not supposed to work that way but sadly what the whole system has evolved to and it goes beyond healthcare as well. Who owns most of the wellness companies, insurance companies, the same folks that sell a lot of data and pay claims...

A good question to think about is do these subsidiaries share data, we don't know but there's nothing stopping them is there. If you think insurance is just about claims and policies anymore, think again and look at the SEC listings of their subsidiaries and types of business they are in..breathtaking...and eye opening.