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Is Mercer Cooking Staywell’s Books At British Petroleum?

StaywellMercer

Short Summary of Intervention:

Comprehensive wellness program offered to all American employees of British Petroleum.   Staywell was the vendor. Mercer was hired by British Petroleum to validate the savings claimed by Staywell.

Materials Being Reviewed

Summary of key figures and outcomes:

No visuals were provided. A review of the articles is recommended.

Questions for Staywell and Mercer

You claimed that spending would have increased by 10.5% instead of 7% across the entire company, absent the wellness program. Since only 1139 people reduced their risk factors (not including non-participants and dropouts whose risk factors might have increased), are you saying that by reducing a risk factor, those 1139 people were responsible for the entire difference in trend for the 62,000 employees and dependents versus the original trend you projected?

ANS: Refused to answer

The savings you are claiming works out to about $17,000 for each person whose risk factors declined, almost the equivalent of avoiding one heart attack for each person who reduced a risk factor. Are you suggesting that most of those 1139 would have had heart attacks otherwise, even though fewer than 200 American BP employees had a heart attack the previous year?

Note to Staywell’s and Mercer’s actuaries: if costs decline $17,000 every time someone reduces a risk factor and your spending is about a third of that level, you can wipe out your healthcare bill by getting a third of your employees to reduce a risk factor.

ANS: Refused to answer

How does $17,000 in savings for BP employee reducing a risk factor reconcile with Staywell’s own website claiming only $100 in savings for each person reducing a risk factor in a multi-employer study?

ANS: Refused to answer

How does this unprecedented savings reconcile with the PepsiCo findings, published in a leading journal (Health Affairs) by leading researchers (RAND), that concluded applying approximately the same interventions to PepsiCo’s workforce using the same consulting firm (Mercer) actually lost money?

ANS: Refused to answer

Did Mercer notice the discrepancy between Staywell’s alleged results and PepsiCo’s (and also Staywell’s own website) and inform British Petroleum of it, since Mercer’s job was to validate this program on behalf of British Petroleum and ensure that the savings were accurate?

ANS:  Refused to answer

Since a wellness program can only reduce wellness-sensitive medical events, how come you elected not to disclose the rate of wellness-sensitive medical events across the entire population before and after the program?

ANS:  Refused to answer

Did you inform British Petroleum that there was an article on The Health Care Blog about their program that reached the opposite conclusion you reached?

ANS: Refused to answer

Staywell employees Jessica Grossmeier (who authored the journal article) and Paul Terry (Chief Science Officer) were asked privately and by many of the people who posted comments to rebut The Health Care Blog and declined. Wouldn’t it have been a useful discussion to explain to readers how British Petroleum could have saved more than 100 times what you yourself said was possible?

ANS: Refused to answer

Pharos Innovations Produces Wellness Savings On Day One

Pharos Innovations

Short Summary of Intervention as described by company:

“Today, Health Systems, Physician Groups and Accountable Care Organizations are utilizing Pharos programs to:

  • Reduce health care costs and increase care quality
  • Increase care coordinator case loads and population penetration
  • Increase care plan and treatment compliance and improve clinical outcomes
  • Drive reduced readmissions and increased gain share bonus participation”

Materials Being Reviewed

Evaluation of Tel-Assurance Heart Failure Module

Summary of key figures and outcomes:

Pharos All-cause Inpatient Admission

79% reduction in admissions, and an 85% reduction in total costs ($4458 per patient per month falling almost immediately to $652).

Questions for Pharos Innovations:

Your savings happened immediately after the program began. No other disease management program claims that its savings are immediate and yet many programs have interventions similar to yours. What did you do differently to make you so successful?

ANS: Refused to answer

You write that to be included in the analysis during this 18-month study period, a member need only have participated for 15 days. How were you able to achieve such dramatic results over such a long period with only 15 days’ required participation?

ANS: Refused to answer

The most dramatic decline in admissions – about 90% — happened the first month (February) of the program. Are you saying that you were able to find all these members’ contact information, schedule the phone calls to the members and their caregivers to convince them to join the program, schedule initial followup calls to start trying to manage the members, make the scheduled phone calls, collect the information, get members to visit their doctors, and adjust lifestyles and medications — all by February 1 for a program starting January 1?

ANS: Refused to answer

Your “unchanged” matched cohort seems to have declined by 25% over the course of your intervention. How are you defining “unchanged”?

ANS: Refused to answer

Why did Wellpoint ask you to take their name off this study?

ANS: Refused to answer

Can you get someone at Wellpoint to endorse this program in the space below?

ANS: No one from Wellness endorsed the program in this space

If admissions declined 79% but total costs declined 85%, wouldn’t the use of physicians, labs, drugs, home care and all other services have to decline by much more than 85% in order to have the average decline in costs be 85%?   Very conservatively assuming that admissions account for only half of all costs for CHF patients, wouldn’t all other costs need to decline to about $200/month, which is much lower than a typical commercially insured person spends and far lower than a Medicare member spends?

ANS: Refused to answer

Wouldn’t such a low non-admissions spending figure mean that most patients would no longer be taking most meds or insulin, seeing doctors regularly, getting tested, participating in therapy, etc.?

ANS: Refused to answer

What did the New England Journal of Medicine get wrong when they tested your intervention and found no impact at all, which is much different from an 85% cost savings?

ANS: Refused to answer

Pharos isn’t just validated, but rather it is claimed to be strongly validated. Can you distinguish being “strongly validated” from garden-variety validation?

ANS: Refused to answer

Who did that “strong validation” and can they explain their rationale below?

ANS: Refused to answer

Why, if you can’t answer these questions that have been asked for several years now and Wellpoint has withdrawn its name, is this study still on your website?

ANS: Refused to answer

More Milliman Magic From North Carolina

Milliman, Community Care of North Carolina

Short Summary of Intervention:

Increase payments to providers and add EMRs and add case managers in the hopes of reducing admissions and emergency room expenses

Links to and List of Materials Being Reviewed

millimanmercer001

millimanmercer002

millimanmercer003

Summary of key figures and outcomes:

$177-million savings in 2007 in children’s admissions alone, increasing in the years after that

Increase in costs of program more than offset by admissions reduction

Questions for Community Care of North Carolina:

The CCNC website says CCNC is “saving money” and yet the federal government data above notes that North Carolina Medicaid’s costs are between 24% and 40% higher than the costs in surrounding states. How is this “saving money”?

North Carolina has suffered cost overruns amounting to more than a billion dollars just since CCNC became the provider for almost all non-disabled adults and children in the state. How is that track record consistent with “saving money”?

Why did you hire consultants — and pay them more taxpayer money than any other consultants had ever been paid to do this work — who had never done this type of analysis before and didn’t even realize that the answers were already online?

Questions for Milliman

How is it possible to save at least $177,000,000/year starting in 2007 in children’s admissions when the government’s own data collected expressly for the purpose of studies like these shows you only spent $114,000,000 in 2006?

Your defense has been that 2006 was not the baseline. However, the years prior to 2006 all show spending figures lower than $114,000,000. So which year was the baseline?

You have also said that there is no baseline period. This strikes us as curious but we could be wrong: Can you point us to any other study in any reputable journal which did not have a baseline period?

Why did you suppress all the government data above that completely contradicted your findings, or did you not know the government collected this data both on comparative per capita costs and on admissions by age group and payer?

If you did not know about this online data, shouldn’t you be changing your conclusions and/or returning North Carolina taxpayers their money?

If you suppressed the data because you thought it was irrelevant, wouldn’t it have been more ethical to acknowledge the existence of the authoritative government data, but then describe why the federal government data didn’t apply and let the reader decide whether it was relevant?

Given that Mercer’s previous study for North Carolina was thoroughly discredited for not using that government data and thereby coming up with an impossible answer (the study has quietly been removed from the Community Care of North Carolina website as a result), wouldn’t it have been wise not to make that same mistake again?

If surrounding states have similar Medicaid programs and most North Carolina children were already in CCNC, why not just take advantage of that “natural control” and compare the state as a whole to other states, especially because the federal data mentioned above had already been collected for all those states?

In your Letter to the Editor following publication of the above article questioning your savings, which consisted of four questions about the savings calculation, why you didn’t answer any of the four questions the article asked?

The very first page of your report says the decline in admissions more than offset the increases in other categories, thus netting out to the massive savings you calculated. Yet after it was shown that admissions did not decline at all, you said in your Letter to the Editor that the decline came from “categories other than admissions.”   Which is it – admissions accounted for more than 100% of the net savings, offset by other categories, or other categories accounted for all the savings?

Page 19 of your report says “other Milliman consultants may hold different views.” If members of your own organization wouldn’t agree with you, why should others agree with you when you suppressed data, contradicted yourself, and found mathematically impossible savings?

Admission rates in the specific disease categories CCNC was focused on — asthma and diabetes — underperformed surrounding states. In diabetes admissions actually increasing on an absolute basis. Didn’t you feel this might be a red flag to suggest that the huge savings your model was showing you might not be valid?

Mercer Says “Choice of Trend” Drives Savings Estimates

Mercer

Short Summary of Intervention as described by company:

Mercer Health AdvantageSM – Mercer Health Advantage (MHA) allows self-funded employers to enroll their employees in new medical plans starting January 1, 2013. These programs are designed to save employers 5% or more of medical plan cost with the same plan design they have in place today. The savings come from select networks with providers chosen for their quality and cost effectiveness. Employers also gain access to dedicated MHA clinical care management with ongoing oversight and audit by a team of Mercer clinicians. Mercer plans to offer MHA to smaller self-funded employers in 2014.   Self-insured clients with Aetna need 1,000 employees, Anthem-1,500 employees or greater on WGS or NASCO claims platform and UHC must have 3,000 employees in the National Accounts segment.

Materials Being Reviewed

All publicly available Mercer outcomes reports and related materials, plus Mercer Health Advantage

Related materials:

  1. Georgia Medicaid
  2. North Carolina Outcomes Excerpts below
  3. Staywell and British Petroleum

Summary of key figures and outcomes:

Comparison of actual vs. predicted spending per North Carolina Medicaid member per month in medical home, by category of service

Predicted vs. actual by age grouping for North Carolina Medicaid enrollees in medical home

predicted versus actual by age for NCpredicted versus actual by age for NC Questions for Mercer

I: Mercer Health Advantage

Since most employers spend less than 5% of their total budget on disease management-sensitive events, how is it possible to save 5% through a disease management program even by eliminating every event with no increase in preventive expenses?

ANS: Refused to answer

If the state of Georgia were able to save 19% through APS disease management, which according to your own reconciliation APS is able to do, shouldn’t you be advising clients to use APS or another vendor instead of yourselves?

ANS: Refused to answer

If you are being retained to help a client find the best disease management solution, wouldn’t offering your own such solution create a conflict of interest?

ANS: Refused to answer

How have you determined the quality and cost-effectiveness of physicians that you “choose” for this network?

ANS: Refused to answer

II: Mercer North Carolina Patient-Centered Medical Home Analysis

The first North Carolina chart shows savings in every category. How is it possible to save money in all categories? Doesn’t some component of spending have to go up to make everything else come down? Or, as the outcomes measurement textbook says: “If you insulate your house, you’ll save money on heat, but not on insulation.”

ANS: Refused to answer

Is it possible that the reason savings appeared in all categories is that you simply chose to project a high trend, so that you could show more savings against that trend, or as you’ve said in the past: ““We can conclude…that the choice of trend has a large impact on estimates of financial savings”?

ANS: Refused to answer

If medical homes save money through more primary care reducing the need for specialist visits, why combine both categories when reporting savings?

ANS: Refused to answer

Inpatient spending fell by more than 50%, which implies that non-birth-event admissions would have fallen by more than 70%. How does this reconcile with the official government admissions data, which shows no change in admissions?

ANS: Refused to answer

There was no noticeable decline in North Carolina in the official government list of primary care-sensitive admissions during the period you analyzed. How do you reconcile that data with your own data showing massive admissions reduction?

ANS: Refused to answer

The second North Carolina chart shows that per-member per-month expenses in children under 1 year of age declined more than 50%. Since there is essentially no common chronic disease in this age group, where did the savings come from?

ANS: Refused to answer

The largest expenditure in this age group is in neonates. How does your data reconcile with the government data showing no change in neonatal admissions?

ANS: Refused to answer

How were you able to show such massive savings for this age group in your medical home analysis when this age group wasn’t eligible for the medical home?

ANS: Refused to answer

III: Mercer Georgia Analysis

Assuming that disease management-sensitive medical events account for roughly 8% of spending in a Medicaid population, how is it possible to save 19% through a disease management program?

ANS: Refused to answer

How do you reconcile your conclusion that the APS disease management program saved 19%, when an FBI investigation found that APS had largely failed to perform its disease management services?

ANS: Refused to answer

IV: Staywell and British Petroleum

Did you caution British Petroleum that the savings you validated for them was at least 100 times the savings that Staywell itself claims is possible?

ANS: Refused to answer

Did you question Staywell about how they were able to outperform their benchmark by 100-fold?

ANS: Refused to answer

Why didn’t you or Staywell provide your viewpoint when requested to, following the observations on The Health Care Blog that these savings were mathematically impossible?

ANS: Refused to answer

V: Mercer Qualifications to Do Outcomes Analysis

It appears that no one at Mercer has ever achieved Advanced or even Standard Certification in Critical Outcomes Report Analysis, either through DMPC or one for the Validation Institute that is specifically geared to benefits consultants.   Has any Mercer consultant taken either course and failed, or has no one at Mercer ever taken either course?

ANS: Refused to answer

Assuming the mistakes highlighted above are innocent miscalculations and not purposeful deceptions – and with senior consultant hourly billing rates well in excess of $500/hour – don’t you think it would be a good idea to become qualified in analyzing outcomes reports and reconciliation methodologies that you are being paid to analyze?

ANS: Refused to answer

Is there another course in outcomes analysis that we are unaware of that your consultants have taken, and if so, how did they still make all the mistakes above?

ANS: Refused to answer

American Heart Association promotes StayWell while violating its conflict of interest policy

American Heart AssociationStayWell


Short Summary of Company:

AHA wellness: “The American Heart Association’s Worksite Wellness Kit encourages companies to give employees an excuse to get away from their desks.”

Staywell: “StayWell helps clients across the health care spectrum address the changing landscape like no other company. We leverage the latest technology, enhanced analytics, and deep consumer insights in an integrated portfolio of best-in-class client solutions.”

Materials Being Reviewed

Questions for AHA

Your conflict-of-interest statement says you “make every effort to avoid actual or potential conflicts of interest that may arise as a result of an outside relationship.” Why doesn’t letting the Chief Science Officer of a wellness company write your wellness policy citing his own articles in support of wellness violate that policy?

ANS: Refused to answer

Were you aware that Staywell perpetrated a scheme in which they worked with Mercer to convince British Petroleum that their outcomes were 100 times better than what Staywell itself said was possible?

ANS: Refused to answer

Why did you allow a writer to source his own articles, thus creating an AHA policy stand that is clearly in his own financial interest?

ANS: Refused to answer

Is it representative of your peer review policy not to “vet” your peer reviewers to see if they themselves were involved in scandals that are very relevant to the article they are reviewing?

ANS: Refused to answer

Why did you as an organization and the writers of that policy decline The Health Care Blog’s invitation to defend your article against observations that it was totally conflicted and based on data known to be invalid?

ANS: Refused to answer

Why did you allow the writers to cherry-pick the available literature, ignoring the overwhelming evidence against your policy and instead continue to cite the old “Harvard study” whose lead author has now walked it back three times?

ANS: Refused to answer

Why did your editors allow the writers to call this (disavowed) Harvard study “recent” even though it was written in 2009 using data with an average date of 2004?

ANS: Refused to answer

Why did your writers knowingly cite studies that no legitimate health services researcher would find acceptable due to obvious study design flaws, like comparing active motivated participants to non-motivated non-participants, claiming that an outcome on volunteers who persisted in the program for three years is representative of the population as a whole, and taking credit for risk reductions in previously high-risk people that would have happened anyway?

ANS: Refused to answer

Why didn’t you mention that the screening frequencies you are endorsing are far in excess of guidelines set by the United States Preventive Services Task Force?

ANS: Refused to answer

As an association named for the human heart, how come you didn’t publish cautions that the screening frequencies you’re recommending can lead to overdiagnosis, overtreatment and other cardiometabolic harms?

ANS: Refused to answer

Postscript:  Any apologies, retractions, explanations etc. other than answering the questions

A July 17 email from co-author Ross Arena: “I am troubled by these accusations, as is AHA.  I have included an AHA representative who will address this.”  [No AHA response followed.]

A July 17 response from us noted that technically these are observations, not accusations.  We “observed” that their screening policy was co-authored by the CEO of  a screening company.  (We offered to link them to dictionary.com to see the difference between the two words, but they declined.)

Keas Meets Lake Wobegon: Everyone Is Above Average (in Stress)

Today we reprise the Keas Stress Survey.  If laughter is the best medicine, an excellent way to reduce stress is to read this survey, using our handy guide below.  Funnier still, we asked Keas all these questions below many months ago, and not only did they not answer them for us, but they didn’t even bother to correct these mistakes on their own website despite all the violations of rules of simple arithmetic. And as we have pointed out on many occasions, rules of arithmetic are strictly enforced.


keas 41 percent

You write that 41% of employees are reporting above-average stress. Shouldn’t that mean another 41% are also below average in stress? We can’t seem to find any mention of even a single employee being below average in your survey.

ANS: Refused to answer

Of those 41% reporting above average stress, you say:

keas sleep

So 24% of 40% of 41% are losing sleep due to work?  Isn’t that 4%?  So 96% of employees are not losing sleep due to work.  Isn’t this a good thing?

ANS:  We didn’t even bother to ask


keas key figures

You say 72% of women experience above-average levels of stress while only 28% of men do. Since women comprise nearly half the workforce, shouldn’t those two figures weight-average out to nearly 50% rather than 41%, assuming you sampled correctly?

ANS: Refused to answer

If indeed only 28% of men report above average levels of stress, doesn’t that imply that 72% of men aren’t unduly stressed and therefore stress reduction for men need not be a corporate priority?

ANS: Refused to answer

You say high stress “causes” many diseases, but every disease you list except depression affects more men than women. Doesn’t this claim that stress causes these diseases contradict your finding that women are three times as stressed as men?

High stress

ANS: Refused to answer

You also claim that high stress levels can also “worsen” a “myriad” of conditions? If that were indeed the case and women have three times the stress of men, how is it that women live five years longer than men?

ANS: Refused to answer


keas average normal

You use the words “average” and “normal” with regard to stress as synonyms, but aren’t they often antonyms? While all of us want our kids to be normal, are you aware of anyone who wants their kids to be average?

ANS: Refused to answer

Just like in Garrison Keillor’s Lake Wobegone, where all the children are above average, is the goal of your anti-stress recommendations to reach a point where everyone’s stress is below average?

ANS: Refused to answer


keas vitamin c

Should you be advising people to take Vitamin C pills when the Mayo Clinic is advising not taking them? Where is the peer-reviewed major journal evidence that Vitamin C pills reduce stress for people who, like most employed Americans, already get adequate Vitamin C?


keas a good chance of unhealthy

ANS: Refused to answer

Can you point us to the objective evidence that says that unhealthy employees can be “fixed,” especially using a stress-reduction program?

ANS: Refused to answer

How much of the additional 36% that “employers at large companies” are paying for healthcare now (vs. five years ago) is due to an increase in medical events in the disease categories that you say are caused by stress? How do you reconcile that statistic with the Agency for Healthcare Research and Quality’s (AHRQ) database indicating that inpatient medical event rates in the disease categories you listed have declined over this five-year period?

ANS: Refused to answer

Likewise, how do you reconcile that 36% increase statistic with the AHRQ’s database finding only about 7% of medical spending is due to inpatient events in those categories you say are caused by stress?

ANS: Refused to answer


Three times the productivity

If companies “where health is actively promoted are three times more productive,” does that mean that a wellness program would allow pilots to fly three times faster? Could class sizes be increased from 20 to 60? Could doctors cure three times as many patients? Could police arrest three times as many criminals? Could customer service recordings could tell us our calls were three times more important to them?

Could Walmart could run its stores with a third as many employees if they were actively told to get into better shape?

ANS: Refused to answer

More importantly, wouldn’t a two-thirds reduction in staff increase stress on the remaining employees, which is exactly what you are trying to avoid?

ANS: Refused to answer

Healthstat Wipes Out Disease

Healthstat

Short Summary of Company:

“The men and women directly involved with improving employee health are at the heart of Healthstat’s singular commitment to wellness. Healthstat’s wellness-minded practitioners establish a more personal relationship with employees, while bringing a combination of compassion and expertise to employers’ existing healthcare programs.”

 

Materials Being Reviewed

Case study of Mt. Vernon Mills, in which Healthstat reports more than $2000/person/year in savings through risk reduction and mitigation.

 Summary of key figures and outcomes:

Summary of key figures chartSummary of key figures chartQuestions for Healthstat:

You are claiming savings well in excess of $2000/person by Year 5, including fees. Since the average person only spends about $2000 on total hospitalizations (excluding birth events), wouldn’t this mean that you wiped out hospitalizations?

ANS: Refused to answer

The average person in an older workforce only spends about $200/year on wellness-sensitive medical events, offset by program fees and preventive expenses. How are you able to save $2000/year when there is only $200/year available to be saved from totally eliminating these events?

ANS: Refused to answer

What is your wellness-sensitive medical event rate for this population? If you don’t track it, why don’t you track it?

ANS: Refused to answer

Is it possible that since instead of comparing rates of wellness-sensitive medical events that you compared forecasted costs to actual costs, that mis-forecasting the costs is responsible for most of the improvement?

ANS: Refused to answer

You displayed the “top 20%” and “top 50%” to show their improvements. Would it be the case that had you displayed the bottom 20% and bottom 50%, their readings would have deteriorated over the period?

ANS: Refused to answer

How did you account for dropouts and non-participants, who presumably would not have shown good results and whose wellness-sensitive medical events might have increased?

ANS: Refused to answer

How can you reduce costs through wellness programs by $2000/year if cholesterol and blood pressure barely improved, even without offsetting those improvements with dropouts and non-participants?

ANS: Refused to answer

Date: June 16-21, 2014

Addendum: Email exchange

Healthstat:

Your questions do talk about wellness and savings, but do not necessarily focus on how our business model works. Therefore, they don’t make sense for us to answer them in the way they are presently written. We work with an insurance free onsite employee wellness center model that is HRA  and preventative wellness driven. Our cost savings are calculated from an insurance premium cost estimate for self-insured companies, as well as preventative treatments for those potentially at risk for more costly services.

They Said What? response:

 Based on your website, and also your email, you say you have a model that is “an employee wellness center” that is “preventative wellness driven” and you provide “preventative treatments for those potentially at risk.”  The questions are therefore quite pertinent in regard to your business model and boil down to one:  How does your “preventative wellness model” reduce wellness-sensitive/risk-sensitive medical events by $2000/person/year, when most companies only spend $200/person/year on wellness-sensitive medical events in the first place?

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