You rarely see the words “healthcare” and “joke” together — except of course figuratively, when we’re talking about certain wellness vendors. And we have never put an actual joke on this blog. However, this one is too good to pass up — and is also exactly what’s wrong with our healthcare system, that Quizzify addresses. [SPOILER ALERT: It’s also a “soft” PG, in case anyone might be offended. To put this in perspective, these wellness vendors are much more offensive…and yet they’re rated G.]
A guy has had these splitting headaches for years. Tried everything but they won’t go away, so he goes to the doctor for a battery of tests. He happily signs up for all of them, because he is fully covered — and he really, really, wants to get rid of these splitting headaches.
The results come back. The doctor says: “According to our tests, there is nothing we can do for you except to remove your testicles. So think it over.”
The guy thinks it over for a few days — two really bad options, but finally decides that getting rid of the headaches is more important. Gets the operation and lo and behold, the pain is gone immediately.
On the way home, he is so happy with his new, pain-free life, that, passing a tailor along the way, he decides to treat himself to a new suit. He goes in, tells the tailor he wants a new suit. The tailor, who’s about 75 years old, looks the guy up and down and says: “42 Long.”
The guy says: “Yes, how’d you know?”
The tailor replies: “I’ve been in this business 55 years. I know all this stuff.”
The guy says: “While I’m at it, I guess I should get a new shirt to go with the suit.”
The tailor looks at him again and says: “Sure. 16 1/2 -34?”
The guy says: “Right again. How’d you know?”
The tailor says: “I’ve been in this business 55 years. I know everything there is to know about fitting men’s clothes.”
The guy gets the suit and the shirt, and then, as he is about to leave, says: “You know, while I’m here, I might as well get some new underwear.”
The tailor looks at him and says: “Sure. 38, right?”
The guy says: “You’re wrong this time. 36.”
The tailor says: “No, you’re definitely a 38.”
The guy says: “Nope. I wear 36.”
The tailor says: “Trust me. You’re a 38. Underwear that’s too tight will squeeze your balls together. You’ll get these splitting headaches.”
The Yale wellness program (the one being sued) is exemplary in its adherence to guidelines. Were this program offered with a $100 incentive instead of a $1300 fine, and/or were Quizzify offered as an alternative to the screening/coaching requirement, I would nominate it for a Health Value Award.
Their Achilles heel is using Healthmine as their wellness vendor, no doubt because Healthmine apparently failed to disclose to Yale that they don’t know anything about wellness. Consequently the following happened on their watch, as described in the Complaint, which I can send you on request. (I don’t think it’s online.)
Christine [Name withheld, but in Complaint], a 57-year-old first cook and a member of Local 35, explained that she is participating in the HEP because she is a single mother who is paying for her child’s college and the $25 per week fine is “the cost of my kid’s books for an entire semester.” To her, paying the $25 per week fine would be a “needless expense,” particularly when she has other pressures such as saving for retirement. Christine said she feels “forced” to participate
in the HEP.
Christine’s experience with the Program has been burdensome and emotionally fraught. The HEP requires female participants over age 50 to undergo a mammogram. Christine previously underwent a double mastectomy when battling cancer and therefore could not comply with the HEP requirement to have a mammogram. As a result, an HEP representative contacted her “several times,” asked about her mammogram results, and told her she would be held in non-compliance and charged the $25 per week fine if she did not get one.
TheySaidWhat presents actual breaking news…
The AARP Foundation has just filed a lawsuit on behalf of unionized employees against Yale University, over a wellness program that puts $1300/year at stake for non-compliance. There is no link yet because this just happened this afternoon.
Here are three of the four things you should know about this:
- Yale’s is not technically an outcomes-based program. Many people had assumed that outcomes-based (“contingent”) programs put employers at much greater legal exposure than participation-based program. That is not the case here. It is more about heavy penalties for non-participation. (Heavy incentives for participation in a high-deductible plan could be viewed in the same light, according to the original judicial decree.)
- Aside from using one vendor with a rather sketchy history, Yale’s is one of the best conventional programs I’ve ever seen. It is one of the few programs in the country actually compliant with the US Preventive Services Task Force recommendations. Their coaching company, Trestle Tree, is a good vendor. In other words, running a good program does not inoculate you against these lawsuits.
- The major risk to you from these lawsuits is not that your own employees will sue you, but rather that a precedent will be established that will cause you to have to reconfigure your own program in order to make it compliant, at least until new EEOC safe harbor rules are published. This will require possibly substantial changes to any penalties or employee ability to access your best healthcare offering. Changes could even be retrospective to the beginning of 2019, at considerable expense.
The fourth thing you should know: Yale’s was totally a self-inflicted wound. Simply offering Quizzify as an alternative to screening and coaching would have inoculated Yale’s entire wellness program against exactly this lawsuit. Don’t take our word for it. Here is our indemnification language:
All Yale would have had to do – all you need to do now to avoid the risk of a lawsuit – is give employees a choice of screening/HRAs or Quizzify. This one poster –one simple poster–would have done the trick.
The Quizzify EEOC indemnification program flyer is right here.
For more information, see:
The following is my foreword to Nurses Take Back Health Care One Employer at a Time, written by our colleague Jeanne Moore. I recommend it to everyone with an interest in “pry, poke and prod” workplace wellness and why it has fizzled.
As the Quizmeister-in-Chief of Quizzify, I write healthcare trivia questions for a living, so it seems appropriate to start this foreword with one: What is the country’s most trusted profession?
I’ll give you a hint: it’s not “workplace wellness vendor.” (In case anyone is keeping score at home, “workplace wellness” actually has the lowest Net Promoter Score ever recorded for an industry, according to WillisTowersWatson.)
The answer? Nursing. When was the last time you saw a nurse involved in a financial scandal? When was the last time a nurse jacked up his or her prices by 1000%? Do contracts for nurses include opaque rebates and volume incentives? Of course not.
And yet until now, no one has ever asked the question: “What do nurses think of the healthcare system?”
Not much, as it turns out. Over time, nurse/patient ratios have dramatically increased, while the number of hospital administrators, insurance executives, middlemen, healthcare trivia quiz writers, and, yes, wellness vendors, has skyrocketed. Ms. Moore describes what nursing care used to be like…and what it’s like today. Essentially everybody who has ever had any experience (their own or family members) with overnight hospital stays has a story…and many of those stories involve either the harms caused by inadequate staffing, or the heroics performed by a Florence Nightingale who turned around a situation that would have led to a bad outcome. Many such stories populate this book.
Yet despite the lack of nurses in many hospital settings, there is no shortage of white-coated healthcare techs waiting to descend upon healthy populations of employees to “pry, poke and prod” them because a wellness vendor snookered an employer into thinking this nonsense saves money. The idea that pry, poke and prod programs save money is so far from the truth that I myself offer a $3 million reward to anyone who can show that it breaks even.
And yet these programs are still popular. Ah, well, as Mark Twain said: “It is easier to fool people than to convince them they’ve been fooled.”
In this book, Jeanne recounts many examples of how we have all been fooled by suppliers who are supposed to be containing our costs and providing better care. In particular, she points out how the insurance companies have been feeding at the ACA trough for 9 years now, taking full advantage of its well-intentioned provision limiting profit margins to 15% or 20% of costs. Which of course means that the only way to increase profit is to increase costs.
I’d be lying, though, if I didn’t admit that my second-favorite part of the book is her smackdown of the wellness industry. Starting with the fraud that was Safeway (whose CEO eventually tired of wellness and moved on to his next bright shiny object, Theranos), which is credited with launching the ACA’s wellness provision despite not having a wellness program, she moves point by point through the fallacies, harms, cluelessness and lies which formulate the industry’s business model. (She is careful to exempt companies, like US Preventive Medicine and It Starts with Me, which have been validated by the Validation Institute.)
And, as one would expect after reading the other insights and stories in this book, Jeanne passes the ultimate IQ test: she recognized upon her first exposure to him that the leader of the wellness industry, Ron Goetzel, can’t produce even an iota of data to contradict my own exposés of the frauds and harms perpetrated by him and his cronies by screening the stuffing out of employees with callous disregard for established clinical guidelines.*
Further, despite the admitted trivial impact of their programs (Mr. Goetzel says it takes fully 2 to 3 years to reduce risk by a mere 1 to 2%), these vendors nonetheless create massive “savings” out of whole cloth. How? They have many ways to lie, but the most common way to “show savings” is to compare active motivated participants to inactive, unmotivated non-participants – even though it’s been proven repeatedly that no matter what you do (including doing nothing at all, including telling diabetics to eat more carbohydrates), participants will dramatically outperform non-participants simply due to being motivated to begin with.
So when Jeanne talks about nurses taking back healthcare, these are the perps she wants to take it back from – the immensely profitable insurance companies and wellness vendors who are sucking resources out of the healthcare system while actual health outcomes continue to stagnate or deteriorate in the US, even as lifespans in other countries continue to lengthen.
Join the movement. Get nurses back into healthcare. Employee experience and outcomes should improve because, let’s face it, they can’t get any worse.
*Mr. Goetzel, these are my own words, not Jeanne’s and not the publisher’s. So, as I’ve been urging you to do for years, sue me, not them. Please don’t make me beg.
In addition to killing millions of defenseless electrons writing about all the things that wellness vendors get wrong — it turns out, for example, that the “risk factors” they obsess with may be the wrong ones — we here at They Said What headquarters also cover employee hazards that wellness vendors don’t cover at all.
The distinguishing feature about risks/hazards we cover here at TSW is they are so easily preventable. To avoid them, you don’t have to lose weight or even eat broccoli.
And, yet, with the exception of Quizzify, vendors seem to have no interest in actually preventing risks that are easily preventable.
Recently, we’ve covered the risks of regular use of over-the-counter “PM”-type sleep aids (bad idea) and heartburn pills (worse idea). But in keeping with the season, it’s time to talk ticks. Summer 2019 could easily see the most cases of tick-borne illness ever.
There are a whole bunch of things employees don’t know about ticks. The reasons I know this are:
- I am writing this from the tick capital of the universe, Martha’s Vineyard (in your face, Nantucket!); and
- My “day job” is writing health education content, so I am supposed to know everything about risk avoidance. (For instance, how many people know that showering daily is unhealthier than showering 2-4 times a week?)
And yet despite plenty of up-close-and-personal encounters with ticks plus an equal amount of research, I myself didn’t know three things about ticks:
- Light-colored clothing attracts more ticks than dark clothing.
- You can now buy entire outfits that are infused with tick repellent that might actually work.
- The EPA rates insect repellents for tick effectiveness.
There is some good news: ticks can’t jump. Nor do they lie-in-wait on tall trees ready to swoop down on unsuspecting pedestrians. If you avoid contact with tall or tall-ish grass or brush, you hugely reduce your risk of ticks.
There is plenty more you can tell your employees about ticks. You can request Quizzify’s tick quiz if you are a customer. Otherwise, just forward this link to them.
Facts are the wellness industry’s kryptonite.
How do we know this?
Last month you may have seen ads from the Health Enhancement Research Organization for something called The JAMA Wellness Study: A Balanced Discussion.
Unfortunately for anyone who for whatever reason dialed into this session, that’s an hour you’ll never get back. Balancing fact and fiction in a webinar leads to curious results. For instance, here’s what would you’d learn by attending a “balanced” webinar on astronomy:
- Ptolemy: The sun revolves around the earth.
- Copernicus: The earth revolves around the sun.
- Balance: The earth revolves halfway around the sun and the sun revolves halfway around the earth.
And that’s exactly what happened here. Instead of actually presenting factual information, as in their very own candid albeit subsequently retracted foray into integrity, HERO wrote:
Hundreds of research studies published in scientific journals conclude that well designed, evidence based, comprehensive health and well-being initiatives work. We know this, yet occasionally, a new study is published that is inconsistent with the overall body of research.
The only thing more tortured than the grammar of that passage are the logic and the facts. Logically, math and science are not popularity contests. It wouldn’t matter if “hundreds of research studies” say the opposite, if indeed the opposite is wrong as a matter of arithmetic proof.
In any event, there are not “hundreds of research studies” showing “evidence-based” wellness programs work, for the simple reason that (along with the math) the “evidence basis” goes exactly the other way.
- The US Preventive Services Task Force and Choosing Wisely recommend against screening the stuffing out of employees, based on the evidence (“tests and screenings can cause problems”);
- You can’t pay people to lose weight any more than you can pay people to cure disease. Obviously if financial incentives were all it took to lose weight, Oprah Winfrey would be Size 2 by now. Quite the contrary, outcomes-based wellness that by definition requires paying people to lose weight, or fining them if they don’t, causes binge-eating and crash-dieting…and has seriously harmed employees with eating disorders;
- The last 5 winners of the wellness industry’s C. Everett Koop Award lost money–and in the most recent case of Wellsteps, harmed employees;
- The last 12 studies published have shown huge losses.
Having seen this webinar promoted, I thought it would be a good idea to enlist some card-carrying grownups to do a fact-based webinar as a counterpoint to a webinar balancing fact and fiction.
One of the original entries in my Rolodex (and that’s how far back we go) for card-carrying grownups would be the Pittsburgh Business Group on Health. PBGH is hosting a webinar on this very topic (meaning wellness) on July 9th. It will present actual facts about wellness outcomes. In that sense it will be the first webinar of its kind following the release of the JAMA study. Entitled Wellness: Is It Time for a Reboot, the registration link is here.
One fact all parties can agree on, unfortunately, is that this webinar will set you back $25. (There are a few friend-of-Al promo codes available.)
“And so, Little Miss Minnow, the wolf ate the big bad outcomes-based wellness vendor, and all the employees lived happily ever after.”
In 2014, the Validation Institute, then a joint property of Intel and GE, tasked me, based on Why Nobody Believes the Numbers, to develop the most sophisticated outcomes measurement course ever devised. That was not a heavy lift, because at the time no other such course existed. They named it Advanced Critical Outcomes Report Analysis, or “Advanced CORA” for short.
Five years later, the course, now called CORA Pro, remains the Gold Standard in outcomes measurement expertise. CORA Pros — and there are only 8 of us — have developed a talent not just for sniffing out questionable claims (anyone can “challenge the data”), but more importantly for identifying contradictory, implausible and even impossible claims that somehow hadn’t been noticed before. Even a simple press release can become a case study in impossibility.
CORA certification itself is very useful, and takes you halfway there. But there’s something special about CORA Pro. Once you are certified in CORA Pro, you never look at a vendor outcomes report the same way again. For instance, consider Livongo’s recent glowing press release about its outcomes. Non-CORA Pros, like whoever these people are, basically just parrot a vendor’s results uncritically with a glowing headline. They sound like Flounder.
By contrast, a CORA Pro would review Livongo’s claims thoughtfully, and ask probing questions, first about the outcomes:
- If your goal is to reduce admissions for diabetes and reduce insulin usage across the population, why didn’t you measure admissions for diabetes, or insulin usage?
- Why does this report show the opposite of your report from 2018? This report showed huge reductions in outpatient and no significant change in inpatient, whereas the 2018 report showed huge reductions in inpatient with no significant change in outpatient?
Then a CORA Pro would ask whether Livongo may be harming employees:
- Why is your goal Hb A1c of 6.5% in conflict with the American College of Physicians and other expert bodies not funded by the diabetes industry, which advocate 7.0% to 8.0%? Perhaps they mean reaching 6.5% with diet-and-exercise, but if insulin use is going up, which is likely because they didn’t claim it was declining, clearly some employees aren’t getting the subtle nuance that they shouldn’t aim for 6.5% with medication.
- Why is Choosing Wisely advocating fewer glucose checks if the right answer is to check multiple times a day?
Just askin’… Because that’s what CORA Pros do.