Insurance Thought Leadership (ITL) has now picked up the thread. This will likely reach a lot more brokers and consultants.
As usual, I would like to caution that I am not a “workplace wellness skeptic.” There are some programs that have value — typically they are the ones validated by the Validation Institute. We also support “wellness done for employees rather than wellness done to employees.”
Nor are we anti-screening. We are only against inappropriate screening, which is bread-and-butter for many vendors. We are also against stupidity, dishonesty, abuse of employees. and force-feeding of broccoli. All of this puts us at odds with the Interactive Healths, Wellsteps, Goetzels and other actors in this field.
This interview has been insanely popular. I suspect it’s because I finally “let loose,” as the ITL headline says. Taking appellations and kicking posteriors.
So if you haven’t already read it, now is your chance…
Dear TheySaidWhat Nation,
Occasionally we like to provide actual useful information on what to do, as opposed to what not to do. If it seems like there is vastly more of the latter than the former, that’s because there is.
However, one dramatic gap in the useful information category is how to avoid surprise bills. We’ve written on this topic before, and even offered the free download into the Apple Wallet, as well as cards to be placed strategically where emergencies are most likely. Bikes and motorcycles come to mind. Parachutes as well but if you skydive, you probably have already negotiated a volume discount with your local ER..
This podcast covers some essential elements of our surprise billing solution. Examples:
- Why only emergencies?
- Why does this solution not work in some free-standing ERs…but works in others?
- Why do we set the consent at 2x Medicare instead of 1x or 3x?
PS As long as you are going to be downloading useful tools into your Apple Wallet, might as well add these 5 Questions to Ask a Doctor before any test or procedure.
To fire up the base, I’m upping the ante in this HISTalk. Judging from the number of click-throughs to TSW, a lot of people read this blog. (Frankly, way more than read this one.)
If you read through it, you’ll see there are actual people and companies called out. I don’t know what more I can do to get them to sue me. Most have enough sense not to take the bait, but Bruce Sherman stepped up when I observed that he thinks healthcare spending correlates with industrial waste, and that health status correlates with healthcare spending and that wellness programs can improve health status and — connecting the dots — wellness programs can reduce industrial waste. Here are his exact words:
Similar cross-sectional data linking workforce health with work quality have been reported in a manufacturing firm, where average employee healthcare costs (as a proxy for health status) correlated directly with waste production as a percentage of final stock value across 5 locations,22 …. At a location-specific level, using annual revenue per employee estimates, differences in healthcare costs of $1000 per employee were correlated with higher quality sufficient to increase stock value production (and therefore, revenue) by $2000 per employee.
I can’t quite figure out what this means. Read verbatim, it seems like higher healthcare costs are associated with more revenue, but I think he means lower healthcare costs, and just accidentally said the reverse of what he intended to say. He said “employee healthcare costs correlated directly” when he meant to say “correlated inversely.” An honest mistake. Could happen to anyone (in the wellness industry, that is).
The two may or may not correlate positively or negatively, but that’s like saying growth in the population is correlated with my age. The two move in tandem, of course, but have nothing to do with each other. Healthcare spending is driven by many things, of which health status, which itself is driven largely by social determinants, is only one. Local pricing/contracting, outlier events, surprise bills, aggressive providers and overdiagnosis/overtreatment, composition of the workforce…all those drive healthcare spending much more.
But now let’s take the next step and connect all the dots to say that a “pry, poke and prod” program will somehow reduce industrial waste. This is a key part of the argument. Otherwise, it’s just academic.
If anything, one might argue the conventional “pry, poke and prod” wellness bag of tricks increases industrial waste. Cajoling employees to reduce their blood sugar will make them more sluggish, urging them stop smoking will annoy them, and trying to make them lose weight encourages cheating. (By far the most popular TSW post is How to cheat in a corporate weight loss contest. ) Hard to see how sluggishness, nicotine withdrawal and dishonesty — not to mention all the time being screened, and following up on false positives with doctor appointments — reduce industrial waste, but maybe I’m missing something.
I did in fact say that Dr. Sherman believes that prying, poking and prodding reduces industrial waste. And in an offline conversation, where he asked for a retraction, I offered that retraction — provided he publicy admits that there is no way prying, poking and prodding employees can reduce industrial waste. Or even that conventional wellness could never reduce industrial waste but that creating a better workforce culture might do that. That way I’ll know I misunderstood him…and would be happy to apologize.
If you haven’t already done so, by all means read the interview. You’ll want to pop some popcorn and settle into your Barcalounger, because interviews don’t get more entertaining than this one.
Here it is. Get ready:
Eat more broccoli.
The real idea is that we’ve (“we” in this case is Quizzify, though normally this blog represents only my own views) taken the 5 classic questions to ask your doctor before a test or treatment…and made them downloadable into an Apple Wallet. Just scroll about 2/3 of the way down the Quizzify landing page using your iPhone and you’ll see this. Click “Add to Apple Wallet.”
And since some people (including myself) are reluctant to question those authority figures wearing white, we anticipate that with the last line of the version in the Wallet: “If you’re reluctant to ask these questions, blame us!”
This will work best in conjunction with Quizzify. We have a lot of quiz material on questions you might ask about specific tests and procedures…and we have questions reminding people to ask these questions generally.
You may also want to do this in conjunction with posting the actual Choosing Wisely poster in break rooms:
One might ask: “This is such a screamingly obviously good idea. Why didn’t anyone in the wellness industry already think of this, given how enamored they are of sending employees to the doctor for no reason other than to brag about how many employees are sick?” Except that I can’t answer snarkily because I didn’t think of it either. Credit goes to Quizzify’s tech guru, our “Millennial-in-Chief.” He built the infrastructure to download our surprise-billing avoidance consent form into an Apple Wallet, and then suggesting adding this too.
Here’s how an ad gets published. It’s a two-step process. I will lay it out so that even the dumbest member of the media who somehow missed this the first time when they swooned over Livongo’s outcomes can understand it now:
- Your employees and their colleagues write it.
- You pay to have it published.
Now, let’s look at what Livongo just published, touting their own outcomes, to see how, if at all, it differs from an ad.
- Their employees and colleagues wrote it.
- They paid to have it published.
- We missed this the first time around. Our excuse is, so did quite literally everyone else who covered the story. And “covering stories” isn’t our Day Job. We aren’t journalists. We don’t even play them on TV. We’ve never even watched journalist shows on TV, unless you include Superman reruns. Livongo seems to have a lot in common with that show, transparency being their kryptonite.
The journal is called the Journal of Medical Economics. Sounds really prestigious, so points for that. Yet virtually no other journal article cites articles in this journal, giving it an Impact Factor south of 2. (New England Journal of Medicine gets a 70.) Turns out there’s a reason no one cites it. Here’s how you get published in it. You pay them money.
They would say, yes, but we got it peer-reviewed. To which I say, apparently you didn’t in any meaningful sense. A real peer reviewer would have found and questioned all the fallacies in their article, rather than rubber-stamp some very sketchy “findings,” which for convenience’ sake are all catalogued in one place.
There is nothing wrong with advertising your outcomes, as long as your ad is labeled as an ad. You often see airline magazines with entire sections advertising various cities, using articles and pictures. But they are always labeled as ads. If you don’t do this, there is always the slight possibility, however remote, that someone doesn’t do the research to figure out that in fact this publication was pay-to-play. If that were to happen, you might see a headline like this:
Whereas a more accurate headline might read: “Livongo Pays for an Article to Claim Its Product Works.”
Update January 3: Someone contacted me to say that the correct term for paid highly information advertising is “Sponsored content.” This term would apply perfectly to Livongo’s self-generated, self-published study. They should relabel it as such.
This means as we enter the 2 weeks with the most emergencies this side of July 4, you are at risk of being snookered in an emergency admit or visit or delivery. However, you can now download this consent language and instructions on use right into your Apple Wallet (sorry, Android users — not your day in the sun yet)
The same link has our paper version, with 8 wallet-sized cards. Print the page and slice it into 8 cards. (The good news is that since the ER can’t overcharge you if you carry these cards, you don’t even have to be careful with the scissors.)
This year we are not naming winners of the Deplorables Award, lovingly bestowed in the past on vendors best exemplifying the wellness industry’s commitment to cluelessness. This is largely because wellness vendors have finally learned to operate in the shadows. Of course, the usual suspects — previous, multiple Deplorables Award-winners like Interactive Health and Wellsteps — are still fabricating outcomes and harming employees. The difference this year is that they have finally learned that snookering employers works best if they don’t actually announce that they are snookering employers.
They have enough sense not to engage, so as not to create a news cycle…which they will invariably lose. For example, watch how Ron Goetzel won’t respond to this:
“Ronald, I’ve documented 14 statements you made in one 45-minute period that look an awful lot like lies. Care to clarify or dispute any of them? If not, we’ll assume they are lies.”
And if you look in the comments below, or on linkedin, you’ll see…nothing.
One might wonder why this simple lesson has taken these people so long to learn, but in their defense it could be noted that many politicians have yet to learn it at all.
Diabetes vendors, Livongo in particular, have proven to be faster learners. They figured out that if data goes in the wrong direction, you simply don’t report it. No one other than yours truly here will notice, and I can’t highlight their failures if they don’t blab them. Specifically, the two most important outcomes metrics in diabetes management are insulin use and primary-coded diabeties admissions. While they reported some rather contradictory and squirrelly “results” for other things, somehow they “forgot” to report on those two variables.
As a result, all the media attention directed at them has been of the reprint-the-press-release variety rather than the Woodward-and-Bernstein approach. I tried to add my two cents but didn’t get sufficient attention because Livongo was wise enough not to voluntarily disclose the self-incriminating data.
Now for the good news: many organizations and individuals have distinguished themselves this year by actually adding value — basically doing the opposite of what Deplorables Awards winners do. It’s been so long since I’ve reported good news in this column that I’m not sure what the opposite of “Deplorables Awards” is? The opposite of Deplorables might be “Human Scum,” but upon careful consideration, deliberation, and focus-grouping, I’ve decided that might not be an appropriate name for an award.
So I have no idea what to name these awards collectively, other than Not The Deplorables Awards. (And a few awards below have their own monikers as well.)
Note that it isn’t enough to be on the right side to earn this accolade — you have be high-visibility too, and willing to take public stands that might get some people annoyed with you.
And the envelopes, please
First, the Validation Institute. “Are you validated by the Validation Institute?” is becoming a common phrase. (It helps that their most recent webinar attracted 1300 registrants.) Some organizations, like Comcast, won’t even consider a non-validated vendor that can’t explain why validation doesn’t apply to them.
Some vendors will respond: “We don’t need to be validated because we hired an actuary to validate our outcomes.”
Here is a newsflash: The sentence: “My client saved no money at all” has been announced by no actuary ever. You pay an actuary to claim savings, not to measure them. This is true matter how obviously they are fabricated.
The VI has also created the single most elegant, easily implemented, and valid tool to measure the cost-effectiveness of various benefits. No tool has ever done that at all, let alone freely and easily. You simply ask employees “How many times if at all did you use this benefit?” and “Was it useful?” Multiply those two scores together to get an engagement index and graph that against the cost of the benefit. The most cost-effective benefits will demonstrate high engagement at low cost, in the upper left. (The size of the bubble scores an optional third question: “Does offering this benefit enhance corporate culture?”)
Second, the companies that have achieved validation. While many companies have now reached this milestone, these awards would specifically go to Virta and IMHealth in diabetes and US Preventive Medicine in wellness. The reason is that they have achieved legitimate outcomes in industry segments in which most of their competitors have not.
Third, Quantum Health would get the Cal Ripken award, for six consecutive years of winning validation at the highest level, which is actual savings achieved.
Fourth, the authors, of which there were no shortage this year:
- The John Dean award goes to Professors Zirui Song and Katherine Baicker, who did exactly what scientists are supposed to do, which is design, conduct and report legitimate experiments instead of fudging the data to show that their initial conclusion — in their case, certainly the most consequential initial conclusion ever — was right. By proving that “pry, poke and prod” is an epic fail (at least for the first year, and it’s hard to imagine a dramatic turnaround in subsequent years), they did the honorable thing, even though it meant invalidating their own previous work.
- The Hire-a-Food-Tester award goes to Marty Makary, whose blockbuster The Price We Pay exposed some mind-bogglingly scandalous behavior by providers harming employees with surprise medical bills and lawsuits. Runner-ups in the authors-of-actual-books department (only because Marty’s is tough to beat) include Jeanne Moore and Zeev Neuwirth.
- Marilyn Bartlett wins the Miss Noncongeniality Award for forcing most of the hospitals in Montana to accept reasonable fees benchmarked to Medicare, saving the state tens of millions. Were she to help other states achieve the same outcomes, the complexion of the entire provider industry would change. Large private-sector employers, and carriers, would start demanding the same rates.
- Joe Andelin, who has published several analyses blowing up conventional wisdom about savings from wellness.
- Lisa Woods, Jonathan Slotkin, Ruth Coleman for documenting mind-blowing rates of inappropriate spinal fusions
- Medencentive, whose published analysis combined both validity and savings, which (aside from Quantum Health) has never happened in employee health services
Fifth, the Joe Hill award to AARP, for representing low-paid hourly workers being abused by Yale University’s wellness program. “Abused” may seem like a strong word, but forcing an employee who has had a double mastectomy to choose between getting a mammogram or being fined up to $1300 might qualify as such.
Sixth, the Tesla 0-to-60 Award goes to Tom Scott, who, from a standing start at the 2018 World Health Care Congress, created the first and most popular full-credit, full-semester course on next-generation health benefit design and administration.
Seventh, the Jacob Riis Award goes to Jon Robison, who never misses an opportunity to point out the fallacies in wellness vendor claims. Those pile up so fast it’s amazing he has time for his Day Job.
Eighth, the Edward R. Murrow award to the podcasters. Podcasts are the new way of reaching people, and exposing “pry, poke and prod” programs seems to be a popular topic. In no particular order, they are Reconstructing Healthcare, Workplace Injury Prevention, Stacy Richter, Josh Luke, Jen Arnold, Zeev Neuwirth, Jeff Bernhard, Michael Andrade, Matt Jeffs.
Then, in the not-really-a-podcast category, hosts who get the message across in 3 minutes or less include Fred Goldstein and Wellable’s NIck Patel.
NInth, the First Amendment Award goes to Brian Klepper. Brian has compiled a listserve of almost 1000 disruptors where folks like me learn we are not alone in the universe. To join the listserve, you can reach Brian at firstname.lastname@example.org.
Tenth, the Grownups in the Room. These are people who, despite running high-visibility organizations that are susceptible to criticism, are completely willing to take unpopular stands when the facts merit it, and have clearly moved the needle.. Leah Binder, Chris Slezak, Jessica Brooks, Neil Goldfarb, Christie Travis, Lisa Morgan, Larry Boress, Bob Smith, Lisa Slavinski, Tina Bowling, Jeff Hogan.
Eleventh, the Nero Award goes to…me. Not for the things I generally excel at, like measuring wellness outcomes, writing heathcare trivia questions, or being tall. Rather, specifically for combining the insights of the aforementioned Marilyn Bartlett and Marty Makary into the first-ever on-the-spot solution for avoiding surprise medical bills for emergency care. The good news is that, following our heavily subscribed webinar (viewable here) on this topic, several hundred people have downloaded this solution. The bad news is, that means several hundred million people haven’t.
And, finally, what would a list of Not the Deplorables Awards be without: The Daves? Dave Chase and David Contorno have used their bully pulpits to influence large numbers of brokers to negotiate better deals on behalf of their customers that also dramatically reduce deductibles and copays. Mr. Contorno’s latest linkedin post got more than 200 “likes,” which implies about 50,000 views. Remind me never to get on his bad side.
By contrast, I am thrilled to be on Ron Goetzel’s bad side. And in all fairness, he has responded to the 14 apparent lies. Not by disputing them (which is what I am offering the chance to do now) but by acknowledging them. The only point he disputed, in the comments, was a true statement. He said on tape he found Quizzify to be “a lot of fun, very clever.” But now he claims that when he said that, he didn’t mean it.
Make that 15.
PS I think you can order both t-shirts from the same company. Is this a great country or what?