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The worst wellness story of all time: harassing a double-mastectomy patient to get a mammogram

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.

 

 

New Book: Nurses Take Back Healthcare One Employer at at Time

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.

Is 2019 the summer of ticks?

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:

  1. Light-colored clothing attracts more ticks than dark clothing.
  2. You can now buy entire outfits that are infused with tick repellent that might actually work.
  3. The EPA rates insect repellents for tick effectiveness.

Who knew?

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.

 

 

Upcoming webinar: Is is time for a wellness reboot?

Facts are the wellness industry’s kryptonite.

Related image

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.

  1. 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”);
  2. 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;
  3. 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;
  4. 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.”

 

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Questions to ask Livongo before signing with them

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.


The full list of questions can be found here.

To learn about CORA certification, click here.

And to see how we predicted many of the ways Livongo would measure outcomes using vendor-friendly metrics, click here.

 

Interactive Health gives clueless wellness vendors a bad name

Someone suggested that I call my Congressman to pass a law against Interactive Health, but I think the Justice Department is the more appropriate route. No, not because they’re harming employees — there is no law against employers harming employees in the name of wellness. Quite the contrary, the most recent Koop Award went to a vendor, Wellsteps, which did exactly that.

Rather, I would propose an antitrust action, because Interactive Health is attempting to create a monopoly on stupidity.

Yes, it seems like hardly a day goes by without the irresistible force of Interactive Health’s corporate IQ colliding with the immovable object of reality.  The thing is, their moles pop up faster than I can whack them on Linkedin, so here is a tasting menu of their greatest hits. You can’t find most of these observations on Linkedin for the simple reason that they delete them.

This was originally going to be a comprehensive retrospective of all their nonsense (Exhibit A for the Grand Jury to review), but in the two weeks since I started writing it, yet another mole popped up. This one could top the list if not for their “smoking recession program.”

  • An analysis of 2017 member data revealed that those clients who test all employees for Hemoglobin A1c identified up to 3 times more individuals at risk for pre-diabetes versus other testing. As a result, inclusion of Hemoglobin A1c testing for all employees is often a strategic recommendation for our clients. 

Since pre-diabetes is a risk factor for diabetes (and only a fraction of pre-diabetics become diabetic, after 5 to 10 years), they are hunting for employees who are “at risk for being at risk.” Who amongst us is not at risk being at risk for something? But that doesn’t mean they’ll end up with diabetes, any more than every kid who steals a cookie from a cookie jar becomes a bank robber — even if every bank robber did in fact at some point in their childhood steal a cookie from a cookie jar.

Using testing guidelines so contrary to the US Preventive Services Task Force that a beam of light leaving USPSTF guidelines wouldn’t reach them for several seconds, Interactive Health takes great pride in “identifying 3 times more individuals” than companies that test employees according to guidelines. Cue Inspector Louis Renault: “Owing to the seriousness of this crime, we are rounding up twice the number of usual suspects.”

One might be excused for assuming that the point of screening would be to “round up” the most appropriate employees, rather than the largest number of employees. One might also be excused for thinking Interactive Health is simply stupid, when in reality they are fully aware they violate guidelines, recognizing that their typical customer doesn’t realize this and is willing to, in the immortal words of that great philosopher the Queen of Hearts, believe six impossible things before breakfast.

Image result for queen of hearts alice in wonderland

in case anyone else is interested — we know Interactive Health isn’t — the USPSTF recommends screening only overweight/obese 40-to-70-year-olds for HbA1c. That’s to prevent exactly the kind of hyperdiagnostic employee harassment that comprises Interactive Health’s signature strategy: more tests = more revenues. They make Wellsteps look like an honest, intelligent vendor, which is no easy feat.

We also thought of contacting the Health Enhancement Research Organization (HERO), to let them know there was a vendor making the industry look bad (or look even worse), but it turns out that for HERO, cluelessness is a feature, not a bug.  Specifically, HERO has highlighted a case study by Interactive Health, which would be like Bernie Madoff highlighting his investment in Enron.


Update. Alas, I’m afraid there won’t be an investigation into their stupidity. At this point, they are so far ahead in the race to the bottom that it would be impossible to empanel a jury of their peers.

 

 

Podcast: Where wellness went wrong…and how to fix it

Dear TheySaidWhat Nation,

Here is our most recent podcast, courtesy of Insurance Thought Leadership.

Summarized as follows:

  1. Conventional “pry, poke and prod” wellness has failed
  2. Trying to morph those 3P programs into “Wellness 2.0” will also fail, largely because you can’t spin straw into gold no matter how hard you try
  3. However, wellness done FOR employees instead of TO employees, like Quizzify, is a welcome addition at most workforces.*
  4. You can’t do that with the same vendors who created 3P programs any more than you’d hire former East German border guards as tour guides.

Al

*That was not clear in the podcast. See the comment below and my apology.

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