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Remember when the sergeant asked for a volunteer to step forward and Moe and Larry took a step back?
Looks like Virgin Pulse has won the best-HRA contest the same way. Yes, it is a complete waste of employee time and employer money. In HRAs, that’s table stakes. It earns a solid “C” not because anyone will learn anything of any value, but rather because the other two are worse. The VP HRA offers so little advice that none of it is really bad. It that sense it is better than Cerner’s (“F”) and Optum’s (F+).
Here’s what Virgin Pulse’s HRA gets points for not doing:
Tell employees to eat nonfat yogurt that is full of sugar (like Cerner):
Imply that employees on opioids should get more opioids (like Optum)
Advise employees against using olive oil (like Optum)
Further, it is actually coherent, instead of containing questions like… (Optum again)
…in which both non-asthmatics and completely uncontrolled asthmatics would give you the same answer.
Virgin Pulse’s “advice”
“Eat a healthy breakfast.” Who can argue with that? It’s like a manager advising the batter to hit a home run. Obviously the key is in the execution, and naturally Virgin Pulse provides none. In that sense, it is the best HRA because the others give such bad advice.
What constitutes a healthy breakfast? Can’t be just any old cereal. Those are full of sugar. Ah, maybe something like Kellogg’s Smart Start with Antioxidants, which is “heart-healthy.”
Oops. That’s on Eat This Not That’s “worst healthy cereals” list. Because it is — you guessed it — full of “heart-healthy” sugar.
Kellogg’s Special K Protein Snack Bars? 10 grams of added sugar apiece (and you’d likely eat 2–they’re small) with six different sugars dispersed throughout the ingredients label.
Eggs? For most people, eggs are a healthier choice than most packaged cereals. Of course, there are exceptions — a bit less than 1% of the population is genetically predisposed to high cholesterol. But wellness vendors would lose money if they actually spent the time to address these nuances. Of course, in this case, the “nuance” is that familial hypercholesterolemia (FH) is a much better predictor of cardiac events than anything in any HRA. As in about 40% of everyone with untreated FH will infarct before age 60.
Oatmeal? Probably the greatest consensus around that. (And that’s the breakfast of choice here at TheySaidWhat? World Headquarters.) Yet plenty of cereal companies, and fast food chains, have turned oatmeal into junk food. Dunkin’s “Brown Sugar Flavored Oatmeal” packs in 28 grams of sugar (none of which is actual brown sugar, as luck would have it).
Orange juice? That counts as a serving of a fruit according to the American Heart Association (AHA) and Virgin Pulse is a big one for telling you to eat up to 11 servings of fruits and vegetables a day, with “1/4 cup” of juice counting as a serving. Using the AHA math, an 8-ounce glass of juice would appear to get you 4/11ths of the way there.
And ads for “healthy” cereal sometimes show a glass of orange juice on the side:
On the other hand, NPR and Consumer Reports advise against considering juice as a healthy alternative. The sugar is “natural,” but there is an awful lot of it. (I myself am not a nutritionist, and don’t even play one on TV, so I don’t have an opinion on whether natural sugar is OK and added sugar isn’t. Except I would point out that grape juice contains natural sugar while grape juice concentrate is an added sugar. Both can’t be right.)
So which is it? Drink more juice, or don’t? Which constitutes “eating a healthy breakfast” ? I don’t know and I suspect neither does Virgin Pulse. The difference, of course, is that TSW isn’t charging lots of money to give employees advice.
Completing the Virgin Pulse HRA
Obviously, employees are going to lie on HRAs, and Virgin Pulse’s is no exception. I was invited to watch a group of employees completing theirs, For each answer, they gamed the system. What is the optimal amount of stress to claim? Too much might harm their career. Too little and someone might give them more work.
How much should they claim to drink? “Not at all” might cause their (well-known!) employer to think they’re lying, so they all decided to cut their true totals in half.
Servings of fruits and vegetables? Most of them just made up a number that would sound good to an employer.
Everyone seems to know employees lie on HRAs (including, of course, Virgin Pulse) except the employers that still use them, whose quest to create a culture of health ends up creating a culture of deceit. No need to take my word for this. Simply complete this chart to see what percentage of your employees with something to lie about are indeed lying — and what the odds are that an employee with something to hide will tell the truth about it:
Let’s try completing this chart, using the most recent winner of the C. Everett Koop Award, Wellsteps.
Result: in the so-called best wellness program, almost 2/3 of employees lie, though in all fairness to Wellsteps, some of those could be the same employee lying twice. And extrapolating from Wellsteps’ result, the odds of an employee coming clean about a bad health habit are about 1-in-4. That’s the average of smoking and drinking. Generally the more socially acceptable habits will show a higher percentage of employees telling the truth.
Keep in mind, too, that there is another way to lie on HRAs, which is understatement. You may recall from Wellsteps that the 23% who drink only imbibe 1.3 drinks a day, while 3% who do admit to smoking indulge in cigarettes only 4.27 times a week, perhaps taking a break on weekends and major holidays, such as Beethoven’s Birthday.
Due to the lying and uselessness, should employers drop HRAs altogether?
In the immortal word of the great philosopher Curly Howard, soitenly.
Apparently the wellness industry does not have a monopoly on invalid research.
A study came out in The Lancet–the British equivalent of the New England Journal of Medicine — finding that the only safe level of alcohol consumption was: none. As the principal investigator said: “Alcohol poses dire ramifications for future population health in the absence of policy action today.” This finding generated myriad headlines like this one at CNBC:
One thing you learn if you hang around wellness promoters long enough is that oftentimes a close perusal of the study in question shows the opposite of what the authors intended. Or, as we often say: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.” And the same is true here.
For example, Denmark leads the world in the number of drinkers — and has life expectancy higher than about 90% of the world’s countries. The lowest alcohol consumers? Pakistan — which ranks #130 in life expectancy. You might say: “Wait, aren’t there many other factors involved in life expectancy?” And the answer is, of course there are. None of those were controlled for in any way in this meta-analysis. To begin with, the more people drink, the more other unhealthy habits they are likely to have.
But that’s not the crux of what is wrong with this study. Two other things should lead wellness professionals to the opposite conclusion: that light drinking is perfectly OK. The remainder of this post addresses those.
Absolute risk vs. relative risk
Absolute vs. relative risk is one of our (many) pet peeves. Here are two other examples that we have had to smack down:
- The American Cancer Society warns of a 22% increase in colon cancer among people under 50, but it turns out that absolute rate of colon cancer in younger people is so low that the chances of your life being saved by screening at age 45 are about the same as your chances of being struck by lightning. The media had a field day with that one too.
- Before that, speaking of colons, a study came out showing that red meat increased risk of dying from colon cancer. Once again, it turned out — using the data right in the study — that more people are killed by lightning than by colon cancer due to eating more red meat than average. Yet once again, the media had a field day.
From the media’s perspective, this makes sense. After all, who is going to click through on a headline that says: “Low quality study finds trivial relationship between variables” ?
In the case of this alcohol study, looking behind the headlines proved equally insightful. (And thank you to Aaron Carroll of The New York Times‘ Upshot for suggesting it.)
Alcohol is a leading risk factor for death and disease worldwide, and is associated with nearly one in 10 deaths in people aged 15-49 years old, according to a Global Burden of Disease study published in The Lancet that estimates levels of alcohol use and health effects in 195 countries between 1990 to 2016.
Based on their analysis, the authors suggest that there is no safe level of alcohol as any health benefits of alcohol are outweighed by its adverse effects on other aspects of health, particularly cancers.
Read the first paragraph again. Two observations:
- almost no one dies between the ages of 15 and 49, so being responsible for “nearly” 10% of those deaths means that alcohol kills about 0.001% of people in that age bracket every year.
- the authors have conflated two things: alcohol and excess alcohol. Virtually all of those deaths in that age bracket were due to the latter, a fact that the authors conveniently overlooked when demonizing any level. of consumption.
Reading a bit farther in…
They estimate that, for one year, in people aged 15-95 years, drinking one alcoholic drink a day  increases the risk of developing one of the 23 alcohol-related health problems  by 0.5%, compared with not drinking at all (from 914 people in 100,000 for one year for non-drinkers aged 15-95 years, to 918 in 100,000 people a year for 15-95 year olds who consume one alcoholic drink a day)
Hello? A 0.5% increase in relative risk? And the increase in absolute risk (not calculated) is 4 per 100,000 people a year — or 0.004% a year. Even two drinks a day increases absolute risk only by 0.06% a year. (Once you get beyond two drinks a day, the chance of harm accelerates exponentially…but that’s not news.)
What the he** are employees going to consume instead?
Our biggest beef with this study is the same as with just about every wellness program: everything is off-limits. Even foods that are OK in moderation for most people — like full-fat dairy, salt, oils, cholesterol/eggs and red meat — are singled out for criticism by health risk assessments. And now alcohol.
Unfortunately, the more foods you demonize, the less likely it is that any employee will pay any attention to any of your dietary pronouncements. And to the extent they do. well what are they going to eat instead? Here is Cerner telling people that non-fat yogurt is a “healthier choice.” Trivia question: What added ingredient makes nonfat yogurt taste good?
Here is Optum railing against oils:
And Cerner, once again, this time incriminating dietary cholesterol, which of course has no impact on blood cholesterol for most people:
Finally, here is Interactive Health hyperventilating about something-or-other in their HRA feedback to an employee. We don’t know what it is other than, given the provenance, it’s wrong. Fortunately, no employee is going to plow through this anyway.
Treat this alcohol finding the same way you would treat advice from most health risk assessments: ignore it.
My recent request to review health risk assessments (HRAs) brought a number of responses. I’m grading the HRAs that I was able to access, on both advice and readability.
Optum’s, the second to be reviewed, receives “F” in advice and, as will be shown below, F- in readability. The scoring system is laid out here.
Advice: Chronic Pain
Optum offers the single most genius piece of advice of any of the very stable HRAs I’ve taken. By way of background, I took this HRA in 3 states where doctors are notorious for regularly giving out opioids as his or her treatment plan to follow, to people who currently have chronic pain. I checked off that I had “currently have chronic pain” just to see if they would say something worth blogging about, and was richly rewarded for that effort:
So this HRA is basically advising me to go get more opioids. The bad news is that they aren’t directing people to Quizzify’s painkiller awareness quiz. The good is that employees who want more opioids will give their program a high satisfaction rating.
This advice to switch to lowfat dairy is more likely to cause harm than to create benefit. Full-fat dairy is preferable to fat-free for most people. As this summary, with links to the studies, shows, full-fat dairy probably offers protection against diabetes.
The advice regarding “lower-fat meats” is controversial but is presented as fact. There is a whole body of research saying the opposite of what Optum says. Once again, we aren’t taking sides except to note that coercing employees to complete HRAs implies that the HRAs should be beyond challenge.
“Avoiding adding extra fats/oils when preparing food or at the table,” besides the questionable sentence structure, is simply wrong. Olive oil is on everyone’s good list, for example, while (aside from trans fats) other fats and oils have their advocates. A much better answer — how hard would it have been to come up with this? — might be “substitute olive oil for other fats and oils.” A bigger point: fats and oils make food taste good. And enjoyment of meals will lead to happier employees.
“Avoid added sugar” is decidedly unhelpful advice. Food companies go through a lot of trouble to hide “added sugar” specifically so people don’t avoid it. See this article: The Extraordinary Science of Addictive Junk Food. Optum’s go-to weapon against this cutting-edge neuroscience is: “Avoid added sugar” ?
Alas, Optum’s HRA is silent on how one goes about accomplishing this feat. This decidedly unhelpful advice runs up against the reality that people have no idea where these “added sugars” lurk, since very few products these days advertise: “An excellent source of added sugar.” By way of contrast, Quizzify does teach employees how to avoid added sugar — see the example right on the home page — and a good thing, because Quizzify’s test-takers, while improving greatly over time, originally score as follows:
- 52% think granola bars are healthy (they’re candy)
- 62% didn’t recognize synonyms for sugar (malted barley extract, dextrose, evaporated cane juice, maltodextrose)
- 68% didn’t realize that the first ingredient in a Clif Bar, organic brown rice syrup, is — you guessed it — sugar.
By contrast, this Optum “avoid added sugar” advice is about as helpful as just asking employees to rate their diet, which would be a useless question no HRA would ask. Oh, wait:
“An excellent diet is low in total fat” is simply wrong information. While saturated fat is controversial, the “low in total fat” myth was killed off decades ago.
While some people’s blood pressure is quite sensitive to changes in sodium intake, blanket recommendations of low-sodium diets are the subject of a great deal of controversy too. The ongoing Framingham Heart Study correlates high sodium intake with low blood pressure, the opposite of what Optum says.
So they’ve told employees to avoid fat and salt. Just to belabor the obvious — and in wellness, the obvious needs a lot of belaboring — what the bleep do they think people are going to eat instead of salty food or fats??? Are they gonna reach for kale, kelp, or a kiwi? Unlikely. They’re going to — get ready — eat something full of that very same added sugar, likely, as noted above, without even realizing it.
Congratulations, Optum. Your HRA greenlights the two biggest no-nos for employees: opioids and sugar. Fortunately for you, few employees take HRAs, seriously, so you probably aren’t doing any harm. This is especially true of yours, because even if someone did want to take yours seriously,you’ve thrown up one more roadblock: people can’t figure out what you’re saying, and that brings us to…
The complete scale for readability is here. Or so I thought, until I read Optum’s, which requires adding an “-” to the “F” on the scale . I took this HRA multiple times and each time it was an exercise in frustration.
Among other things, there were literally 100 screens that had to be scrolled through. And if you “saved” your work-in-process, you had to scroll through them all again to get back to where you left off.
Here is my favorite screen:
Stay with me on this one:
- If you are a good person, by definition, you check off the following: “I strongly agree that I am a good person.”
- If, by contrast, you are a bad person, by definition, you check off the following: “I strongly agree that I am a good person.”
After all, isn’t the whole point of being a bad person is to pretend you’re a good person? Bad people don’t exactly announce that fact on their Linkedin profiles. Sometimes they don’t even know themselves they are bad people. Walter White thinks he is a good person.
What does this mean?
Stay with me on this one.
- If you do not have asthma, meaning you are at the lowest risk, you check off the third box: “No, not being treated or taking meds.”
- If you do have asthma but are ignoring it, meaning you are at the highest risk, you check off the third box: “No, not being treated or taking meds.”
It’s also not clear how one would get treated for asthma without taking meds, making the second box a head-scratcher too.
Optum repeated this three-box choice for every other chronic disease as well, including diabetes. Diabetes, of course, is a disease that is very common to have but not be treated for. Indeed, it is so common to have diabetes and not be treated for it that there is an entire industry — that would be your industry, Optum — devoted to bribing, coaxing, cajoling or threatening every single suspected diabetic into treatment.
And yet somehow diabetes is nonetheless not common enough for you to draw an additional box on a screen that people can use to distinguish between whether they have diabetes and are not being treated for it, or whether they don’t have diabetes at all.
Indeed, one would think, with 100 screens to scroll through that could easily be consolidated into half that number (for instance, if you don’t use nicotine, you shouldn’t need to scroll through four screens to make your point), the disease inquiry category would be the wrong place to try to economize on electrons by causing people to check off the same box for opposite answers.
To summarize, I’m not following the advice on this HRA, either because it is terrible advice but I need it, or because it is great advice but I don’t need it.
It’s not just that Maryland is setting the record for most epic financial fail ever recorded in wellness. We are also bringing you an eyewitness account from the Belly of the Beast, an employee willing to give out her name in order to help spare other state employees and taxpayers the pain of this program.
The Most Epic Fail Ever?
Maryland is on track to miss its savings goals by 18 decimal places. To put that in perspective, the total economic output of the world sums to only 14 decimal places.
Here’s how the math works. The state is claiming that avoiding wellness-sensitive medical events will save $4 billion dollars — a number with 10 decimals. Thanks in part to Maryland’s lowest-in-country hospital rates of about $20,000/heart attack, the state would have to avoid 20,000 heart attacks a year to do this. No easy feat when the entire insured Maryland population — all private- and public-sector employees and their families combined — only suffer about 2700 heart attacks/year.
Plus, in the history of wellness, it appears that not a single heart attack, or for that matter, diabetes event, has ever been avoided. (More likely, a few have been avoided, but a few also have been caused by employees taking bad wellness vendor advice.)
Put yet another way, that’s $4000/family/year in savings. Achieving that outcome that would require wiping out all hospitalizations on all state employees and dependents, along with some of their closest friends.
Taxpayers, this is on you
Meanwhile, Maryland state taxpayers are paying Optum on the magnitude of $70,000,000 (8 decimal places) over this period, plus the cost of hundreds of thousands of useless and possibly counterproductive coerced checkups.
The best-case scenario? It’s a very safe bet–one I am willing to make to the tune of $3-million and give out 10-to-1 odds– that they will save nothing. That’s 10 decimals in missed savings targets and 8 decimals in fees — a truly epic fail of 18 decimal places.
And yet even this is an optimistic assessment. Like both other public sector employers — Connecticut and Boise — which have reported outcomes, Maryland’s program will likely drive up spending and possibly harm their employees. And if you guessed that Optum’s contract calls for them to receive bonuses based on invalid measurement of non-existent savings, then update your resume. You are too smart to be in this field.
Further, Optum (through its representation on the board of the wellness trade association), has already publicly admitted wellness loses money. Their cabal tried to take that back by pretending they lied when they admitted it, but it turned out they lied when they said they lied. The data was real, meaning the admission was real.
It happens that I know two state employees. One bragged to me about how their entire quasi-public organization was able to dodge this program because everyone hated it so much. The other shared her “wellness” story, a typical one rather than the stories of great harms, or the experiences of employees who make constructive comments in the lay media, such as: “I’d like to punch them in the face.”
Instead, her story sounds like every other employee wellness story — with the notable exception that she is allowing me to use her name, since she no longer works for the state and is concerned about the stress and potential harms caused to employees, including her former colleagues. (Plus, as a taxpayer, she’d like her $50 back, representing her share of the total program expense.)
Her name is Alice, and here is her experience. (Anyone who would like her last name and contact info may contact me and I will pass that along to her. She is willing to talk, though not for attribution.)
As a state employee and with my entire family being on the state plan, my husband and I have had the joy of recently completing our wellness assessments. Here is my rant:
First, it’s a giant pain in the butt. Second, the questionnaire could not have been more ridiculous and third, my doctor didn’t really do anything with it. She just gets to bill an unnecessary office visit to the state, in order to sign a form.
On the first topic, the questionnaire took 45 min for each of us, plus the inconvenience of having to schedule and go to an appointment we didn’t need. And in my case, having just gone through 9 months of prenatal care, labor and delivery care and postpartum care on top of all the newborn appointments, the last thing I needed was another doctor’s appointment.
On the second point, the questions they asked were terrible for assessing my actual health. There was an obvious right answer in every case, and it seemed to want to judge my mental health/level of happiness more than actual health. “Think of yourself on a ladder in terms of xxx (happiness, social status, personal accomplishments). What rung on the ladder would you place yourself, 1 being the lowest and 10 the highest?” How does that assess my health? It’s a personal fulfillment questionnaire that also asks if you exercise. At the end they ask for all these lab values which I don’t have and my doctor didn’t think she was supposed to request so they aren’t filled out at all.
And on the last point, my doctor never looked at the 30 page final assessment that I had to print and she just asked me if I think I’m healthy and I said yes. She was fine with that. The only thing she told me was that I could lose a few pounds to get my BMI in the right place – well OF COURSE! I just had a baby, which on a side note is not a part of the wellness assessment at all. There are all these questions about how much sleep I’m getting, am I stressed, etc… but no accounting for the natural things that happen in life like a newborn.
Shame, shame, shame on Alice!
Like every other Maryland employee, Alice needs to pull her weight, if she ever expects to account for her $40,000 share of the $4 billion in savings. Unfortunately, according to the actual arithmetic, she is already way behind in her quest. She hasn’t saved a nickel but has cost the state:
- 1 doctor bill
- 1 vendor fee
- 30 pages of paper from needlessly destroyed trees
- 45 minutes of lost productivity completing her kumbaya assessment, plus the time spent at the doctor
Fortunately, the doctor didn’t realize she was supposed to run (and charge for) a bunch of lab tests, so she saved the state some money there.
Where should the state go from here?
A quick plausibility test should determine that they didn’t save anything to speak of. Then Optum should be forced to give their money back, and issue an apology to Alice and others for wasting their time. The Attorney General should announce to overjoyed state employees that they are no longer required to do this — and that he just saved the taxpayers $70 million. Then he should run for governor. Alice could be his running mate.
Where will the state go from here? Like Connecticut and Boise, in exactly the opposite direction. The state HR people will claim they are heroes, using the classic combination of regression to the mean, ignoring dropouts, and participants-vs-non-participants study design, to pretend to show how much employees love the program and how much money it’s saving. When carefully read, of course, the data will show the opposite.
They will also find one state employee willing to claim he or she started eating more broccoli. As for the rest? For a more typical assessment of the Maryland program, I would recommend that the state, in the immortal words of those great philosophers Jefferson Airplane, go ask Alice.
Wellness vendors were into alternative facts before alternative facts were cool. They even expanded the domain to include alternative math, like Wellsteps showing that costs had increased and decreased at the same time.
Is Optum (United Healthcare) going a step further, into alternative ethics? Here are two Optum claims, which appear to be exactly the opposite of each other. Now, we aren’t going to call anyone an alternative fact-er, but we would invite them to explain — and we’ll provide equal time — how both these seemingly incompatible statements can be true.
First, the head of their wellness group, Seth Serxner, acknowledged that biometric screening is supposed to be done in accordance with guidelines. (The guidelines are reproduced below, by the way, since he seems to have trouble remembering them when he’s approving marketing materials.)
He insisted, on tape, that the only reason Optum flouts screening guidelines is because employers make them do it: “Many clients won’t let us [screen appropriately],” he said. The full tape can be downloaded from that link, but it is tough to find the audio. (The time stamps appear to vary by download. However, it is towards the end and you can manually sync by following The Great Debate in total, which starts here.)
So, on Seth’s planet, Optum begs employers to pay them less money by screening their employees at longer, more appropriate, age-adjusted intervals…and employers refuse.
However, it appears, based on the marketing material below, that the reason employers refuse to let Optum screen appropriately is that Optum requires employers to screen inappropriately. You read that right: “participation in our wellness program…is a requirement.” And that decidedly includes screening…which employers must pay extra for in order to get the “savings” on their premium.
They then go on to quote — you guessed it — Kate Baicker’s 7-year-old study based on alternative data that even she appears not to believe any more. The second alternative quote is attributed to WELCOA, a quote which WELCOA’s CEO, Ryan Picarella, assures me he never made, nor did anyone currently in his organization, and that he doesn’t believe.
Update: It was observed on Linkedin that the reason they do this (for their fully insured business) could be as an ACA play. You don’t mind if spending on claims increases because you need to get to 80% (or 85%, depending on size) loss ratio anyway. The screening isn’t counted towards the 85% because it’s not a claim, so you make money there too by charging separately. Brilliant! United Healthcare’s shareholders should be very impressed.
Here are the USPSTF guidelines, by the way, also reproduced below, albeit badly. (There is nothing wrong with your TV set. Do not attempt to adjust the picture.) This is actually the version published by “Choosing Wisely” (a joint project of Consumer Reports and the Society of General Internal Medicine), and they don’t totally sync with USPSTF, but whatever the minor differences are, neither looks anything like what Optum and their alternative friends advocate.
This is the second part in the series on wellness vendors and the US Preventive Services Task Force (USPSTF).
Q: Why do vendors ignore or flout the USPSTF?
There are five reasons, three of which are unfortunate:
- Many vendors don’t understand the entire concept of screening, neither the science nor the arithmetic described in Part 1. Healthcare is hard, and the USPSTF can’t be expected to dumb themselves down so that wellness vendors, for whom simple math is a challenge and who don’t have to meet any educational or licensing requirements other than eight days of training, can understand it.
- Obviously, the more vendors screen, the more money they make. Guidelines propose infrequent screening for fewer blood values than most vendors do. That means vendors who abide by guidelines can collect much less money from employers than those who charge what the market will bear. Examples of companies screening the stuffing out of employees include Total Wellness, Interactive Health, Star Wellness, Healthfair, and Healthfairs USA. Needless to say they make a lot of money. (Quizzify is very jealous! Doing the right thing and guaranteeing savings isn’t remotely as profitable as ripping off employers.)
- Many wellness vendors are dishonest. We’ve already pointed out that Wellsteps bragged about how they screen every Boise employee every year for everything, with no mention of USPSTF guidelines. But after they got caught, they admitted they knew that the guidelines say the opposite. And Optum’s Seth Serxner insisted — out loud, on tape, that they would be happy to screen according to guidelines, if only employers would let them. And yet, here is Optum’s ad, saying exactly the opposite: if you want us not to raise your rates as much on insurance, it’s a “requirement” to pay us even more than you would save on insurance, to do annual screens. (Naturally they are quoting two sources that they know to be false as well.)
Q; Those are three bad reasons. What are the two good reasons?
I would like to credit Pete Arens for bigly influencing my answer on this. It’s rare that someone does that, and even rarer that I admit it. However, in this case, huge credit where credit is due. Pete’s the man.
USPSTF publishes guidelines, not requirements. It is perfectly OK not to follow them — as long as you have a good reason. The reasons above — ignorance, dishonesty and greed — would clearly not qualify. However, here are some excellent examples of reasons that would:
- You work in a high-stress environment, like a law firm. Making blood pressure screening available easily and much more frequently than once a year, even having some discreetly placed cuffs, might be a good idea. (Some maintain that stress doesn’t cause high blood pressure. Perhaps not, but to them I say, watch Episode 5 of The People vs. OJ Simpson.)
- Your workforce is largely outdoors. Skin cancer and Lyme Disease screens might be indicated.
- You have alternatives to screening (like Quizzify) for younger employees, but encourage and educate older employees and other employees at high risk to get screened. The USPSTF doesn’t say, “no screens.” It says screens should be age- and risk-appropriate. You offer both to everyone (that’s the law) but steer some employees one way and some the other.
- Your company is in the chemical dye or railroad industries. A bladder cancer screen or at least educational session to raise awareness might be advisable. (Bladder cancer can be identified and easily treated very early.)
Mr. Arens raised the question specifically of obesity screens. Are they appropriate at all, especially in a workplace? And that brings us to the other good reason to flout the guidelines: you think they’re wrong. In that situation, make your case. But it has to be a real case, and obesity screening could very well be such a case:
- The Employee Health and Wellness Code of Conduct specifically says, don’t embarrass or single out employees. This would be a perfect example doing exactly that;
- You are unable to find any meaningful literature or technique that is even remotely shown to successfully address obesity for more than a short, clinically meaningless period of time, so why screen for something you can’t address?
- To the extent you, in a corporate setting, do want to make your workplace healthier, you don’t need screens to do that. Encouraging exercise and avoidance of sugary foods at work would have the same impact.
Read carefully: we aren’t saying specifically you have to pass on obesity screens for those reasons. We are saying that if you differ with USPSTF on any screen, disclose the reasons and/or cite the literature, so it looks like a thoughtful decision. This is an example in which we would differ with guidelines.
Q: What would be a funny example of a vendor who tries to attack the USPSTF but falls on its sword?
Glad you asked. That would be Healthmine, whose credibility, um, collapsed as a result. Rule of thumb: to attack USPSTF credibly, a good start would be spelling their name right. We’re just sayin’…
Q: What would be a funny example of a vendor who flouts the USPSTF recommendations?
You’re asking all the right questions. That would be Angioscreen. The only screen they offer, for carotid artery disease, is D-rated by USPSTF.
Q: I don’t see what’s so funny about that. Stupid, yes. Harmful, yes. Expensive, yes. But what makes them so funny?
They admit right on their website that employees shouldn’t get these screens.
Honestly, I’m not sure which of those two things is dumber — offering the screen or admitting working-age people shouldn’t get it. But at least no one can accuse them of lying.
Q: They also can’t spell “New England Journal of Medicine.”
Good point. I didn’t even notice that until you brought it up. Maybe their head of their advisory board can help them with spelling, since “quality control is extremely important” to them.
Q: What does the USPSTF think of the wellness industry?
Their guidelines are intended for use by real doctors and medical practitioners. My guess is that they are horrified by the idea of an entire industry, unsupervised and uneducated, “playing doctor” with employees. Meanwhile, the National Business Group on Health, a vendor-fest if ever there was one, lobbies against the USPSTF for not understanding the importance of screening the stuffing out of employees.
Q: Why do employers go along with overscreening?
That’s a great question. They need only look at their own hospitalization rates to see that hospitalizations from diseases they are trying to prevent by screening, like diabetes and heart attacks, are already ridiculously low. However, rather than look at their own data, they prefer to spout the “86% of illness is caused by chronic disease” meme, which was already discredited when it was 75%, before the CDC decided to jump it up to 86%.
Anybody who reads that article can see that either is an impossibly stupid statistic. Most hospitalizations at most employers have something to do with birth events, and most expense at most employers can be traced to one-time items not addressable through eating more broccoli (neonates, transplants, cancer) or employees who either have a rare disease or more likely have a dependent with a rare disease.
Q: Maybe This isn’t fair, and vendors screen more than guidelines because they don’t think cost should be an issue and that employees should get all the prevention they can possibly use regardless of price
Actually, the USPSTF specifically does not include cost in its analysis. It balances harms and benefits, not costs and benefits. Screening according to guidelines will therefore lose money, as Ron Goetzel just admitted, even if over the long run more employees may benefit from screens than are harmed.
Quite the opposite. Tons of vendors obsess with hyperprevention because they are totally ignorant of the science and math involved. Our favorite is one called: “HEALTHIER is WEALTHIER and ASSOCIATES.” Along with the usually assortment of wellness industry THC-infused folderol (“our program, if followed diligently for a year, will decrease your employee health cost by as much as $24 for every pound of weight loss, an amount quoted by Dr Michael Roisen [sic] MD, Chief Wellness Officer and Chairman, Cleveland Clinic Wellness Institute”), they want to screen employees every three months. Don’t believe us?
Stay tuned for Part 3: Vendors who understand the USPSTF
For this year’s Deplorables Awards, I think we’re gonna need a bigger basket. As a result, this will be a two-part series.
Why? Because we need to accommodate all the bad hombres and nasty women who have subverted the perfect elegant philosophy of wellness into nothing more than a profit machine, with no regard for integrity, customers, or employees.
Yes, 2016 was a year in which a record number self-anointed industry leaders gave lying and cheating a bad name. In that sense it was no different from any other year, though 2016 offered even more good news and bad news:
- The bad news: not content with merely lying and cheating, this cabal branched out into harming employees, fat-shaming, and pure misanthropy;
- The good news: wellness did succeed in one way, as a “natural experiment” showing what happens in healthcare if being a provider requires no credentials beyond a GED, a driver’s license, and a pulse.
Indeed, whatever mathematician first postulated that everyone can’t be worse than average had apparently never experienced the wellness industry. (Exceptions of course, being the few that, like Quizzify, are validated by the Validation Institute or have accepted the Employee Health Program Code of Conduct.)
#10 Optum and Wellsteps (Runners-Up);
What do you do when you need to defend your blatant disregard of the US Preventive Services Task Force guidelines? Simple — you blame your customers. Optum’s Seth Serxner said: “Customers make us” do this. Optum’s PR hack said I was making Optum “look bad.”
I said: “Sure, I’ll apologize. Just name one account that will admit to insisting on paying a higher price than you wanted to charge, in order to screen the stuffing out of their employees.” Never heard from them again.
#9 The Johnson & Johnson Fat Tax gives misanthropy a bad name. (Honorable mentions to Vitality and Ron Goetzel.)
Misanthropy, greed, and weight-shaming provided the wellness industry with its key “talking points” in 2016. And nothing combined the three like the Johnson & Johnson Fat Tax fiasco. The point of the (apparently stillborn) Fat Tax was to stigmatize overweight employees, by “pressuring” (their word) companies into disclosing to shareholders how many fat employees they had. That in turn would somehow pressure these employers into spending more money on wellness vendors.
It’s not altogether clear what that disclosure would do for the actual overweight/obese employees, but somehow this disclosure was supposed to allegedly benefit shareholders. Indeed, the Fat Tax cabal is right about that in one respect: this disclosure would benefit shareholders — it would indicate to shareholders that they ought to unload their shares in a hurry, because management just disclosed it is stupid.
Vitality was a co-conspirator in hatching this scheme, which is ironic because they admitted they couldn’t even get their own employees to lose weight. And where you hear the word “stupid,” can the name “Goetzel” be far behind? This whole thing was his idea, based on the notion that “playing doctor” with employees makes stock prices increase. However, his claim that companies with Koop Award-winning wellness programs outperformed the market can easily be invalidated by anyone with a calculator and a triple-digit IQ.
#8 IBISWorld: How is wellness different from King Midas and Gold?
Here are links to the postings on the most hilarious report we’ve ever read about the wellness industry:
- New wellness industry report costs $5400 (but that includes shipping)
- New report raises the bar for cluelessness in wellness
- How is wellness different from King Midas and gold?
The answer to the question in the header? Everyone who touches wellness turns to stupid. Not just garden-variety stupid. More like fifty shades of stupid.
Mind you, most wellness industry leaders don’t need to touch anything first before reaching that endpoint, but occasionally a company like IBIS, with no prior experience in wellness, ventures into this field — and that’s where the fun starts. These IBISWorld Young Turks (literally–the writer is named “Turk”) are so excited about this industry, they practically speak in tongues:
Wellness firms may offer employers stress management courses and sessions that offer music therapy, aromatherapy, Tai Chi, and post disaster stress reduction through coaching.
Government-funded initiatives that promote wellness to cut costs related to chronic ailments (e.g., obesity and diabetes) has further exacerbated many businesses movement toward purchasing corporate wellness services.
And my own personal favorite:
The industry provides wellness programs to businesses across the United States, including small, medium and large businesses in the private sector and businesses in the public sector.
“Businesses in the public sector”? I knew that many of our legislators are for sale but I didn’t realize they had incorporated.
Healthfairs USA doubled down in 2016 on lying and cheating with an elegant new strategy: insurance fraud. They not only harm employees, but bill insurance companies directly for the privilege of paying for those harms. They offer cancer tests that are “99% accurate” (hence their multiple Nobel Prizes), and over-the-counter nutritional supplements…all of which are covered by most insurance companies because they get a doctor to sign a claim form.
Disclosure: we aren’t entirely sure that billing insurance companies for USPSTF D-rated screens and worthless, possibly harmful, pills constitutes insurance fraud. Our opinion is probably no more accurate than their cancer tests.
In 2014, Aetna decided to “play doctor” with obese members of self-insured customers by telemarketing their employees to pitch very controversial high-priced drugs whose sales are “flailing” because almost no patients seem to want to take them. Among other things, Aetna said these drugs increase productivity even though right on the label, the drugs warn that they could reduce productivity (attention span and language facility).
Not content with the warm welcome that scheme brought them, in 2015 they introduced a DNA-based wellness program and claimed a whopping $1464/participant in savings. What put the whop in that whopper were these two tidbits. These savings were achieved:
- in the first year alone;
- on participants who were not actually sick to begin with. (You couldn’t qualify for this study if you were already sick.)
The reason Aetna needed to fabricate such a high savings figure is that the wellness field requires ROIs greater than 2-to-1, and this DNA test sells for $500/employee. So you need to show savings between $1000 and $1500.
Also, in 2015, we were able to show the program was completely ineffective, a convincing enough demonstration that one of the board members of the journal that published the study with the $1464 claim publicly apologized.
What do you do when it turns out your science is all wrong (news flash: being told you have a gene for obesity doesn’t motivate you to lose weight) and your math is all wrong? Of course, you apologize and retract the study, and offer to return the money to the lucky few companies that signed up for your program.
Haha, good one, Al. Obviously, like all the other Deplorable Award-winners on this list, you sell your snake oil harder than ever, and that’s what gets them on the 2016 list. Whereas in 2015, they could use the dumb-and-dumber defense, this year they know the numbers don’t add up and yet they are still flogging it.
Don’t miss the slam-bang conclusion as we count down to #1. Will Ron Goetzel retain his crown, or will he be unseated as the wellness industry’s #1 Deplorable?
Yes, we realize he has already appeared on this list at #9, but many lists feature the same entities making multiple entries. For instance, the Beatles once held positions #1 through #5 in Billboard’s Top 40, so it can be done.
Not that I want to put any ideas in his head.