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Our best-ever idea for employee health

Here it is. Get ready:

Eat more broccoli. 

Not!


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.

My trip into the “treatment trap” and the birth of Quizzify

Does wondering how Quizzify got started keep you up at night? Wonder no longer.

It was not obvious to combine overdiagnosis with Jeopardy.  That is, unless you were both on Jeopardy, and also were overdiagnosed, which describes me.

In 2012 I was hired to host a radio series for the NPR affiliate in Washington DC (The Big Fix). After the first taping, the producer said so far so good, but I’d sound better after I got over my cold. Unfortunately, I didn’t actually have a cold. Newsflash to those of you who have heard me on podcasts by Josh Luke, David Contorno/Jeff Bernhard, Jen Arnold, Zeev Neuwirth, or anywhere else: this is the way I sound. I’ve been told I have a face for radio and a voice for newspaper.

Nonetheless, not wanting to be fired my first day on the job, and recalling that a few years earlier a doctor told me I had a deviated septum (“we ought to do something about that”), I immediately called my PCP for advice.

My PCP immediately set up an appointment to see an ENT, who determined that my stuffiness was likely being caused not by the deviated septum, but rather by a raging case of the polyps. (“Your deviated septum is the least of your problems.”)

The ENT suggested surgery, Flonase, or Flonase combined with a three-week course of antibiotics. “So,” she asked after quite literally six minutes explaining the options, “which do you want to do?”

“Um, shouldn’t we do the most conservative therapy first?” I inquired.

“Well, you could,” she replied, using a tone of voice implying that only an imbecile would.

Why was this diagnosis and treatment problematic? Six reasons…

 

Q&A about landmark AARP v. EEOC court decision on wellness

UPDATE: Here is the link to a January 18th webinar on this topic.



This is a follow-up to the announcement and “back story” of the December 21 wellness decision in AARP vs. EEOC, a decision which could severely curtail incentives and penalties…and which could, to paraphrase the most memorable G-rated words ever spoken by Bill Clinton, end wellness as we know it.

That’s the bad news. The good news is that as you’ll see later, this decision may actually be a windfall for employers with heavily incentivized wellness programs.


Q: What just happened?

AARP just won a very favorable district court ruling against the Equal Employment Opportunity Commission (EEOC), the agency charged with enforcing the Americans with Disabilities Act (ADA) and the Genetic Information Non-Discrimination Act (GINA). The full decision is here.


Q: How is this different from the previous ruling in AARP v. EEOC?

The original ruling, though in favor of AARP, gave EEOC more than three years to amend its rules to redefine “voluntary” to match the dictionary definition. The new ruling gives one year both for the EEOC to write the rules and for employers to implement the rules, and makes clear what is expected of them. Here  is the key to why this decision should stick:

The government can’t define “voluntary” to include fines of $2000 or more for non-compliance if it also requires a “mandate” — the opposite of a voluntary option — that carries only a $695 penalty for non-compliance.  A voluntary option can’t include remotely as high a penalty for non-compliance as a mandatory requirement, especially in the very same law.


Q: What will remain as of January 2019 that employers can require subject to forfeitures?

It is still OK to offer medical screenings and HRAs (collectively, “medical exams”) OR dangle incentives or fines (collectively “forfeitures”), just as it is today. The difference is that the programs involving required forfeitures can’t also require medical exams, which both the ADA and GINA say can only be “voluntary.” The court ruled that you can’t force employees to undergo “voluntary” exams by dangling or threatening to withhold large sums of money.

So you can still require employee forfeitures up to 30% (50% for smokers), and you can still offer medical exams. You just can’t combine the two. That’s because in order for a wellness program to fall under ADA and GINA in the first place, medical exams must be involved. So, for example, requiring employees to either do screening or do Quizzify is still allowed.


Q: Isn’t this already the “reasonable alternative” language for employees to avoid screening?

No, for two totally distinct reasons. First, those “reasonable alternatives” nonetheless involved medical exams. Second, an employee had to petition. An employee couldn’t just say: “I don’t want to be screened. Give me something else.”


Q: Does this cover screenings only, or are programs combining annual physicals and forfeitures also affected?

A: If the results of the latter are not shared with the employer,  it appears that they may still be require-able. A better question is why an employer would want to require them. First, they lose money.  Second, they don’t appear to benefit employees either. The New England Journal of Medicine, The Journal of the American Medical Association, Choosing Wisely and Consumer Reports (and also Slate) have all looked at the data and concluded that for most people annual physicals confer no net health benefit, meaning even if they were free they would be worthless. (People who have ongoing health issues should of course see their doctor regularly. Those would not be considered checkups under this definition.)

Logically and intuitively, this conclusion would appear to be especially true when employees submit to those physicals under duress. Quizzify — and this question, like most Quizzify questions, carries the Harvard Medical School (HMS) shield — recommends two checkups in one’s twenties, three in one’s thirties, four in one’s forties, five in one’s fifties and for most people annually after that. However, this is also Quizzify’s most edited-out Q&A, as some employers nonetheless want even healthy employees to get physicals every year, and Quizzify respects that choice (though a customized question advocating it could not carry the HMS shield).


Q: These Q&A’s seem very Quizzify-centric.

A: That’s not a question but I’ll answer it anyway. There are two reasons for that:

  1. We know of no other vendor that solves the problem and guarantees the solution, with EEOC indemnification. Quizzify was both conceived and architected in anticipation that this court decision would happen someday. (I just didn’t expect it to happen four days before Christmas, which meant a lot of my cousins got gift cards instead of ugly sweaters.)  All my exposes on the wellness industry led me to conclude that conventional “wellness or else” (as Jon Robison calls it) could never survive a court challenge…and I designed a product specifically to allow employers to address that challenge immediately and completely.
  2. Those of you familiar with my work know I have only three talents in life: wellness outcomes measurement, employee health literacy/consumerism education, and self-promotion.

Your vendor, Quizzify or not, should offer something like this right on their website. If they do, you’re safe:


Q: What other analyses should we be looking at?

The best is The Incidental Economist. AARP hasn’t released a formal statement but their informal back story can be found at the bottom of this posting.


Q: So what should we do about it?

Simply add the option of taking Quizzify quizzes to the option of HRAs/screenings. That one-step fix is guaranteed and indemnified to solve your legal issues. It will also save money both up front (a year of Quizzify costs much less than a single screening) and down the road, because wiser employees make healthier decisions…and healthier decisions save money. Employees also like playing trivia more than they like being browbeaten into promising to eat more broccoli.

If your vendor refuses to add Quizzify via a “single sign on” and you don’t want to add it separately, you can fire the vendor (we can help you do that — if they show a positive ROI it means their outcomes are fabricated, which we can easily demonstrate) and replace them with one that will, of which there are quite literally more to choose from every week.


Q: What happens next?

A: The EEOC needs to rewrite the rules to comply with this decision by making new rules — and needs to do it in 2018 so that they can be adopted and implemented by employers by January 2019. The definition of “voluntary” will be a line-drawing exercise. Likely gift cards and small incentives will be considered “voluntary.” If your incentive falls within whatever cap they decide upon already, you’re fine, with or without Quizzify.


Q: Is this is last word?

A: No.  First, the final rules have yet to be written, as noted above. The rules then have to be approved by the district court.

Along with that uncertainty are two others. The EEOC could appeal, since these days it tends to oppose employee rights, rather than support them. However, the DC Appellate Circuit, led by Merrick Garland, would likely not be favorably disposed towards arguments that require, for example, defining “involuntary” as “voluntary,”  especially when the Court will know that even award-winning vendors harm employees, vendors flout guidelines and screen the stuffing out of employees and give incorrect advice, creating further harms, and that the industry itself is rife with corruption, starting at the top. (I published my last paper in a medical-legal journal rather than a clinical journal specifically in anticipation that it might be the basis for an amicus curiae brief specifically in a situation like this.)

In an unregulated, employee emptor, environment like this, voluntary fines collected by shareholders from employees wanting to protect themselves from the harms above should not exceed fines set as penalties for a mandate, and paid into a pool to create an insurance product. (That the mandate is going away is not relevant — it’s the fact the government has two words with opposite meanings that have inverse fines.)

Alternatively, an Act of Congress could gut GINA. The American Benefits Council could try to convince the legislators their colleagues contribute heavily to, like Virginia Foxx (R-NC5), to push HR1313, for example.  HR1313 is arguably the worst bill of any type ever to clear a Congressional Committee, in that nobody benefits from it (other than DNA collection vendors, for whom it would be a windfall), but the ABC has already demonstrated their disregard for the best interest of its own members by browbeating Rep. Foxx into proposing that bill in the first place.  The ABC is down, but not out…and as this video shows, being down but not out can cloud one’s judgment.

However, since quite literally none of her constituents are helped by this bill and most of them in both parties detest it, Foxx may decide to disappoint her corporate overlords on this one, especially because it’s an election year.


Q: How is HR1313 (or a bill like it) that ABC might propose on behalf of its members (large employers) not in “the best interest of its own members” as noted above?

A: Many employers have finally figured out that even their own vendors know wellness loses money, and that incentives generally don’t change behavior because employees revert to their old behaviors once the incentive ends.  (Incentives do work for Quizzify-type programs, because as you’ll see for yourself if you take the quiz, once you pay an employee to know things, they can’t un-know them. Pay an employee to learn that CT scans are full of radiation once, and they will stop demanding unnecessary CT scans forever.)

However, employers are stuck with these huge incentives now, which some employees expect annually. This rewrite of the “voluntary” rules, likely capping incentives in the low three figures, will allow employers to spend much less on incentives…and blame the government. (Obviously we hope they maintain the incentives and instead just offer the Quizzify alternative. This will also save money due to Quizzify’s low price and a much-reduced number of employees having to follow up on false positives.)

If ABC were to be successful in gutting GINA and allowing financially coercive wellness programs to continue unabated, employers would still have to fork over large incentives.

We interrupt this blog to bring you a special wellness bulletin

Normally we draw a bright line between Quizzify and TSW.  However, today we are going to re-blog from Quizzify, because of the importance of the hazard of tick-borne illness to about a third of the residents of the US.

And also because this particular hazard is getting completely ignored by the wellness industry. I guess that’s because they are spending all their time educating employers and employees on the opioid epidemic. (Not.)

Like the opioid epidemic, tick-borne illness is a far greater hazard than obesity or cholesterol or not taking enough steps. This summer, the odds of an employee getting Lyme Disease, in the mid-Atlantic and Northeast, are probably 5-10 times the odds of an employee having a heart attack.  (I won’t bore — or, in the case of Interactive Health, confuse — anyone with the relative incidence rates, but the numbers add up.)  There are also other tick-borne illnesses — 15 of them — in the other 38 states as well, but not yet in epidemic proportions.


And while my $2-million reward supports the proven observation that heart attacks are about 0% preventable with “pry, poke and prod” programs, tick-borne illness should be 100% preventable by following a few self-evident rules…and one not-so-self-evident rule.

We’d urge everyone in states where ticks are an issue to read the blog post, post the downloadable infographic in break rooms, and educate their employees generally. We are now in high-tick season so it is important to do it soon.

It’s not possible to do attachments on WordPress blog posts (translation: I personally have no clue), but here is a low-res preview:

The following is an unpaid apolitical announcement

We live in an era which can’t exactly be characterized as bipartisan, but every review shows — and as you can confirm by playing the game yourself — all members of every party agree on one thing: Quizzify.

Why? Because employee health literacy is a huge issue. You can’t achieve a culture of health without achieving a culture of health literacy.  And quite literally the only company that addresses it — in an engaging Jeopardy-meets-health education-meets-Comedy Central format, no less — is Quizzify. Literally, the only company of any note. Try googling on “employee health literacy” if you want to see for yourself.

Put another way, why wouldn’t you want to improve health literacy? Is there an argument for keeping employees in the dark, when for about $1 PEPM you could enlighten them? Wiser employees make healthier decisions…and it’s your money they’re making those decisions with.

Or, viewed yet another way, a three-part question:

  1. What is the only expense your employees are allowed to spend unlimited amounts of your money on?
  2. What is the only expense employees can spend your money on without training in how to spend it?
  3. How do your answers to those two questions make any sense in combination, or even individually?

The specific occasion for this posting is a terrific article in Workforce about Quizzify, featuring one of Quizzify’s many valued customers (and such a power-user that Quizzify routinely incorporates her edits into the main question database), Debbie Youngblood of the Hilliard City Board of Education.  While we encourage reading the article in its entirety, here are a couple of tidbits, starting with a quote from Debbie:

“I’ve always felt that there was a need to have more [information] available to people as they go through their stages of life,” she said. “It always surprises me that we expect people to know how to achieve overall well-being. We’ve given them very little opportunity to know, understand and practice the things that might be beneficial…”

She also believes it’s valuable to educate adults on health-related topics because it drives conversation. She sees employees discussing topics and questioning the information gained through their health literacy program.

To summarize…

Employees are talking about Quizzify.  About what they learned, what surprised them, and what they would do differently now. By contrast, employee comments about conventional wellness can’t be repeated in a family publication like TSW. Here are some of the more printable ones.  Oh, yeah, and don’t forget these.  (To be fair, occasionally an employee does benefit.)

Another tidbit in the article describes (in as many words) how Quizzify and Hilliard have morphed “cheating” into “learning.” Employees are encouraged to look up the answers in order to improve their scores. That’s how they learn — which of course is exactly what Ms. Youngblood and Quizzify want them to do. So employees brag about what they’ve learned, whereas in other wellness programs they brag about how they cheat.

Consequently, companies that think they’re creating a culture of health are instead creating a culture of deceit. Call us wacky idealists, but for $1 PEPY (in lieu of the likely much higher fee you are paying now), you could replace that culture of deceit with a culture of health literacy. Why wouldn’t you?


Disclosure
TSW principals, while not salaried by Quizzify, have an ownership interest in it. However, this site is not affiliated with Quizzify and opinions expressed in this blog are our own. Except this one, which seems to be shared by everyone.

Wellness program quote of the day

An uberfit Ultimate Frisbee teammate of mine reported that his company’s wellness vendor asked if his doctor had measured his waist size.

“No,” my friend replied. “He’s not a tailor.”

The Great Debate, Part 6: Goetzel Throws HERO under the Bus

The question-and-answer period is now underway.  

If you are just joining the thread, this is Part 6 of The Great Debate, a November 2015 exchange between Ron Goetzel and me, at the Population Health Alliance Annual Leadership Forum. Part 5 is here.  You can download the audio here


1:09:00

To the question: “What would you do to reduce healthcare costs?” Ron replies that he is “focused on prevention.” And that’s the issue.   I point out that “too much of anything is bad for you, ours is already the most over-prevented society on earth, and these programs are all out of compliance with guidelines.”  All these programs screen everybody far more than guidelines advise. Here are the guidelines. Find anything other than blood pressure where the wellness industry’s obsessive annual screens are recommended.

[Postscript: after the debate, the Connecticut study came out, showing that overprevention through wellness increases costs, as one would expect.]


1:12:20

The moderator asks how can Quizzify be the most effective company in employee health education.  He challenges our 100% guarantee of savings. This is ironic. No wellness company offers any meaningful guarantee of savings, for the simple reason that it is mathematically impossible to save money in wellness.

Somehow in wellness, guaranteeing savings is a bad thing but losing money is a “good thing.” (Really, a direct quote — click on it.)  It’s curious to challenge someone’s own willingness to guarantee their own results as part of their own business.  Obviously, if my business judgment is wrong, Quizzify will fail. And what I didn’t say because I didn’t want to brag, is that people questioned my last business venture too, Matrix Medical. Fast forward: Matrix is now the most valuable population health company start-up of this millennium.  (Before you ask me to lend you money, we mostly sold out on the “cheap” in 2013 to a private equity firm named Welsh Carson.)


1:13:40

Ron Goetzel endorses Quizzify. He went on the website and played the game. “It was a lot of fun. Very clever.”  Then he asks — quite justifiably — how Quizzify can make problems like obesity and smoking go away.  The answer, of course, is that Quizzify isn’t going to make obesity and smoking go away any more than wellness does.  For example, consider McKesson’s Koop Award-winning program, where both weight and smoking went up.  We can’t do worse than that. If we did, we could win a Koop Award.

Instead, Quizzify guarantees reductions in overall healthcare spending on “low value care.” As you can see from the demo on the website, we also educate people on hidden sources of sugar, of which there are more than you can count, but we don’t expect immediate savings from this and other nutrition/smoking education questions. Immediate savings are provided by our emphasis on avoiding low-value care.


1:15:00

Consistent with his theme of running away from his own work, Ron now runs away from his own HERO Report.  Keep in mind two things as you listen to this section:

  • Ron is disowning his own report. He is on the board of HERO, a tidbit which he overlooks in this hasty retreat;
  • Within days of this debate, he was circulating his famous poison pen letter to the media completely owning it, and accusing me of reading it too carefully.

The moderator (who otherwise moderated fairly) for some reason jumped in and said the HERO Guidebook just used an allegedly hypothetical example to show losses.  Since their “example” costs were $18/employee/year as opposed to the more typical $100 AND since the HERO example failed to control for the countrywide decline in wellness-sensitive medical events, the HERO example grossly underestimated losses from wellness.

Ron says “those numbers in [my HERO Guidebook] are wildly off,” and “have nothing to do with reality.”  He says I “misrepresented and misinterpreted” these figures.  But they are right there: A program costs $1.50 PEPM and saves $0.99.  What’s to misinterpret?   Ron apparently hadn’t noticed that his little Guidebook accidentally told the truth until I pointed it out — exactly like he hadn’t noticed that Eastman Chemical/Health Fitness self-invalidated. In both cases if fell upon me to point it out to these Einsteins.

Here is a posting showing what happens when you adjust those HERO figures for Mr. Goetzel’s alternative “reality” — losses skyrocket, just like Health Affairs showed in the Connecticut study.

Perhaps HERO would have more credibility telling us that wellness saves money if their own allegedly* “fabricated” example and any of the legitimate literature supported that claim. I’m just sayin’…


*The word “allegedly” is used because the example in the HERO guidebook is not a “fabricated” or “hypothetical” example. The words “fabricated” or “hypothetical” do not even appear in the chapter. Instead the example is an actual report. That’s why the Guidebook says it’s a report, and gives very specific details of the report–in the past tense, no less, as you would for a completed report. A “hypothetical” would use the present tense throughout, along with saying that it’s a hypothetical.

heroreportp22language-on-report

And like:

hero-report-language-p-23

So Ron’s whole argument about this being somehow a hypothetical is shot, just like all his other arguments, by showing his own data.



To summarize Ron’s view so far in this debate: everyone who thinks wellness is a total waste of money — including RAND, basically all the media and every economist who has looked at it in the last six years — is wrong.  Every time his own materials accidentally tell the truth and say wellness loses money, they’re wrong.  

And as we’ll see in the next installment, every employee who hates their company’s wellness vendor is either in a bad program or they are a bad employee.

Basically everyone is out of step but Ronnie.

 

 

Tom Emerick reviews Quizzify: “There May Be a Cure for Wellness.”

Not all wellness vendors are as bad as Slate makes them out to be. Companies whose names begin with “Q” are doing quite splendidly.

Quizzify’s stack of stellar reviews and reviewers (see Employee Benefit News, Not Running a Hospital (Paul Levy), and Bob Merberg) now includes Tom Emerick, who just wrote an Insurance Thought Leadership review entitled: There May Be a Cure for Wellness.

Far be it from us to discourage anyone from reading the full review, but here are some excerpts:

“Quizzify…transforms the boring but long-overdue task of educating employees about health, healthcare and their health benefit into an entertaining trivia game.”

“Quizzify provides a plethora of shock-and-awe, ‘counter-detailing’ questions-and-answers (with full links to sources) that will educate even the savviest consumers of healthcare and entertain even the dourest CFO.”

“Scores and scores of people have told me they fudge answers on HRAs. Interestingly, they feel they are on the ethical high ground to do that because of the goofy, nosy and intrusive questions they are asked to answer, e.g., asking about your [future] pregnancy plans… Quizzify, on the other hand, encourages people to cheat. Quizzify wants you to look up the answers because that’s how you learn. So instead of denying human nature, Quizzify channels it.”

Tom also addresses the concern that employees might think Quizzify is all about trying to keep them from spending money on healthcare:

“On the other hand, there are instances where people should go to the doctor but don’t. Swollen ankles? Painless, perhaps, but you may have a circulation problem, possibly a serious one. Blood in your urine, but it goes away before you even make an appointment? That could be a bladder tumor tearing and then re-attaching itself, especially if you smoke. And show me one health risk assessment that correctly advises people over 55 or 60 to get a shingles vaccine if they had chicken pox as a kid.”

That last point is pretty emblematic of the difference between wellness and Quizzify. It’s a classic example of wellness vendors wasting opportunities to actually provide employees with useful information. Virtually no HRA advises shingles vaccines for the relevant subset of employees.

Conversely, to focus on one of the longstanding obsessions of wellness vendors, there are no questions in Quizzify where the answer is: “Buckle your seat belt.” We figure HRAs have that covered.

We would also observe that if your employees don’t realize they should buckle their seat belts, wellness is probably not your biggest problem.


Boring but Important Disclosure: While this blog is independent of Quizzify, I am a principal in Quizzify.

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