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Four More Vendors Caught…Doing Something Right

The popular perception is that They Said What tries to catch vendors doing something wrong.  Nope – they generally self-immolate and we just take screenshots.  Or as we say, in this industry, “you don’t have to challenge the data to invalidate it.  You merely have to read the data. It will invalidate itself.”

Yet no matter how screamingly obvious the data, a journalist, essayist, or blogger loses credibility if they always say the same thing.  That’s why we try very hard to catch vendors doing something right.

For us to do that, vendors have to give us the opportunity – by actually doing something right. To avoid being judgmental, we like to see them independently validated for, in as many words, “doing something right.” Validated not just by anyone, but by the Care Innovations Validation Institute. Care Innovations, a wholly owned subsidiary of Intel Corporation, launched the Validation Institute in 2014 to provide companies with 3rd party validation of their outcome claims.   (Disclosure: while I am neither a Validation Institute employee nor an advisor, my book Why Nobody Believes the Numbers provides the methodological basis for some of their validations, and they sometimes retain me as an outside expert/validator.)

The Validation Institute is the Gold Standard of validation.  Everything is vetted carefully and has never been challenged. Validation can be done two ways: on the basis of valid contractual representations or on the basis of actual outcomes.  The vast majority of validated organizations have the former, because their outcomes to date are insufficient for the latter.  An example of contractual language validation would be Quizzify’s savings guarantee. (Disclosure: I founded Quizzify. The validation for Quizzify was obviously conducted by another of the Validation Institute’s team of 3rd party, independent validators).

While many companies guarantee or show savings, it turns out the language used in that guarantee or demonstration of savings determines whether savings can quite literally happen on their own due to faulty study design or whether they truly reflect underlying improvements.  Quizzify, for example, couldn’t get outcomes validation because it hasn’t been around long enough to apply these valid contractual representations/guarantees to its own outcomes.

By contrast, the four organizations below are among the few whose validation is specifically outcomes-based – meaning these companies took the next step and what they say they did, is what they actually did.

Even so, if you read the validation language carefully, you’ll see it never exceeds what the outcomes data allows.

Alphabetically, we look at each of these four in some detail, describing the outcomes that were achieved. Just to reiterate, these four companies are among the very few in population health that can lay claim to outcomes improvement, measured validly.  Why? Because any company that could get Validation Institute validation, would.  (Quizzify sought it as soon as we had language that could be validated…and are very pleased with the attention it has brought us and the doors it has opened.)

Evolent Health: Focused on the Most “Impactable” Patients

Evolent is the first value-based care company with a complex care management program to show savings.  Typically, companies compare the “pre” cost to the “post” cost, but anytime you target a chronic group that is high-need, high-cost, the “post” will always look better compared to the “pre.”  Statisticians dryly call this regression to the mean and many vendors claim credit for the decline in cost when it had nothing to do with their interventions.

Instead, Evolent showed savings the hard way – by actually achieving them.  They measured how much the cost of high-risk chronic patients declined on their own and then only took credit for the additional reduction. Suppose you have a magic potion to flip 100 coins from heads to tails.  If only 50 flip, your potion is worthless; the probability of landing on tails is already 50-50. If 60 coins flip, the Validation Institute would give you credit for 10.  Evolent showed that their program lowered utilization and costs beyond the reductions that would have happened anyway.

In a field known for the time lapses between a patient’s need for care management and its delivery, Evolent’s more advanced predictive modeling (covering more datasets than a carrier would typically use) expeditiously determine those at highest risk of having an “impactable” event.  Further, whereas most such programs focus on just checking off boxes, Evolent intervenes across the spectrum of clinical, behavioral, social, nutritional and environmental domains.

Having reviewed many of these programs, I’ve been shocked by how long it takes them to find and enroll patients, how little they do for the patient, and how little they know about what they’re doing. Evolent is the opposite.  This is their business, not a sideline – they take it seriously and it shows.

Healthways Well-Being: It’s Not Just about the Cholesterol

For the uninitiated, the philosophy of well-being is to address gaps not just in employee physical health but – as importantly – in their emotional, financial, occupational and social health.  In many cases, those latter issues are the root cause of high healthcare spending and low productivity.  Addressing those issues should help a given population – from the healthy to the sick – perform noticeably better while possibly spending less on healthcare.

Before you even heard of “well-being,” Healthways was measuring it, more than a decade ago. Since 2008, Healthways has partnered with Gallup to definitively measure well-being via the Gallup-Healthways Well-Being Index, the most proven, seasoned and comprehensive measure of well-being in populations in the world.  Quite literally, if there is any component of this industry which has penetrated the public consciousness in a positive way, it’s the Gallup-Healthways Well-Being Index, whose publication often reaches the lay media.

Healthways can use surveys, down to the community level, to benchmark similar surveys for companies, departments and employees, so that organizations can focus their improvement efforts where they are needed most.  The Validation Institute has confirmed Healthways’ findings that in fact performance (holding constant as many other variables as possible) correlates far more closely with indicators of well-being than with biometrics alone.  This data collection, insight and benchmarking allows targeted interventions to complement or replace conventional wellness…and get closer to the root cause of underperformance.

Rarely is the root cause of poor health “I-don’t-care-itis,” as one wellness vendor calls it. Often it’s a different personal issue. Sometimes the root cause is department-specific. This data can be used to identify managerial or process flow issues far beyond the scope of – and far more powerfully than — conventional wellness.

Quantum Health:  the Story Tells Itself

While I make more general comments about the other vendors on this list, I don’t need to for Quantum Health. They were the first and are still the only company validated for total savings across an entire organization.

Instead I will share a story that shows how their incentives for members to call in – combined with their non-siloed approach to those calls – create a confluence of time and place that change behaviors and likely outcomes.

Once, when I visited them, an employee of a new customer called, asking if diabetic shoes were a covered benefit. In most, if not all, carriers, the employee answering that query would be evaluated based on accuracy of the answer, number of rings, politeness and how many calls they handled that hour. So the person would say “yes” or “no” and then get off the phone. At Quantum Health, the agent answered the query but was prompted by the supporting software (and by training) to recognize that question as a red flag. Here was an employee whose diabetes was already so advanced he was asking about shoes…and yet he was nowhere in the diabetes registry. A typical carrier wouldn’t find out about this person until after the inpatient claim for his inevitable crash was filed, warehoused, prioritized and queued for telephonic outreach. And then, assuming the carrier had the correct phone number, and this patient answered the call and was receptive, rehabilitation could begin.

And yet there he was – right on the phone – asking for help. So the agent probed a little further and then transferred him to a nurse in the same pod, who engaged him right away, almost certainly avoiding or forestalling a future high-cost medical event.

US Preventive Medicine: Finding the Formula

The editor of the American Journal of Health Promotion, Michael O’Donnell, famously admitted that up to 95% of wellness programs fail. U.S. Preventive Medicine is squarely in his other 5%.  As quite literally the purest wellness program validated by the Validation Institute, USPM has – alone in the wellness industry – found the formula for a significant and sustained reduction of wellness-sensitive medical events (hospitalizations and ER visits).

The Validation Institute analysis showed that USPM generated a sustained average 41% reduction of hospitalizations and ER visits across several chronic conditions (Diabetes, Asthma, Coronary Artery Disease, Hypertension, Chronic Obstructive Pulmonary Disease and Congestive Heart Failure) over a four-year timeframe, significantly outperforming the averages as tallied by the Healthcare Cost and Utilization Project (HCUP). USPM provides a unique data-driven, high-tech and high-touch combination of conventional and unconventional interventions to enhance engagement and translate that engagement into actual behavior change.

The Validation Institute has publicly urged all wellness vendors to collect real data, apply their value event rate-based template (the only methodology that They Said What and HERO agree on, as also described in Health Affairs), to see if they can match USPM’s performance…and so far, none have come close.

Michael O’Donnell might have been optimistic in his assessment—the failure rate seems much higher. But it’s not 100% — USPM is the exception that proves wellness can indeed be done successfully…if all the components fit together.

Goofus and Gallant Meet Viverae and Quizzify

Goofus and Gallant is a Highlights for Children feature contrasting different behaviors.  Example:

goofusGallant2


Viverae’s and Quizzify’s guarantees lend themselves to this type of comparison. Honestly, we don’t even know if Viverae still offer theirs. Nonetheless, through the years a number of people have sent it to us and asked for our help interpreting it. (That’s a polite phrasing of what the emails said, and of course we are nothing if not polite.)  It provides an excellent opportunity to learn how to read a guarantee with a discerning eye, and we thank Viverae for offering it and hope they too are able to gain some insights from our analysis of it.

Here is Viverae’s guarantee, which we will review clause by clause:

viverae


Goofus: Viverae’s Clause #1 doesn’t allow any leeway in program design.

Gallant: Quizzify offers the guarantee even if you want to tweak the program design.


Goofus: Viverae’s Clause #2 is an EEOC violation. You can’t “require” employees to do biometric screens. The program wouldn’t be voluntary. You might as well just send a memo to your employees with the phone number of the EEOC and tell them to sue you.

Gallant: Quizzify guarantees no EEOC lawsuits, and actually indemnifies against them.


Goofus: Viverae’s Clause #3 would seem fairly self-evident–except that in wellness, as the example at the end of this posting* shows,  some wellness vendors don’t know there are 12 months in a year.

Gallant: Quizzify assumes its customers know that a year has 12 months in it, so this clause isn’t part of our guarantee.


Goofus: Viverae’s Clause #4 requires you to not only sign up for 3 years to get this 20% guarantee in the third year only, but also to waive your rights to early termination.  So basically they are saying: “If you sign up for 3 years with no ‘out’ clause, we might possibly give you a guarantee worth 6.67%/year on average, assuming we measure validly.”

Gallant: Quizzify’s price list offers customers discounts exceeding 6.7% a year for multiyear contracts anyway, even before any guarantee, and allows not-for-cause termination for a small upcharge.

Gallant: Quizzify’s guarantee is 100% in all years, not 20% in year 3.


Goofus: Viverae’s Clause #5 requires a minimum number of 1000 employees, making it off-limits to more than 98% of America’s employers.

Gallant: Quizzify offers a straight 100% satisfaction guarantee if the number of eligible employees is too small to measure savings objectively.


Goofus: Viverae’s employee incentive/penalty requirement in Clause #6 is the “maximum allowed by law.”

Gallant: Quizzify requires a minimum incentive of only $100. We believe that the program should be attractive enough that you don’t need to force employees to participate.


Goofus: Viverae’s Clause #7 requires all carriers and PBMs for all years to turn over all employee-identifiable claims files. Since Viverae is not HIPAA-compliant, that creates a HIPAA issue.  (In all fairness to Viverae, most wellness vendors are not HIPAA-compliant. Quizzify is the exception.  Quizzify doesn’t collect or store private health information, so HIPAA doesn’t apply.)

It also means Viverae determines how much money Viverae saved, with no oversight.

Gallant: Quizzify allows the customer or its consultant to complete its simple claims extraction algorithm and determine savings, or Quizzify can do it for them. Its claims extraction algorithm is the industry standard required by the Intel-GE Care Innovations Validation Institute.

Speaking of the Validation Institute, Goofus’s guarantee is not validated by them.

Quizzify’s is.

validation institute seal


Postscript:

Gallant reminds readers that both he and Goofus are trademarks of Highlights for Children so don’t even think about using these characters without attribution.

Goofus sprinkles Gallant’s DNA at crime scenes.


*Avivia “three-year” study of drug adherence:

kaiser three year study

If you like this example, you’ll love This Is Your Brain on Wellness

Something in Wellness that Actually Works (Pinch Me)

Yes, I know it’s not always about me (my ex-wife was quite clear about that) but we did just receive our first “review” of Quizzify from a major, highly respected healthcare blogger, Paul Levy, former CEO of Beth Israel-Deaconess Medical Center in Boston. (Disclosure: I do know Mr. Levy socially, but nowhere near well enough to convince him to lie for me.)

Because there are so many new scams in workplace wellness to expose (and every time we expose one, they come up with another, this being our favorite example of invalidity-meets-Whack-a-Mole), we don’t have time for a lot of selfies.

Today is one of those rare exceptions.  Here is the summary of the review:

“If I were in the corporate world, I’d seriously consider offering this service to my employees.  The messages learned are much more likely to have a beneficial effect on people’s health and on their use of the health care system than a lot of the more invasive programs being forced on employees.”

 If anyone out there would like to play the Launch Quiz — the first step in creating a culture in which employees understand that wise and cost-effective choices in healthcare extend way beyond eating broccoli, obsessing with cholesterol, walking 5000 steps, and buckling seat belts — let me know and I’ll set you up.


 

Update January 12: Here is a comment submitted on the original blog. We think it captures the essence of workplace wellness — the bewilderment by an employee that HR thinks these things could possibly save money, and the running joke in this person’s office that the program has become:

My employer has added a wellness program. I’m not sure if its the same category as the Safeway ones that you refer to, but what it does is give funds to a health-care account for completing programs run by an outside wellness company about healthy eating, meditation, stress, etc. You can get $100 or so in real money (spendable only on health care) for doing these, up to a capped amount. So the cost to the company is this money plus whatever the 3rd party charges to run it.

If the research shows these to be effective, I can’t imagine how. People joke about going “click, click, click” until they’ve completed as much of a program as they are allowed that day, then coming back a day or two later for more.

 

 

Just because it’s healthcare, doesn’t mean it’s good for you

Wellness is about pushing employees into the healthcare system, almost always both against their will and their better judgment.  This story is a perfect example of the consequences of how too much healthcare can be hazardous to your health, and why your best defense against overdoctoring is knowledge.

Once you start asking questions, doctors have to start answering them.  While many doctors welcome that, others start fidgeting.  If your doctor is one of the latter, it’s probably time to switch.

I myself get occasional bladder tumors.  Ironically — and once again, showing the unintended consequences of wellness — I got bladder cancer from eating more broccoli, which of course is exactly what wellness programs would have us do.  (And which, in all fairness, is generally a good idea.)  The problem was that the broccoli was grown in a garden that was way too close to railroad ties, which leach creosote into the soil.  Creosote causes bladder tumors.

So every few years, one grows back and has to be scooped out “non-invasively” (that’s easy for the doctor to say).  And every year I go in and get checked, also “non-invasively”.  After my last check, the urologist — a new one, whom I had never seen before — suggested a CT scan of the kidneys and ureters.

I asked her why, and she said, because I had had bladder cancer for 15 years and never had this scan.

I replied: “Well, I founded a company, Quizzify, that educates on overutilization.  CT scans have 500 times the radiation of x-rays, and that particular set of views is likely to spot tumors on my adrenal glands that are completely clinically insignificant, and yet once spotted will be tracked and possibly removed, for no good reason other than that they are there.”

She said: “OK, why don’t we just start with a urinanalysis.”

Quizzify Q in B and W

Quizzify Q&A is your tool to save employees’ time & money

From a hazardous and likely counterproductive $1000 scan to a $10 urinalysis in 30 seconds.  That’s what knowledge is worth.

 

 

Hyperdiagnosis: The Wellness Industry’s Anti-Employee Jihad


Healthmine just released a survey bragging about how many employees were diagnosed through wellness programs. That reminded us of our popular 2013 posting on The Health Care Blog called Hyperdiagnosis.  We are re-posting and updating it below.   


By now we are all familiar with the concept of overdiagnosis, where “we” is defined as “everyone except the wellness industry.”

Wellness vendors haven’t gotten the memo that most employees should simply be left alone.  Instead, they want to screen the stuffing of employees, at considerable cost to the employer and risk to the employee.  The wellness vendors who overscreen employees the most win awards for it, like Health Fitness Corporation did with the Nebraska state employee program.

We call this new plateau of clinical unreality “hyperdiagnosis,” and it is the wellness industry’s bread-and-butter.  It differs from overdiagnosis four ways:

  1. It is pre-emptive;
  2. It is either negligently inaccurate or purposefully deceptive;
  3. It is powered by pay-or-play forfeitures;
  4. The final hallmark of hyperdiagnosis is braggadocio – wellness companies love to announce how many sick people they find in their screens.

1. Pre-Emptive

Overdiagnosis starts when a patient in need of testing visits a doctor. By contrast, in hyperdiagnosis, the testing comes in need of patients, via annual workplace screening of up to seventy different lab values–most of which, as They Said What? has shown, make no clinical sense.  Testing for large numbers of abnormalities on large numbers of employees guarantees large numbers of “findings,” clinically significant or not.  The more findings, the more money wellness vendors can add on for coaching and the more savings they can claim when they re-test.

2.Inaccurate or Deceptive

Most of these findings turn out to be clinically insignificant or simply wrong, no surprise given that the US Preventive Services Task Force recommends universal annual screening only for blood pressure, because for other screens the potential harms of annual screening outweigh the benefits.  The wellness industry knows this, and they also know that the book Seeking Sickness:  Medical Screening and the Misguided Hunt for Disease demolishes their highly profitable screening business model.   (We are not cherry-picking titles here—there is no book Here’s an Idea:  Let’s Hunt for Disease.)  And yet most wellness programs require employees to undergo annual screens in order to avoid a financial forfeiture.

Hyperdiagnosis also obsesses with annual preventive doctor visits.  Like screening, though, annual “preventive” visits on balance cause more harm than good.  The wellness industry knows this, because we posted this information on their LinkedIn groups, before we were banned from most of them.  They also presumably have internet access on their own.

3. Pay-or-play forfeitures

The worthlessness, the inconvenience, and the privacy invasion make screens very unpopular.  The wellness industry and their corporate customers “solve” that problem by tying large and increasing sums of money annually — now $694 on average – to participation in these schemes.  Yet participation rates are still low.

4. Braggadocio

While doctors are embarrassed by overdiagnosis, boasting is an essential ingredient of hyperdiagnosis.  We’ve already blogged on how Health Fitness Corporation bragged (and lied, as they later admitted) about the number of cancer cases they found in Nebraska.  They also bragged about the rate of cardiometabolic disease they found — 40% in the screened population — even though they admitted almost no employee did anything about those findings, and only 161 state employees reduced risk factors.  Hence, it was the worst of both worlds:  telling people they are sick without helping them get better.  Nothing like telling someone they’re sick to increase their productivity.

Compass Health is our favorite example of hyperdiagnosis braggadocio.  We realize this screenshot is a bit tough to read, but the hilarity is worth the effort.  We pulled this vignette from On The (even) Lighter Side, They Said What?‘s most popular feature.


The Definition of a “Healthy Employee” Is One Who Has Not Been Diagnosed by Compass Health

Feeling fine today?  Alas, you better get your affairs in order, bid your loved ones adieu, and watch the shows you’ve DVR-ed.  Why? Because, dodo-brain, feeling fine means you have:

compass health title I feel fine syndrome

You are “walking around without a clue that [you have] a debilitating or terminal condition.”  According to Compass Health (which at this point, having been “outed” by us, had the good sense to take this off their website…but not until we captured a screen shot), the major symptom of I Feel Fine Syndrome is:  not having symptoms.

We’ll let them take it from here, to display not only their epidemiological prowess but also, this being the wellness industry, their grammar and spelling prowess as well:

compass health screen shot2

We must confess we learned a lot from Compass.  We had not realized that employers’ concerns about employees feeling fine had their roots in ancient history.  But there it is, right in the opening words:  these concerns date back “millenia” [sic], when employers failed to get their employees tested for “percolating” conditions before throwing them to the lions.

So the bad news is that feeling fine may be hazardous to your health.  The good news is that your ICU bed may not need a DNR notice anytime soon because elsewhere Compass says it “has programs and solutions to help your employees overcome their I Feel Fine Syndrome.”  And it is “very likely” these programs and solutions can “completely cure the problem…forever in our bodies.”

And not a moment too soon, because we’re never felt better in our lives, which means the clock is ticking.  That’s the good news.  The bad news is, if we join Compass’s program it sounds like we need to start contributing more to our 401K’s.


 

Summary

We’d like to think that all our exposés have made a dent in the wellness industry’s business model, but the forces arrayed in the other direction have so far overwhelmed us.   The price of screening has plummeted almost to the $1-per-lab-value level for comprehensive screens, and as with anything, the lower the price, the greater the amount sold.

Couple those economics with the advent of genetic testing as part of wellness, big and profitable fines for non-participants, and the EEOC being defanged as a sop to the Business Roundtable, and it’s clear the wellness industry’s highly profitable hyperdiagnostic jihad against the American workforce has barely begun.

By contrast, Quizzify teaches employees that “just because it’s healthcare, doesn’t mean it’s good for you,” and to only get screened according to the USPSTF guidelines.  That’s a message that employees would love to hear, but that wellness vendors can’t afford to tell them.

We Concede the HERO Report is right–wellness does lose money

The HERO Report concludes that wellness loses money.  We agree.  We also think it loses much more money than they will admit to, but the news here is not about us.  The news is that more than 3 dozen self-described experts and industry leaders representing more than 2 dozen companies have reached consensus that their industry loses moneySlide1

Count us more shocked now than we were by the report’s admission that wellness adversely impacts morale, (This is covered in Installment 1.)

Together, the HERO findings — and our broad consensus with those findings — have serious Affordable Care Act policy implications.  The entire basis for the ACA “Safeway Amendment” allowing large fines for (among other things) failure to lose weight is that the cost savings from skinnier employees merits invading their privacy, dignity and automony through medicalizing the workplace (“companies playing doctor” as some have called it).  Senate committee hearings, proposed new legislation, and EEOC lawsuits around this provision have all been based on the assumption that wellness saves money.  The Senate committee never even lobbed a softball question about that assumption, and even the more hostile witnesses didn’t challenge it.

Recently there was even an eyeball-to-eyeball encounter between the Business Roundtable’s (BRT) Gary Loveman and President Obama.  Even though his company (Caesar’s) went bankrupt while embracing wellness as essential to their profitability, Mr. Loveman argued that corporations should be allowed to fine workers who don’t lose weight because the benefit to corporate bottom lines would trump both privacy concerns and the substantial health hazards of these programs.

gary loveman

Gary Loveman, Business Roundtable

 

Apparently, though, Mr. Loveman’s company went bankrupt slightly faster because of wellness.  Yes, along with employees, employers would be better off without forced (highly penalized or incentivized) workplace medicalization.  If you fire your wellness vendor, everyone benefits.

Everyone, that is, except the wellness industry denizens who make their money off this.  That’s why we think HERO spoke the truth unintentionally.  Very few people (I was one of them, having switched sides in 2007 when I saw that data failed to support wellness/disease management) willingly undermine their own incomes for integrity’s sake.  So this posting will proceed on the basis that is was a gaffe on their part.

Curiously, this is the second time in recent months wellness industry leaders have accidentally admitted wellness loses money, and the third time they’ve accidentally told the truth and had to walk it back.

Equally curiously, wellness economics information disseminates very slowly if at all — testament in large part to the absolutely brilliant and flawlessly executed strategy by the Wellness Ignorati of ensuring that facts get ignored (hence their name).  So even as the vendors are admitting that wellness loses money, benefits consultants and HR executives have once again pushed participation incentives/penalties to new highs, a whopping $693/employee/year, according to a new report.

As for the figures themselves, we are also attaching a spreadsheet so that you—as an employer—can figure this out on your own in your own population, rather than just take HERO’s word for it that wellness loses money.

The costs, according to the HERO report’s own screenshots

First, review the screenshot from the first installment, showing the costs of wellness.   The list of cost elements is fairly exhaustive –down to the level of a space allocation for a health fair — though the Committee conveniently left out consulting fees.   No surprise there, given that Mercer consultants sit on the committee.

HERO list of costs

Then, compare the list of costs in that screenshot to costs in this second screenshot, from Page 15 of the HERO Report.  That comparison won’t take long because only one program cost is listed:  “$1.50 — Cost of EHM [Employee Health Management] PMPM fees.”

HERO list of costs

The two lists of costs are totally inconsistent.  Suddenly, when it comes time to measure ROI on page 15, most of the costs on Page 10 have disappeared…

The reason for that?  The savings from wellness – in the HERO committee’s own words below – are so trivial that in order for wellness to produce savings, the second screenshot has to ignore most of the costs listed on the first one.  Whereas the first screenshot listed three categories of costs covering 12 different line items (13 if you count the AWOL consulting expenses), the second screenshot says you should only count one item:  vendor fees.

And by the way, the vendor fees themselves self-invalidate.  At about $40 per employee per year, biometric screening fees alone cost more than the stated $1.50 per person per month, or $18/year.  Yet $18/year is the total they list for all fees combined, including the $40 screenings.

Rather than point out the many cost elements on the first screenshot missing from the second, we’ll invite you to use our spreadsheet and enter your own data instead of theirs.  Simply fill in your own direct costs of wellness.

Whatever number you get will dramatically understate your true costs because there are three elements of cost that we aren’t counting on this spreadsheet:

  • What their spreadsheet call the “indirect” costs, which we have listed as “$0”,
  • What their spreadsheet calls the “tangential” costs of damaged reputations and employee morale—ask Honeywell whether they brag about their wellness fines and lawsuit in their recruiting (and, ironically, I just returned from a consult for Penn State itself, where the adverse morale impact still overhangs employee relations);
  • The massive costs of overscreening, overdiagnosis, and overtreatment generated by biometric screens – all of which are conducted far more often than the USPSTF recommends and most of which (as in the examples we occasionally post on this site) include screens that no one other than a wellness vendor or consultant would ever propose.

The financial benefits

Against those costs are the benefits. Page 15 lists some alleged benefits of wellness that leave us scratching our heads.

Generic substitution?  How does that have anything to do with wellness?  Quite the contrary, obsessing with wellness might take your eye off the generic substitution ball, and cause you to miss some tiering opportunities.  (The company that is best at tiering its pharmacy benefit, Procter & Gamble, is also known for its current employee-friendly wellness program, sort of the anti-Honeywell.)   And has anyone ever seen one health risk assessment (HRA) or participated in one health screen that even mentioned generic substitution?

Outpatient procedures?   Try to find one person in your organization whose outpatient procedure could have been prevented by eating more broccoli.

ER visits?  Maybe they decline.  But maybe they increase, due to sports injuries sustained by newly activated employees.  And someone who really is eating more broccoli might slice their finger chopping the crowns off the stalks.  (Anybody who voluntarily eats the crowns with the stalks still attached doesn’t need a wellness program.)

And then the catch-all:  savings through “overall wiser use of healthcare.”  Come again?  This is an industry that — as well documented by their own words captured on this website — makes its living telling employees to do exactly the opposite:  go get checkups you don’t need and won’t benefit from, submit to screens far in excess of USPSTF guidelines so that vendors can brag about how many sick people they find, yo-yo diet for “biggest loser contests” and weigh-ins, like ShapeUp’s get-thin-quick 8-week crash-diet programs, and avoid eating fat and cholesterol and load up on carbs instead.

cerner cholesterol

Perhaps what the HERO committee intends is that since employees largely don’t trust their employers, they will do the opposite of the recommendations.

The savings from wellness

Quizzify 4

When wellness doesn’t add up, Quizzify does

We are going to leave out respiratory savings.   To capture those, charge a smoking differential and make smoking cessation available.  Done.  You don’t need an intrusive and expensive wellness program for that.  (We are big believers in a “smoking differential” for employee-paid premiums.  It makes sense for all the reasons weight loss and other wellness programs don’t.)

Instead let’s focus on people who have cardiometabolic issues.  In order to lose weight and reduce their risk, they need to switch to a low-fat, low-cholesterol diet.

Oh, my bad!  That is sooo 2014!  While most of us not in the wellness business already knew the dangers of eating too many simple carbohydrates long before now, even the most ardent card-carrying member of the Wellness Ignorati learned in March that all their dietary advice has been wrong — to go along with their incorrect screening and checkup advice.  Yet recommending exactly the wrong things hasn’t stopped most vendors from claiming massive savings.  See “On the (Even) Lighter Side” and The Smoking Guns for examples.

Now let’s look at all the hospitalizations that can be avoided through wellness – heart attacks, angina, hypertension, and…um, hmm…did we mention heart attacks?   You’re thinking: “What about diabetes events?”  OK, we’ll add diabetes, only because the HERO report lists it and we want to be true to the report.  But diabetes complications admissions (like CHF, which they also list) are a disease management issue, not a wellness issue — you can’t prevent or manage diabetic neuropathy or left-ventricular heart failure by eating more broccoli. The $1.50 PMPM price would not be high enough to also include disease management, and in any event what one does in disease management for complex cases is much different from a typical “pry, poke, prod and punish” wellness program.

And “straight” diabetes admissions are usually the result of diabetic employees pushing their blood sugar too low by over-medicating themselves—often in a good-faith effort to hit Hba1c “targets” that your wellness program set, no doubt on the advice of your consultants.   Low blood sugar won’t do much for productivity either.  Without the advice of a company specializing in diabetes, you’re likely to get this result.  (And if this is the first you are hearing about the likely causes of “straight” diabetes ER visits and admissions, you should consider such an option.)

So we are now adding all ischemic and hypertensive heart events and diabetes as what they call “potentially preventable hospitalizations.”  How many of your hospitalizations are for those items?  Simply run the primary codes for those events, being careful not to double-count professional fees, to see how many you had.  Here’s what happens when you do it for the United States as a whole.

HCUP WSMEs non-respiratory

Next, divide the relevant figure (Private insurance, 432,065) by the total number of privately insured discharges in the US (7,360,684)

HCUP US as a whole

So—using the HERO Committee’s own acknowledgment of the undeniable fact that wellness can only impact wellness-sensitive medical events (WSMEs) and using the diseases that the report says to use — less than 6% of admissions are WSMEs.  If your non-birth-event admit rate is, as the report says, 45 per 1000, then you have 2.6 admissions per 1000 in non-smoking-related WSMEs.  Once again, don’t take our word for this.  Run this analysis on your own admissions.  You won’t be surprised by how few there are.  Do you even know anyone admitted to the hospital for these things, especially where the admissions could have been prevented with a few more screens, HRA and servings of broccoli?

Shameless plug:  We are happy to do this WSME analysis for you.  We do these all the time.  It’s $4000.  We can also tell you your savings, ROI, trend, comparison to others over time, and more.  We also adjust for the major secular decline in cardiac events that has been taking place anyway for decades that the Committee seems to be unaware of, sort of surprising given their alleged expertise in cardiac risk reduction.

Let’s say you run this analysis with or without our help, and a rate/1000 similar to the US average pops up.  The HERO report says you need to reduce this rate by “only 1 or 1.25 admissions.”  But that’s almost half of your total 2.6/1000 WSMEs!  And in any event, you’ve probably seen by now – if you downloaded the spreadsheet – that Page 15 seriously underestimates your wellness program expenses, meaning your breakeven reduction needs to be much higher than “only 1 or 1.25.”  It’s probably higher than the number of admissions you have available to be reduced.

You can enter both your admissions per 1000 and the reduction in that figure you achieved directly into the spreadsheet.

But for now let’s very generously assume their expenses are right, and you only need to reduce admissions by 1 to succeed. How hard would it be to go from 2.6 to 1.6 WSMEs per 1000, a reduction of 39%?  Here are five things to keep in mind:

  • Your true engagement rate itself is probably much lower than that aforementioned 39%, not including people who simply participate for the money, and the people who are engaged generally aren’t the ones who would crash anyway;
  • A big chunk of all heart attacks can’t be predicted at all, and certainly not now that law prohibits asking about family history;
  • Even events that can be generally predicted can’t necessarily be prevented (we all know people who are “walking heart attacks” and have been ignoring advice for years);
  • “Straight” diabetes admissions are more likely to be for over-control than under-control;
  • In 7 years of measuring this, we have never seen a reduction in WSMEs remotely approaching 39% after adjusting for secular declines in cardiac events that take place even without a wellness program (which the report overlooks)

See The Million Dollar Workplace Wellness Heart Attack Screen in Health Affairs for a more in-depth view of the math. But the entire committee writing this HERO report insists wellness saves money, right?  So, it’s us against them, right?  A he said-she said?  Wrong.  Here’s the denouement.  On Page 23, the report’s own example shows that wellness only saves $0.99 PMPM!   That figure, by the way, is grossly overstated for reasons we will get to when we deconstruct Page 23.  But for the time being, here it is.

hero page 23 99 cents  

So even their own comparison of their own overstated savings estimates to their own understated cost estimates reveal:  wellness is a loser financially.  They have already admitted it is a loser for employee relations.  Funny — if we had made these two arguments, they would attack us.  But they are making these two arguments themselves.

Once again, the Surviving Workplace Wellness mantra applies:  “In wellness, you don’t have to challenge the data to invalidate it.  You merely have to read the data.  It will invalidate itself.”

Where does this leave us?

To summarize, pages 10, 15 and 23 combined tell us:

  1. Even before adding page 10’s cost categories back to page 15, costs are $1.50 PMPM;
  2. Savings are only $0.99 PMPM, meaning wellness loses $0.51 PMPM;
  3. The first two points are not our estimates — they’re their estimates and are far more optimistic than ours;
  4. Adding back the cost elements on page 10 to page 15, and then on Page 23 removing the respiratory savings, adjusting for secular decline in WSMEs, and adding in all the extra doctor visits would create a much larger loss from wellness;
  5. And they have already admitted that “pry, poke, prod and punish” programs are bad for morale.

Now you see why RAND’s PepsiCo study showed a negative ROI from wellness:  It’s because there is a negative ROI from wellness, which no one disputes any more.

And you see the reason we asked the question in the last installment:  Why would any company “do wellness” if the biggest proponents of wellness – people who make their living off it – admit that it’s a waste of money that adversely impacts morale?

Likewise, now you see why wellness vendors and consultants get “outed” all the time on this site, advocate savings methodologies designed to obfuscate rather than enlighten, and try to prevent you from learning that we exist.  We are not saying they are sociopaths.  Sociopaths lie for no reason.  Conversely, wellness vendors and consultants are just trying to keep their jobs.  Bleeding customers or clients dry is only a good job security plan if indeed the customers or clients never find out about it.

But now customers know how their own vendors and consultants really feel.  And we can all work together to dismantle these programs and start doing wellness for employees instead of to them.


Poll: Cue the Wellness Industry Response…  

We have a little dispute with RAND’s Soeren Mattke.  He says the wellness industry modus operandi is, whenever one claim is disproven, to switch to another claim.

We say the reason they are known as the Wellness Ignorati is, their strategy is to ignore facts, including ones they admit, and they will simply just ignore this posting so as not to create a news cycle, rather than switch claims.

There is also the chance that they admit that their own financial model is accurate. This would demonstrate integrity, a quality historically in short supply in this field.

So vote early (but not often)…

 

 

While we aren’t deconstructing this as a sales tool for Quizzify.  But as it happens, Quizzify is literally the only wellness program that does pay for itself.  Don’t take our word for it.  Quizzify is 100% guaranteed to save money and improve morale/engagement–exactly the opposite of what the HERO report says usually happens.  No other wellness program is either, let alone both.

Quizzify 3

Quizzify: the antidote to poke-prod-pry-punish wellness

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