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Every time I think wellness promoters can’t possibly match their previous shock-and-awe levels of egregious statements and proposals, they come through with another one. This post is from the employee’s viewpoint. To see it from the employer’s viewpoint, view the posting on the Proposed Johnson & Johnson Fat Tax. That company wants corporate America to pay them to count the number of overweight employees a corporation has.
PS Obviously we don’t have any money to oppose this with, so please share it on social media.
Suppose there were: (1) a widely held but false perception that gays had lower productivity and higher healthcare costs than straights; (2) false literature that companies with gay conversion programs outperformed the stock market; and (3) a proposal that companies disclose to shareholders the percentage of gays they employ.
Obviously, many corporate CEOs would stop hiring gays, de facto require gay conversion among current employees, and fire gays who failed the program, in order to maximize stock price and hence their own net worth.
Preposterous? Of course, but if Johnson & Johnson (J&J), Vitality Group and a few pharmaceutical companies get their way, this exact same scenario will befall overweight employees. Indeed, two-thirds of this dystopian scenario is already in place:
- Despite proof to the contrary, the popular misperception is that working-age thin people have higher productivity and spend less on healthcare than working-age overweight people;
- To help bring weight discrimination into the boardroom, some wellness apologists — led by Ron Goetzel, of course — published a facile and misleading study in a third-tier journal (that had already admitted poor peer review practices) showing companies with wellness programs (the obesity equivalent of gay conversion in ineffectiveness, and almost as likely to harm participants) outperformed the stock market. The opposite is actually true, if one uses sector indexes as benchmarks. (This is the correct methodology with small numbers of companies concentrated in a few industries. And it’s the correct result given the fact that conventional “pry, poke and prod” wellness loses money, period.)
To complete this trifecta of weight discrimination, all that remains is to convince publicly traded corporations to disclose the weight of their employees…and that’s exactly what this cabal — led by J&J and Vitality — proposed at Davos. (They also want companies to disclose their stress levels. I have no idea how one measures stress. The one company that tried measuring stress, Keas, failed both miserably–and, this being the wellness industry, hilariously.)
Weight measures used by companies are also facile and misleading. Typically — as with Vitality Group, an outspoken advocate of this proposed regulation — they use the Body Mass Index, or BMI. The BMI was invented by a mathematician 200 years ago, using a simplistic formula that he could never really justify…and yet has been the de facto standard for measuring overweight ever since. It’s misleading along many dimensions. Further, it now turns out that the whole workplace BMI obsession might be pointless, as people with normal BMIs are at higher risk than people with high BMIs, if their weight is distributed badly. Most recently, it’s been shown to be just plain wrong, doing a horrible disservice to overweight people and, in some workplaces, costing them money,
While I can’t explain why PepsiCo would be signing on other than for corporate image reasons, the agendas of J&J and Vitality are quite clear: disclosing weight to shareholders would encourage publicly traded companies to use “pry, poke and prod” workplace wellness services, which they coincidentally happen to provide. (The drug companies involved, such as Novo Nordisk, stand to benefit from selling more drugs.)
Unintended Ironies: A Hallmark of Wellness
Ironically, though, during that same Davos meeting, Vitality also candidly admitted that their wellness services don’t work even in the best-case scenario of their own employees. That admission undermines the entire fiction that this scheme would somehow benefit the employees being fat-shamed.
Here is another irony. (One hallmark of the wellness industry is its obliviousness to its own many ironies.) This industry thrives on being totally unregulated — uniquely in healthcare, wellness companies and individuals face no licensing, education, training, oversight or certification requirements. Consequently they can and do get away with whatever they want. And yet now they want every other company to make more disclosures in regulated filings, for no purpose other than enhancing their own bottom lines.
Still another irony: The prime schemer behind this initiative, David Yach of Vitality, assured STATNews that existing laws would prevent employees from bring fired due to weight. But “existing laws” don’t prevent anything in wellness now. A federal court says it’s fine to deny insurance to employees for failing to participate in wellness. And despite flouting federal health guidelines with impunity, no wellness vendor has ever been prosecuted for doing things to employees that would get doctors sent to jail. And as Health Fitness Corporation learned, you can lie to states as much as you want about anything — including saving the lives of cancer victims who don’t have cancer — and not be prosecuted. Indeed, no wellness company or program has ever been successfully prosecuted or sued for anything under “existing laws.”
The Inevitable Result: Institutionalized Weight Discrimination
Many things in life have unforeseeable consequences. However, the consequence here is perfectly foreseeable: If you are overweight or especially if you are obese, you should be able to keep your current job if your company likes your work. But your chances of getting hired anew by a publicly traded company — if you are competing for the job with an almost-but-not-quite-equally qualified thin person — would nosedive.
I rarely editorialize in this blog, because I don’t have to — facts are the wellness industry’s worst nightmare. (See the Vitality example above. I don’t need to come out and say they’re clueless. I merely highlight the data they themselves helpfully provided to make that conclusion self-evident.) However, I’ll make an exception here: I find it appalling that J&J, Vitality, and Novo Nordisk advocate subjecting huge numbers of employees to institutionalized discrimination and to programs that they admit don’t work, simply to make a few bucks.
By now our mantra is well-known amongst the Welligentsia: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
Today’s example: Vitality Group. They have already been profiled here, as one of the approximately eleventy zillion wellness vendors who don’t understand wellness. Their customer, McKesson, was also profiled for showing massive savings despite the apparent failure of their wellness program to make a nontrivial impact on smoking or weight or anything else. Even Employee Benefit News piled on that one.
However, if there is anyplace wellness should work, it’s at a wellness vendor, right? After all, it’s a closed system. There is huge bias among the investigators, the subjects of the experiment self-select to go work at a wellness vendor, and presumably they have a state-of-the-art program. So if Vitality showed positive results at its own workplace, no one would put any stock in them.
But what if they show negative results? What if a wellness vendor can’t even make wellness work for its own employees despite all the biases, self-selection and program excellence?
In today’s STATNews, Vitality admitted its own inability to both “do wellness” on its own employees and to measure the results of their own programs on their own employees. According to the article itself, the percentage of employees who are eating badly increased 2 percentage points. This is ironic given that they eat at least one meal a day at work. So much for “serve healthier food in the company cafeteria,” one of our fallback recommendations that seemed like it couldn’t miss. Even a wellness company can’t pull it off. (In all fairness, though, I have eaten at Healthways’ cafeteria. The food is fabulous and healthy…and they grow a little of it themselves out back.)
But wait…there’s more.
The weight of employees climbed as well. Employees with high BMIs rose from 58% to 60%. OK, so employees got fatter. Big deal. We’ve proven no correlation between weight and financial savings, and we have also urged employers to stop embarrassing employees because of their weight. Vitality does the opposite — weight-cycling, which is probably unhealthy. They promote a biggest-loser program called the “10-Ton Challenge” to see which department can lose the most weight.
What makes this a classic wellness story is that “employees lost a collective 210 inches from their waist circumference.” How can BMIs be rising at the same time waistlines are shrinking? Perhaps everyone is popping steroids, so their weight is being redistributed? Or maybe BMI is, as many people have said for years, the wrong measure? Or maybe they are not counting employees who gain weight, a la ShapeUp?
Whatever it is, in classic wellness vendor fashion and as our mantra predicts, Vitality has now proven exactly the opposite of what it intended to prove, which is that their own program doesn’t work in their own company. Their “collective” weight-loss claims self-invalidate due to a fundamental, massive, inconsistency in their own reported findings that, in classic wellness vendor fashion, they didn’t explain — either because they didn’t notice or figured we wouldn’t notice.
But we did.
John Hancock Insurance recently announced a plan to sell life insurance based on healthy behaviors. You get a discount on life and disability insurance for exercising and reporting good blood values on an ongoing basis, not just once when you sign up.
While we have been quite vocal in saying wellness is a waste of money and potentially injurious to health and morale (and lately the two wellness trade associations themselves have candidly supported that position), we find Hancock’s strategy to be a shockingly good idea.
There are many distinctions between Hancock’s offering and health insurance. First, life and disability insurance are opt-in products. No one is forcing you to buy them in order to get health insurance at work, or fining you if you don’t. No one is violating USPSTF guidelines, screening the entire workforce, or making you get checkups that are worthless at best.
Second, the same numbers that don’t remotely add up for wellness add up quite elegantly for life and disability. Cut 50% out of your heart attack rate for the latter and you probably reduce overall claims payout by 5%. Cut 50% out of your heart attack rate for health insurance and you reduce overall claims payout by less than 1%. Additionally, Hancock can possibly accomplish that goal through underwriting. An employer doesn’t have that option. So besides being worth more, a 50% reduction is achievable.
Finally, they should be able to generate some good self-selection into this product. People have to be willing to give up some privacy, and our colleague Anna Slomovic is quoted on this topic in the article in the New York Times, but as long as you know what risk you are taking and as long as there is some recourse, it isn’t the same thing as being forced to reveal personal information for a wellness program.
One asterisk: the article says they are relying on Vitality to come up with the risk adjustments. I doubt seriously that is the case. Hancock has real grownup actuaries whose job it is to price these risk adjustments. We assume the article is wrong — Hancock isn’t going to rely on a vendor that can’t even quote Dee Edington correctly and doesn’t understand how to design a study.
Absent that asterisk, we are confident that they will be successful and wish them the best of luck.
The Vitality Group
Short Summary of Company:
“Vitality is an active, fully integrated wellness program designed to engage your employees on their Personal Pathway to better health. Employers can choose to introduce the Vitality experience with one of our comprehensive plans. Activate is designed to bring wellness into the workplace. Elevate includes all the components of Activate, plus additional engagement features.”
Materials Being Reviewed
The Vitality Group “wearables at work” presentation. This presentation describes the health risk reduction achievable through engaging members at workplaces by wearing activity trackers.
Summary of key figures and outcomes:
Questions for Vitality Group:
You appear to be claiming that people who are “not active” reduced their risk factors simply by being engaged, without actually doing or reporting anything. A health services researcher might say that instead of taking credit for both the 6-point decline in the study group and the 5-point decline in the de facto control group risk, in reality only the difference between the two groups (1 point) could be attributable to fitness activities. If you disagree, can you explain exactly what it is that makes people in the inactive group so successful even if they don’t do anything?
The amount that could be attributable to fitness activities is the difference between the two groups compared. For clarification, we compared (1) individuals who were engaged in fitness activities with the Vitality program (who might also be using other program elements), with (2) those who were engaged in the Vitality program on other elements but were not recording fitness activities directly with us.
So the graphic focused only on the incremental difference between the described fitness and non-fitness cohorts. Both the fitness and non-fitness cohorts were participating in other aspects of the Vitality program to track and improve their health, but the non-fitness group did not record their fitness activities through Vitality. Individuals in the non-fitness group may also have engaged in some fitness activities but simply did not log any of these activities through the Vitality program.
Thank you for that clarification. When I look at the “difference between the two groups compared” I am seeing a 5-point decline in the first group and a 6-point decline in the second group, netting out to 1% as an “incremental difference,” rather than the 13% and 22% declines you claim,, but perhaps readers will see it differently.
How does your claim of success adjust for dropouts, and the likelihood that dropouts would have worse performance than people who were willing to be measured twice?
This analysis did not include an adjustment for dropouts as the intent was not to make assumptions about unknown risk factors. A more detailed investigation could include this as a refinement.
Are you familiar with the concept of the “natural flow of risk” described on this slide researched and prepared by the “father of wellness measurement,” Dee Edington?
Edington’s research shows that nearly 50% of people with >4 risk factors will eventually move to a lower risk category on their own. Having been exposed to this “natural flow of risk” data, do you still believe that the non-active and active members (both groups were selected on the basis of having >4 risk factors) declined in risk due to the program, or else could some or all of the decline be due to (a) self-selection into the active group; (b) ignoring discouraged dropouts; and (c) the natural flow of risk?
Yes, we did allow for this effect by looking at the net changes in overall risk groupings by level of activity in the Vitality program. In other words, the percentages shown account for the overall flow of risk, including those who improved over the period but also those who deteriorated. The graphic focused on the proportion of high risk people in each group, but did allow for people moving into the group over the period.
Dee Edington’s work found that expected natural migration is actually a deterioration in risk groups as people naturally flow to high risk.
Often there is a tendency in wellness to compare consistent cohort risk transitions to these expected natural migration increases. Although both cohorts in the analysis saw an overall net improvement in risk groups, this comparison to natural migration was not the intent of this analysis. Instead the intent was to compare the relative changes in the two cohorts. This analysis showed that the cohort who engaged in fitness activities through Vitality had a lower proportion of high risk individuals as of their first risk measure, but had a greater net improvement in risk groups as of the last measure than those who did not engage in fitness activity through Vitality
Hmm…well we can’t both be right. I’m looking at the exact same Dee Edington slide you are, but I am seeing the population’s risk “naturally flow” in both directions, not just “a deterioration in risk groups as people naturally flow to high risk.” Obviously the validity of the alleged declines in your cohorts is dramatically different depending on whether one uses your interpretation of Dr. Edington’s work (in which case your results are outstanding) or mine (in which case except for 1%, they are due to the natural flow downward of the highest-risk segment).
Like Alvy Singer did with Marshall McLuhan in Annie Hall, I took the liberty of asking Dee Edington himself to referee our disagreement. This is his response:
“The correct interpretation of that slide and of my work is that the natural flow of risk in a population moves in both directions, and must be understood in order to gauge impact of an intervention. It is not valid to simply start with people who were high-risk and claim credit for all risk reduction in that cohort while ignoring people who migrate in the other direction.”