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Wellnet Detects Undetected Claims Costs

Wellnet

Short Summary of Intervention:

Risk reduction program. “Our company’s focus is on exceptional execution and the manner in which health benefits are delivered and managed. Healthcare is personal and we treat it that way. Our mission to provide a level of service, collaboration and integration you will not find elsewhere in the marketplace.”

Materials Being Reviewed:

Wellnet's 18-1 ROI claim

Summary of key figures and outcomes:

  • 18-to-1 ROI
  • $463,000 reduction ($180 per person) in medical spending, on a base of about $6 million.
  • $21 million reduction in “undetected claims costs” on 55 high-risk members ($4 million) and 453 medium-risk members ($17 million).
  • Medical trend reduction from 8% to 0.06%

Questions for Wellnet:

What are “undetected claims costs”? We can’t find an insurance company that has heard of them, and we can’t find any definition on Google, or even any reference to them at all, other than Wellnet’s.

ANS: Refused to answer

It’s not clear whether the 18-to-1 ROI is driven by the $180/person reduction in medical spending or the $21 million reduction in “undetected claims cost.” If the former, does that mean your wellness program only cost $10 per person?

ANS: Refused to answer

If the latter, how does the $21 million in “undetected claims costs” relate to the $6 million in detected claims costs?

ANS: Refused to answer

You list 508 medium-risk and high-risk members whose risk reduction accounted for the $21 million in “undetected claims costs.” Is it possible that many of the unmentioned 2000 employees and dependents who are low-risk might increase risk factors and therefore offset those savings, as Dee Edington’s model below would predict?

ANS: Refused to answer

Dee Edington's model

By changing the axes on the graphs so that the cost bars are not drawn to scale, wouldn’t the physical difference in the height of the bars (about 50%) appear to dramatically overstate the savings (about 7.3%)? Doesn’t omitting the “$5.0” hashmark on the top graph exacerbate this effect even more?

ANS: Refused to answer

How does the 7.3% negative spending trend on the lower graph tie to the 0.06% positive spending trend claimed in the first section?

ANS: Refused to answer

On just the 55 high-risk members alone, you are saving $73,000 apiece, about 4 hospitalizations each. Can you share how this might be possible to do, through your wellness tools?

ANS: Refused to answer

HealthFitness takes credit for program savings without having a program

HealthFitness

Short Summary of Intervention:

“When you partner with HealthFitness, we work collaboratively with you to develop a strategic plan for program implementation, which includes a cultural assessment and an operational plan. You can expect results-oriented programs and services delivered through a highly personalized strategy, matched to your employees and culture.”

Materials Being Reviewed:

Success at risk reduction and translation of that risk reduction into cost savings.  These excerpts are from the successful Koop Award application at http://www.thehealthproject.com/documents/2011/EastmanEval.pdf.

health fitness corp risk reduction form koop award

total savings chart

Summary of key figures and outcomes:

  • Reduction in risk factors from 3.20 to 3.03 — net change of 0.17 — over 5 years.  This success excludes dropouts.
  • 24% improvement in costs vs. non-participants, or $460/year at Eastman Chemical (currently up to >$500/year according to HFC website)

Questions for Health Fitness Corporation:

Since only about 20% of all inpatient events are wellness-sensitive, and you only reduced risk factors by 0.17 per person, and hospital expenses are at most 50% of total spending, how is it that you are able to reduce spending by 24%?

ANS: Refused to answer

Why did you take credit for savings in 2005, even though according to your own slide you didn’t have a program in 2005?

ANS: Refused to answer

Does starting the Y-axis at $1800 instead of $0 create the illusion of greater separation between the two cohorts?

ANS: Refused to answer

Your website says that comparing participants to non-participants “adheres to statistical rigor and current scientific standards for program evaluation” and “is recognized by the industry as the best method for measurement in a real-world corporate wellness program.”   Can you explain how non-motivated non-volunteers who decline financial incentives to improve their health are comparable to motivated volunteers, especially in light of the separation between the two groups that took place just on the basis of differential mindset in 2005, before you had a program?

ANS: Refused to answer

You and your customers have won three Koop Awards in the last 4 years. Do you think also being a sponsor of the Koop Award (along with Eastman, in this case) has helped you win these awards or is this just a coincidence?

wellness logos

ANS: Refused to answer

Why Nobody Believes the Numbers defines the “Wishful Thinking Multiplier” as “alleged cost saviings divided by alleged risk reduction.”  Your cost savings is $460 and your risk reduction in 0.17, for a Wishful Thinking Multiplier of 2700, the highest in the industry.  The book calculates that a risk reduction of your magnitude (even assuming dropouts also reduced risk by the same amount) could generate roughly a $8 reduction in annual spending.  To what do you attribute your ability to reduce spending by 50x what is mathematically possible?

ANS: Refused to answer

Help us with the arithmetic below, also from this Koop Award application.

eastman ROI

How is it mathematically possible to have a higher ROI ($3.62) when also including the cost of incentives in program expense than the ROI ($3.20) excluding the cost of paying incentives to employees to participate?

ANS: Refused to answer


 

Update December 2014:  Ron Goetzel admits HFC lied.  (See #5 and #6.)  The slide was “unfortunately mislabeled,” using the passive voice, as though it was an act of God (“the game was rained out” ) or else perhaps the North Koreans.  The geniuses at HFC apparently didn’t notice this “unfortunate mislabeling” for 4 years, despite it’s having been pointed out to them many times before this.

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