The population health industry never ceases to delight us with its creativity. Vendors come up with ways of demonstrating their incompetence that are so creative we are compelled to use screenshots to back up our observations. Otherwise no one would believe us.
Consider Vivify. They reported on a study of in-home post-discharge telemonitoring led by a:
Not being able to spell the name of his own occupation is the good news. The bad news is, the “principle investigator” also can’t write, can’t do simple arithmetic, and – most importantly for someone who claims to be a “principle investigator” — can’t investigate. (Those shortcomings aside, this is a very impressive study. For instance, the font is among the most legible we’ve ever seen.)
There is some redundancy in the writing, but, giving Vivify the benefit of the doubt, perhaps the extra verbiage reflects the principle investigator’s concern that someone might miss the nuances or subtleties in his exposition. Examples:
- Vivify’s home monitoring system is “simple and easy”;
- The patient receives a “weight scale”;
- They had an “ROI of $2.44 return for every dollar invested”, and…
- “With appropriate connectivity, patients could engage in real-time interactive videoconferencing.”
Needless to say, these product attributes are very intriguing, so intriguing that you may want to learn more about the company. They are only too happy to oblige, making sure we catch yet another nuance:
The study claims the average patient’s cost declined $11,706, for a 2.44-to-1 ROI. Doing the math, that means Vivify’s post-discharge in-home self-care tele-monitoring costs…let me just get my calculator out here…$4797/patient? At that price, why rely on self-monitoring? Why not just move a nurse in?
(Note for the literal-minded: the ROI language is slightly different here than the passage we quoted, which appears elsewhere in the case study.)
The Principle Investigation
In general, Vivify targets patients with “specific chronic illnesses,” including pneumonia. (Vivify, I don’t know how to break this to you gently, but: pneumonia isn’t a chronic illness, specific or otherwise. No one ever says: “I was diagnosed with chronic pneumonia a few years ago, but my doctor says we’re staying on top of it.”)
However, for this investigation, only CHF was targeted: a cohort of 44 recently discharged CHF patients with an average age of 66. This raises the question: How did the principle investigator scrounge up a cohort of 44 discharged CHF patients with an average age of only 66? More than half of CHF discharges are over 75. It’s statistically impossible to randomly select 44 CHF discharges with an average age of 66. And – isn’t this a lucky coincidence – the study claimed a large (65%!) reduction in readmission rates but readmission rates are already much lower for younger patients. Once again, not a word of explanation.
Because Vivify’s apparent level of misunderstanding of basic arithmetic and study design boggled even our minds (which is difficult to do, given that we mostly blog about wellness), we decided to give them a chance to explain directly that we might have missed something. Further, because these explanations would have taken them 15 minutes if indeed we were missing something obvious, we offered them $1000 to answer them, money they decided to leave on the table. (Anyone have questions for me? Send me $1000 and I will happily spend 15 minutes answering them.)
This email to Vivify is available upon request.
We don’t even know what the 65% reduction is compared to. Usually – and call us sticklers for details here – when someone claims a 65% reduction in something vs. something else, they tell us what the “something else” is. Are they saying 35% were readmitted? Or 66-year-olds are readmitted 65% less than 75-year-olds?
My freshman roommate was like the bad seed in the old Richie Rich comics. Among other things, he would have a snifter of cognac before bed, whereas I had never tasted cognac and thought a “snifter” was for storing tobacco. We didn’t get along and at one point I accused him of being decadent.
“Decadent, Al? Let me tell you about decadent. I spent last summer at a summer camp – everyone was there, Caroline Kennedy, everyone – where we played tennis on the Riviera for a month and then went skiing in the Alps.” I had to admit that was indeed decadent.
“Al,” he replied. “I haven’t even gotten to the decadent part yet.”
Likewise, we haven’t even gotten to the best example of arithmetic-gone-wild: the savings claim. Remember that $11,706 savings claim above? Well, read that passage again–it turns out that represents a “90% decrease in the cost of care.” Apparently, the patients cost $12,937 when they were in the hospital, but after they went home, they only cost $1231. (We have no idea how that squares with the other finding, that the Vivify system itself costs $4797, based on the ROI of 2.44, or, as they put it, “an ROI of $2.44 return for every dollar invested.”.)
The irony is that other vendors in this space really do save money and really do measure validly. It’s one thing to make up outcomes in wellness. That’s a core part of the industry value proposition. But, unlike wellness vendors, tele-monitoring vendors other than Vivify typically know the basics: what they are doing, how to measure outcomes, how to save money–and how to spell.
Oh, when bad things happen to good bloggers…
Shame on us! Here’s what Wellness Corporate Solutions had to say about our observations of the wellness industry:
And, in all fairness, when we went to the Wellness Corporate Solutions website, we felt quite chastened. Their website was a breath of fresh air, taking the rest of the industry to task for expecting “instant cost savings,” noting that a “focus on ROI is short-sighted.”
Further, they are totally opposed to wacky crash diets, of the type that 8-week weight loss “challenges” inspire, that cause abnormally large weight swings As most people know by now, those may be harmful and are of course ineffective at long-term weight control. The weight is likely to be regained and then some. Plus contestants often binge before the initial weigh-ins to maximize contest weight loss. That’s why Wellness Corporate Solutions quite appropriately says “stop dieting,” and “avoid making unreasonable weight loss goals.” And “banish weight-obsessive thoughts.”
We were also thrilled to see that they “respect and appreciate size diversity” because “size prejudice hurts us all.”
Finally, a company that has done enough research to realize that you can’t save money instantly by getting employees to crash-diet for 8 weeks! How exciting is that – we discovered a wellness vendor with access to Google!
Unfortunately, perhaps along the way someone at Corporate Wellness Solutions must have failed to “respect and appreciate the size diversity” of a certain Kim Jung Un, because the North Koreans appear to have hacked into their website and announced: a program that saves money instantly by getting employees to crash-diet for 8 weeks.
Naturally, this being a wellness vendor, the savings are made up. If 20% of your employees achieve a “healthy” BMI (a statement which by itself is open to a great deal of debate, since recent research overwhelmingly says it’s better to be fit and fat than to lose weight and not keep it off), for a company to reduce its total cost by 20% means that the costs for each employee who lost the weight would have to fall 100%.
And naturally, being a wellness vendor, they don’t stop there. It’s part of wellness vendor DNA to ignore US Preventive Services Task Force recommendations, while saying they abide by them. In this case, they are doing both thyroid screens (not recommended) and PSA tests (emphatically not recommended).
And, naturally, being a wellness vendor, there is no concept of learning. They did exactly the same thing that ShapeUp, Ron “the Pretzel” Goetzel, Wellsteps and others have done, which is failing to realize that we bite back. Actually, we don’t bite back as much as we allow these geniuses to bite themselves back. The wellness ignorati invariably self-immolate in the attempt to criticize us. Hence our mantra: “In wellness you don’t need to challenge the data to invalidate it. You merely need to read the data. It will invalidate itself.”
However, there is some good news about Wellness Corporate Solutions: NASA employees don’t need to worry about their job security, because these people are not rocket scientists.
With all the incompetence, innumeracy, illiteracy and downright dishonesty we’ve documented in this field and with all the employee dissatisfaction, revolts and lawsuits, one can’t help but wonder: Why?
Why would any employer do this to their employees?
Why aren’t vendors held to minimal standards of competence?
Why do vendors and consultants caught lying simply double down on the lies and/or ignore questions about their lies–knowing full well they’ll get away with it because workplace wellness has nothing to do with actual wellness so no one cares that it doesn’t work?
Why are benefits consultants allowed to lie about outcomes for their partnered vendors?
Why, after they get caught lying, do they win awards for those very same outcomes?
Why doesn’t anyone care that much of what they say and do is wrong?
Why doesn’t anyone care that poking employees with needles far more than the USPSTF advises produces no savings?
Why put up with the morale hit from disgruntled employees and possible lawsuits?
Bravo to Bravo for admitting the reason: It’s to claw back insurance money from employees by making programs so unappealing and requirements so onerous that many employees would rather forfeit their money than have anything to do with them. Here are Bravo’s exact words:
You might say, they don’t actually “admit” it. Well, obviously they aren’t going to skywrite it. But how else would one interpret this comment? Obviously they aren’t going to save money right away by “playing doctor” and poking employees with needles. Especially because they aren’t even adhering to legitimate preventive services guidelines, such as those from the United States Preventive Services Task Force (USPSTF).
They also still subscribe to the urban legend that 75% of an employer’s spending is lifestyle-related, even though that myth has long since been discredited as meaningless and misleading for employers.
Creatinine and thyroid screens are not recommended by the USPSTF, so they shouldn’t be done at all, let alone provide the basis for claiming savings. So, we have eliminated everything except the obvious: employers get to collect fines for employees who care too much about their health and/or their dignity to submit to Bravo’s offer to play doctor.
This is the classic example of wellness done to employees instead of for them. The Bravo website is sprinkled with discussions of appeals processes for employees who face punishments for the crime of weighing too much and/or other personal shortcomings having nothing to do with work performance (and precious little to do with healthcare spending during the working years)…but everything to do with transfering wealth back to the owners.
As is our policy, we offered Bravo a chance — and $1000 — to provide an alternate explanation in a timely way, which they didn’t. Two differences between that forfeiture and Bravo’s punishments: Bravo lost their $1000 (of our money) for simply being unwilling to jot down a few words, whereas they brag about fining employees $1000 (of their money) for not being able to lose weight and keep it off, which is far harder than writing down a few words. And the other difference about the $1000? Having just raised $22-million, Bravo won’t miss it.
August Update: As a result of this expose, Bravo has taken all this stuff off their website. They no longer brag about fining employees, they no longer discuss their appeals process at length on their site and they no longer pitch their D-rated lab tests like creatinine and thyroid. This is typical vendor behavior after getting caught. Score one for They Said What.