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.