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Tenn. Blue Cross tumbles into the wellness outcomes rabbit hole

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I know it’s not always about me (my ex-wife was quite clear on that point), but I was deeply saddened to see one of the Blues – specifically, Blue Cross of Tennessee — descending into the fabricated-wellness-outcomes abyss.

In all fairness, wellness vendors have to lie, since it turns out that achieving savings is mathematically impossible.  If they told the truth, they’d all be fired.  Even so, Blues should be held to a higher standard for integrity than independent wellness vendors, because lies told by one Blue affect all the others by sullying one of the most readily identified and respected trademarks in America.

Before continuing, I do want to emphasize that this isn’t about “the Blues,” which are all independent of one another.  It’s specifically about Blue Cross of Tennessee (BCBSTN).  By contrast, other Blues – Massachusetts, Rhode Island, Louisiana, Northeast Pennsylvania, Carefirst and South Carolina come to mind (along with the Blue Care Network subsidiary of Blue Cross of Michigan) – have created exemplary outcomes reports.  For them, integrity trumps impossibility.  Two have even been validated by the Intel-GE Care Innovations Validation Institute, the gold standard in outcomes measurement.

Not so BCBSTN.   They published a report in which Onlife Health showed some of the best outcomes in wellness history.  BCBSTN calls Onlife their “partner” company in this report. However, a corporate lawyer – or BCBSTN itself, in this other press release – would call Onlife a “subsidiary,” for the simple reason that BCBTN owns Onlife.   By contrast, you don’t own your partner (though my ex-wife tried).

In other words, BCBSTN is “validating” itself, not a partner.  Normally “validation” is not performed by the entity being validated any more than an attorney is allowed to render the verdict in a case he or she is arguing.

The “intervention” was that these admittedly overweight employees walked an extra 2500 steps (about 19 minutes) a day.  Here’s what those literal and figurative “baby steps,” as the report calls them, achieved.  This is verbatim from the report:

  • Emergency room visits and inpatient hospital stays were more than 50 percent lower in the moderate exercise group, as well. There were 219.6 ER visits and 59.9 inpatient stays per 1,000 for overweight non-exercisers compared to 73.6 ER visits and 30.1 inpatient stays per 1,000 for overweight moderate exercisers.

Let’s consider ER and inpatient separately. About 40-million ER visits a year are specifically caused by injuries, or roughly 126 per 1000 people. This injuries-only figure dwarfs BCBSTN’s all-in ER visit figure of 73.6 per 1000 allegedly achieved by this program.  In other words, walking an extra 19 minutes a day not only wiped out every single non-injury-related ER visit, but also about 40% of all injury-related ER visits.

Next, let’s consider the inpatient stays.  Their 30 stays per 1000 includes birth events, as compared to the more typical figure, which BCBSTN also experienced in the control group, of about 60 per 1000.  All birth events combined are about 15 to 20 per 1000.  Taking those birth events out of the BCBSTN tally yields 10-15 admissions per 1000, a Nobel Prize-winning figure.

And all achieved by walking an extra 19 minutes a day.

Another way of looking at it:  here are the top 21 admissions categories for Tennesseans insured through their employers.  With the exceptions of categories #9 and #10 (morbid obesity and heart attacks), probably not one single admission in any of these categories could have been prevented by walking an extra 19 minutes a day.  Even in those two categories, optimistically only a handful of admissions would be prevented by short walks.

tennessee admissions

In addition – this is also part of wellness vendor DNA as this Wellsteps example shows – BCBSTN’s numbers contradict themselves.  Compare these three bullet points from the study (italics are ours):

  • Contrary to the popular guideline of 10,000 steps a day, employees who took as few as 5,000 steps per day, had annual healthcare costs nearly 20 percent lower than their sedentary counterparts who did not exercise. Spending was $2,038 per member per year (PMPY) for non-exercisers compared to $1,646 PMPY for moderate exercisers.
  • Average claims cost PMPY dropped from $5,712 for non-users to $4,248 for employees who participated in one program and $3,120 for those participating in two programs. Employees engaged in three programs saw their claims cost cut almost in half at $2,892.
  • Looking at BCBST overall, Danny Timblin, president and CEO of Onlife Health, noted, “Over a three-year period of time when we did this study, their claims were essentially flat.

Well, which is it?  (And you gotta click through here.)  Is it $2,038 per year for non-exercisers, or $5,712?  How is it that “moderate exercisers” only spend $1,646 in the first bullet point but $2,892 in the second?  And how can any sizable group of people only spend $1646 per year per person, vs. the more typical $5000-$6000?  (Even adding up the cost of just those impossibly low ER and Inpatient utilization figures totals half of the $1646, leaving only enough room in the budget for a couple of doctor visits and non-specialty prescriptions.)

And how does “their claims were essentially flat” in the third bullet point reconcile with the massive decline in claims in the second bullet point?

Yet another head-scratcher: these massive savings were achieved despite the wellness industry’s own report admitting wellness loses money.  You might say: “So what? Maybe Onlife disagrees with their own industry’s report.”  Except that Onlife cowrote that report, unless there is a different Onlife Health that is listed as a collaborator on it:

hero collaborators

This Onlife “study,” if nothing else, validates the observation in our book Surviving Workplace Wellness: “In wellness, you don’t have to challenge the numbers to invalidate them.  You merely have to read the numbers.  They will invalidate themselves.”

Which brings us back to what Blue Cross of Tennessee needs to do next, now that their numbers have self-immolated (along with their ability to define the word “partner”).  It seems they have, in the immortal words of the great philosopher Ricky Ricardo, some ‘splainin’ to do.  At the very least, perhaps an apology to the Blue Cross Association and to their fellow Blues.

And I owe an apology to my ex-wife, who served the purpose of a humorous literary device in this posting, but who in reality is quite charming and lovely, and is inviting us over for Thanksgiving, and all we have to do is bring the pies.  But I think BCBSTN will need to give the Association more than a pie or two to make up for this one.

In the immortal words of the great philosopher Pat Benatar, hit me with your best shot.

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