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Has the “Epidemic of Chronic Disease” Gone MIA from the Workplace?

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Looks like employers have been fighting the wrong battle: fat employees are not the bad guys.  So stop letting wellness vendors harass your employees about their BMIs, and start creating a safer, healthier work environment instead, using the tips below.


Wellness vendors live by the mantra that “75% of healthcare spending is due to preventable chronic disease.”  Some variation of this appears 200,000 times on google.  For instance, Johnson & Johnson (the same Johnson & Johnson proposing that companies disclose the number of fat employees to shareholders) says:  “chronic diseases, most of which are preventable, account for 75%” of healthcare spending.

Leading wellness defender Ron Goetzel, in our soon-to-be-released debate tape, upped the ante. He says companies should do wellness because 80% of their cost is due to mostly preventable chronic disease.

A few observations about this claim. For starters, if I had one of the many non-preventable chronic diseases afflicting mankind, I might be offended by this blame-the-victim generalization, but maybe that’s just me being hypersensitive. And wouldn’t this statistic literally mean that if you eat broccoli, wear Fitbits, and (as recommended by Johnson & Johnson, among others) get your annual useless and possibly harmful checkups, you can live forever?

Plus, that whole 75%-(or 80%-)of-spending-due-to-chronic-disease epidemic-in-the-workplace  cliche turns out to be a complete urban legend.

But rather than argue with these people, we will simply quote them, since the wellness industry’s own worst enemy is their own data.  It turns out that healthcare is not about the broccoli.  And Ron Goetzel’s own company, Truven, has published exactly the opposite of his sound bite — wellness-sensitive hospitalizations are rare in commercially insured populations.  In the HCUP database that Truven maintains for the government, the top 25 commercially insured hospitalizations are:

hcup rank order top 25

To paraphrase the immortal words of the great philosopher Clara Peller, where’s the broccoli?

clara peller

There is none. instead, the corporate mania of massive overscreening, broccoli, Fitbits and the now-fully-discredited employee BMI jihad is distracting companies from noticing exactly what actually does drive hospital spending and hence where prevention opportunities arise.  Here are some random observations about Truven’s revelation:

  • The musculoskeletal category certainly has many preventable opportunities. Ergonomics is one. Exercise classes, for sure. Benefits design and education to include encouraging access to lower-cost care is another. Reference pricing is one more. And opiate abuse is also tied into this category…but doesn’t get remotely the attention accord to cholesterol, or even seat belts.
  • A lot of items on this list shouldn’t be there at all. Spinal fusion?  Stents? Hysterectomies for non-cancers?   Many of these procedures are unnecessary and/or harmful. (We know it’s not always about us, but the Quizzify business model helps educate employees on avoiding harms.)
  • The wellness industry is ignoring the actual preventable hospitalizations in order to focus on the only thing that generates revenues for them, which is to”pry, poke and prod” employees, make them try to lose weight, and insist that they “know their numbers.” And when employees fail, they forfeit money back to their employer, which is what finances these programs in the first place.
  • Why hasn’t Ron Goetzel told his wellness friends about this database his company maintains?  Why is he running away from his own company’s great insights?  Why doesn’t the Koop Award recognize companies that address these issues?  Why is there not a single mention of this database in any of his writings?
  • Despite the wellness industry’s breathless hyperdiagnosis of cardiometabolic disease due to rising BMIs, there are no diabetes events on this list. And the only cardiac events are arrythmias (no amount of broccoli will prevent them) and heart events other than heart attacks.  Those events (like angina) have warning signs and symptoms, so you don’t need to hunt for them at great expense. (Heart attacks themselves are way down at #70 and #85.)
  • Hospital infections appear twice on this list (#12 and #23).  These could be addressed with benefits design: pay hospitals a few dollars more for each case, but don’t pay them at all for hospital errors and infections…and sit back and watch them clean up their acts, literally and figuratively.  Speaking of which, why doesn’t every major employer join the Leapfrog Group and quit the National Business Group on Health instead, which still promotes biggest-loser competitions and overscreening?
  • Finally, why is the government (both President Obama’s EEOC and the GOP-controlled Congress) encouraging employers to harass their employees with “pry, poke and prod” programs instead of helping employers and employees avoid low-value care?  Employers can demand intrusive medical exams and even employee DNA. But they can’t simply tell employees: “You need to complete this education module before demanding low-value care.”  (Quizzify has created some workarounds here, of course.)

Isn’t the right approach to look at the actual data before racing ahead with a program? Of course, but the wellness industry prefers the Yogi Berra approach: “We don’t know where we’re going, but we’re making good time.” Isn’t the right approach to tailor the solution to the problem? Of course.

But they won’t.  In the immortal words of the great philosopher Upton Sinclair, you can’t prove something to someone whose salary depends on believing the opposite.


A commenter suggested doing this by costs instead. You get different DRGS…but still no wellness-sensitive medical events:

hcup rank order top 25 costs

 


7 Comments

  1. Tom Emerick says:

    I agree. Someday all the wellness ventures of this era will be seen as one big hoax.

    Like

    • whynobodybelievesthenumbers says:

      Thanks in large part to support from you, Mitch, Jon etc. who help spread the word. Every day, more people hear our message, and substitute thought for blind faith. Every post gets more views and shares than the previous one. (Not really but directionally true.) The wellness ignorati never respond. And when — like HERO — they try to secretly undermine us by passing around innuendo, our friends expose their slimy tactics, and we shine a light on them and smack ’em right down. We don’t stoop to their level of name-calling. We merely cut-and-paste from their own propaganda.

      Like

  2. Doug Paden says:

    Can you also look at the top 25 by billed charges since DRG’s vary greatly by cost? I’m not doubting your conclusion but another metric to analyze to further point out the issue with the wellness industry claim.

    Thanks for your insight and industry accountability–

    Like

  3. Doug Dame says:

    I have been stunned over the past 10 or so years to see how bariatric surgery, (part of) which shows on the cost-ranked list as DRG 621, now at #15, has been rising on the charts with a bullet, as Casey Kasem might have said.

    It’s been a MAJOR growth industry.

    I should root around some and see if there’s been any recent papers on the necessity and cost effectiveness of that intervention, and the safety record. I should do that, but maybe some reader here can offers some pointers.

    Like

    • whynobodybelievesthenumbers says:

      You get lots of points for this one, and not just for making a reference to “Casey’s Coast to Coast,” which I hesitate to add, is incorrect. Casey never used that expression. It long predates him, originating in Billboard magazine. But you are totally right about the bariatric surgery. There are all sorts of long-term issues. For example, the rate of alcoholism is much higher, as people transfer their addictions. Thanks again for the great comment!

      Like

      • Doug Dame says:

        I knew Casey Kasem didn’t sound quite right .. should have trusted my instincts and checked. Billboard Mag it is. Thanks for the correction.

        Like

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