Opioids are the opiates of the masses: how wellness vendors failed us yet again
If there is one thing that has directly impacted the health and productivity of many workers over the last ten years that was to a large degree predictable, avoidable, and remediable, it would have been opioid use.
So naturally, the workplace wellness industry (along with most wellness-obsessed insurance carriers and the equally wellness-obsessed CDC, the subject of a future posting) missed it altogether. Health risk assessments (HRAs) asked lots of questions and gave lots of advice about drinking and illegal drug use. But opioids were generally obtained legally, with prescriptions, and reimbursed through PBMs…and rarely if ever found their way into HRAs.
The wellness industry ignored opioids in every way possible. They thought it was much more profitable and less controversial to tell employees to eat less saturated fat and, of course, salt. And of course get annual physicals and prostate checks.
We talk about the those direct harms of “pry, poke and prod” workplace wellness all the time. However, the indirect harm was equivalent: we were taking our eye completely off the opioid ball.
I encourage everyone to read the full article here.
*In defense of the wellness industry, since most employees lie when they answer those HRA questions and/or ignore the advice, it is possible wellness vendors would have had as trivial an impact on opioid use as on everything else they address. However, they could have at least tried.
Between the picnics and parades this weekend, you’ll no doubt be saying to yourself…
“Let’s make this a real family holiday weekend. Boys and girls, let’s listen to blogtalkradio.”
Well, if you insist. Here is the link to the interview Fred Goldstein just did with me on Gregg Masters’ show.
And if you ever get a chance to go on the show or advertise on it, take it. Check out the little icon that we web administrators see in the upper LH corner of our screens. We usually get a lot of visitors (way over 100,000 in our existence, and 5130 followers) but the hour when the podcast was live is our best-ever hour, and makes our typical hours look pretty trivial by comparison.
A 14 Year Old Girl Teaches Wellness Vendors How BMI Works
We often point out that the average eighth-grader knows more about math than wellness vendors do. But that’s OK. No one expects wellness vendors to know math better than an eighth-grader. However, we do expect them to know wellness better than an eighth-grader. But it turns out at least one eighth-grader also knows more about wellness than wellness vendors do.
Within the last few months, we and others have explained to wellness vendors why their obsession with BMI is misguided in many ways. It turns out that BMI misses both people who are healthy but fat, and people who are unhealthy but thin. No surprise, given that BMI was invented by a 19th century mathematician more concerned with measuring whether populations as a whole were not getting enough food than whether individuals were getting too much.
Now, along comes an Indiana teenager to teach wellness vendors about the other harms of BMI — what it does to people’s body images. She was classified as obese, and yet she is a high school athlete. You and I should be so healthy:
A 14-year-old girl who carries 175 pounds or more on a 5-foot-7 frame, such as Tessa’s, falls into the obese range, regardless of how muscular her frame may be. Earlier this year, Tessa writes, she started having doubts about her body — not unheard of for a teenager. She recounts wrapping Ace bandages around her stomach to make her look slimmer.
Her essay is reproduced here:
So we ask vendors, why? Why do you insist on using a metric that is less than worthless? The employed population (not to mention the employers who pay for this stuff) gets no benefit from this. And as this article describes, BMI obsession creates a body-image issue as well.
There is also the slight problem that — assuming for the sake of argument that BMI is a worthwhile measure:
- Koop award-winning programs can’t reduce it;
- a wellness vendor (Vitality) can’t reduce it on their own employees;
- and Aetna spent $500/employee but didn’t reduce it.
I realize that, as wellness vendors, you need to find some way to snooker employers and show employees who’s boss, but can’t you come up with something that doesn’t actually harm people and might possibly have a chance of working?
Ironically, the wellness industry doesn’t understand irony.
The wellness industry is about nothing if not irony. Ironically, wellness vendors and consultants don’t understand irony, so they keep doing and saying things they think are being taken seriously. Ironically, they are being taken seriously, but only by students of irony.
For example, these wellness people don’t understand that it is ironic that employees can be forced to submit to “voluntary” wellness programs, or face fines of thousands of dollars. They say this unabashedly. Whereas when we make an ironic comment, such as: “Wellness vendors make employees happy whether they like it or not,” we do it deliberately.
The May issue of Managed Care displays a cornucopia of unintended irony, in a debate between myself and Harris Allen, of Navistar fame, on the effectiveness of wellness programs in preventing diabetes.
Speaking of Navistar, Mr. Allen was already famous for irony before this debate. He showed Navistar how to claim a wellness ROI of 400-to-1, later reduced to 40-to-1, before jumping again to 400-to-1. That by itself — adding/removing extra zeros in your ROI but claiming it’s real the whole time — is ironic, but that’s not even the ironic part. The irony is that he was concocting these figures even as Navistar itself was making up $4-billion of phony shareholder equity, perhaps including these wellness savings. A lot of the perps (excluding Harris) are ending up in jail over this caper. Ironically, despite his pride in his work on wellness for Navistar, he didn’t cite their results in his counterpoint.
Not being Navistar shareholders ourselves, we found this whole escapade highly amusing, so it is recounted in This Is Your Brain on Wellness, our humor column.
Back to the debate irony. The irony is that, in his attempt to justify wellness, he cited two examples that lead to the opposite conclusion. First, he cited US Preventive Medicine (USPM). USPM did indeed achieve an excellent result, and it is validated by and displayed by the Validation Institute. On that everyone can agree. I myself just wrote a column praising their performance. The thesis of the column: “See, not every wellness vendor fails.”
He cites that exact same company and exact same validation to conclude: “See, wellness vendors can succeed.” Yeah, one wellness company has succeeded while the staggering number of failures — companies that couldn’t get validation or didn’t even bother to apply — is in the thousands, a statistic I noted just yesterday.
Using the same logic as Mr. Allen, one might profile Powerball winners and say: “See? Powerball works.”
The other irony is that he cited the Koop Award-winning companies as examples of successes in preventing diabetes, when — according to their own applications — they basically failed. Ironically, I also cited that very same award in my argument. Specifically, McKesson won an award for preventing diabetes even though its employees’ glucose and BMIs increased. Mr. Goetzel’s and his Koop Award committee cronies never been much for fact-checking, even when the facts are right on the application itself:
The final irony is that Mr. Harris ends his argument with a call for “evidence-based” wellness programs. Ironically, the “evidence” is overwhelming…in the other direction: wellness programs have not avoided a single wellness-sensitive medical admission, according to US government figures. The green line below represents the wellness-exposed population while the red line represents the rest of the country. There is no separation, meaning that the wellness-exposed population has achieved zilch.
Actually, there is slight separation –but ironically it goes the other way. You’d statistically be better off not being exposed to wellness.
This graph is part of my proof of the ineffectiveness of wellness vendors, and allows me to offer a million-dollar reward to anyone who can show wellness doesn’t lose money.
Where did the government get the data for this graph? It was compiled by Truven Health, the division of IBM that — you guessed it, ironically — employs Mr. Goetzel.
New Wellness Book Costs $5400 (but that includes shipping)
It seems like wellness economics are the opposite of regular economics. The more expensive the books, the less accurate they are. My books–Surviving Workplace Wellness, Cracking Health Costs, and Why Nobody Believes the Numbers — are completely accurate, in that readers have purchased more than 13,000 copies and reported no mistakes. (There actually is an inconsequential division mistake in a sidebar in Why Nobody Believes but I seem to be the only one to have noticed.)
In total, those books cost less than $100.
Or, you could “upgrade” to the IBISWorld report for $895 and read literary gems like:
Wellness firms may offer employers stress management courses and sessions that offer music therapy, aromatherapy, Tai Chi, and post disaster stress reduction through coaching.
Government-funded initiatives that promote wellness to cut costs related to chronic ailments (e.g., obesity and diabetes) has further exacerbated many businesses movement toward purchasing corporate wellness services.
And my favorite:
The industry provides wellness programs to businesses across the United States, including small, medium and large businesses in the private sector and businesses in the public sector.
“Businesses in the public sector”? I realize many of our legislators are for sale but I didn’t know they had incorporated.
A full review of the IBISWorld tome, “New Report Raises the Bar for Cluelessness in Wellness,” can be found here.
And now may I introduce The Global Market for Population Health Management, 2016. Before you mortgage your firstborn to fork over $5400 for this one, I would suggest reading the “highlight” that they were kind enough to put right on their website.
The “global economic burden of chronic disease” rising to $240-trillion would be quite a feat, given that total global economic output itself is only about $70-trillion. However, macroeconomics might be the opposite in wellness too.
The triple-digit IQ crowd will be most surprised to learn that:
At the same time, suppliers are deterred from entry or expansion due to success-based compensation models, global recession-based pricing pressures and the consequent perception of low margins.
Vendors are “deterred from entry”??? So the world is suffering from a shortage of wellness vendors? That might be news to the thousands of HR departments who get pestered by these vendors on a constant basis. Try googling on “empower” and “wellness.” You’ll find seven companies with some variation of those words in their name. A good rule of thumb is that an industry in which seven companies have the same name is not suffering from a vendor shortage.
Quite the opposite, the industry has so many vendors that it is literally running out of names. There is an “Interactive Health” and a “Healthy Interactions,” a “Wellness Corporate Solutions” and a “Corporate Wellness Solutions.” In addition to running out of names, the industry is running out of non-names, so they end up with letter combinations more closely associated with Scrabble tiles, such as “Dacadoo.”
Mr. McGrigor attributes this shortage to two factors.
First, “success-based compensation models” are holding the industry back. In other words, the reason wellness vendors are failing is that they can’t succeed. As an aside, Quizzify has a success-based model. We are often asked why we offer such a model when wellness vendors don’t, as though guaranteeing success is a bad thing. So Mr. McGrigor has it the opposite of the way it is: buyers assume wellness vendors will fail, and look askance at those that guarantee success.
Second, vendors are “deterred from entry” because of the “perception of low margins.” For $5400, an author should be required to understand basic economics. It’s just the opposite of what Mr. McGrigor says. As I used to explain to the students when I taught economics at Harvard (you knew I would work that in), the price of milk isn’t low when the price of cows is low. The price of cows is low when the price of milk is low.
So if wellness margins are low, it’s not because vendors don’t want to enter the market. It’s because the world is drowning in a sea of “empowered” wellness vendors.
One place margins are not low, though, is in books telling everyone how great the wellness industry is. However, there is another rule of thumb in economics too: you could have the highest margins in the world but you still won’t make any money if you have no understanding of the subject matter you are writing about.
Unless he is banking that wellness economics are the opposite of everything else, which history suggests isn’t such a bad bet.
Top Ten Reasons to Tell Wellness Vendors to “Just Walk Away”
Jon Robison just posted the best-ever summary of arguments against “doing wellness to employees” that I’ve seen. He summarized and invalidated all the nonsense in about 600 words (admittedly including a bunch of links, to this site and others).
However, the posting was unbalanced. He left out the best argument in favor of undertaking a “pry, poke and prod” program, the more comprehensive, the better. If you are located in “Silicon Alley” in Manhattan, compelling your employees to participate in a “voluntary” program will inspire some of them to quit, because it will be perfectly obvious to them that management has no idea how to treat valuable employees.
Then Quizzify can hire them…and we don’t care what they weigh.
We hope you hate our new Pulse posting
A word means whatever I want it to mean, neither more nor less.”
Like George Orwell and Humpty Dumpty, the wellness industry (thanks largely to the Business Roundtable pressuring the EEOC) has now managed to redefine wellness programs as their opposite: “voluntary” now means “required,” in the sense that if you don’t volunteer to submit to “wellness or else” you could be fined up to about $3600 (if you spouse is on your insurance), which is a little less than 10% of the median annual wage, and exceeds the amount in many people’s savings.
But the wellness program is still voluntary, according to the EEOC. Or as Surviving Workplace Wellness says: “wellness programs will make employees happy whether they like it or not.”
These wellness people have experience at redefining words as their opposites. Health Fitness Corporation’s Dennis Richling redefined “514 Nebraska state employees didn’t have cancer at all” to “we made life-saving catches of 514 employees with cancer.” He referred to this subtle difference as “semantics.”
Jon Robison and I just posted a “Pulse” on the wellness industry’s creative use of the English language, which rivals their creative use of fifth-grade math.
We hope you hate it, where “hate” means “love.”
Business Roundtable Bludgeons EEOC into Allowing Employers to Require Genetic Information
In a deep dark recess of today’s Federal Register, large corporations just quietly received permission to “play doctor” with their employees. They can now impose even more draconian and counterproductive wellness schemes on their workers than they already do. Their hope is to claw back a big chunk of the insurance premiums paid on behalf of employees who refuse to submit to these programs, or who can’t lose weight.
A Bit of Background on Wellness
The Affordable Care Act (ACA) allowed employers to force employees to submit to wellness under threat of fines. Specifically, the ACA’s “Safeway Amendment” — named after the supermarket chain whose wellness program was highlighted as a shining example of how corporations could help employees become healthier — encouraged corporations to tie 30% to 50% of the total health insurance premium to employee health behaviors and outcomes. (As was revealed while ACA was being debated, Safeway didn’t have a wellness program. The fictional Safeway success was a smokescreen for corporate lobbyists to shoehorn this withhold into the ACA.)
Once this 30% to 50% windfall became apparent, many corporations figured out what this vendor (Bravo Wellness) advertised: there is much more money to be made in clawing back large sums of money from employees who refuse to submit to these programs than in improving the health of employees enough to allegedly reduce spending many years from now. “Allegedly” because–unlike simply collecting fines or withholding incentive payments–improving employee health turns out to be remarkably hard and ridiculously expensive to do, so hard and expensive that:
- The entire wellness industry has not avoided even a single heart attack or case of diabetes, statistically speaking, according to data compiled by a wellness consulting firm for the federal government;
- The only wellness company willing to release results of its own wellness program on its own employees,admits the program failed;
- Even the employerswhose wellness programs have won awards as the best in the field have made only trivial improvements in employee health.
Most importantly, the complete lack of regulation has allowed the wellness industry and health plans to expose employees to significant potential harms, in order to maximize revenues.
The Federal Government Green-Lights “Wellness-or-Else” Programs
There are no regulations, licensure requirements or oversight boards constraining the conduct of wellness vendors, and only one agency — the Equal Employment Opportunity Commission (EEOC) — providing any employee recourse. The Business Roundtable has taken on the latter at every opportunity. First they threatened President Obama that it would withdraw its support for ACA unless he declawed the EEOC. Then they held sham Senate hearings entitled: “Employer Wellness Programs: Better Health Outcomes and Lower Costs.” Finally, they threatened to push the“Preserving Employee Wellness Programs Act” to eviscerate the EEOC’s protections legislatively.
But it turns out the legislative end-around wasn’t necessary. The EEOC has now caved in. These programs are defined as “voluntary,” and yet as of now, employees can be forced to hand over genetic and family history information, or pay penalties. So, as in 1984, where “war” means “peace,” employees can be required to voluntarily hand over this information.
Let’s be clear. This isn’t about employee wellness programs, which don’t work. It’s all about the penalties. Genetic information is worthless in the prevention of heart disease and diabetes, as Aetna just showed in a failed experiment on its own employees.
Knowing family history does have some predictive value, but it is unclear how employees are going to benefit from employers collecting it. Self-insured employers could either fire the employee or do nothing. Neither is useful for the employee. If the employer is fully insured, this information is akin to a “pre-existing condition” in the old days. The employer’s premiums will increase as long as employees with bad family histories remain on their payroll.
The Good News, Part 1: Corporations Wising Up
The Business Roundtable, and their friends at the US Chamber of Commerce, might want to connect their computers to the internet. It turns out that many companies are finally realizing that compelling employees to submit to medical screens just to claw back some insurance money isn’t worth the morale hit.
Increasingly, employers are learning that what the national data shows is also true for themselves: these programs simply do not work. For example:
- The prestigious journal Health Affairsconfirmed previous analysis that fining or bribing employees to lose weight is a waste of time and money;
- The state of Connecticut, also in Health Affairs, admitted that their program has caused coststo increase;
- The Health Enhancement Research Organization (HERO), the wellness industry’s trade association, admitted wellness causes such massive cost increases that it loses money–even when HERO acknowledges fabricating data to try to show savings.
And the morale hit? A formerly obscure faculty member who led the successful employee revolt against the Penn State wellness program just got elected president of the Penn State Faculty Senate–largely because employees were so grateful to him for his leadership in that revolt.
The Good News, Part 2: Wellness For Employees
As a result, many companies are deciding that clawing back some insurance money isn’t worth the damage done to their workforces. They are replacing “wellness done to employees” with “wellness done for employees.” These companies are improving the built environment, upgrading their foodservice, encouraging fitness, or simply adding features to the health benefit like paternal leave or financial counseling. They might still hold a “health fair” every now and then, but their medical tests are conducted infrequently–according to actual clinical guidelines–instead of allowing vendors to screen the stuffing out of their employees to find diseases that don’t exist.
Or they are actually focusing efforts where they can make a difference, like steering employees to safer hospitals or educating employees on how to purchase healthcare services wisely. (Disclosure: my own company, Quizzify, is in the business of teaching employees how to do the latter.)
Notwithstanding this disruption and regardless of the harms it has caused, the $7-billion wellness industry has excelled in perpetuating its own existence. Industry “thought leaders” recently proposed a scheme to encourage companies to disclose how fat their employees are–and have even managed to get a few large employers to sign on to it.
The sheer audacity of that scheme and complete disregard for its consequences on overweight employees means the war on “voluntary” wellness-or-else programs is by no means over. Like every other industry threatened by reality but supported by deep-pocketed allies like the Business Roundtable, the wellness industry can rely on the government to delay the inevitable.
Consequently, it might be quite some time before the inevitable course of reality overcomes the wellness-or-else pox on the healthcare system.
NIOSH Publishes Groundbreaking “Total Worker Health” Agenda
NIOSH is the National Institute for Occupational Safety and Health. It is part of the Centers for Disease Control and Prevention. Their charter is the opposite of the wellness industry’s, and can best be described as a focus on the health of workers, rather than on the health of workplace wellness vendors. That puts me and them (meaning NIOSH) in total alignment.
They recently published their workplace safety and health agenda for the next 10 years. Readers can either read these highlights, a longer summary, or the actual report, entitled: A National Agenda to Advance Total Worker Health® Research, Practice, Policy, and Capacity.
By way of background, since the federal government became actively involved in workplace safety 43 years ago, deaths in the workplace have fallen by about two-thirds, while the size of the workforce has doubled–meaning the death rate is down about more than 80%. To put this in perspective, the entire age-adjusted death rate overall during this period has fallen by less than half. Plus, the reductions in the latter rate are concentrated among the very young and very old, not so much working-age people.
Lately, of course, death rates in one of NIOSH’s target populations have been rising–making the workplace mortality improvement even more striking.
The improvement is multi-factorial. Yes, NIOSH and OSHA regulations, oversight, inspections and penalties are partly responsible. But reputation, safety features, technology, offshoring of “dirty” work, and fewer inherently dangerous jobs (like coal mining) also contribute. Note that the improvement in the overall age-adjusted death rate has also benefited from similar major favorable trends. Yet the workplace death rate reduction has far outpaced the general decline.
On the other hand, there remain 3-million workplace-related injuries and illnesses/year, meaning the task is still at hand. And unlike heart attacks and diabetes, many of these injuries and illnesses can actually be prevented by the employer.
The centerpiece of the NIOSH Total Worker Health agenda is that the workplace should be a safe and healthy place. Employees should be safe from accidents, hazards, chemicals, bullying and other “risk factors in the workplace that contribute to common health problems previously considered unrelated to work.”
The report calls for “risk assessment and risk management” in the workplace. That is, of course, exactly the opposite of what’s done by the wellness industry, which could never be confused with MENSA. They (meaning the wellness industry) continue to flog the same discredited, worthless “biggest loser” and “pry, poke and prod” programs despite the overwhelming evidence that these programs contribute to, rather than ameliorate, risks and hazards and stress in the workplace–and of course lose money.
As a wellness professional, you should read the section: “Issues Relevant to Advancing Worker Well-Being through Total Worker Health.” That, my friends, (plus Quizzify, which does address worker health) should be your agenda for the next 10 years, just like it’s theirs.
The report goes on to specify how NIOSH and their collaborators are going to address this agenda, but the gist is in that one section.
Along with what the NIOSH report does advocate in its 10-year agenda, it’s important to note what it doesn’t advocate: conventional “pry, poke and prod” wellness.
One can only imagine the political pressure NIOSH had to withstand in order to avoid turning this outstanding document into a paean to wellness, or at least including a section on wellness–or at least a few passing mentions of the word, which doesn’t appear once. Likewise “screenings,” “health risk assessments,” and any form of crash-dieting weight-loss initiatives are also omitted.
Why do I infer “political pressure”? Because NIOSH’s overlords are the CDC. Having allowed Ron Goetzel to paint them into the wellness corner, they are doing exactly the opposite of NIOSH: in order to try to prop up their wellness friends, they are doubling down on demonizing chronic disease. Using a round-up-twice-the-number-of-usual-suspects approach to biostatistics, they recently and inexplicably bumped their previous mantra of 75% of healthcare spending being on people with chronic disease up to 86%.
How? Simple: among other things, that figure includes someone with allergies having a baby or breaking a leg. Naturally vendors take advantage of their trademark innumeracy to further misinterpret the CDC’s already-fictional figure as “86% of spending is due to chronic disease.” Neither 86% nor even 75% makes any sense whatsoever as a practical matter, and long ago we debunked the 75% as healthcare’s biggest urban legend.
This isn’t the first time the CDC’s numbers haven’t added up. These are also the people who are horrified both that “7 out of 10 deaths are due to chronic disease” (that’s called “civilization,” folks) and that a shocking 20% of children are at or above the 95th percentile for weight.*
And yet, these are the same people who wiped out malaria in the US, smallpox worldwide, (eventually) helped contain the spread of AIDS, and possibly prevented a domestic Ebola mini-epidemic.
So here’s a modest four-part proposal. The CDC should:
- Let NIOSH take the lead on total worker health;
- Let me take the lead on fifth-grade arithmetic;
- Let Mr. Goetzel take the lead on delaying the wellness industry’s asymptotic decline into irrelevance; and instead
- Do the one thing they know how to do very well, which is keeping people alive.
*Yes, we know what they meant. The growth charts were developed in 1979 (as it happens my very own uncle, Dr. Michael Lane, led the project, after he led the smallpox eradication project). They meant to say that 20% of today’s kids would be at or above 1979’s 95th percentile. But that’s not what they did say.
Ironically given the Chicken Little-esque histrionics in the CDC’s other bogus claims, this particular observation would have actually been both dramatic and compelling — if they had only managed to get it right.
Four More Vendors Caught…Doing Something Right
The popular perception is that They Said What tries to catch vendors doing something wrong. Nope – they generally self-immolate and we just take screenshots. Or as we say, in this industry, “you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
Yet no matter how screamingly obvious the data, a journalist, essayist, or blogger loses credibility if they always say the same thing. That’s why we try very hard to catch vendors doing something right.
For us to do that, vendors have to give us the opportunity – by actually doing something right. To avoid being judgmental, we like to see them independently validated for, in as many words, “doing something right.” Validated not just by anyone, but by the Care Innovations Validation Institute. Care Innovations, a wholly owned subsidiary of Intel Corporation, launched the Validation Institute in 2014 to provide companies with 3rd party validation of their outcome claims. (Disclosure: while I am neither a Validation Institute employee nor an advisor, my book Why Nobody Believes the Numbers provides the methodological basis for some of their validations, and they sometimes retain me as an outside expert/validator.)
The Validation Institute is the Gold Standard of validation. Everything is vetted carefully and has never been challenged. Validation can be done two ways: on the basis of valid contractual representations or on the basis of actual outcomes. The vast majority of validated organizations have the former, because their outcomes to date are insufficient for the latter. An example of contractual language validation would be Quizzify’s savings guarantee. (Disclosure: I founded Quizzify. The validation for Quizzify was obviously conducted by another of the Validation Institute’s team of 3rd party, independent validators).
While many companies guarantee or show savings, it turns out the language used in that guarantee or demonstration of savings determines whether savings can quite literally happen on their own due to faulty study design or whether they truly reflect underlying improvements. Quizzify, for example, couldn’t get outcomes validation because it hasn’t been around long enough to apply these valid contractual representations/guarantees to its own outcomes.
By contrast, the four organizations below are among the few whose validation is specifically outcomes-based – meaning these companies took the next step and what they say they did, is what they actually did.
Even so, if you read the validation language carefully, you’ll see it never exceeds what the outcomes data allows.
Alphabetically, we look at each of these four in some detail, describing the outcomes that were achieved. Just to reiterate, these four companies are among the very few in population health that can lay claim to outcomes improvement, measured validly. Why? Because any company that could get Validation Institute validation, would. (Quizzify sought it as soon as we had language that could be validated…and are very pleased with the attention it has brought us and the doors it has opened.)
Evolent Health: Focused on the Most “Impactable” Patients
Evolent is the first value-based care company with a complex care management program to show savings. Typically, companies compare the “pre” cost to the “post” cost, but anytime you target a chronic group that is high-need, high-cost, the “post” will always look better compared to the “pre.” Statisticians dryly call this regression to the mean and many vendors claim credit for the decline in cost when it had nothing to do with their interventions.
Instead, Evolent showed savings the hard way – by actually achieving them. They measured how much the cost of high-risk chronic patients declined on their own and then only took credit for the additional reduction. Suppose you have a magic potion to flip 100 coins from heads to tails. If only 50 flip, your potion is worthless; the probability of landing on tails is already 50-50. If 60 coins flip, the Validation Institute would give you credit for 10. Evolent showed that their program lowered utilization and costs beyond the reductions that would have happened anyway.
In a field known for the time lapses between a patient’s need for care management and its delivery, Evolent’s more advanced predictive modeling (covering more datasets than a carrier would typically use) expeditiously determine those at highest risk of having an “impactable” event. Further, whereas most such programs focus on just checking off boxes, Evolent intervenes across the spectrum of clinical, behavioral, social, nutritional and environmental domains.
Having reviewed many of these programs, I’ve been shocked by how long it takes them to find and enroll patients, how little they do for the patient, and how little they know about what they’re doing. Evolent is the opposite. This is their business, not a sideline – they take it seriously and it shows.
Healthways Well-Being: It’s Not Just about the Cholesterol
For the uninitiated, the philosophy of well-being is to address gaps not just in employee physical health but – as importantly – in their emotional, financial, occupational and social health. In many cases, those latter issues are the root cause of high healthcare spending and low productivity. Addressing those issues should help a given population – from the healthy to the sick – perform noticeably better while possibly spending less on healthcare.
Before you even heard of “well-being,” Healthways was measuring it, more than a decade ago. Since 2008, Healthways has partnered with Gallup to definitively measure well-being via the Gallup-Healthways Well-Being Index, the most proven, seasoned and comprehensive measure of well-being in populations in the world. Quite literally, if there is any component of this industry which has penetrated the public consciousness in a positive way, it’s the Gallup-Healthways Well-Being Index, whose publication often reaches the lay media.
Healthways can use surveys, down to the community level, to benchmark similar surveys for companies, departments and employees, so that organizations can focus their improvement efforts where they are needed most. The Validation Institute has confirmed Healthways’ findings that in fact performance (holding constant as many other variables as possible) correlates far more closely with indicators of well-being than with biometrics alone. This data collection, insight and benchmarking allows targeted interventions to complement or replace conventional wellness…and get closer to the root cause of underperformance.
Rarely is the root cause of poor health “I-don’t-care-itis,” as one wellness vendor calls it. Often it’s a different personal issue. Sometimes the root cause is department-specific. This data can be used to identify managerial or process flow issues far beyond the scope of – and far more powerfully than — conventional wellness.
Quantum Health: the Story Tells Itself
While I make more general comments about the other vendors on this list, I don’t need to for Quantum Health. They were the first and are still the only company validated for total savings across an entire organization.
Instead I will share a story that shows how their incentives for members to call in – combined with their non-siloed approach to those calls – create a confluence of time and place that change behaviors and likely outcomes.
Once, when I visited them, an employee of a new customer called, asking if diabetic shoes were a covered benefit. In most, if not all, carriers, the employee answering that query would be evaluated based on accuracy of the answer, number of rings, politeness and how many calls they handled that hour. So the person would say “yes” or “no” and then get off the phone. At Quantum Health, the agent answered the query but was prompted by the supporting software (and by training) to recognize that question as a red flag. Here was an employee whose diabetes was already so advanced he was asking about shoes…and yet he was nowhere in the diabetes registry. A typical carrier wouldn’t find out about this person until after the inpatient claim for his inevitable crash was filed, warehoused, prioritized and queued for telephonic outreach. And then, assuming the carrier had the correct phone number, and this patient answered the call and was receptive, rehabilitation could begin.
And yet there he was – right on the phone – asking for help. So the agent probed a little further and then transferred him to a nurse in the same pod, who engaged him right away, almost certainly avoiding or forestalling a future high-cost medical event.
US Preventive Medicine: Finding the Formula
The editor of the American Journal of Health Promotion, Michael O’Donnell, famously admitted that up to 95% of wellness programs fail. U.S. Preventive Medicine is squarely in his other 5%. As quite literally the purest wellness program validated by the Validation Institute, USPM has – alone in the wellness industry – found the formula for a significant and sustained reduction of wellness-sensitive medical events (hospitalizations and ER visits).
The Validation Institute analysis showed that USPM generated a sustained average 41% reduction of hospitalizations and ER visits across several chronic conditions (Diabetes, Asthma, Coronary Artery Disease, Hypertension, Chronic Obstructive Pulmonary Disease and Congestive Heart Failure) over a four-year timeframe, significantly outperforming the averages as tallied by the Healthcare Cost and Utilization Project (HCUP). USPM provides a unique data-driven, high-tech and high-touch combination of conventional and unconventional interventions to enhance engagement and translate that engagement into actual behavior change.
The Validation Institute has publicly urged all wellness vendors to collect real data, apply their value event rate-based template (the only methodology that They Said What and HERO agree on, as also described in Health Affairs), to see if they can match USPM’s performance…and so far, none have come close.
Michael O’Donnell might have been optimistic in his assessment—the failure rate seems much higher. But it’s not 100% — USPM is the exception that proves wellness can indeed be done successfully…if all the components fit together.