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Is Optum Alternative-Facting?

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Wellness vendors were into alternative facts before alternative facts were cool.  They even expanded the domain to include alternative math, like Wellsteps showing that costs had increased and decreased at the same time.

Is Optum (United Healthcare) going a step further, into alternative ethics?  Here are two Optum claims, which appear to be exactly the opposite of each other.  Now, we aren’t going to call anyone an alternative fact-er, but we would invite them to explain — and we’ll provide equal time — how both these seemingly incompatible statements can be true.

First, the head of their wellness group, Seth Serxner, acknowledged that biometric screening is supposed to be done in accordance with guidelines.  (The guidelines are reproduced below, by the way, since he seems to have trouble remembering them when he’s approving marketing materials.)

He insisted, on tape, that the only reason Optum flouts screening guidelines is because employers make them do it: “Many clients won’t let us [screen appropriately],” he said.  The full tape can be downloaded from that link, but it is tough to find the audio. (The time stamps appear to vary by download. However, it is towards the end and you can manually sync by following The Great Debate in total, which starts here.)

So, on Seth’s planet, Optum begs employers to pay them less money by screening their employees at longer, more appropriate, age-adjusted intervals…and employers refuse.

However, it appears, based on the marketing material below, that the reason employers refuse to let Optum screen appropriately is that Optum requires employers to screen inappropriately.  You read that right: “participation in our wellness program…is a requirement.” And that decidedly includes screening…which employers must pay extra for in order to get the “savings” on their premium.

united-healthcare-lies

They then go on to quote — you guessed it — Kate Baicker’s 7-year-old study based on alternative data that even she appears not to believe any more.  The second alternative quote is attributed to WELCOA, a quote which WELCOA’s CEO, Ryan Picarella, assures me he never made, nor did anyone currently in his organization, and that he doesn’t believe.


Update: It was observed on Linkedin that the reason they do this (for their fully insured business) could be as an ACA play. You don’t mind if spending on claims increases because you need to get to 80% (or 85%, depending on size) loss ratio anyway. The screening isn’t counted towards the 85% because it’s not a claim, so you make money there too by charging separately. Brilliant!  United Healthcare’s shareholders should be very impressed.


Here are the USPSTF guidelines, by the way, also reproduced below, albeit badly.  (There is nothing wrong with your TV set. Do not attempt to adjust the picture.)  This is actually the version published by “Choosing Wisely”  (a joint project of Consumer Reports and the Society of General Internal Medicine), and they don’t totally sync with USPSTF, but whatever the minor differences are, neither looks anything like what Optum and their alternative friends advocate.

choosing-wisely-uspstf-guidelines

 

 

 

 

 


2 Comments

  1. Dave Ruminant says:

    I’m sorry… as a former employee of ‘Optum Insight’ *ick*, I recall all we ever did (besides sell overpriced consulting services and antiquated software) was ‘PIVOT.’ Pivot here, pivot there, pivot damn near everywhere etc. Long management phone calls (with everyone on mute of course) to discuss how, when and why we were Pivoting. Obviously we were way ahead of the always-murmured about (but highly non-mathematical) ‘curve’; there seems to be a whole bunch of pivoting going on these days.

    So with that caveat, I must say that ‘Seth Serxner’ is the most phony, made-up name I have ever heard. It sounds like an evil supervillain created by a wanna-be Marvel Comics rival that went out of business in the 1960s.

    At first I tried plugging it into your generic anagram generator, as ‘Sex’ seems to involve a lot of pivoting… but nothing really sexy resulted.

    However… it is dying to be the first line of an impossible to construct limerick, e.g.

    “There once was a dude named Seth Serxner…
    Who * *** ** **
    His ****
    Did ****
    And everyone then was ***”

    Even better if you fake a lisp. I know where United found me (they called me); where did they find this guy!!!1!? Like the square root of a negative number… I hereby proffer $50 in wellness bonus points, redeemable anywhere Mallo-Cup money is accepted, to anyone who can finish this limerick.

    Like

    • whynobodybelievesthenumbers says:

      lol –You should be writing this blog, not me. I’m afraid, however, that finding something to rhyme with “Serxner” would be like finding something to rhyme with “Orange” or “Silver.”

      Like

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