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Final installment: 3 more stories of wellness shame and harms

Included in this concluding batch is yet another wellness program debacle regarding eating disorders. The irony is, this one takes place at an addiction facility.  I’ve always maintained that, along with facts, integrity, math, data, employees and me, another thing the wellness industry has no appreciation of is irony. Examples:

This final set of case studies concludes with a statement from an actual named, LCSW who specializes in the treatment of eating disorders.

Links to previous installments:

  • Part 1: Recovering executive with anorexia nervosa begs not to be weighed…DENIED
  • Part 2: Recovering technologist with bulimia told to “fit into his skinny jeans”
  • Part 3: Recovering employee with anorexia nervosa told “nothing tastes as good as skinny feels” and advised to eat only half her lunch.
  • Part 4: Recovering employee with bulimia and a severe grain allergy penalized for eating too many natural fats, as correctly prescribed by her dietitian…and begins purging again.

Joan

The school where I work recently instituted a wellness program.  In order for our insurance premiums to not increase, we had to go through a series of tests:  total cholesterol, blood pressure, BMI, LDL cholesterol and fasting glucose.  If we did not “pass” 4 out of 5 of these biometric screenings, we had to go through six weeks of phone therapy and then have the screenings done again after that time.

If, after the six weeks of phone therapy, the results did not change, our insurance would go up about $50.00/month.

The whole experience was a nightmare.  They conducted the screenings in the music room at school, with different tables and stations set up.  About 10 or 12 teachers and staff members were in the room at one time, so there was little privacy.

We moved from one station to the next as each of our results was written down and passed to the next person.

When we got to the end, a wellness “counselor” went over our results.  The lady saw my triglycerides number and immediately asked, “Does diabetes run in your family?”  “Is obesity an issue in your family?”  I asked why.  She said that a high level of triglycerides means that the body has “too many fat cells” and that I am at an “increased risk.”

To someone who has struggled with an eating disorder, as I have, this was tantamount to saying “Because of your high triglycerides, you are fat.  You are obese.”

Being weighed is always a humiliating and shameful experience for me, as it is for many people with eating disorders, and it can trigger exacerbations of my disorder (treating professionals familiar with eating disorders are well aware of this phenomenon and structure treatment accordingly).  To have to be weighed in front of my peers made that experience even worse.

This biometric screening triggered my disorder.  I was in tears by the time I got to the last “counselor” and had a very hard time controlling my feelings.  Right after this, I needed to get into my classroom and be with my kids.  I had to “suck it up,” until the end of the day.

It was horrible and it makes me wonder what is in our future in regard to all of this.


Katie

My workplace, an addiction treatment facility, has an employee “wellness” program.

If employees want to obtain the insurance “wellness rate” (the lower of two rates available to employees), we are required to start every year in January with a “health fair” and a “know your numbers screen” where they check weight, blood pressure, glucose levels and cholesterol.  Then we are “advised” by a registered nurse to exercise more and eat less (as if that had never occurred to anyone previously).

This year, the medical assistant drawing my blood engaged in numerous behaviors that would trigger most people with an eating disorder.  She informed me she “used to be as big as” I am until she “got bypass surgery.”  Despite mentioning several times that I see a nutritionist who recommends that I not weigh myself or know my weight, I was asked to guess my weight before I stepped on the scale.  I turned around when I stepped on the scale to avoid seeing my weight, but the assistant nonetheless chattered on about my weight.

I was reminded of embarrassing weigh-ins with school nurses and weight loss programs before I was exposed to eating disorder recovery.

This year we are also assigned to a “wellness team” where everyone is supposed to wear pedometers every day and log their steps weekly on a website.  Everyone can see everyone else’s steps on the site and a competitive spirit is encouraged.

I am especially saddened and concerned that we have this potentially damaging environment that encourages obsession with weight and numbers in a facility that treats addiction, where one would hope we would be steered away from, rather than toward, the process of addiction to disordered eating.


Rhonda Lee Benner, LCSW

I have worked with hundreds of patients over the 13 years during which I have worked with people with eating disorders.   In the past two years, I have seen a number of patients who were quite negatively impacted by the wellness programs at their place of work.

In one instance, a patient with binge eating disorder reported that she would be financially penalized if she didn’t set weight loss as a goal and make progress toward this goal. However, this was in direct conflict with her treatment goals to stabilize eating and set any goals for weight loss aside.  This patient could see how focusing on weight loss increased her binge eating; however, she felt shame and anxiety as a result of these pressures put on her by her employer.  She did not feel that as a larger-sized person she could speak up about this injustice.

In another instance, a patient reported that her employer required her to complete a health screening or be charged $600.00, and when she didn’t meet the health targets she was given an opportunity to still get the monetary “rewards” by meeting with a dietician three times.  She was also informed that she could get a “Healthy Weight Improvement Reward” by losing five pounds since her last health screening. Again, this is a patient with binge eating disorder whose condition is destabilized by focusing on weight loss. She too felt that as a larger-sized person she could not speak up about how this program could cause her harm.


What now?

Next week, and with the help of others, we will ask, what does this all mean? What can be done to prevent or discourage wellness vendors from harming employees?

And once again, kudos to the good guys, the vendors who are not implicated in this series at all, and indeed would never do such things to people:

American Institute of Preventive Medicine, Health Advocate, HealthCheck360, It Starts with Me, Limeade, Redbrick, SelfHelpWorks, Sterling, Sonic Boom, Sustainable Health Index, US Health Centers, US Preventive Medicine

Wellness vendor penalizes employee with severe grain allergy for eating too much fat. (Part 4)

Imagine if you were a recovering alcoholic. You hadn’t taken a drink in quite some time, attended AA meetings conscientiously, and were getting on with your life. Then your employer had a drinking contest and told you that you weren’t drinking enough. Further, if you failed to drink more, you would be fined.

Preposterous? Yes — but that is exactly what people with eating disorders are forced to endure in many wellness programs. They are told to eat less to become thinner, docked points or money if they don’t, and are made to feel inadequate by vendors who have no idea what they’re talking about.



This is the fourth in the series of major wellness harms perpetrated on employees by wellness vendors and indifferent employers. These narratives have been painstakingly compiled, edited only lightly, and with no detail omitted other than the victim’s name and employer. I won’t tell you who the perps are yet, other than to say that the vendors I have consistently noted to be the best — American Institute of Preventive Medicine, Health Advocate, HealthCheck360, It Starts with Me, Limeade, Redbrick, SelfHelpWorks, Sterling, Sonic Boom, Sustainable Health Index, US Health Centers, US Preventive Medicine — are not among them. 

See:

  • Part 1: Recovering executive with anorexia nervosa begs not to be weighed…DENIED
  • Part 2: Recovering technologist with bulimia told to “fit into his skinny jeans”
  • Part 3: Recovering employee with anorexia nervosa told “nothing tastes as good as skinny feels” and advised to eat only half her lunch.

Sue

I struggle with bulimia. My employer instituted a wellness program that requires employees to undergo yearly medical screenings of cholesterol, blood sugar, blood pressure, and body mass index.  We also have to fill out an annual health questionnaire.  Employees who undergo the screenings and complete the questionnaire receive a reduction in their health insurance premiums, whereas employees who decline to do either of these things cannot receive this reduction.  If an employee’s spouse is covered under his or her insurance, the spouse must undergo the screening as well in order for the employee to receive the premium reduction.

The program recommends that you join coaching and weight management classes if the screening identifies your body mass index as “too high.”  It suggests that being thin means being healthy, and being heavier means being less healthy, even though this is far from true for many people.  For individuals who have struggled with eating disorders, it is particularly troubling to be labelled as having a weight problem or a problem with body mass index despite having worked closely with treating professionals to manage the disorder.  Telling such individuals that they have a weight problem is precisely the type of response that professionals who treat eating disorders know to avoid. When nurses with no knowledge of our treatment history or progress, and no knowledge of eating disorders generally, respond this way, it undermines our treatment and progress.  It is even worse when that undermining happens at one’s place of work.

Like the screenings, the health questionnaire inappropriately suggests that thinner is always better.  Based on my answers, the wellness program assumes that I have unhealthy eating habits, but it does not account for the fact that my diet is carefully prescribed by my treating doctor in response to a multitude of food allergies.  I am allergic to all grains, and as a consequence, in 2013 I switched to a natural fat, unprocessed, grain-free diet.  My health markers began to improve at that time.  The wellness program, however, identified my eating as unhealthy because of the fats included in my diet.  As a result, I was docked “health points” and was given recommendations such as “eat less,” “unsupersize your meals,” and “go Mediterranean to transform your health and your weight,” and attend Weight Watchers.  After receiving these messages that suggested I was overweight and eating poorly, I began experiencing greater symptoms of my eating disorder and began purging.  While the wellness program did not start my eating disorder, it has certainly made it worse.

 

Victims of Wellness Programs Tell Their Stories of Shame and Harm — Part 3

This is the third in the series of major wellness harms perpetrated on employees by wellness vendors and indifferent employers. These narratives have been painstakingly compiled, edited only lightly, and with no detail omitted other than the victim’s name and employer. I won’t tell you who the perps are yet, other than to say that the vendors I have consistently noted to be the best — American Institute of Preventive Medicine, Health Advocate, HealthCheck360, It Starts with Me, Limeade, Redbrick, SelfHelpWorks, Sterling, Sonic Boom, Sustainable Health Index, US Health Centers, US Preventive Medicine — are not among them. 

See:


Mary

I used to work for a county health program that established a workplace wellness program. One cold January morning, I returned to work for the first time in nearly eight weeks. I had taken a leave of absence after a suicide attempt and inpatient treatment for chronic depression and anorexia. I had gained a few pounds and my depression had stabilized, and I was looking forward to returning to work I found meaningful.

But when I walked in the door, I was inundated with signs about our workplace weight loss contest—a “Biggest Loser”-style competition. For someone who was struggling desperately to gain weight, this was nothing less than an affront. Signs told me that “Nothing tastes as good as skinny feels.” Besides being the same slogans plastered all over the anorexia-enabling websites I used to visit, I had spent the past decade feeling exactly how skinny could make you feel—miserable enough to complete a near-lethal overdose.

I pulled my chin up, set my things down at my desk and walked into the break room for a hot cup of coffee. There, on a big sheet of blue posterboard, was a tally of how much weight everyone had lost. Veronica in accounts receivable had already lost 3.4 pounds. Then, flooding in my inbox were the emails encouraging us to only eat half our lunch, and to try to sneak in an extra workout during our lunch break. Never mind that these behaviors were exactly what had landed me in the hospital. Now, I had a prescribed diet developed in consultation with my dietitian.

For several months, I tried to grin and bear it, but eventually, the madness was just too much. I couldn’t bear the meetings about how good steamed broccoli was. I couldn’t stand working in an external environment that was, quite possibly, more toxic than the internal chatter I endured all day. The poster listing everyone’s weight loss statistics was removed upon my request, but the fact remained that the workplace wellness program had created an environment that was anything but healthy.  I had to quit my job.

Perhaps my experience is an unavoidable side effect of a war against obesity that some have determined should be won at all costs (and regardless of strong evidence that existing wellness programs don’t work).

But when you consider that around one in 20 Americans will struggle with an eating disorder at some point in his or her lifetime, that’s a lot of collateral damage.

Victims of Wellness Programs Tell Their Stories of Shame and Harm — Part 2

This is the second in a series of first-person narratives of harms caused by wellness vendors. These narratives have been painstakingly compiled, unretouched except for formatting, and with no detail omitted other than the victim’s name and employer. I won’t tell you who the perps are yet, other than to say that the vendors I have consistently noted to be the best — American Institute of Preventive Medicine, Health Advocate, HealthCheck360, It Starts with Me, Limeade, Redbrick, SelfHelpWorks, Sterling, Sonic Boom, Sustainable Health Index, US Preventive Medicine — are not among them. 


John

I’m 37 and have put a lot of work into recovering from bulimia.  I have been in treatment for bulimia for 12 years.  I see a therapist, a doctor specializing in eating disorders, and a psychiatrist.

For the last five years, I’ve worked at a technology company.  I’ve noticed that every year, their “wellness program” has become more and more triggering, as it has become increasingly tied to health biometrics and “rewards” on my paycheck.  The “rewards” for taking answering the health risk assessment, taking various biometric tests, and meeting certain health outcomes are so significant that I felt I had to participate.  These rewards now come to a total of $2470 per year for taking the tests and meeting all of the health targets.  With a family and a child in day care, I cannot afford to forego such a large amount of money.

A couple of years ago, the wellness program started to require that employees’ weight, triglycerides, and blood pressure be checked. These biometric screenings happen every year, and I dread it. If my body mass index does not fall into what the program considers “normal,” then I don’t get a “reward” on my paycheck—or, to put it another way, I get penalized.  If I forego even one part of the biometric screens, such as the weight check, I lose the reward for all of the screenings.   In addition, the program’s instructions for employees, including to keep their meal portions “as small as possible” (to “fit into your skinny jeans”) are inconsistent with and undermine all the work that I have done to overcome my disability.

The wellness program allows employees to have their own physicians perform the screenings.  When my doctor heard about the screenings, he was incredulous.  He indicated that, out of concern for my health, he did not want me to participate in these tests.  But I felt compelled to do so given the large sum at stake.  My doctor wrote a letter explaining that having me step on a scale and having my weight read out loud would be extremely damaging.  After three months of requests and negotiations, I was ultimately able to get the program to permit me to apply for the incentive without my doctor filling out the screening form (a special “manual process” was used), but this process was extraordinarily stressful and I have no assurance that I will be permitted to do this in the future.  I was the first person who was able to forego the screening without losing the incentive—and to my knowledge, the only person.  And guess what? It’s time to do the entire thing again for this year’s screening!


Part 1 can be found here.

Victims of Wellness Programs Tell Their Stories of Shame and Harm

This begins a series of first-person narratives of harms caused by wellness vendors. These narratives have been painstakingly compiled, unretouched except for formatting, and with no detail omitted other than the victim’s name and employer. I won’t tell you who the perps are yet, other than to say that the vendors I have consistently noted to be the best — American Institute of Preventive Medicine, Health Advocate, HealthCheck360, It Starts with Me, Limeade, Redbrick, SelfHelpWorks, Sterling, Sonic Boom, Sustainable Health Index, US Preventive Medicine — are not among them. 


Jane

I am a corporate executive in a Fortune 500 company.  My employer operates a wellness program.  Every year, as part of that program, we are required either to have blood drawn and have our weight, height, blood pressure and other things measured or contribute more toward our health insurance.  This testing is done on site at the workplace.

I have anorexia.  I have been in treatment for four years.  Over the years I have built a relationship with my dietician, my therapist, my psychiatrist, and my medical doctor.  Their familiarity with my needs, including what helps and what triggers the symptoms of my disability, is critical to ensuring that I receive effective treatment.

In contrast, the wellness program at my workplace is operated by people who have no familiarity with my particular needs and no knowledge of how to address them.  Among other things, the program requires employees to undergo weight-related screenings administered in a manner that undermined the treatment regimen carefully designed by my treating professionals and resulted in my relapse and admission to an intensive outpatient treatment program.


I would never have participated in this wellness program of my own accord, but due to the large financial incentives to participate, I felt like I had no choice but to do so.  When I found out that the wellness program required me to be weighed, I told my dietician, who was extremely concerned.  She wrote a letter indicating that I was receiving intensive nutrition therapy with her and that I should not be weighed or have my body mass index measured by the program, as that would be detrimental to the progress that I had made under her care.

The wellness program nurse read the letter but proceeded to weigh me and, despite my stepping on the scale backward so I would not see my weight, she announced how much I weighed and what my body mass index was.  She remarked that “it wouldn’t hurt you to enroll in our healthy eating program.”  This is precisely the type of trigger that my treatment – and the treatment of people with similar eating disorders – is designed to avoid.  She was telling me I was fat—exactly what I needed to hear to stop eating again.

After this incident, I stopped eating for two weeks and ultimately ended up in an intensive outpatient treatment program.  My dietitian was furious about the damage caused by the wellness program.

I am dreading participating in the wellness program again this year.  I am uncomfortable about having to tell my employer about my eating disorder – a very personal matter—and I do not want to repeat the experience of questions and screening that are counterproductive to my treatment.  If I don’t participate, however, I will have to pay an additional $750.00 for my health insurance, so I cannot afford to avoid it.

A Twofer: Interactive Health botches both its analysis and the cover-up

I usually say the reason I can’t expose all the lies in wellness is that there aren’t enough hours in a day. Unfortunately for Interactive Health, today there are. (In your face, Arizona residents!)

PS For my next and final posting in the Interactive Health trilogy, it would help if anyone could send me some of their outcomes reports. Obviously I won’t use your name or the name of your accounts. The advantage for you is if I use your stats, it’s like getting a free consult. 


When we last left our antiheroes, we were counting the number of lies their consulting firm told in their report underpinning Interactive Health’s financial savings model. We found ten. That may not seem like a lot by wellness standards, but those were in just two little bullet points. The only people who tell more lies in fewer words have Twitter accounts.

After publication, we discovered a new tidbit about Zoe Consulting. Along with the adjectives “top-tier” and “nationally recognized,” which they used to describe themselves, another would be “hunh?” Yeah, I know, not technically an adjective but Zoe is not technically a company.

Yes, this “top-tier nationally recognized” outfit has disconnected both its internet and its telephone.

And don’t try to find them in person, either. The address listed for them shows this streetview. If you can’t quite see it on your smartphone, I can describe the scene: imagine Narnia-meets-Stephen King.


Interactive Health Outcomes Report

Zoe Consulting called me soon after my first expose of Interactive Health appeared in the Wall Street Journal, and offered to pay me not to write about Interactive Health’s squirrelly outcomes any more, at least on my old website. I agreed — but only on the condition that they promise to tell the truth in the future, which has proven to be an insurmountable hurdle.

By the way, good news for any perps who think they have to pay me to have their material removed. If you are honest and I make a mistake, I pay you! Or if you make a mistake and own up to it, I pay you.

This is not either situation. Indeed, we have never encountered either situation.

Here is the report in question. You’ll notice there are lots of claims about massive savings, extending to workers comp and disability too. But not a peep about risk factors. That’s why they call this a “research summary” and not a “research study”: they removed the actual research after I observed that it invalidated their financial claims. Speaking of which, here is their financial claim: after three years, costs are magically about 18% — thousands of dollars — lower than they would have been.

The “research summary” contains only one sentence about the program itself: “The findings below indicate actual costs fell below the projected costs due to the positive impact of the Interactive Health program.”

How “positive” was that “impact of the Interactive Health program”?  Excluding dropouts which of course they conveniently ignore, the number of high-risk employees fell by 1.4%. Since spending on wellness-sensitive medical events is about $100/year, optimistically you’d save $1.40/year by reducing risk 1.4% — assuming the savings accrued immediately. To cover up their mistake, they removed the risk analysis.

Anticipating they would attempt this cover-up, I kept a screenshot. This screenshot is also quite useful to illustrate regression to the mean in my course on Critical Outcomes Report Analysis. (In the display below, the green represents improvement and the red represents deterioration. Obviously — meaning obviously to everyone except Interactive Health — people who are low risk can only get worse or stay the same, while people who are high-risk can only improve or stay the same. Classic regression to the mean.)

In this graphic, you can see 10% as the starting point and 8.6% as the ending point in the high-risk categories:

Instead of $1.40/year, they claimed savings of up to $3084/year — exaggerating by a factor exceeding 2000. Not 2000%. In wellness, 2000% would be rounding error. By contrast, a factor of 2000 equates to 200,000%.

200,000 is a big number. To put the number 200,000 in perspective, imagine stacking 6 Empire State Buildings on top of one other. Do that 200,000 times, and you reach the moon.

We are going to call Interactive Health liars. However, we don’t mean that as an insult, or even an objective observation (though that too). We mean that as a compliment. We have too much respect for their intelligence to believe that they could possibly be stupid enough to make a mistake of that magnitude.

However, if they would like to insist that they were this stupid (the “dumb and dumber” defense pioneered by Ron Goetzel) — and substitute what they now know to be the correct answer of $1.40 in place of the $3084 and circulate the revised result to their customers — we will publicly apologize for calling them liars. And, yes, we will pay them the honorarium noted above.

As for their botched cover-up of the initial results, perhaps that was just an unfortunate but inadvertent omission that coincidentally took place immediately after I pointed out their own risk analysis invalidated all their own claims about savings.


Postscript: Zoe Consulting’s Wisest Move 

Zoe Consulting did do something right. At one point in the conversation I mentioned above, I recommended that they hire a smart person, based on the observation that a smart person would realize that the trivial risk factor reduction couldn’t possibly support the gargantuan savings claims. The CEO replied: “Al, the savings have nothing to do with the risk reduction. The two analyses are completely separate.”

If you are prone to comments like that, the wisest move is indeed to disconnect your phones and internet.

 

Interactive Health doubles down on diagnoses (Part 1)

So much to say about Interactive Health, so little room on the internet. As a result this will be a two-part blog, at least.

Meanwhile, on the opposite end of the spectrum, we are going to be highlighting the most positively influential people and organizations in the field. Please go vote or submit additional nominations.


The following axiom proffered in Surviving Workplace Wellness used to be ironclad:

“In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”

I thought this axiom applied to every vendor claiming huge savings. But, alas, Interactive Health is an exception. Yessiree, it turns out you can invalidate their data without reading the data.  It had been easy enough to invalidate their data by actually reading it — so much so that my original observations about them made it intp the Wall Street Journal .  They counterpunched by redacting all the raw statistics on risk reduction. (They didn’t realize I kept a screenshot, which will be the subject of Part II.)

Since risk reduction is what generates financial outcomes, taking risk reduction stats out of an financial outcomes report is like the movie theater in South Korea that decided The Sound of Music was too long, so they edited out the songs.

The Wall Street Journal debacle taught them half their lesson: they learned not to publish data, because data will obviously invalidate their savings claims. Last week they learned the other half of their lesson the hard way, which is that they shouldn’t publish anything, period. On Linkedin they bragged — without any data at all — about the gobs of money they saved by discovering all sorts of undiagnosed conditions and achieving trivial reductions in overall risk scores.

Of course it’s mathematically impossible to achieve massive savings by making asymptomatic employees anxious about diseases they almost certainly don’t have in any clinically meaningful sense, and/or slightly by reducing risk factors. With that in mind, I merely asked a question or two about the whereabouts of the data to support this mathematical impossibility…and <poof> their posting disappeared from Linkedin.

Even absent the data, it’s well-known that Interactive’s modus operandi is to do exactly that — attribute massive savings to trivial risk score reductions and “newly discovered conditions.”  Neither m.o. is unique to them. Indeed both are common enough to have names — the Wishful Thinking Multiplier and Hyperdiagnosis. Interactive’s brilliance is in marrying the two.


Interactive Health, the Wishful Thinking Multiplier and Hyperdiagnosis

The Wishful Thinking Multiplier is defined as:

total savings/total reduction in risk factors. 

The Multiplier originated with Staywell allegedly saving British Petroleum million of dollars when only a few hundred employees reduced a risk factor — which worked out to almost $20,000 for every risk factor reduced. As luck would have it, this Multiplier was about 100 times what Staywell themselves previously claimed was even possible, which in turn was about 100 times what is actually possible.  Yet, as we’ll see in the next installment, Interactive’s Wishful Thinking Multiplier leaves Staywell in the dust.

The practice of wellness vendors bragging about how many sick people they find is called “hyperdiagnosis.”  It originated when Health Fitness Corp breathlessly declared that about 1 in 10 screened Nebraska state employees had cancer.

Hyperdiagnosis differs from “overdiagnosis” in that doctors try to avoid overdiagnosis, because it results in expensive and potentially harmful overtreatment.

By contrast, hyperdiagnosis is something that vendors like Interactive embrace. Indeed, Interactive practically hyperventilates every time someone tests positive for something.  Since Interactive screens for everything under the sun — 38 panels, way more than most checkups and ten times what guidelines recommend — it’s tough to get out of one of their screenings without a false positive finding on something.

Here are examples of their hyperventilation in words and pictures, wisely not naming the client in their Linkedin post to avoid embarrassment:

[Their client] recently shared with their employees the successful outcomes they have achieved. First, hundreds of employees discovered new health conditions they were previously unaware of.

I’m sure the employees shared Interactive’s joy in finding out how sick they are! What employee wouldn’t be excited about such a “successful outcome”? And not just a few employees, but rather almost half are now “at risk” with “newly discovered conditions.”

A vendor bragging that nearly half the employees are might lead you to think: “Where do these people get their ideas?”

Glad you asked. Interactive bases their “proven…amazing results” on a report by an outfit called Zoe Consulting. Let’s take a looksee at Zoe Consulting, to learn more about the people they are basing their entire financial value proposition on.


Hey, Butch, Who Are These Guys?

As you can see from this screenshot, Zoe Consulting is a “top-tier nationally recognized research firm.” (Source: Zoe Consulting.)  Here are the awards they’ve won (with Google’s commentary in parentheses):

  1. Two Koop Awards (they didn’t);
  2. The American Cancer Society Award for Program Excellence (they didn’t);
  3. The Ethel-somebody Leadership Award from UNC (they didn’t); and
  4. The Distinguished Leadership and Service Award from the Association for Workplace Health Promotion (they didn’t).

The last reminds me of a summer job selling Collier’s Encyclopedia door-to-door. Collier’s salespeople were instructed to say: “National Geographic won the Kodacolor Award 10 years in a row, but last year we copped the award from them.” One evening I ran into a Grolier’s salesman, who, as it turned out, used exactly the same line in his pitch, down to the exact same faux-cool-70’s-speak verb right out of The Deuce. I called Kodak to see who really won it, only to learn that no such award existed.

Likewise, one of the many reasons Zoe Consulting didn’t win an award from the Association for Workplace Health Promotion is that no such organization exists. So depending on how you count (and whether you count the Koop Awards as one lie or two), they lied six times in two bullet points, which may be a record even in the wellness industry. Seven if you count “top-tier nationally recognized research firm.” Eight if you count “top-tier” and “nationally recognized” separately. Nine for “unbiased.” To reach a round number, I’d say the tenth would be “research.”  That’s ten lies already.

In other words, Zoe Consulting is a perfect fit for Interactive Health.


Stay tuned for the next installment to learn why.

 

What if they gave a Koop Award and nobody came?

You have to read this all the way through because, in breaking with long-established precedent (which needless to say is recounted in loving detail), in 2017 the Koop Award Committee — wait for it — did the right thing. 


In 2017, 3 companies applied for a Koop Award. This is down from a peak of 21, and represents the belated recognition on the part of wellness vendors that it simply isn’t mathematically possible to satisfy the requirement of saving money. Thankfully, one of the best attributes of math is that it’s true whether you believe it or not.

Many an employer has won an award, only to learn later — via the media — that their vendor had fabricated the savings. This litany might explain the slight reticence of vendors to shine a light on their own programs:

  1. Wellsteps: “Top Wellness Award Goes to Workplace Where Many Health Measures Got Worse,” STATNews
  2. McKesson: “Wellness ROI Comes under Fire,” Employee Benefit News
  3. Health Fitness Corporation:”Nebraska’s Acclaimed Wellness Program Under Fire,” Omaha World-Herald

An example of what transpires when employers find out they’ve been snookered would be McKesson. If the name “McKesson” sounds familiar, it’s probably because you saw 60 Minutes the other night explaining how drug distributors including McKesson facilitated the opioid crisis.

The good news is, illegally trafficking in opioids doesn’t disqualify a company from winning a wellness award. Is this a great country or what?

Once McKesson got wind that Employee Benefit News was going to publish an expose on how they got snookered, they called in a consultant, not to investigate how they got snookered but rather to mount a coverup. The consultant “clarified” to Employee Benefit News  — in lay terms that any fifth-grader could understand — how, among other things, employees’ weight could go down and up at the same time:

“Health indicators in 2013 and 2014 were adjusted in the analysis, while several sensitivity analyses of the ‘inter-individual’ impact that used a matching approach confirmed the results.”

Silly me! Of course weight can go up and down at the same time!

McKesson was not exactly copacetic about this coverage. Here is the reaction of McKesson’s wellness program champion to my analysis, as reported to me:

“I wish you could have been in the room when I questioned the architect of that whole program. I’ve never unintentionally pissed anyone off that much. Red faced and table pounding, it was a moment! He retired 3 days later. Coincidence?”


Next, consider last year’s award, bestowed upon their Wellsteps buddies.  Wellsteps (motto: “It’s fun to get fat; it’s fun to be lazy”) is the kind of company that gives cronyism a bad name…but they were overdue for the award, never having won one despite their years of service on the Awards Committee.

Sure, Wellsteps harmed employees, but harming employees has never been a deal-killer for a wellness award. Ron Goetzel observed that employees en masse becoming sicker — both objectively and according to their own self-assessment — only meant that the program did not “[go] exactly right.”  By that logic, the Vietnam War did not go exactly right either.

 


The 2017 Awards

No one won in 2017. The Committee deserves great credit for getting it right this year, finally albeit belatedly acknowledging that it is indeed impossible to get a positive ROI by screening the stuffing out of your employees.  So kudos to them!

Instead, they gave “honorable mentions” to the three applicants: Delta Airlines, IDEXX Labs, and Pepsico.  I’m sure all three deserved their —

Whoa! In the immortal words of the great philosopher Meat Loaf, stop right there! Come again? Pepsico?  That Pepsico?

If one excludes the total debacles at Penn State, Nebraska and Boise — Pepsico runs the single most-pilloried wellness program in history. It was the subject of a Health Affairs article showing massive losses on its wellness program. These losses, massive as they appeared, were likely understated. I was the peer reviewer, and I passed it rather than make the author do more work, because I thought it was more important to get the word out there promptly than to make him recount every single stupid thing they did.


Pepsi’s Latest Innovation

In all fairness to Pepsico, maybe they do deserve at least a “most improved” award, because now you can buy Pepsi made with real sugar. This is a good thing, according to their announcement, even if the people who run their wellness program disagree. One can only imagine what a beleaguered Pepsico employee’s Outlook calendar looks like:

Perhaps McKesson’s consultant could explain this to us.


Delta and IDEXX

I can’t really comment on the other two because none of the four flight attendants I talked to at Delta had any familiarity with their program beyond the basics (“Yeah, I think if you fill out a form and go to the doctor, you get a discount on insurance or something like that”), while IDEXX doesn’t use vendors connected with the Awards Committee and doesn’t make up savings. To bestow an outright win in that situation would go against all precedent, so IDEXX should be happy with their honorable mention.

Theirs is a fitness-based program that deserves a closer look, as a model for what a wellness program should look like.  I hope to do that someday.

And perhaps IDEXX is a harbinger of things to come, where wellness is done for employees and not to them, wellness vendors don’t lie about savings, and they endorse and agree to adhere to the Employee Health and Wellness Code of Conduct.

Otherwise, for the wellness industry, there might be trouble on the horizon.

 

 

 

 

 

 

 

 

Review of “Rule the Rules of Workplace Wellness Programs,” a how-to on compliance

In the wellness industry, vendors are allowed — indeed, encouraged by the prospect of winning a Koop Award  — to flout clinical guidelines, pay employees to crash diet, sell franchises by bragging by the lack of qualifications needed by franchisees, and of course actually harm employees. One would think such an industry is totally unregulated. And, yet, as described in the erudite but highly readable Rule the Rules of Workplace Wellness Programs, by Barbara Zabawa, there are mind-boggling numbers of regulations. It happens that none of them actually prevent rogue vendors from harming employees, though. You’d think just by random chance one of them would, but no such luck.

This book is the compendium of everything needed to assure compliance with the myriad of sometimes contradictory regulations that govern workplace wellness. Over the years, a large number of generally disconnected laws have spawned an even larger number of regulations, opinions and interpretations of those of laws, and this book covers all of them. I was impressed by how the authors tackled the mind-boggling complexity and interplay of these rules in such a readable fashion. I myself dog-eared many pages for future reference.

For my company (Quizzify), this book has been especially helpful as, thanks to its guidance, we are able to now offer an HRA which satisfies the “reasonably designed to promote health or prevent disease” standard far better than the typical buckle-your-seat-belt-and-eat-more-broccoli HRA — and does it without collecting personal health information. Hence we avoid all the HIPAA concerns while satisfying the standard for what constitutes an HRA many times over. Absent hiring an expensive attorney, this would not have been possible for us to do without this book as a touchstone.

While designed to be read and hence not classically termed a “reference book,” the chapter most readers will want to refer to time and time again is #4, covering the laws of workplace screening and incentives. If you are going to get in trouble, that’s where it will happen. Virtually all the lawsuits filed by various employees have alleged violations of laws and regulations around screenings and incentives/penalties.

The ultimate irony is that this book is about 400 pages long.. That’s how much space is required to cover all these rules. And yet there is no rule saying that vendors can’t harm employees, which would seem like it should be the most basic if not the only rule of wellness. So Wellsteps was able to get away with harming employees of the Boise School District (and, this being the wellness industry, be rewarded for this performance with a Koop Award) and — aside from a scathing expose by ace journalist Sharon Begley in STATNews — face no consequences or liability. Yet if you don’t follow all the steps listed in here for avoiding minor transgressions (for instance, your coaches may accidentally ask people about their family histories — a useful but in most cases illegal line of inquiry) you could find yourself in violation of one or more of the laws which somehow manage to make wellness programs both more complex and less effective at the same time.

At some point, all these regulations should be shelved in favor of a “do no harm” standards as covered in the Wellness Code of Conduct (for which Ms. Zabawa is an endorser and co-author), findable at ethicalwellness.org. But until then, these rules rule the industry, and as the title says, you need to rule the rules.

 

Dave Chase’s New Book Reveals that Wellness Is Not the Only Scam in Healthcare

Healthcare meets Network.

That is the one-sentence summary of Dave Chase’s new book, A CEO’s Guide to Restoring the American Dream: How to Deliver World-Class Healthcare to Your Employees at Half the Cost.

Dissecting the title, the “restoring the American Dream” reference is as follows: While wages have barely budged in the last 20 years, employee compensation has risen quite a bit — with most of the increase being the health benefit. Dave’s observation is that if the health benefit were managed much more tightly, wages could climb noticeably for the workforce without increasing the total employee compensation budget.

As for “half the cost,” that number may be overstated…but not by much. For instance, I just saw a wellness vendor send 2/3 of a company’s employees to the doctor because they have “conditions” they didn’t know about, that this vendor “discovered” by — you guessed it — screening the stuffing out of them by flouting clinical guidelines. This employer could save about 3% simply by firing the vendor and not consigning all those employees to the treatment trap. (And of course there has been no measurable improvement in outcomes from all these doctor visits.)

This employer and others could save another 0.5% simply by not insisting that their employees and spouses get annual checkups (and “well-woman” visits) because as readers of this site know, they have no value. The good news is that checkups are not likely to harm employees, which is more than can be said for many wellness programs.

So we are already saving 3.5% and we haven’t even done anything hard yet, where “hard” is defined as “something that does not delight employees, like getting rid of ‘pry, poke and prod’ programs.” In other words, “hard” isn’t really hard.


Slightly harder opportunities

In addition to an expose on wellness, Dave Chase exposes some scams that make wellness look like child’s play. (Wellness is child’s play, in the sense that any fifth-grader knows more arithmetic than a wellness vendor. And a 14-year-old knows more about BMI.)

In no particular order, we’ll start with PBMs. Their stock prices have exploded — literally, 300-fold — in the last 30 years.  You think they achieved that growth honestly? They make wellness vendors look like boy scouts. They obfuscate everything, with “rebates” and “formularies” and under-the-table payments from drug companies, and all sorts of other things that we probably don’t even know about. Here is a New York Times article that casts just a little light on the subject…but more than enough light to indict the entire industry.

It isn’t easy to ditch a PBM, but increasing numbers of alternatives are popping up. A good rule of thumb is, the thicker the contract with your PBM, the more you are getting ripped off.  I invite folks who offer one of these new alternatives to add a comment at the bottom of this posting and/or on linkedin following this posting.

Then there are the carriers, who typically make more money, the more money gets spent. The number of scams is mind-boggling. For example, consider Dave’s explanation of what happens when a claim is overbilled:

Another fee opportunity is so-called “pay and chase” programs,
in which the insurance carrier doing your claims administration
gets paid 30-40 percent for recovering fraudulent or
duplicative claims. Thus, there is a perverse incentive to tacitly
allow fraudulent and duplicative claims to be paid, get paid as
the plan administrator, then get paid a second time for recovering
the originally paid claim.

And good luck trying to ferret your own claims data out of carriers so that you can do your own analysis on them and change policy accordingly. I do quite a bit of work for top-flight carriers, measuring their wellness-sensitive medical events. They always seem to have the data at their fingertips. We can complete the analysis for the year within weeks after claims run-out ends, meaning sometime in April. Meanwhile, I’ve got a Fortune 50 client whose carrier, Optum, still hasn’t managed to provide them (at an extra fee!) with their own event rates for 2016, a delay which more than coincidentally will make it impossible to implement any cutbacks in Optum’s services for 2018 if the event rates show that — hang onto your hats — Optum didn’t achieve anything.

Don’t get Dave started on providers, who find highly creative ways to snooker employers and employees.  Like staffing in-network facilities with out-of-network doctors, who then bill patients ridiculously high charges.  You need to re-contract with your carrier and put that one on them.  Or, if you’re large enough, recontract with the hospital.

And speaking of hospitals, why have Leapfrog D- and F-rated hospitals in your network at all? If geographic necessity, then at a miimum educate your employees that it might be worth the extra drive to avoid some major complications.

Providers also bill companies what they think they can get away with, rather than what a buyer would expect to pay given what others in the area are charging. Since the company is generally not the decision-maker (the employee or doctor generally decides where to go, not based on price), they often get away with it. An entire chapter is devoted to provider pricing scams and the importance of transparency.

Or, my own personal favorite provider scam, disguising emergency rooms as urgent care centers, like the one below. (A rather naively idealistic Colorado legislator tried to make freestanding ERs disclose that they are not urgent care centers, but the provider lobbyists prevailed.)

A sidebar: Quizzify trains employees to be on the lookout for these scams, which is helpful for the 0.1% of the 150,000,000 commercially insured employees who actually have access to the quizzes. The other 99.9% are on their own.


And yet it all comes back to wellness

Employer obsession with wellness has caused them to take their eyes off these many other balls, because wellness was supposed to solve everything (including industrial waste, according to HERO stalwart Bruce Sherman).   Truly wellness has been the Maginot Line of healthcare cost containment strategies. While a vastly disproportionate share of resources has gone into wellness, PBMs, carriers, providers and various middlemen simply circumvented these efforts, to dig right into your pocketbooks.

I can only scratch the surface here — just go out and buy the book, and then you’ll understand both why when it comes to scamming employers and employees, wellness vendors have a lot to learn, and also why you should be mad as hell and not take it any more.

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