It’s not just that Maryland is setting the record for most epic financial fail ever recorded in wellness. We are also bringing you an eyewitness account from the Belly of the Beast, an employee willing to give out her name in order to help spare other state employees and taxpayers the pain of this program.
The Most Epic Fail Ever?
Maryland is on track to miss its savings goals by 18 decimal places. To put that in perspective, the total economic output of the world sums to only 14 decimal places.
Here’s how the math works. The state is claiming that avoiding wellness-sensitive medical events will save $4 billion dollars — a number with 10 decimals. Thanks in part to Maryland’s lowest-in-country hospital rates of about $20,000/heart attack, the state would have to avoid 20,000 heart attacks a year to do this. No easy feat when the entire insured Maryland population — all private- and public-sector employees and their families combined — only suffer about 2700 heart attacks/year.
Plus, in the history of wellness, it appears that not a single heart attack, or for that matter, diabetes event, has ever been avoided. (More likely, a few have been avoided, but a few also have been caused by employees taking bad wellness vendor advice.)
Put yet another way, that’s $4000/family/year in savings. Achieving that outcome that would require wiping out all hospitalizations on all state employees and dependents, along with some of their closest friends.
Taxpayers, this is on you
Meanwhile, Maryland state taxpayers are paying Optum on the magnitude of $70,000,000 (8 decimal places) over this period, plus the cost of hundreds of thousands of useless and possibly counterproductive coerced checkups.
The best-case scenario? It’s a very safe bet–one I am willing to make to the tune of $3-million and give out 10-to-1 odds– that they will save nothing. That’s 10 decimals in missed savings targets and 8 decimals in fees — a truly epic fail of 18 decimal places.
And yet even this is an optimistic assessment. Like both other public sector employers — Connecticut and Boise — which have reported outcomes, Maryland’s program will likely drive up spending and possibly harm their employees. And if you guessed that Optum’s contract calls for them to receive bonuses based on invalid measurement of non-existent savings, then update your resume. You are too smart to be in this field.
Further, Optum (through its representation on the board of the wellness trade association), has already publicly admitted wellness loses money. Their cabal tried to take that back by pretending they lied when they admitted it, but it turned out they lied when they said they lied. The data was real, meaning the admission was real.
It happens that I know two state employees. One bragged to me about how their entire quasi-public organization was able to dodge this program because everyone hated it so much. The other shared her “wellness” story, a typical one rather than the stories of great harms, or the experiences of employees who make constructive comments in the lay media, such as: “I’d like to punch them in the face.”
Instead, her story sounds like every other employee wellness story — with the notable exception that she is allowing me to use her name, since she no longer works for the state and is concerned about the stress and potential harms caused to employees, including her former colleagues. (Plus, as a taxpayer, she’d like her $50 back, representing her share of the total program expense.)
Her name is Alice, and here is her experience. (Anyone who would like her last name and contact info may contact me and I will pass that along to her. She is willing to talk, though not for attribution.)
As a state employee and with my entire family being on the state plan, my husband and I have had the joy of recently completing our wellness assessments. Here is my rant:
First, it’s a giant pain in the butt. Second, the questionnaire could not have been more ridiculous and third, my doctor didn’t really do anything with it. She just gets to bill an unnecessary office visit to the state, in order to sign a form.
On the first topic, the questionnaire took 45 min for each of us, plus the inconvenience of having to schedule and go to an appointment we didn’t need. And in my case, having just gone through 9 months of prenatal care, labor and delivery care and postpartum care on top of all the newborn appointments, the last thing I needed was another doctor’s appointment.
On the second point, the questions they asked were terrible for assessing my actual health. There was an obvious right answer in every case, and it seemed to want to judge my mental health/level of happiness more than actual health. “Think of yourself on a ladder in terms of xxx (happiness, social status, personal accomplishments). What rung on the ladder would you place yourself, 1 being the lowest and 10 the highest?” How does that assess my health? It’s a personal fulfillment questionnaire that also asks if you exercise. At the end they ask for all these lab values which I don’t have and my doctor didn’t think she was supposed to request so they aren’t filled out at all.
And on the last point, my doctor never looked at the 30 page final assessment that I had to print and she just asked me if I think I’m healthy and I said yes. She was fine with that. The only thing she told me was that I could lose a few pounds to get my BMI in the right place – well OF COURSE! I just had a baby, which on a side note is not a part of the wellness assessment at all. There are all these questions about how much sleep I’m getting, am I stressed, etc… but no accounting for the natural things that happen in life like a newborn.
Shame, shame, shame on Alice!
Like every other Maryland employee, Alice needs to pull her weight, if she ever expects to account for her $40,000 share of the $4 billion in savings. Unfortunately, according to the actual arithmetic, she is already way behind in her quest. She hasn’t saved a nickel but has cost the state:
- 1 doctor bill
- 1 vendor fee
- 30 pages of paper from needlessly destroyed trees
- 45 minutes of lost productivity completing her kumbaya assessment, plus the time spent at the doctor
Fortunately, the doctor didn’t realize she was supposed to run (and charge for) a bunch of lab tests, so she saved the state some money there.
Where should the state go from here?
A quick plausibility test should determine that they didn’t save anything to speak of. Then Optum should be forced to give their money back, and issue an apology to Alice and others for wasting their time. The Attorney General should announce to overjoyed state employees that they are no longer required to do this — and that he just saved the taxpayers $70 million. Then he should run for governor. Alice could be his running mate.
Where will the state go from here? Like Connecticut and Boise, in exactly the opposite direction. The state HR people will claim they are heroes, using the classic combination of regression to the mean, ignoring dropouts, and participants-vs-non-participants study design, to pretend to show how much employees love the program and how much money it’s saving. When carefully read, of course, the data will show the opposite.
They will also find one state employee willing to claim he or she started eating more broccoli. As for the rest? For a more typical assessment of the Maryland program, I would recommend that the state, in the immortal words of those great philosophers Jefferson Airplane, go ask Alice.
You are so evil, Mr Lewis!
(Blushing) Thank you.
Indeed, I am headed straight to hell, which I think is one of Interactive Health’s reference accounts.
Surely there is some grownup in state government who can do arithmetic.
And who might that be?
This is not about the post here, but I read this blog regularly with great interest. I am a teacher and work in a school district where you are required to buy their insurance. There are various options, none good, and the one that is “free” is especially bad. A lot of us would rather choose “none” and get good insurance through our spouse’s jobs (which we do understand we would have to pay for). [Me especially — my spouse’s work doesn’t have a wellness program either.] So — there’s a $600 penalty for refusal to participate in the untethered-from-reality HRA and biometric screen — most people do it but it feels very coercive. So I’ve been watching the AARP case with great interest (and kudos to AARP) and I like the court’s view that “voluntary means voluntary”. What do you think happens next if the EEOC just says “OK we’re not going to write regs attempting to reconcile the ‘voluntary’ requirement of the ADA and the GINA”. And — how is the analysis impacted by the fact that for us, buying the insurance is mandatory, not voluntary, which appears to be legal — but it makes it harder to argue that providing the corporations our medical data is voluntary, doesn’t it ? What do you think ?
Great questions. On Tuesday, the EEOC asked if it was OK for them not to write the regs. In that case, courts would be guided by the statute itself, and likely define voluntary the way a normal person would define it. That would mean this $600 penalty would have to likely go down to perhaps $200. (Some small amount could be construed as voluntary, I suppose. Not $600.) I’m not quite understanding your last point. There is a mandate in 2018 to buy insurance, but it goes away in 2019.
Who is your vendor, and if you can take screenshots of their untethered-from-reality HRA I could perhaps call them out and make fun of them?
I think more than a few employees will be suing over this nonsense in 2019, which means other programs will back off.
I can email you the whole HRA. But the mandate to which I refer is my employer’s mandate that WE buy the insurance from them. And it has to be primary (so, for example, we can’t choose to be insured by buying insurance through our spouse’s job). I think this is sort of unusual — but it appears to be legal, as far as I can find. So the question is if the insurance itself is mandatory (because of the employer’s requirement, not the ACA mandate), does that make the HRA / biometric screen feel more coercive ?
I removed the vendor name (until I review the HRA). By all means send it along to firstname.lastname@example.org .
Starting in 2019, I would be quite certain that what you describe would be considered a coercive HRA. The way the courts will be defining “voluntary” is very likely to be a reasonable-person standard rather than an artificial rule, like the one in place now.
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