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The wellness industry’s terrible, horrible, no-good, very bad year just got worse.

The Wellness Industry’s Terrible, Horrible, No-Good, Very Bad Year  just got worse. Seems like CMS (Medicare) and Modern Healthcare are also ganging up on the Health Enhancement Research Organization (HERO) and all their cronies.

The headline in today’s Modern Heathcare turns out to be a bit of an understatement:

Wellness programs aren’t generating Medicare savings

Read farther the article and you’ll come up with gems like:

Utiization and expenditures actually increased among program participants… The results mirror those in the corporate world.

Asked for comment, the National Business Group on Health’s very stable spokesgenius, Steve Wojcik, said:

So, while it didn’t reduce healthcare expense or utilization, it seems to have had a positive impact…by preventing or delaying normal deterioration that comes with age.

Where Mr. Wojcik came up with this spin, creative even by wellness industry standards, is anyone’s guess. Nothing in the program suggests it and when he finds something that does prevent age-related decline, I will be the first to nominate him for a Nobel Prize.

The curious thing is this failed approach is not “wellness or else” as Jon Robison calls it. Instead these programs are truly voluntary. Also unlike corporate wellness programs, vendors aren’t harassing healthy employees to eat more broccoli but rather focusing on unhealthy ones.  Instead of making healthy 30-year-olds get unneeded checkups, they’re encouraging 70-year-olds with chronic disease to get more medical care.

And yet the programs still don’t work. Color me surprised. I genuinely thought (and I honestly still think) that willing participants in voluntary programs who have chronic disease would benefit from these programs. Perhaps when they re-review another year’s data they will find a benefit.

Alternatively, instead of trying to maintain the revenue streams of their members, perhaps HERO could actually try to find a new model that does provide a benefit. Certainly there are plenty of vendors out there with possibly better mousetraps, but they all have one thing in common: they have no use for HERO’s pet vendors, any more than companies that make solar panels have a use for coal.


Speaking of HERO, let us review HERO’s comments from just last week:

Teddy Roosevelt said, “complaining about a problem without posing a solution is called whining.” It’s a quote that also reminds me why I’ve not thought of angry bloggers who target health promotion [vendors] as bullies. Though they relish trolling for bad apples, their scolding is toothless, more the stuff of chronic whiners.

Not to mention:

We’re fortunate to work in a profession with a scant number of vociferous critics. My take is that there is one thing these few angry loners want more desperately than attention: that’s to be taken seriously.

Just like wellness vendors like to define “voluntary” as “forced,” I guess in wellness-speak “scant number of vociferous critics and chronic whiners” mean “every commentator,”  and an “angry blogger” is any blogger with a great big smile on his face.

The Outcomes, Economics and Ethics of the Workplace Wellness Industry: A Review by Tom Emerick

A bunch of months back I published a comprehensive, richly sourced, linked and footnoted review of the three greatest failures of the workplace wellness industry’s leading vendors, consultants and promoters. Those three greatest failures, of course, would be: outcomes, economics and ethics.  Hence the title.

The paper is quite uncharacteristically, rather dry, as befits publication in the country’s leading law-medicine journal. However, I’d encourage everyone to download it and at least skim it.

To get you started, Tom Emerick just now reviewed it in Insurance Thought Leadership, so that might be a good place to start. If that catches your attention, then you can link through to the main event. (And, yes, there is a juicy tidbit in there.)

PS The journal issue includes four other articles on wellness too, including one by The Incidental Economist. They couldn’t find anyone unconnected with the wellness industry to defend it, so the entire issue is an evisceration of its shortcomings.

 

 

The wellness industry’s terrible, horrible, no-good, very bad year

OK, this time I’m not the one causing the kerfluffle in the wellness industry, though I will confess to being a force multiplier.

Not since 2014, when the very unstable morons at the Incidental Economist made fun of the very stable geniuses who give out the Koop Award and also unequivocally concluded wellness loses money — combined with continued fallout from the Penn State debacle and the Nebraska scandal — has the wellness industry had such a bad year. And it’s only February.

Let’s review what’s happened so far in 2018. First, a federal judge ruled that voluntary wellness programs need to be — get ready — voluntary. The EEOC’s responded with the legalese equivalent of:  “Fine, be that way.”

Next, WillisTowersWatson did something that might get them in hot water with the very stable wellness industry leaders: they were honest. They published a study revealing that employees hate wellness even more — way more — than they hate waiting for the cable guy to show up.

Finally, the very unstable National Bureau of Economic Research conducted a controlled study finding basically no impact whatsoever of a wellness program.  More importantly, they specifically invalidated the “pre-post” methodology.  Even more importantly, they specifically invalidated 78% of the studies used in Kate Baicker’s “Harvard Study” meta-analysis.

Here is an interesting piece of trivia. The lead researcher is an assistant professor at the Harris School of Public Policy. Why is this interesting trivia? Because Katherine Baicker — the Typhoid Mary of Wellness, whose THC-infused 3.27-to-1 ROI is the basis for essentially every subsequent genius wellness outcomes claim — is now the dean of that very same Harris School.  I’m just guessing here, but I’d say it’s gotta be a trifle embarrassing when your own subordinate publicly disproves your own study. I mean, it’s one thing for me, RAND, Bloomberg, and anyone else with five minutes, internet access and a calculator to do it, but…your very subordinate?

On the other hand, the researcher, Damon Jones, just demonstrated not just amazing competence, but amazing integrity as well. In other words, he has no future in wellness.


The Wellness Empire Strikes Back

How does the wellness industry respond to these smoking guns threatening their entire revenue stream? Apparently, there is little cause for concern on their planet.

Let’s start with America’s Health Insurance Plans (AHIP), the health insurance industry lobbying group. Here is AHIP’s oxymoronic Wellness Smartbrief (January 26), on the NBER research. Yes, it summarizes the same wellness-emasculating study as the one above, though you could never guess it from the headline:

Continuing, AHIP said:

Offering incentives for completing wellness activities might be more cost-effective than offering incentives for wellness screening, a recent study of a comprehensive program found. 

Perhaps AHIP has been infiltrated by Russian trolls, because here’s what the NBER article actually said about “completing wellness activities”:

We…do not find any effect of treatment on the number of visits to campus gym facilities or on the probability of participating in a popular annual community running event, two health behaviors that are relatively simple for a motivated employee to change over the course of one year.

AHIP continues:

Wellness programs might attract mostly employees who are already fitness-conscious, but the potential to attract healthy employees whose medical spending is already low could nonetheless be a boon to employers, the researchers found.

And on the subject of “the potential to attract healthy employees” being a “boon to employers,” the authors actually said:

We further find that selection into wellness programs is associated with both lower average spending and healthier behaviors prior to the beginning of the study. Thus, one motivation for a firm to adopt a wellness program is its potential to screen for workers with low medical spending. Considering only health care costs, reducing the share of non-participating (high-spending) employees by just 4.5 percentage points would suffice to cover the costs of our wellness program intervention.

In other words, you can apply some workplace eugenics to your company by using wellness to weed out obese employees, employees with chronic or congenital diseases, and so on. Good for you!

Soon, if AHIP and others have their way, there will be no need for guesswork in eugenics: employer wellness programs will be able to screen these employees out based on their actual DNA.


AHIP’s take on AARP v. EEOC

And now, AHIP’s take on this landmark case, their ace reporters scooping everyone with this February 2 headline on the December 20th court ruling:

Here are more typical headlines on that court ruling, headlines that came out the same month that the court ruling came out. Perhaps AHIP used the interim six weeks to focus-group various verbs until they settled on…tweak???


AHIP:  It’s not just the headlines

One prominent healthcare executive recently attended an AHIP conference and reports:

I just returned from one of the dumbest meetings I’ve ever attended in Washington. Report of a new “study” by AHIP. Turns out people don’t mind health costs all that much, they just want more benefits. And everything is hunky-dory with their health plans, people like them so much. They love wellness benefits and crave more. Prescription drug prices have been nicely controlled thanks to the competitive marketplace (no, I am not making this up or exaggerating for drama). For every $1 employers spend on benefits workers get $4 in value. Priorities for SHRM rep: Fitbits for all employees, solving the outrage that only 20% of her employees got an annual physical. 85 cents of every dollar spent on health care goes to chronic disease.

Over these same two hours, I’d estimate about a thousand employees were misinformed, harmed or harassed by wellness vendors, roughly equal numbers of  employees got useless annual checkups, employers spent about $200-million on healthcare and 40 people died in hospitals from preventable errors. But I’m being such a Debbie Downer! I’m going home to read Why Nobody Believes the Numbers to remove myself from this alternative universe.


Enter the Health Enhancement Research Organization (HERO)

HERO’s Prevaricator-in-Chief, Paul Terry, is demonstrating his usual leadership abilities in this crisis, of course. After all, HERO is the wellness industry trade association and these three items — the NBER invalidating their product, employees hating their product, and a federal judge forbidding them to force employees to use their product — represent existential threats to his “pry, poke and prod” members.

Here is quite literally his only blog post on any of these three items:

Teddy Roosevelt said, “complaining about a problem without posing a solution is called whining.” It’s a quote that also reminds me why I’ve not thought of angry bloggers who target health promotion [vendors] as bullies. Though they relish trolling for bad apples, their scolding is toothless, more the stuff of chronic whiners.

I suspect he is talking about me here as the “chronic whiner” who is  “scolding” them. Or perhaps he is referring to the “angry bloggers” at  the Los Angeles Times, the New York Times, Slate, or STATNews, since those “toothless” publications seem to be scolding wellness vendors more than I ever have.  For instance, I’ve never called wellness vendors’ offering a “scam” or a “sham.” I simply quote these very stable wellness geniuses verbatim, as above or below, or last week.

Being quoted verbatim, not angry bloggers, is their worst nightmare. (One thing I would concede, though, is that “Paul Terry and the Angry Bloggers” would be a great name for a rock band.)

Yep, looks like the implosion of his industry all my fault. Otherwise, I’m not quite sure who is the “angry blogger” he is referring to, other than to note that Mr. Terry himself seems to blog a tad angrily himself, both above, and here

Why I choose to ignore the blogger critics: We’re fortunate to work in a profession with a scant number of vociferous critics. My take is that there is one thing these few angry loners [Editor’s note: the complete “scant list” of the 220 “few angry loners” who have been “vociferous critics” can be found here] want more desperately than attention: that’s to be taken seriously. What they fail to comprehend is that as they’ve gotten ever more farfetched and vitriolic in search of the former, they’ve cinched their inability to attain the latter.

Baiting people with misinformation and offensive insults (but just a tad under highly offensive) is a pesky ploy that trolls hope will eventually land a bite that confers credibility where there is none. Even reading such drivel is a form of taking the bait; responding is swallowing it whole. Some say dishonesty should not go unchallenged and I respect their view; nevertheless, I’m convinced responding to bloggers who show disdain for our field is an utter waste of time. I’ve rarely been persuaded to respond to bloggers, and each time I did it affirmed my worry that, more than a waste, it’s counter-productive.

and especially here, a seemingly incongruous decision to “act out” by someone who claims to be “choosing to ignore the blogger critics.”

Having read years of my “drivel” alongside Mr. Terry’s posting explaining why you shouldn’t “swallow this bait,” perhaps readers might opine here: which of us, exactly, is the “chronic whiner”?

Coincidentally, when I run live health-and-wellness trivia contests, the first of our 3 rules is: No Whining. Seems to me that he would have just violated it. Indeed the only rule HERO hasn’t violated so far is #3 below. Not that I want to put ideas in their head.

 

 

 

Al Lewis — uncut, unedited…and uncombed

Dear Welligentsia Nation,

For some reason there seems to be a ton of interest in the podcast that Josh Luke just did with me. I’m a bit embarrassed because most podcasts are audio and hence I didn’t really gussy myself up in anticipation of video, but nonetheless worth a looksee. Even in the best of circumstances I do look like I just fell off a mountain bike — and that’s after making an effort to look presentable, as in these shots from a couple of trivia contests.

This podcast covers everything you want to know about how wellness got to the state it’s in, how I stumbled into figuring out that it wasn’t working, and how Quizzify arose from its ashes.

 

Al

 

 

Two reviews: The Resident and rEvolution

Even more than blowing the whistle on the very stable geniuses in the wellness industry, I love catching people doing something right, partly because it is so rare. This is one of those moments.


Two books that would seem to have little in common are Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Healthcare, by Marty Makery and rEvolution: Turn Crisis into Clarity and Ignite Growth, by Tim Leman, CEO of Gibson, northern Indiana’s largest insurance brokerage. Dr. Makery has never set foot inside an insurance brokerage while Mr. Leman has never set foot inside an OR. (He may or may not have been wheeled in at one point or another but I don’t know. If I did know, HIPAA rules are quite clear: if I told ya, I’d have to kill ya.) And yet these books have share a common thread.

Coincidentally, and why I am writing today about both books, Unaccountable is back in the news because Fox made a very watchable drama out of it, called The Resident. And rEvolution is in the news — my news, at least, because I have been blown away by what I have seen of Gibson’s competence and professionalism.

The Resident

First, a brief word on The Resident. It is a highly watchable medical drama that got a notch-less-than-great reviews only because, unlike in every other medical drama, reviewers didn’t appreciate that the characters are based on real people. There really was a surgeon at Dr. Makery’s hospital known as “Dr. Death” because of his high failure rate, and yet patients loved him because of his bedside manner. And admittedly the show goes over the top:

  • While hospitals upcode all the time, vendors of these coding tools don’t distribute brochures titled The Art of Upcoding.
  • Revenue-maximization consultants don’t watch patients get MRIs.
  • Hospital CEOs don’t have conference calls like baseball’s winter meetings where they propose swapping patients with each other.
  • No federal ICE agent has ever dragged an undocumented immigrant out of an intensive care unit. (Not that I want to put ideas in their head.)

[To read the rest, click through to Linkedin]

 

 

Wellsteps stumbles over their own words

Often I don’t have time to write a full blog in my own words, but fortunately I usually don’t need to. It’s enough to quote the words of the very stable geniuses in the wellness industry verbatim. Being quoted verbatim, of course, is one of these geniuses’ worst nightmares.

Among the most stable of the wellness industry geniuses is Steve Aldana, CEO of Wellsteps, winner of the 2016 Koop Award as well as the 2016 Deplorables Award. How does he report the National Bureau of Economic Research’s complete evisceration of wellness industry research methods? Let’s take a looksee at the highlights of his posting.

First, it appears that two opposing studies, “one for and one against wellness,” came out “at the same time.”

One the one hand, someone — apparently he doesn’t know who — seems to say that there “wasn’t much improvement” at the University of Illinois.  And something must have been wrong with this result, because “these results contradict over 90% of publish [sic] studies.”

“At the same time,” a publication no one has heard of found the opposite: health behaviors improved for “over 2 full years” in — get ready — one of Wellsteps’ very own accounts.


This is a textbook example of a false equivalence, the wellness version of: “You also had some people that were very fine people on both sides.”

To begin with, the researchers in the first group weren’t just any old researchers. This was the National Bureau of Economic Research (NBER). And the NBER didn’t say “they didn’t see much improvement.” Their specific words were that the causal effects were — get ready — nearly indistinguishable from zero for nearly every outcome.

Further to say this conclusion “contradicts over 90% of published studies about wellness,” would be like saying Galileo’s findings “contradicted” over 90% of published studies about astronomy.

The study’s actual conclusion used a slightly different verb:

Our 95% confidence intervals rule out 78 percent of previous estimates [of the effect of wellness] on medical spending and absenteeism from the prior literature. [Let me translate that, in case the words are too long for the very stable geniuses at Wellsteps to understand: you and all your very stable friends have been geniusing about savings for decades now.]

The reason the NBER was able to be so conclusive is that, to quote one of our Alert Readers, Robert Dawkins: “They foolishly included a valid control group.” Kudos to Mr. Dawkins for that very unstable moronic observation. (In any event, far from contradicting other research, the study is quite consistent with most articles on wellness not written by someone feeding at the employer wellness trough.)

The other journal, which published an article “at the same time,” found an improvement in healthy behaviors. That journal is called Health Promotion Practice. And if you haven’t heard of it, you’ve got company. Their “impact factor” is the lowest in an industry whose journals are notable for low impact factors. I googled quite extensively, and it appears — get ready — that no article from this journal has ever been cited, excerpted or even had the fact of its very existence even grudgingly acknowledged in the lay or scholarly media.

By contrast, the NBER article has been picked up everywhere — except of course by the wellness industry. See if you can find any reference to this article — or AARP v. EEOC, which was also national news — on the Health Enhancement Research Organization website.

Turns out there’s a reason no one cites this journal. It’s because it’s so genius. Exhibit A is this very same article, a rehash of the Boise School District findings that somehow overlooked the key finding, which is that the employees got unhealthier during Wellsteps’ program. Instead, the author — displaying not the slightest intellectual curiosity as to how this could possibly be true — reports the most genius findings we’ve ever seen in a journal:

  • only 3% of Boise School District employees smoke, and…
  • …they smoke only 4 days a week.

Perhaps — just playing devil’s advocate here — the other 17% of Boise employees who smoke (Idaho has a 20% smoking rate) might have lied on their health risk assessment? The “tell” is that everybody knows smokers don’t smoke only 4 days a week. Obviously, they smoke 5 days a week, with time off for weekends, major holidays and Beethoven’s Birthday.

Very stable genius that he is, the author (both a friend of Wellsteps’ Mr. Aldana, according to the disclosure statement, and also a genius who has already been profiled on this site for his previous insights) also admits that with a high non-participation rate and a 20% dropout rate:

There exists the possibility of selection or dropout bias that could have influenced the results reported.

Ya think? Maybe just a tiny bit?


But wait…there’s more

We’ve highlighted Mr. Aldana’s phrase “at the same time” describing how these articles were simultaneously published. We repeated the phrase in three separate places above for emphasis because — get ready — these two results were not published at anything like the same time.

To begin with, Mr. Aldana has been very stably geniusing about his Boise results for more than two years now. (See my article from September 2015 accurately forecasting that, thanks to the number of obvious errors and self-immolating contradictions, this study would win a Koop Award. And of course the Boise employees got harmed.)

This article, using that same data set, was published last July, whereas the NBER article just came out a few weeks ago. Perhaps in some geologic sense July 2017 and January 2018 are “the same time,” but imagine if the rest of the world defined “at the same time” as “six months apart.” For instance, let’s join Sherman and Mr. Peabody in the Wayback Machine and set the dial for June 1944:

Eisenhower: “OK, we’ll storm Omaha and Utah Beaches, and you guys can storm Juno and Sword Beaches at the same time, and then we’ll hook up and say…”

Churchill: “…Merry Christmas, chaps.”



For a good time, try googling on Wellsteps.

And no need to google on their “ROI Calculator.”  I’ve done it for you.

A clip-and-save list of AARP v. EEOC resources

On-demand webinar for credit

Illumeo offer professional credit for taking this webinar 

Other webinars

Greater Pittsburgh Business Group on Health  (Wednesday, February 14, 2:00 PM to 3:00 PM.)

Clear your calendars, call the kids, wake the neighbors. This will be a great AARP v. EEOC webinar. How do we know this?  Simple: they are charging non-members money. $30, to be exact. That $30, and the extended, hour-long time allotment, assures all your submitted questions will be answered.

Connect Healthcare Collaboration

This one is free, and is also an hour.  It will offer live Q&A as well. It is much more about the solution — how to make AARP v. EEOC a non-issue by getting your vendor to indemnify you — than the problem. So if you are already aware of the problem and want to solve it posthaste, this is the webinar for you.


Articles and other resources by vendors.

These have been surprisingly hard to come by, and the silence from vendor trade organizations is itself data. These people know there is really no good news for so-called “pry, poke and prod” vendors, other than that their customers can indemnify themselves through Quizzify.


Articles by commentators other than me

Because Quizzify knew this decision was coming and designed the product to be a one-stop solution to achieve 100% compliance with whatever the new rules (if any), most of the interpretative “what does this all mean” articles are indeed by me. However, others have weighed in:


Articles by me


Summaries of the Decision

These are all written as news articles rather than opinion, and pretty much all say the same thing:


The follow-up January 16 motion by EEOC

Some people believe that the EEOC actually intends to publish rules by January 2, 2019. While we have no crystal ball, here are some articles describing EEOC’s most recent motion filed January 16, plus a quote from the Justice Department on behalf of EEOC. Draw your own conclusion as to whether this sounds like an agency that is prioritizing wellness rule-writing.

Highlight of ruling: “It would also be permissible for the EEOC to decide never to issue such regulations, or for the EEOC to study the issue for several years before commencing a new rulemaking,” the U.S. Justice Department said on behalf of the EEOC.


The actual court decision and follow-up motion

Here is the actual December 20 decision 

Here is the follow-up (unopposed) motion by EEOC clarifying they are not actually required to do anything


Actual language on “Voluntariness”

There is some difference of opinion on what constitutes a program being “voluntary,” starting in January. It might be helpful to review what Judge Bates said…

 A 30% penalty for refusing to provide protected information would double the cost of health insurance for most employees. … At around $1800 a year, this is the equivalent of several months’ worth of food for the average family, two months of child care in most states, and roughly two months’ rent.

…and what EEOC conceded…

Even after [the current rules are struck from the Code of Federal Regulations, for example, the ADA regulation will still require participation in wellness programs to be voluntary … the regulation will simply no longer provide a specific safe harbor for particular levels of incentives.

…before concluding that high incentives are going to be allowed in the future, as wellness vendors are wont to conclude.

 

 

 

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