It’s a 3-way tie for the Deplorables Award this year, so I think we’re gonna need a bigger basket.
This race to the bottom was hotly contested this year, as we try to determine who, in the wellness industry’s epidemic of very stable geniuses, is Patient Einstein. These wellness vendors routinely violate rules of grammar, ethics, math and even wellness itself in their attempts to outstupid each other. Yes, I know that word is not in the dictionary but that’s only because Merriam-Webster uses a different wellness vendor.
They also violate the rule that there are two sides to every story. In each case, this is their story, just annotated. In no case are we “challenging the data.” Quite the opposite. There is a saying that: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
It’s a 3-way tie, in that three companies accomplished more in 2021 than most stupid people accomplish in a lifetime. It may seem impolite to call them “stupid,” but the alternative would be that they know their claims are false, so the alternative would be to call them liars.
And sometimes, as in the case of one of our winners, we ourselves would be lying if we didn’t call them stupid. Here is the official catchphrase from the landing page of their website. I would call this collection of wellness industry cliches a word salad, if only all of these were words.
That’s because they’ve achieved the elusive quadruple aim of wellness: reducing employee costs, increasing employee productivity, raising employee engagne-ment, and poking employee cheeks.
Needless to say, Wellsteps is back in the Deplorables Award winner’s circle, for the third time in six tries. I keep trying to retire from the business of exposing fraud in wellness. But just when I thought I was out, Wellsteps pulls me back in.
I’d like to propose that the Justice Department go after them. Not because they are lying, cheating and harming employees. Those are table stakes for wellness vendors profiled in these pages. Rather, they should be investigated by the Antitrust Division for trying to create a monopoly on stupidity.
Yes, it seems like hardly a month goes by without the irresistible force of Wellsteps’ corporate IQ colliding with the immovable object of reality. They lit up the scorecard twice in 2021. First was Wellsteps Accomplished the Impossible: They Got Stupider. The highlight was that they “updated their ROI calculator.” But here are the three asterisks to that statement. Their “ROI Calculator”:
- is not updated.
- doesn’t show an ROI.
- doesn’t calculate.
Not content with a single entry in this year’s contest, they entered a second time, with Dog Bites Man…and Wellsteps Fabricates Its Outcomes Again. At the risk of insulting the 76 million canines in this country, Wellsteps fabricating its outcomes is the “Dog Bites Man” headline of the wellness world. it really shouldn’t make the front page, especially in an industry segment as idiot-intensive as theirs. Yet transparently fabricating outcomes is their signature move, so I do like to make sure they get credit for it.
Wellsteps’ problem is that they aren’t remotely smart enough to lie without being caught. They may or may not be the most dishonest vendor, and they may or may not be the stupidest vendor, but they are certainly the stupidest dishonest vendor.
They would also be a finailist for the Chiquita Award, by the CEO, Steve Aldana claiming that health can be improved with “even one more bite of a banana.”
I’ve always recommended to Mr. Aldana that if he is going to lie so much, he needs to hire a smart person.
Just when I thought wellness vendors couldn’t get any dumber than Wellsteps, I found this one. See Wellsteps: We’re the Stupidest Wellness Vendor. Wellness360: Hold My Beer.
The difference is that Wellness360 is not dishonest. They genuinely believe that we must drink 15 glasses of water a day – they aren’t just saying it to qualify for the pole position in our award competition.
How do I know they genuinely believe we need “hydration wellbeing challenges” to meet this goal, even though the quoted study itself says “the vast majority of healthy people meet their hydration needs by letting thirst be their guide”? They wrote to me to defend their findings, and also cited the massive savings reported in the 2010 Health Affairs article. I pointed out the slight problem that the authors of that study themselves retracted that conclusion when they did their own results, and found the opposite. Wellness360 replied: “Thousand’s [sic] of studies monthly give different results for sure,” which of course clears everything up.
They also posted a recipe for ginger snaps that sounded quite tasty…
…largely because it calls for a cup of sugar and 1/4 cup of molasses. I observed that perhaps it wasn’t exactly on-message for a wellness vendor to be advocating consumption of sugar by the cupful. They posted back that, to offset the sugar, the ginger offers three attributes that I had apparently overlooked. Ginger:
- “Keeps your body warm,”
- “Keeps your health in check,” and
- “Is a diaphoretic.”
It’s not just you. I had no clue what “diaphoretic” meant either. So I looked it up. Diaphoresis is a medical condition characterized by “excessive sweating for no apparent reason.”
The good news is we’ve solved that medical mystery by finding that there is an “apparent reason” – those 15 glasses of water a day have to go somewhere.
Yes, I know. You read TheySaidWhat for the same reason you rubberneck. You simply can’t look away. You were hoping this week we would be publishing the annual Deplorables Awards. They are coming next week, when we will reveal which very stable genius is Vendor Zero in the wellness industry’s epidemic of cluelessness.
Today we are doing the opposite: giving credit to the people and corporations (they are people too, you know) who stood out in 2021 for advancing the causes of cost-effectiveness, quality, innovation, and health equity.
These are in alphabetical order and if you think I left someone out send me a linkedin note and I will add them if I agree they are worthy.
I would like to separately recognize my uncle, Dr. J. Michael Lane, who passed away fairly recently. He did more than anyone else to wipe out smallpox. First, he wrote the paper which provided the economic justification for investing in the eradication of smallpox, in lieu of vaccinating everyone in sight.
He observed that the vanishingly low smallpox incidence rate outside Africa was maintained by millions of vaccinations that created thousands of complications. And that the cost of going to Africa to eradicate the disease from its last strongholds was far less than the cost of said vaccines and complications. He then procured the budget from CDC and WHO, and led the team which went to Africa to teach the locals how to inoculate up to 10,000 people a day. The logistics of convincing local and tribal leaders, some of whom were Russian allies carrying AK-47s, to stick their friends and families with needles, were challenging, to put it mildly.
It turns out he didn’t win a Nobel Prize in Medicine because prizewinners are required to invent or discover something. Whereas all he did was wipe out the biggest viral scourge in the history of mankind, albeit using a technology that had been around for centuries.
And now, the winners…
Marshall Allen’s Never Pay the First Bill almost hit the New York Times bestseller list. it is the first how-to book empowering patients/consumers to pay a fair price for services rendered. You shouldn’t need a book for that. I mean, no one has written a book to teach people how not to get snookered by, for example, laundromats. And yet we do. And yet he did.
His expose of broker compensation helped lead to the Comprehensive Appropriations Act, which requires full disclosure of all streams of payment between vendors/carrier/PBMs and middlepeople. This could change the industry, favoring honest vendors like Quizzify that don’t make under-the-table payments.
Jerry Ashton’s nonprofit, RIP Medical Debt, has paid off a total of $5 Billion of old medical debt, and as part of that, restored credit to the debtors, most of whom were otherwise essentially barred from procuring credit on favorable terms (if they can get credit at all), not to mentioned totally stressed. There is still tons more to go. Mind-blowing numbers of insured Americans carry mind-blowing amounts of medical debt. They accumulate this debt even as they’ve paid down their credit card debt in record amounts.
Dr. Bill Bestermann has developed an enormous national following among PCPs and cardiometablic clinicians by studiously mastering and integrating the genomic and metabolic evidence behind Optimal Medical Therapy and a unified theory of chronic disease. The health outcomes he achieved working with BCBS Louisiana, Ochsner, andea other groups are consistently far beyond conventional care, and he has been open and mission driven about sharing his model for the betterment of all humankind.
Katherine Baicker and Zirui Song, for publishing the definitive cluster randomization study on wellness, which naturally showed no impact at all. Special kudos for allowing themselves to be guided by the evidence. Yes, you shouldn’t get an award for that, but in this industry you do. Likewise, we reversed our opinion on these two. As Prof. Baicker demonstrated with her study on Oregon Medicaid’s natural experiment using a lottery control, she is the #1 researcher in this field. (The 2010 Health Affairs thing was well-intentioned, but wrong. I would add that I can’t talk — I didn’t figure out these vendors were scamming people until 2013. If you look hard at my 2012 textbook on outcomes measurement in disease management and patient-centered medical homes, you will see a brief but positive mention of wellness.)
Leah Binder dramatically expanded the Leapfrog Group’s scope, forging ahead with ethical billing ratings (inspired in part by Marty Makary and one other guy…hmmm…wonder who that was?). Combined with Dr. Makary’s efforts, shining a light on these practices has without question had an impact on billing practices.
Dr. Eric Bricker consistently produces the best short video exposes of anyone in the industry and nothing seems to escape his smackdowns. I learned from him, for example, why hospitals charge so much more for emergency care than for electives. I had always just assumed it was because you don’t really have a choice in an emergency. That would explain out-of-network price-gouging (which is ending a couple weeks after you read this), but Dr. Bricker explained the specific reason in-network rates are so high, summarized here.
Dave Chase, and other next-generation benefits advisors, showed it really is possible to reduce the overall cost of healthcare while increasing benefits. Maybe you could attribute the first few cases to good luck but after hundreds of similar outcomes, you have to think Health Rosetta’s special sauce works.
Christin Deacon became the highest-visibility benefits manager in the country, running the 4th largest health benefit in the country. The state of New Jersey had the good sense to combine all public-sector employees into one group, to increase purchasing power. Overcoming many hurdles from politicians and others, she made major changes that saved billions, to be shared with employees and taxpayers. Hear Chris tell her story in our January 6th webinar Presenting Chris Deacon…Unplugged.
Bryce Heinbaugh, who has been working tirelessly and successfully to make Direct Primary Care available for participants in the plans that he serves in rural areas of Ohio and West Virginia. He has put in a couple of years of effort to find and recruit DPC practices in underserved areas, and then drove a couple of thousand miles in a week to tell the participants about this great feature of their health plans. And yet you’ve never heard of him. That’s what we’re here for.
Brian Klepper devotes an absurd amount of time to curating a googlegroup in which like-minded (well, in the broadest sense of the word) disruptors can find common ground, share ideas and make connections. It is important for those of us on the “bleeding edge” to realize we are not alone in the universe, so this Healthcare Hackers Group performs an invaluable function. Curating it is way harder than it looks. Or as I sometimes say, it takes a lot of effort to make something look easy.
The advisors on the Hackers Group – Alera, Connect Health Collaboration, EPoweredBenefits, Higgenbotham, Mitigate Partners, Provinsure, and more – are all “next generation” advisors who have achieved excellent results and who welcome next month’s Consolidated Appropriations Act (CAA) instead of dreading its bright lights behind shined on their business practices. Indeed, asking two questions of your advisor or vendor will determine their ethics:
- What do you think of the CAA?
- What do you think of Al Lewis?
Dr. Marty Makary’s The Price We Pay also hit the bestseller list (in paperback). His quest to reduce or eliminate the number of lawsuits filed by hospitals against patients who unwittingly sign financial consents has shown clear results, as the number of such suits has plummeted. Only a small minority of hospitals were doing this, but they compensated for those small numbers with lots of lawsuits. (And some are still at it, of course.) Dr. Makary was also the inspiration for the “Prevent Consent,” which Quizzify literally guarantees will keep ER bills in the 3 figures, in the continental US.
Rosen Hotels is arguably the best employer health benefit in the country, per dollar spent. They get plenty of plaudits already, but we can pile on.
Gillian Pieper, Ashley Johnson, Amy Gilbert and colleagues at VEHI PATH have achieved a relationship with their constituents, the 19,000 Vermont teachers, that would be the envy of any organization anywhere. Quizzify is very engaging in most places, and yet somehow they are twice as engaging as the Quizzify average. It isn’t just Quizzify. Their combination of mutual trust, “champions” in every building, and an easily accessible and interesting set of offerings doesn’t just result in mind-blowing engagement levels, but does so with among the most modest incentives we’ve ever seen.
We should also give shout-outs to some of the leading Business Coalitions. It’s a tough thing to do because you have to rely on funding (at least partially) from exactly the organizations you are trying to negotiate with. But Jessica Brooks of PBGH, Chris Skisak of HBGH, and Bob Smith of CBGH deserve a special shout-out. (This is not to say some others don’t, but these three are willing to take bullets.)
The Vendors of 2021
Among vendors, we’d like to draw special attention to three which solve specific problems. This is no knock against some other vendors, but it’s very unusual for a vendor to make a bright-line change. Usually, with more or less success, the idea of vendors is to change employee behavior.
Quizzify also changes behavior, by teaching employees how to recognize and avoid useless and potentially harmful tests and procedures. Quizzify also tries to change eating behavior. For example, you probably think cranberries are a “superfruit,” if for no other reason than the package tells us so.
Yet they are completely devoid of vitamins. That’s not even the bad part. The bad part is that in the form we usually eat them, “Craisins,” are literally 50% sugar, a proportion that could make Captain Horatio Crunch himself blush. You have to do the math on the label below, which needless to say Ocean Spray is not exactly forthcoming about. 1/4 Cup is 2 ounces. There are 29 grams in an ounce. Ergo…
See? We just changed your eating behavior.
But the reason Quizzify is on the list of bright-line change is the Prevent Consent. As noted above, this was largely inspired by Dr. Makary. We simply took the next step from “Don’t sign their consent,” to “Sign your own instead.” So far this Consent has been accepted everywhere (treatment in the ER without affirmative objection constitutes acceptance–Contract Law 101), though occasionally the hospital seems to “forget” that they agreed to it and tries to send a conventional bill. Quizzify will take care of that.
It is now available in a mobile app, Quizzify2Go, which includes a “cheat sheet” to remind employees of their rights in the ER, and a support hotline if the ER intake person is being recalcitrant. It also has a full list of questions to ask during doctor visits for 100+ different topics.
The next is Sera Prognostics. They market a test called PreTRM, which dramatically increases an obstetrician’s ability to predict prematurity. If followed by an intensive prenatal health program, accurate prediction can substantially reduce, and has substantially reduced, the number of NICU days in a population. I’m not undertanding why employers who spend large sums to help employees get pregnant seem less interested in saving large sums by helping employees stay pregnant. But maybe that’s just me.
Employers who compare their NICU days/1000 to their primary-coded diabetes days per 1000 will see that with all the fuss about diabetes, reducing NICU days is a vastly more economically worthwhile activity. This is a list of the top 25 inpatient total spends by employers. Do you see a trend? The plurality are birth events. Diabetes doesn’t show up at all.
Not to mention that, unlike diabetes, your employees will love you for it and you won’t get reviews like Livongo’s.
Next is the Validation Institute, which really came into its own this year. Employers have finally figured out that vendors don’t retain actuaries to determine whether money was saved. They retain actuaries to “prove” that money was saved. Here is their master list of vendor sleight-of-hand techniques.
In 2021, the Validation Institute (VI) drew a bright line between its own validations and actuarial number salad with its Credibility Guarantee. If you, as a customer of a validated entity, can show VI overstated a vendor claim, the VI will send you a multiple of the fee that the vendor paid to be validated.
And, finally, it is important to recognize that the wellness industry has some fine, upstanding citizens. As far as we know, this is the all-inclusive list but we are happy to add others if indeed they qualify. US Preventive Medicine leads the list because, uniquely in wellness, it has achieved validation by the Validation Institute for making a clear reduction in risk factors. Aduro, Limeade, Sonic Boom, Wellable, and Wellright also make the cut.
Please put comments on Linkedin instead of here. I don’t moderate these posts for comments.
Continuing December’s guest posts of Quizzify’s greatest hits…
The vast majority of your employees take nutritional supplements, whose consumption just reached an all-time high. That increase means someone, somewhere – maybe even your very own wellness vendor – is telling them this is a good idea.
Or maybe they are thinking: “Hey, what harm can they do?”
Plenty, as it turns out.
Here are six things employee should know about nutritional supplements.
1. Virtually all the benefits of supplements with virtually none of the risk can be achieved by taking a regular multivitamin
There is plenty of evidence for the health benefits of virtually all vitamins and minerals and even a couple of supplements, so much evidence that we have room to highlight only a few.
Examples include fish oil for menopausal women with dry eye or possibly people at high risk of heart attack. Or folic acid for pregnant women and iron for pregnant women who are anemic. Or Vitamin D for people who have dark skin, live in cloudy climates, avoid all sun exposure and/or don’t each much dairy. And of course, Vitamin B12 for vegans. (Vitamin B12 is found only in animal products.)
Women likely benefit from small combined extra amounts of calcium and Vitamin D…but as noted below, don’t overdo it.
The 10% of the population who drink to excess really should be taking daily multivitamins. This is partly because alcohol interferes with absorption, and partly because they aren’t getting enough calories from real foods.
And as we noted in Six Things Employees Should Know about Antibiotics, probiotic supplements are a very wise idea for employees taking antibiotics. Ironically, pouring bacteria down your throat is (at least in that circumstance) more beneficial than any megavitamin or mineral.
With these exceptions, most people should be getting enough vitamins (and prebiotics, which feed probiotics) in a balanced diet, but a few cents a day of an “insurance” multivitamin pays for itself just in the psychological benefit of not worrying about that. However, the story changes when we talk about megavitamins, and especially when we talk about other supplements.
2. Almost every megavitamin which once showed “promise” in fighting cancer, heart disease, etc. doesn’t. Quite the opposite, they may cause harm.
Niacin, once thought to have magical properties against heart attacks, has been completely debunked. Vitamin E supplements could prevent cancer in some women but cause it in others, depending on genes. Men who are concerned about prostate cancer (meaning all of us) should specifically avoid Vitamin E supplements, which likely increase the odds of it. Vitamin D in large quantities is the latest to be debunked, just last month. Taking too much may cause osteoporosis, rather than prevent it.
And monitor your own wellness vendors. Interactive Health, for example, tests every employee for anemia. This is contrary to the advice of clinical guidelines, which oppose anemia screening except for pregnant women, where evidence is mixed. Employees who then take iron supplements risk stomach pain, nausea, vomiting and serious long-term complications.
The good news? It is possible large amounts of Vitamin C do offer modest benefits with respect to common colds, and that those possible benefits outweigh the possible harms. But just large amounts, like 200-400 mg., not massive amounts — and not so large that you need pills.
3. If you have to go to GNC to obtain a supplement, or order it through the mail, it has no value and may cause harm.
As a random example we picked because we like the name, consider horny goatweed, as a treatment for erectile dysfunction (ED). Along with the name, it also has a great back story, something about Mongolian herders observing goats getting aroused after grazing on it.
It is actually proven to work, and not just on goats. It also works on rats. For the rest of us, there is zero evidence. Plus, ED is one of those conditions, like obesity or baldness, where, if something really worked, we’d know about it by now.
At least the likelihood of harm is pretty low, other than to your wallet and self-confidence.
This is another installment in Quizzify’s “Six Things” Greatest Hits, which we are posting from now until Festivus.
The best and safest way to control your heartburn is through altering your diet and lifestyle, as outlined in the previous installment of Six Things Employees Should Know about Heartburn.
However, if you control your heartburn through regular use of Nexium, Prevacid, Prilosec or Protonix, be aware that these are very effective drugs specifically because they control stomach acid so well, with no obvious short-term side effects in most cases.
And yet they are probably the riskiest, most misunderstood and most overused drugs currently available without a prescription.
4. PPIs should be a last choice, not a first choice — and even then, only for the short term
Ask about effective non-drug or OTC drug options to control your heartburn.
Ask about the potential long-term harms of PPIs.
Ask about an end date: if you have simple heartburn and you are started on a PPI, it should never be for more than 8 weeks, after which you should be reassessed, or reduce the use of your PPI to an “as needed” intermittent basis.
This is another in Quizzify’s Six Things Employees Should Know series, that They Said What? is offering this month. Heartburn is a two-part series.
To all of us who have experienced it (which is to say, virtually all of us), heartburn — otherwise known as indigestion or acid reflux — seems to be a part of the human condition. We would cite the massive numbers of people — probably a third of the American adult population — who experience this condition at least once a month, but we don’t have to because you, or at least many of the employees in your organization, are likely among them.
Rather than suffer through an episode or repeat episodes, many of us reach for a remedy. That remedy ranges from an occasional chewable Tums or Rolaids to daily dosages of Proton Pump Inhibitor (PPI) drugs, like Nexium, Prevacid or Prilosec. Most of these options reliably relieve most people’s symptoms without immediate side effects, so few people question either the need or the remedy.
And yet it turns out both the need and the remedy should be questioned. Simple lifestyle changes can reduce the need, and nobody should be taking any drug designed as a remedy every day. Most drugs intended to be taken intermittently or for short periods of time are not labeled, tested or, as we shall see in the next installment, safe for long-term use. (Our most recent Six Things post exposed another example: harmless-sounding OTC sleep aids.)
1. Some of the causes of heartburn can easily be addressed
Overeating, eating without an accompanying beverage, eating too fast, eating too late at night – all these things can cause indigestion. https://www.health.harvard.edu/staying-healthy/8-ways-to-quell-the-fire-of-heartburn Other less obvious physical causes include:
- Eating while slouching,
- Not loosening your belt while filling your stomach
- Too much alcohol, caffeine, or even peppermint, carbonated beverages or chocolate
- Fatty or greasy foods.
- Exercising right after eating
Simply addressing these items – particularly in combination and particularly before bed — could go a long way towards relieving symptoms.
2. Three simple remedies are overlooked
First, try chewing sugarless gum after eating. This stimulates saliva production. You’ll often feel a satisfying burp as a result. (Or at least here at Quizzify we do. Yes, we know. TMI.) https://www.health.harvard.edu/staying-healthy/8-ways-to-quell-the-fire-of-heartburn
Next, probiotics found naturally in some yogurts (or kombucha) can solve many people’s indigestion if eaten regularly for two weeks or so.
There are hundreds of yogurts on the market, so how can you tell if a yogurt has probiotics? Rule of thumb: if you recognize the brand from your childhood, it doesn’t. There are also many types of probiotics. None fit everyone’s needs exactly, so varying your yogurt choices might be a good idea.
Caution: like every other nutritional supplement, probiotics should not become an obsession. Get them from natural sources rather than pills or other concentrated sources.
Finally, if you have nighttime indigestion, try elevating the head of your bed to create a slight downward plane. Not just adding pillows (see comment above about not scrunching your stomach), but rather inclining your entire bed — using books, or wedges available online or in any medical supply store. https://www.health.harvard.edu/diseases-and-conditions/gastroesophageal-reflux-disease While you’re sleeping, this small angle helps keep digestive juices out of your esophagus — which is specifically the body part that “acid reflux” irritates, as the next section describes.
Better sleeping through chemistry? Your employees need to know the risks…
By way of background, Benadryl is an antihistamine originally developed, using technology older than virtually everyone reading this posting, to relieve allergies. Its sleep-inducing property was originally a bug but is now a feature.
Wellness vendors tell employees that getting a good night’s sleep is important to overall health. Their sound observations include:
- Avoiding caffeine later in the day
- Keeping a consistent bedtime
- Sleeping in a dark, quiet room, and
- Turning off the computer 1-2 hours before bed.
Of course, Quizzify’s popular sleep quizzes include these Q&As because a few employees may not know them. But we also include 12 more things that many employees who have difficulty sleeping don’t know…and would benefit from learning because in every case, the required behavior change is as easy as screwing in a light bulb.
Speaking of which, that is the first of the Six Things we will cover in this two-part installment.
1. Energy-efficient light bulbs
Who knew? These give off far more “blue light” than conventional Thomas Edison-type incandescent bulbs. And blue light is probably one of the biggest causes of insomnia. Here’s an easy behavior change: screw one of the old-fashioned bulbs into your bedside table lamp. All you’d ever want to know about blue light can be found here.
2. Orange Soda
Everyone knows colas contain caffeine. Some folks know that most root beers and even cream sodas do too. But orange soda? Turns out that Sunkist Orange Soda contains more caffeine than Coke. Along with more sugar too. The good news is that, being orange-based, it provides some Vitamin C. (Not.) Here is a list of all popular beverages containing caffeine, including some you wouldn’t expect.
3. Over-the-counter headache relievers like Extra-Strength Excedrin
Yes, Excedrin. The irony is that caffeine is suspected as a migraine trigger. So the last thing you’d expect a headache remedy to contain would be caffeine. And yet it does. Some (but not all) medications labeled “non-drowsy” also contain caffeine. And while we’re on the subject of surprising sources of caffeine, let’s add breath mints, decaffeinated coffee, and any product that contains the word “energy.”