Even by wellness industry standards, Provant Health’s business practices earned it our first multi-part series. It required nine parts to do them justice…
And now they are bankrupt too. Their remaining assets are being purchased by Quest Diagnostics, a reference lab company no doubt hoping to run additional lab tests on Provant’s dwindling employee base.
We knew this was coming because they had already started cutting back on spending, by dropping their internet connection, and hence didn’t realize that employees are not supposed to drink 8 glasses of water a day.
Here is a real-life example of what an employer can expect to achieve by spending a million bucks on these very stable geniuses:
BMI and glucose got worse. Somehow, blood pressure stayed the same — 120 over 75. Yes, despite the average employee being almost prediabetic, and sporting a 40-inch waist for males (and close to that for females), pretty much everyone in this company has ideal blood pressure. One explanation for this would be that Provant, whatever their shortcomings in weight control, are the world’s leading excepts in all things cardio.
That expertise might also explain how they were able to keep the cardiac ratio so low. An alternative explanation might be that there is no such thing as a “cardiac ratio.” (Google it.) I’ve heard of wellness vendors making up data, but this is a first–making up an entire metric to present its made-up data. Maybe the reason Quest Diagnostics purchased them was to develop a new lab test for cardiac ratios.
The good news is that, despite these underwhelming results, Provant was able to beat its targets, which is easy enough if you move the goalposts to the opposite end zone:
So much winning! Provant “wins” if the average employee is overweight but not quite obese yet, has glucose only 74 points higher than the threshold to be considered diabetic, and is only borderline hypertensive. No target is set for the cardiac ratio, of course, because it doesn’t exist.
In that sense the cardiac ratio is not unlike Provant itself.
Too much healthcare can be hazardous to your health, as three findings released last week have shown.
- America’s Epidemic of Overtreatment
Health Affairs reports an epidemic of overtreatment. Author Shannon Brownlee proposes that patients “start asking uncomfortable questions,” to determine if treatments are appropriate. The problem is that employees don’t know what uncomfortable questions to ask, unless one counts: “Do you mean to say I’m not eating enough broccoli?” The questions don’t have to be uncomfortable. They get more comfortable, the more one learns about healthcare. Seems simple enough, and yet 99% of employers still don’t offer employee healthcare literacy education.
2. America’s Epidemic of Innumeracy
It would help if doctors knew the first thing about interpreting lab test results before recommending these treatments, but apparently they don’t. The Washington Post reports that professionals reading lab test results don’t understand false positive arithmetic. As a result, your employees may be getting diagnosed and treated for conditions they don’t have. Wellness vendors don’t understand it either. As compared to real medical professionals, the difference is that the they take great pride in their ignorance, and brag about how many false positives they find. I’m talking to you, Interactive Health.
No, they don’t. We’ll post on false positive arithmetic next week.
3. America’s Epidemic of Overprevention
As reported on They Said What Thursday, it looks like too much spending on prevention can backfire. Specifically, spending more on employee healthcare, and sending more employees to the doctor, does not deliver better outcomes, fewer ER visits, or even more HbA1c checks for diabetics. Quite the contrary, the correlation, though weak, goes in the “wrong” direction.
Bottom line: looks like Quizzify had it right all along: just because it’s healthcare doesn’t mean it’s good for you.
The Commonwealth Fund recently released a comprehensive report comparing employer healthcare spending with various outcomes measures. The result — and you’re way ahead of me here, I’m sure — is bad news for the wellness industry. It shows basically no correlation between employer spending and outcomes. Examples:
- No correlation between doctor office visits and prevention of avoidable ER visits
- No correlation between total employer spending and prevention of avoidable ER vistis
Let’s see how all those diabetes programs are doing…
- A slightly negative correlation between employer spending and people getting their HbA1cs checked.
And of course, the holy grail: how are employers doing in preventing hospitalizations?
- Spending more doesn’t get better results. It’s in how wisely the money is spent. Iowa scores way ahead in preventing hospitalizations while spending less than average, perhaps due to Bill Appelgate’s Iowa Chronic Care Consortium. Nebraska, right next door, shows the opposite, spending somewhat more and preventing somewhat less. As you recall, Nebraska put their very stable genius wellness vendors on the case and ended up on the front page of the Omaha World Herald. Not to mention ongoing color commentary from They Said What, featuring — you guessed it — Ron Goetzel, trying to explain how Nebraska’s state program got an award for lying about saving the lives of cancer patients who didn’t have cancer in the first place. Not to mention the rest of program simply threw money away: of 20,000 state employees, only 180 reduced a risk factor.
Curiously, the loser states in these analyses are not the usual loser states in health status. Mississippi scores high. Not because the outcomes are great. They are around the average. However, very few employers in Mississippi spend anything on prevention or workplace wellness to achieve those outcomes. Other states spend tons of money on vendors and doctor visits…with basically the same results as Mississippi.
The displays don’t lend themselves to cut-and-pasting, since they are interactive (by state) and for some reason the axes are rather shy when you try to copy them. Nonetheless, worth noting is the slightly negative correlation between spending and quality in the employer population. (Quality on the left axis, spending on the bottom.) After a point, more healthcare only makes things worse. Or, as Quizzify says, “Just because it’s healthcare doesn’t mean it’s good for you.” Exhibit A being Interactive Health, of course. They are the most expensive wellness vendor, do the most tests, and send the most employees (45%!) to the doctor with “newly discovered conditions.” And yet they haven’t actually accomplished anything, other than getting exposed in the Wall Street Journal.
The conclusion? Like everything else in life, there can be too much prevention. Annual screenings plus annual doctor visits for asymptomatic and younger employees is simply way too much…and as this graph shows, too much healthcare can be hazardous to your health.
Too much healthcare and not enough healthcare education is a recipe for lots of excess costs.
New England Journal of Medicine published its first-ever article about wellness. Its viewpoint: primary care physicians should not be forced to choose whether to report employee noncompliance (which itself could harm the employee, violating the Hippocratic Oath) or whether to give employees a pass and allow them to earn their incentives or avoid fines even if they aren’t complying. See: The Physician as Double-Agent. (Behind a paywall but worth signing up for the free near-term subscription.)
The Cochrane Review (the most influential publication no one has heard of) published a meta-analysis concluding that nicotine replacement therapy is much more successful than previously believed. It might be time to reconfigure wellness programs to incorporate more of it.
Obesity is a more complex problem than many people think. And wellness programs to “help” employees may be backfiring. See Everything We Know About Obesity is Wrong. (OK, that was two weeks ago but still worth a read this week.)
The keynote session at the HEROForum18 conference, presented by Professor Gary Bennett of Duke University, had a similar theme: “We know that just about any diet program will show success at 3/6 months, but within a year or two they’ve gained it back.” He also noted that coaching may produce behavior change (not necessarily sustained weight loss) – if an employee gets the same coach, the coach is highly competent, and both parties have sufficient time for coaching.
Adding to the well-deserved woes of the “pry, poke and prod” industry is today’s New England Journal of Medicine, certainly the most influential publication in healthcare. Written from a physician’s perspective (adding to the patient’s and coach’s perspectives we have documented earlier), it details the conflicts of interest created when a patient’s primary care physician has to rat out the patient for not adhering to a treatment plan.
The title of the article, “Physician as Double Agent,” says it all. A typical observation:
Requiring physicians to report their patients’ noncompliance to insurers can put them in a quandary. Doctors’ primary ethical duty is to promote their patients’ health and well-being. When a patient’s health care costs hinge on a physician’s report, refusing to certify the patient’s compliance can inflict meaningful harm.
The author uses the example of Blue Cross of Michigan, which (in certain violation of the upcoming EEOC rule changes) makes employees get physical exams or lose up to $4000/year…and makes the doctor report noncompliance:
Placing physicians in this reporting role is also potentially devastating to the trust on which a productive doctor–patient relationship is built. For example, an employee in the Healthy Blue Living HMO who has depression can qualify for lower-cost insurance only if he complies with his physician’s treatment plan. Yet many patients discontinue antidepressant medications prematurely, often because they doubt the drugs’ benefits or experience unwanted side effects. When these patients view their physicians as agents of their insurers and know they face penalties for noncompliance, they may be less likely to share these concerns with their doctors. Some may terminate treatment while falsely claiming to comply.
The author also points out the obvious: to what end? Outcomes-based wellness programs don’t work, so why do them? There is no upside and therefore no argument in favor of poisoning the doctor-patient relationship. He concludes by admitting any one doctor is powerless against the forces of the insurance industry but:
As a group, doctors can advocate for policies that protect patients, the medical profession, and the relationship between the two. In the absence of compelling evidence that incentive-based wellness programs improve employee health, I would urge physicians to oppose arrangements in which the penalty for poor health is reduced access to health care.
Opposing outcomes-based wellness? Join the crowd.
PS Sorry but this article is behind a paywall. Presumably it will soon be in the public domain.
When a true genius appears, you can know him by this sign: that all the dunces are in a confederacy against him.
If this list looks familiar, it’s likely because it largely coincides with finalists for the Deplorables Awards. One exception would be Keas, though. They’re on Wellsteps’ best vendor list even though they no longer exist, likely victims of their own stupidity. I will miss them though — if laughter were the best medicine, they would be the best vendor. You would, however, be better off contracting with a vendor that didn’t exist than with Wellsteps — at least your employees wouldn’t get worse.
Likewise, Provant is no longer with us. They drank themselves to death. (Water, that is — they insisted every employee drink 8 glasses a day.)
The law of averages did catch up with Wellsteps, though. They listed US Preventive Medicine, whose outcomes, almost uniquely in the wellness industry, are validated by the Validation Institute.
A couple of other quality vendors are listed too. I asked one how they got mixed up with these people, and he replied that he had no idea how they got on that list. Another vendor thinks the point of the list is to help Wellsteps with SEO, on the theory that these vendors, to show off this award, will link to Wellsteps, thus raising Wellsteps’ Google ranking. Let’s see how that’s working out for ’em:
Likely Google ends up this way because no self-respecting, honest, vendor would deliberately link to Wellsteps. If they put Quizzify on this awards list, Quizzify would send a cease-and-desist letter. It would be a worse stain on Quizzify’s reputation than winning a Koop Award.
Another thing the Koop Award has in common with Wellsteps: Channeling Nero, they both bestow awards upon themselves. Look closely at that list: one of the best vendors named by Wellsteps is: Wellsteps.
One other observation: the very stable geniuses on the Koop Award Committee — which loves to give its board members and sponsors awards — are largely also mixed up with the Health Enhancement Research Organization, known as HERO. HERO rhymes with Nero. Coincidence? I think not.
This is the second time Wellsteps has published this list. Since the list is unchanged, our write-up can be unchanged too. Below is the write-up from the first time they pulled this caper, the first Sunday in November of last year.
Wellsteps’ Steve Aldana has “endorsed” a confederacy of 25 wellness vendors, including his own company, Wellsteps. Alas, in the world of the Welligentsia, in which an increasing number of employers reside, an endorsement from Mr. Aldana earns about as many points in a vendor selection process as neat handwriting.
There are usually not enough hours in a week to both do my Day Job running a fast-growing company (Quizzify, which plenty of thought leaders have endorsed, so we don’t have to endorse ourselves), and also play wellness-meets-whack-a-mole with the Wellness Ignorati. Fortunately, this week does have enough hours, thanks to the time change. (The wellness industry is lucky that “falling back” is not a regular occurrence.)
I haven’t heard of many members of this confederacy, but I’ve heard more than enough about the ones below. Each link takes you to our own “endorsements.”
Keas Meets Lake Wobegon: All Employees Are Above Average (in Stress). This is the best argument for requiring that wellness vendors attain a GED.
Provant: “In the Belly of the Beast” A nine-part series that one line can’t do justice to. We would simply note that you do not have to drink eight glasses of water a day. Indeed, you probably shouldn’t if you expect to get anything else done.
Staywell’s Wellness Program for British Petroleum is Spewing Invalidity. It wasn’t just that their savings claim was mathematically impossible. That’s just the threshold for wellness savings claims. Staywell also somehow saved BP 100x as much as Staywell’s own website says is possible. And because they have a “special relationship” with Mercer (meaning they pay them), Mercer “validated” this fiction for BP, at BP’s expense…
Staywell and British Petroleum Meet Groundhog Day. They won a Koop Award. Since Staywell and Mercer are both on the Koop Committee and their results are completely invalid and they are obviously lying, they satisfy all the award criteria.
Total Wellness’s Total Package of Totally Inappropriate Tests. They could lose their license for subjecting employees to this panoply of US Preventive Services Task Force D-rated quackery, except that in wellness the only license you need is a license to steal from unsuspecting HR directors. This leads to…
…Total Wellness: The Best Argument for Regulating the Wellness Industry. Total Wellness isn’t about to lose this Race to the Bottom without a fight. Watch as they try to out-stupid Star Wellness in their quest for that prize.
US Corporate Wellness Saves Money on People Who Don’t Cost Money. We call this Seinfeld-meets-wellness, because it’s about nothing: even if you have absolutely no risk factors, these very stable geniuses will still save you a fortune. And someone should also tell them you can’t reduce a number by more than 100% no matter how hard you try.
Vitality’s Glass House: Their Own Program Fails Their Own Employees. These people might have more luck selling you a crash-dieting program if they could get their own employees to lose weight.
Wellness Corporate Solutions Gives Us a Dose of Much-Needed Criticism. We don’t want to spoil the punchline.
And that brings us to Wellsteps itself, which earns its “endorsement” from its own CEO by making so many appearances on this list that there is barely enough room for the rest of the confederacy. If you only have time for the Executive Summary, this is the one to read. But squeezing it all into one place requires sacrificing the laugh lines, and if there is one thing Wellsteps excels at, it’s providing laugh lines.
Wellsteps ROI Calculator Doesn’t Calculate an ROI…and That’s the Good News. Watch what happens when Wellsteps meets Fischer-Price. No matter what variables you enter in this model, you get the same result.
Wellsteps Stumbles Onward: Costs Go Up and Down at the Same Time. This isn’t possible even using wellness arithmetic. Eventually Wellsteps solved this problem by simply deleting one of the slides. But because we long ago learned that doctoring/suppressing data is one of the wellness industry’s signature moves, we took a screenshot before we did our expose.
Prediction: Wellsteps Wins Koop Award. In 2015, I went out on a limb to make this prediction, noting Wellsteps’ perfect Koop Award storm of invalidity, incompetence, and cronyism.
Wellsteps: “It’s Fun to Get Fat. It’s Fun to Be Lazy.” This one was penned by Dr. Aldana’s waterboy, Troy Adams, who apparently during his self-proclaimed “11 years of college” never learned that “fat” and “lazy” aren’t synonyms. Paraphrasing the immortal words of the great philosopher Bluto Blutarski, 11 years of college down the drain.
Does Wellsteps Understand Wellness? They are demonizing even the slightest consumption of alcohol, among many other misunderstandings. Shame on me for enjoying a glass of wine on a Saturday night!
The Back Story of the Scathing STATNews Smackdown of Wellsteps and the Koop Committee. This one leads to several other links.
The Koop Committee Raises Lying to an Art Form. It turns out Steve Aldana is not stupid: he apparently has heard of regression to the mean, but just pretended he hadn’t so he could take credit for it with the Boise Schools, who were not familiar with the concept.
if Wellsteps Isn’t Lying, I’ll Pay Them $1 Million but let’s just say I’m not taking out a second mortgage just yet.
An Honorable Mention goes to another vendor on Wellsteps’ list, in the form of the Don Draper Award, for this advertising gem, aimed at ensuring that even the most stable genius HERO Board member can catch their name:
To quote the immortal words of the great philosopher Rick Perry, even a stopped clock is right once a day.* And, yes, on that Wellsteps list there is one standout vendor, US Preventive Medicine. It has validation from the Validation Institute. As you read their validation, note that while they show an enviable reduction in wellness-sensitive medical events, they don’t claim an ROI. This is testament to the integrity of both USPM and the Validation Institute.
*If you are a regular reader and didn’t find this quote amusing, read it again. If you are a wellness vendor, find a smart person to explain it to you.
Wellness vendors may dislike facts, but apparently wellness coaches embrace them, when presented from their viewpoint. At WELCOA last month, Rex Miller presented on why 95% of wellness programs don’t and can’t work…and three strategies which should yield much better results. (He likely gets more plaudits than I do because my observations are misperceived as dissing coaches, whereas I am trying to dis a system in which wellness vendors snooker employers.)
Even though he is viewed as being “anti-wellness,” he (like me) is better described as “anti-stupid,” which puts him (like me) in the crosshairs of many wellness vendors. Hence his book, The Healthy Workplace Nudge, has not gotten him invited to speak at HERO or NBGH. WELCOA, on the other hand, pleased to provide a forum for disruptors.
I have heard from multiple sources that his presentation was very well-received, largely because wellness coaches were relieved to learn that they are not alone in the universe as being frustrated by the constraints of the wellness vendor universe, where measuring outcomes and checking off boxes are more important than actually finding employees who need and appreciate the help and spending adequate time with those employees.
I would urge people to look at the video of the session. You need to sign in, but that takes all of two minutes.
- The key business issues every leader needs to know about the current and growing health crisis.
- Why 95% of wellness programs don’t and won’t work.
- Why 2013 became a catalyst for a new revolution in workplace health and well-being.
- The three strategies that are proven to work for 100% of your employees, every day.