TSW reader know that we usually devote this space to blowing the whistle on the most dishonest and clueless vendors, most recently and frequently and hilariously Wellsteps. However, thanks to long-time Quizzi-fan Justin Leader, we have discovered a vendor that is actually better than Quizzify. Quizzify is now only #2, but that’s as compared to thousands of others. So, to slightly paraphrase the immortal words of the great philosopher Bill Murray, we’ve got that going for us, which is nice.
Quizzify has conferred our Valid Vendor award on Sera Prognostics…and now we would like to show you why. Valid Vendors is no ordinary award — joint customers actually earn a financial guarantee from Quizzify itself, to go with whatever the vendor itself offers.
Theirs isn’t just another “point solution” that “shows savings” by violating every rule of study design. Quite the opposite, the College of American Pathology and CLIA have such strict guidelines for their class of product that this is the first time one of our webinar registrations has included footnotes.
Sera Prognostics has developed the only validated, commercially available blood test providing accurate, early, individualized prediction of premature birth risk for asymptomatic, singleton pregnancies. It is a giant leap ahead of other approaches. In 25 years of vendor evaluation, I’ve never seen anything close. I feel like Robert August and that other guy searching the world for the perfect wave…and then finally finding it.
The difference is that even the non-perfect wave spots in Endless Summer were good, whereas until now I’ve been surfing largely in raw sewage.
We consider Sera Prognostics, freshly validated by the Validation Institute, to be the perfect wave of vendors, or at least as close as we can come to it. Totally voluntary, makes your employees happy, truly improves their lives in every respect. Yes, it saves money (guaranteed) but as one of my clients said: “I don’t care if it doesn’t save a nickel. We’re doing this.”
To be sure, there are plenty of speedbumps. The moms have to be educated (that’s Quizzify’s job), obstetricians have to be detailed, the protocols have to be in place once the prediction is made, the moms have to follow the protocols…and even then, there is no certainty of going to term. Nonetheless, if you sign up for Thursday’s webinar, you see that even if their data is half right (meaning that a much larger study might show more modest results), they would still be the best vendor I’ve ever seen.
A cynic might say that being the “best vendor” is partly this is because most vendors, to use a technical term, suck. So that my calling Sera the best vendor is a little like Benjamin assuring Mrs. Robinson that he considers her to be the most attractive of all of his parents’ friends.
I beg to differ. If you join this webinar, you will see that Sera truly is an outstanding vendor even as compared to Elaine.
Join the webinar to see for yourself.
Readers of Why Nobody Believes the Numbers may recall that you can’t reduce a number by more than 100%. This is true no matter how hard you try. And just in case our friends Down Under were wondering, this is not one of those things that’s the opposite in the Southern Hemisphere.
Wellsteps is giving that assertion a run for its money.
Following that headline above (from a full-page spread in the Boston Globe) they’ve doubled down on stupidity to win the wellness industry’s race to the bottom, and, with the demise of Interactive Health, Wellsteps is easily the dumbest vendor in all of wellness.
Still, you have to admire their commitment to stupidity. I and others have pointed out maybe a dozen times that their entire business doesn’t accomplish anything other than harming employees, but they refuse to budge.
Calling them the dumbest vendor in all of wellness is quite a compliment. That’s because the alternative would be to call them the most dishonest vendor in all of wellness. Besides insulting their integrity, that’s not an easy feat to accomplish in this industry. It would be like calling out a specific entitled zillionaire as the most dishonest parent in the entire Varsity Blues scandal.
Their “Updated ROI Calculator”
The reason they’ve made the news today is that they’ve just published an “updated ROI calculator.” And a big thank you to Jon Robison for forwarding it to me, as Wellsteps has banned me from their linkedin group and everything else.
There are a few things you might want to know about their updated ROI calculator. As you’ll see once you expose it to light, this updated ROi calculator:
- is not “updated“
- doesn’t show an ROI
- doesn’t calculate.
Three lies in three words. That breaks Ron Goetzel’s record of 14 lies in 45 minutes.
No need to take our word for any of this. Here’s the only thing that is updated: the font. This makes it easier to see what happens if you actually try to enter data into this model. Sort of like actually trying to drive a Yugo
Start by zeroing out inflation as a confounder (“0”). Then, for simplicity and consistency, enter “1” into number of employees, as below. I entered $1000 into annual healthcare costs, just to use a round number.
Then let the games begin.
Let’s see how much they save in the best-case scenario. Enter 100% into the two fields “% Employees that [sic] are obese” and “% Employees that [sic] are smokers.”
As an aside, normally one would use “who” in this situation, but they don’t, for two reasons. First, One of Wellsteps’ signature moves is creative sentence structure, spelling, and mixed metaphors. The CEO, Dr. Steve Aldana, called the late award-winning journalist Sharon Begley a “lier.” He once accused me of violating the Law of Conservation of Matter, saying that I am “great at creating BS out of thin air.”
Second, perhaps the reason they preferred “employees that” to “employees who” is because another of their signature moves is to dehumanize employees. Their exact words, subsequently deleted after criticism, were: “It’s fun to get fat. It’s fun to be lazy.”
Back to the Calculator
Let’s see what happens if you do a fantastic job, and reduce the number of “employees that are obese” and “employees that are smokers” from 100% to 0%. So enter those two figures:
Then go to the right — directly on top of this “hockey stick” graph as you can see, and hit “savings from wellness programs.”
Congratulations. You’ve reduced the $1000 spend by $1379, which is a reduction of more than 100%. While I merely allegedly violated the Law of Conservation of Matter, they’ve just clearly violated a basic law of arithmetic, and those are strictly enforced.
You might say: “That’s not fair. Let’s use a more realistic risk reduction figure, like 0%, which is what all the literature says is achieved:
In the immortal words of the great philosopher Gomer Pyle: “Surprise, surprise, surprise.” You still show mathematicaly impossible savings.
You still show savings even if employees get worse. This is Wellsteps’ signature move in real life, as they harmed the employees at the Boise School district…and still fabricated massive savings:
The actual savings they fabricated — along with their inadvertent admission that costs actually increased — can be found here. Costs can’t go up and down at the same time. Yet another rule of math that is strictly enforced.
What if you don’t have any employees on your health plan, so you spend $0 to begin with? Turns out you can still save a bundle if you have no costs to begin with, even without reducing smoking or obesity.
Before you start fiddling with it, be aware that the very stable geniuses at Wellsteps who came up with this calculator once accused me of “entering false data” into it. So make sure your “data” isn’t “false.” To avoid that:
- use only arabic numerals…
- …in base ten.
Turns out no matter what data you enter, you save money. Don’t take my word for it–see it with your own eyes.
Stupid? Well, let’s just put it this way. NASA engineers need not worry about their job security on account of Wellsteps, because these people are not rocket scientists.
Or Wellsteps’ CEO, Steve Aldana, actually dishonest?
Let’s examine the evidence both ways. Here are the three best arguments for stupid:
- He says he needed 11 years to get through college. (p. 7) That’s 4 more years than Bluto Blutarski.
- He thinks “even one more bite of a banana” will improve your health.
- He is friends with Ron Goetzel.
Here are the the three best arguments for dishonest:
- He admitted that his alleged savings at the Boise School District was just regression to the mean. (Scroll down.)
- He knows this “model” is fabricated and has criticized me for pointing that out.
- He is friends with Ron Goetzel.
And let’s not forget that Wellsteps’ claim to fame is actually bragging about harming employees. To this day, they are the only vendor willing to publish data admitting that employees got worse on their watch. And that puts them in a category all their own. Like Juan Garcia, whose espionage work won him the highest military awards from both Germany and Britain, this performance earned them both a Koop Award (see #3 above) and a Deplorables Award.
Does that mean they are dishonest, stupid, or both? To slightly paraphrase the immortal words of the great philosopher Clarice Starling, there isn’t a word for what they are.
Update: Many of you know about the $3 million reward for showing wellness works. If Steve Aldana and his team of very stable geniuses with very good brains can show that their calculator is more accurate than Quizzify’s ROI calculator, I am doubling my $3 million reward and halving the $300,000 entry fee. The rest of you can stop reading here. Steve, that would be a $6 million reward for a mere $150,000 entry fee.
Until now, the word “emergency” has never been used to modify the word “webinar.”
But this April 7th webinar is kinda sorta an emergency, by webinar standards. COVID vaccine hesitancy could derail your entire return-to-work effort by polarizing your workforce. This topic is not just clickbait for Quizzify to get more business (though that too). It’s been widely reported in the last several weeks:
• Employee Benefit News (“Vaccine misinformation is a hurdle”)
• The New England Journal of Medicine (“Overcoming COVID vaccine hesitancy”)
• The National Library of Medicine (“A Challenge the US must overcome”)
But the good news comes from a widely reported focus group of vaccine skeptics. 19 out of 20 of them changed their minds after learning more from objective sources. One said: “We want to be educated, not indoctrinated.”
And this simple 45-minute webinar —Wednesday, April 7 at 1 PM EDT — will show you how to do exactly that, starting now. Plus, you yourself can test your COVID vaccine IQ in real time with a few of our “Vaccine Mythbusters” questions.
The Expert Panel
We are featuring two Experts, with a capital “E,” to address your questions, Dr. Christa-Marie Singleton and Dr. Scott Conard. In any ordinary webinar, Scott would get top billing…but this is no ordinary webinar.
Dr. Singleton is the Associate Director for Science and Science Lead in the CDC’s COVID-19 Response Chief Health Equity Office. She is also the Senior Medical Advisor in the CDC’s Population Health and Healthcare Office where she serves as the senior medical advisor regarding planning with commercial insurer partners and physician providers. In terms of COVID and the COVID vaccine, she works with teams to include health equity principles in science-related projects and improve the impact of COVID in disproportionally affected populations.
She will be joined by Dr. Scott Conard. One of the country’s best-known practicing family physicians and Linkedin commentators, Dr. Conard also serves as Medical Director for corporations and regional benefit coalitions. As such, he will apply his unparalleled understanding of the intersection of corporate communications with employee/patient concerns to show attendees how to overcome vaccine hesitancy.
Or you could just cut to the chase and contact us about getting started with the full set of questions posthaste.
Dear TSW nation,
So maybe this posting is not funny like last month’s, when Angioscreen won the uncoveted Deplorables Award. But “funny” isn’t going to give you insights into how to perform more effectively — other than, of course, not using Angioscreen, a decision that will benefit your workforce immeasurably.
This posting has a bit more substance to it, announcing a webinar Monday, March 22nd at 1 PM EDT on “Hospital Financial Ethics.” It will feature a real price-gouging incident with a real bill — and a real patient with a real name (James Hamilton).
This bill will be deconstructed by an expert panel. I am humbled (which doesn’t happen often) by the talent we’ve been able to attract to this panel, none of whom even need an introduction:
- Marty Makary
- Leah Binder
- Marshall Allen
And as long as you are signing up for our webinars, there are more on the docket (all at 1 PM EDT)
April 22: The best premature birth avoidance technology we have ever seen…and we never endorse vendors. We’re making an exception here because they actually do something that employees love and saves money besides.
May 12: The Top Ten Easiest Employee Behavior Changes. Turns out — who knew? — that employees can’t keep weight off, they don’t like broccoli, and they already buckle their seat belts. But there are ten behavior changes that either save money or improve health or both, that are so easy to make you don’t need to bribe or fine them.
June 15: Never Pay the First Bill. A pre-publication look at Pro Publica uber-investigator Marshall Allen’s new book of the same name on how not to get snookered by a healthcare bill.
July 15: Featuring Dr. Eric Bricker (yes, the very same) on aligning incentives with your providers, your PBMs and your consultants.
This is reprinted from Quizzify. I probably should have posted it here in the first place because, as someone has already noted, my particular style of writing works very well with this, uh, material.
As you can no doubt tell from all the store window displays and promotions, March is colorectal cancer awareness month. That’s only the start of the good news.
The other good news is that the colonoscopy guideline-writers, whom I suspect are all over 50 by now, don’t want a colonoscopy any more than you do. Hence, they now say a colonoscopy once every ten years is OK, up from every five.
The procedure itself is uncomfortable and carries a 1.7% chance of a complication. That means a company with 150 people getting screened will see two landing back in the doctor’s office, the ER or even the hospital. (The odds are actually a bit more favorable than 1.7%, because complications are more common in older patients.)
And that fluid they make you drink for 24 hours beforehand? I don’t know what’s in it but, in the immortal words of the great philosopher Dave Barry, it should never be allowed to fall into the hands of America’s enemies.
The better news is there are three non-invasive alternatives that can avoid both the discomfort and the complications of a routine colonoscopy screening. This blog post looks at each in turn.
But before you click through to that page-turner, don’t forget to register for the March 22nd webinar featuring healthcare uberstars Marty Makary and Leah Binder, speaking on the oxymoronic topic of Hospital Financial Ethics.
In the wellness industry’s very stable genius pandemic, AngioScreen is Patient Einstein.
The Deplorables Award, as many of you might remember (you’re excused if you’ve forgotten — it’s been 2 years since a vendor was deemed worthy enough to qualify) goes to that vendor whose combination of dishonesty and patient harms would make Ron Goetzel blush. Angioscreen is all that and more — the kind of outfit that gives clueless wellness vendors a bad name.
Angioscreen had earned the pole position for 2021’s award even before this month’s Journal of the American Medical Association (JAMA) reminded us that — for the third time in as many plate appearances (2007, 2014 and now 2021) —they struck out with the US Preventive Services Task Force (USPSTF). They gave Angioscreen’s go-to carotid artery screen a “D.” In no uncertain terms, JAMA and USPSTF say: “Don’t do these screens to your employees.”
I “profiled” Angioscreen years ago…but never gave them a Deplorables Award on the assumption that they would asymptotically approach irrelevance on their own merit. After all, what benefits manager would ever retain this outfit? Surely no actuary would be dishonest enough to be paid to “find savings” in these screens, and no consultant or broker would be corrupt enough to take money to pitch them, right?
Surely someone would notice that right on their very own website, they cited the fact that the USPSTF gives them a “D.”
And surely someone would notice that Angioscreen’s other business is convincing hospitals to screen communities in order to find new well-insured patients to admit for major surgery…and make the obvious inference that the same screens that are designed to generate admissions can’t also reduce admissions, right?
Haha, good ones, Al.
The hospitals nailed this
Angioscreen is a surgery-generating machine. Here is an employer, who at least had enough sense to withhold his name, bragging about the major vascular surgeries his employees underwent for asymptomatic carotid artery stenosis (CAS) thanks to Angioscreen:
Two of our employees were found to have blockages in their carotid arteries. Through follow-up visits with their physician, these employees found arteries that were significantly blocked that required surgery.
Maybe the employees really needed the surgery? In the immortal word of the great philosopher Brittany Spears, oops. The National Institutes of Health warns against precisely this:
Despite a D recommendation from the USPSTF… many surgeries or interventions for asymptomatic CAS continue to be performed [due to] free screenings.
Wait, you might say, maybe those patients needed those screens to avoid a stroke.
Haha, good one again, Al:
- As JAMA says, “only 11% of strokes” are caused by internal carotid stenosis. Since only about 1 in 1000 employer-covered people has a stroke, you’d have to screen almost 10,000 <65 employer-covered people to possibly have a slight chance of preventing a stroke with a major surgery.
- If Angioscreen’s test is 95% accurate (in their dreams), you’d also refer 500 false positives to their doctors, and some would undergo risky, painful, and expensive major vascular surgery as well, probably like those two in the mercifully unnamed employer above.
The employers got snookered for a change
Funny that Angioscreen wouldn’t attach a name to that reference site, because it’s only a slight exaggeration to say Angioscreen’s customer list includes practically every non-Quizzify-customer (the latter tend to have triple-digit IQs, making them poor prospects for Angioscreen) in the Fortune 500. Here it is:
You might say, that’s not many. True, but that excerpt is only a tiny fraction of the total – I didn’t want to hog the internet by listing all of them.
Perhaps you see some employers on that list that make you think: “Why would a smart, capable company like so-and-so be an Angioscreen customer?” I asked myself the same thing, as I was surprised to see a Quizzify customer on the list. So I asked them, mentioning my surprise.
Turns out they were every bit as surprised as I was. They had no idea they were on that list and had never heard of Angioscreen.
But wait…there’s more. Now how many inappropriate screens would you pay for?
Another reason I had originally demurred from bestowing this award on them was that I also thought that maybe after a while their conscience would get the better of them, and they would stop doing these screens. Perhaps they might pivot from decidedly harmful screens into the more mundane screens that are simply a useless waste of money.
How silly of me.
Quite the contrary, once they realized they had stumbled upon a huge untapped market for employee hyperdiagnosis, they added several more inappropriate screens:
If “Ankle Brachial Index” screening sounds familiar, it’s precisely what Marty Makary warned us against in The Price We Pay as the poster-test for generating unneeded and harmful surgeries.
If ”peak systolic velocity” sounds unfamiliar, it’s because it’s such a stupid idea for a screen that the USPSTF has never even bothered to recommend against it, on the theory that no one would screen their asymptomatic patients for this. A doctor would literally lose their license for routinely doing these screens and billing insurance for these.
And, just in case there is still any employee naively of the mistaken impression they are living their lives diagnosislessly, there’s the D-rated ECG/EKG. These are not supposed to be done because they — get ready — often “reveal” abnormalities that don’t really exist or are harmless…but once revealed, generate follow-up tests.
Fortunately, this next inappropriate screen costs extra, which might discourage a few employers.
Of course, if you indicate to a real doctor something that might suggest you are at risk for an aneurysm, you should get tested, and if the aneurysm is truly large and life-threatening, be referred for this surgery, despite its mortality rate exceeding 7%. That’s different from an unlicensed vendor playing doctor by screening unsuspecting employees for no reason other than to earn “supplemental” fees. Or, as one commentator put it:
My main objection, however, is that I’m uneasy about taking people off the street who think they are perfectly well and subjecting them to a procedure from which 1 in 14 will die.
And so it is with great honor that I bestow the Deplorables Award on Angioscreen as the fourth recipient of this august distinction, joining Wellsteps, and bankruptcy court denizens Interactive Health and Provant. (The latter avoided a Deplorables Award only by going bankrupt after our initial expose, before we had time to bestow the award.)
Unless you follow the EEOC very closely, you are likely unaware that the Biden Administration is putting the kibosh on conventional “pry, poke and prod” wellness programs.
Here are six things about this kibosh that will be covered in today’s webinar at 1:00 EST.
- Your Safe Harbor is kaput. If your program has a strong clinical component, you are out of compliance, period.
- The AARP v. Yale decision, likely within the next 8 weeks, will arouse the plaintiff bar, and we can expect more lawsuits.
- At the very least, that decision will spur many more EEOC administrative hearings/sanctions. While financial exposure there is very limited, the career-limiting embarrassment of being caught out of compliance for two years is not.
- How sure are we that the court will rule against Yale’s program? Quizzify is offering to double our contract lengths free to anyone who signs up before that happens, if we are wrong.
- There will be no “grace period” or “transition period.” In the 2017 AARP v. EEOC case, the judge stayed compliance until January 2019. The grace period train has left the station.
- If you don’t attend, you’ll be one of the few people who aren’t. 800+ people are already signed up.
This webinar will show you how you can easily comply within days…and immediately make your program more effective and more engaging. All with no changes to incentives, penalties, clinical components, or even your budget.
Remember “El Paso” by Marty Robbins? At the end you were pretty sure he was going to die because he “felt the bullet go deep in his chest.” Somehow he made it back to the bar where the guy whose girlfriend he tried to steal (before he stole the guy’s horse) let him and her profess their love while he (Mr. Robbins) was apparently bleeding to death.
The only way you know he survived is that he recorded a song about the mishap.
Well, likewise, the only way you know the author of this blog post about COVID survived is that he wrote the blog post about it. it is a richly detailed, harrowing, painful seemingly unending tale that will scare anyone who reads it into wearing a mask anad taking other safety precautions beyond just the “six foot rule.” Makes Mr. Robbins’ bullet wound sound like a mosquito bite.
I would recommend forwarding Mr. Bujalski’s posting to your employees if they have any doubt whatsoever about whether COVID is a “hoax.” (Mr. Bujalski is very much on the mend but nowhere near 100%, and I’m sure he would appreciate a visit to his blog to send him best wishes for a full recovery.)
When I created this blog, it was my intent to post thoughts, insights, or musings at least once a week. Unfortunately, it has been over two months since I last posted an entry here. The circumstances that interfered with those intentions are suggested in today’s title.
It is important to note that from the beginning of the public health warnings regarding the coronavirus, my wife and I took every advised precaution. We were dedicated “maskers.” We washed our hands frequently. We avoided unnecessary social contact, and when we needed to go out (grocery store, take-out food), did our best to maintain six feet or more between us and other people. If anything, I was compulsive in adhering to the guidelines, perhaps taking them to extremes: I wore nitrile gloves to the grocery store and washed the purchased fruit and vegetables when I got home. Sadly, we had to cancel two planned trips to see grandchildren in other states. We were careful.
Yes, we were careful, but not 100% isolated from the outside world. We’ve given much thought to where we might have been exposed to the virus. As dining out restrictions were lifted in NC, we did venture out to dinner once a week, typically on a Wednesday. We wore masks into a restaurant, only took them off to eat or drink, then wore them as we left the restaurant. The staff at these restaurants always wore masks. The restaurants never had many people, and we were at least 8 to 10 feet away from other diners.
(Editor’s note: 8 to 10 feet helps, but there is no magic in a specific distance in indoor spaces. Just probabilities of infection that decline fairly linearly with distance.)
One other possibility: My wife attended pottery classes at a community college. Everyone wore masks, and attendance was limited to allow for social distancing. However, there was a pair of “shared goggles” that people wore when using the grinder to smooth edges of fired pieces. While most of what we’ve read suggests that it is unlikely that COVID can be transmitted via the eyes, we’ve considered this as a possible source…
I am saddened to report the loss, over the weekend, of perhaps the best health/science writer of her generation, Sharon Begley. Though a “never-smoker,”, the cause of death was lung cancer.
To appreciate the full scope of her accomplishments over her 43-year career at Newsweek, the Wall Street Journal, Reuters and STATNews, peruse this obituary. A highlight (along the many other highlights, including 5 books) might be:
She won more awards and accolades than could fit in an obituary. The accomplishments she was prouder of were making complex ideas accessible to anyone — and beautiful — through her articles and books, and in doing so, training and inspiring generations of science journalists. She taught by example, showing that you could be tough-minded while being kind, that you could be literary without any big-personality bull.
And kind she was. We found common ground and shared hilarity in our respective exposes of the wellness industry and its many foibles. We bonded over this and became good social friends over the last four years of her life, as she and her husband Ned joined our group for bridge and games nights, while Ned played ultimate frisbee with us.
But let’s get to the “kind” part and — rather than duplicate what other obits have said — focus on her contributions to the wellnss industry.
One of her gifts as a journalist was interviewing people in such a kind, low-key, manner that they would accidentally tell the truth. While she wrote many articles on wellness, one article exemplifies this talent, as we bridge players might say, in spades: Top Wellness Award Goes to Workplace Where Many Health Measures Got Worse.
In it, she documented the dishonesty/corruption of the Koop Award, and the harms to the employees of the Boise School System caused by the “award-winning” Wellsteps program. Over the course of two years, Boise teacher risk scores deteriorated by 20%, self-reported health status declined, and costs increased.
Needless to say, the perps wouldn’t talk to me, but she got them to spill their guts before they even realized they had just self-immolated. Specifically, Wellsteps’ CEO, Steve Aldana, admitted to:
- knowingly using regression to the mean to fabricate a claim of risk reduction among the highest-risk employees
- recognizing that trivial self-reported changes in (for example) fruit and vegetable consumption had no effect on healthcare costs
- recognizing that wellness programs increase overall costs
- violating US Preventive Services Task Force guidelines.
She got Ron Goetzel to admit to bestowing an award on Wellsteps for improving employee health despite knowing they harmed employees. (Mr. Aldana served on the awards committee but was the only committee member vendor who hadn’t won one of its own awards, so his award was predictable — and actually predicted.)
But her kindness wasn’t used just for the purposes of extracting self-incriminating information. When Steve Aldana called her a “lier”, her reaction was: “I need to find out what I got wrong, correct and acknowledge it,” as opposed to my own reaction, which was to quote him verbatim. Of course, she never heard from him again.
And the truly kindest thing she ever did was, despite the delicious irony, decline to write anything more about Ron Goetzel after he suffered his heart attack. I should be so kind! (On the other hand, he still maintains enough of an ejection fraction to summon the energy to attempt to sully my reputation, so I still defend myself.)
Two other articles — subsequently picked up by major media outlets — probably helped galvanize opinion to prevent employers from genetically testing employees and their dependents for hidden disease as part of workplace wellness programs:
- Opposition grows to ‘workplace wellness’ bill that would scale back genetic privacy
- House Republicans would let employers demand workers’ genetic test results
She also helped put the kibosh on yet another Goetzel-infused idea, this one to create a so-called “fat tax,” which would require employers to disclose the number of overweight employees, the idea being this would encourage employers to use more punitive and expensive wellness programs. (She handed this one off to a colleague.) It would likely have backfired, but wiser heads prevailed, largely thanks to this article, and Ron’s idea was stillborn.
- Do workplace wellness programs improve employee health?
- Think preventive care saves money? Think again.
Sharon, we miss you already and it’s only been 2 days. Thank you for your great contributions to the workplace wellness field. They played a major role in curbing its excesses, and also for generally improving the health-and-science literacy of the population for more than four decades. And for that time you didn’t double my rather aspirational 6-hearts bid even when you had the other five hearts in your hand.
June 14, 1956 to January 16, 2021
Within minutes of Quizzify’s blast email predicting that the EEOC’s rules released two weeks ago would be DOA, it is now a lock that they are toast. The White House made two announcements last week confirming this:
- They froze all non-emergency Notices of Proposed Rulemakings (not a misprint — two plurals)
- They rejiggered the EEOC, promoting the two pro-employee Commissioners to the Chairmanship and Vice Chairmanship.
This means the huge loophole in the announced rules, allowing most outcomes-based wellness programs, will be closed.
Is this an existential threat to the wellness industry? At first glance, it would seem to be. But you can join our webinar to learn so this existential lemon can be turned into existential lemonade.
Leading wellness attorney Barbara Zabawa and I are hosting a webinar on this topic on Monday, February 1st, 1:00 EST. You can register here (and get access to the recording and slides as well.) Focus will be on how to ignore the new rules, and maintain your program as is. Yep, just like with surprise bills, we’ve figured out how to game the system.
The EEOC has just released their rules for clinically based wellness programs.This step is called the “Notice of Proposed Rulemaking,” or NPRM, to be published in the Federal Register’s mellifluously named Notices of Proposed Rulemakings for public comment. “Public comment” is code for “the perps with the most to lose will flood the thread with disinformation.” Expect the US Chamber of Commerce, the vendors and Ron Goetzel and his cronies to weigh in heavily, each more shamelessly than the next. They have a lot of (your) money at stake here.
When NPRMs are posted for public comments, you know who never makes public comments? The public. So it’s up to you and me to pick up the slack, and point out that these perps have no clothes. Feel free to grab posts from TSW to add to the comments.
And the envelope please…
Most importantly, incentives for participation-based programs need to be cut back to “de minimis.” And, unlike when the rules were first floated (and true to the intent of the judge who found that forced wellness programs were not voluntary), de minimis has been defined. It looks like the IRS definition — water bottles, t-shirts, small-denomination gift cards. I had thought perhaps $200 would be OK. That is clearly outside the realm of de minimis. That could change if the perps flood the comments.
My own opinion: it is perfectly ok, even desirable, for organizations to offer employees screening. Just don’t make them do it. I myself voluntarily get my Hb a1c screened every year, to make sure I’m playing enough ultimate frisbee to offset my consumption of LA Burdick’s insanely good chocolate.
And it is perfectly OK to educate employees on why they should want to get screened (or, in the case of younger, healther employees, why they shouldn’t). Screening would then be truly voluntary.
However, many organizations want to maintain their current participation-based programs with their current incentives or penalties…and many vendors want to keep their revenues intact.
So far, so good, but…
That was all about participation-based programs. Health-contingent, or outcomes-based, programs are a different story altogether. The EEOC is basically pro-employer these days. So they have figured out how to circumvent the spirit of Judge Bates’ December 2017 decision vacating the old rules in which forced programs were defined as “voluntary,” without violating the letter of his decision. But this massive loopholecould circumvent the ruling only for outcomes-based programs, not participatory ones.
This loophole allows you to continue to be able to subject employees to fines of thousands of dollars in outcomes-based programs. Most employees hate being forced to submit to these programs (“I’d like to punch them in the face,” said one), and they invariably lose money. However, the losses in program fees and employee morale — all admitted by the wellness industry trade association — is more than offset by the “immediate employer cost savings,” as Bravo puts it, generated by collecting the penalties from employees who refuse to let unlicensed wellness vendors play doctor.
However, most outcomes-based programs, while arguably complying with these new rules under the Americans with Disabilities Act, violate the Affordable Care Act. With the well-documented, Validation Institute-validated exception of US Preventive Medicine, they invariably fall short of the ACA’s standard of being “reasonably designed to reduce risk or prevent disease.” That hurdle was set low enough to allow even the worst outcomes-based wellness vendors to clear it, and yet they don’t. They violate guidelines with impunity, forcing employees to undergo tests that no doctor would ever order and that get D ratings from the US Preventive Services Task Force (USPSTF).
Just too many epic fails, all documented for the last five years on this blog and sometimes in the media, including Koop award winners like Wellsteps, arguably the industry’s worst program now that Interactive Health has gone bankrupt. Ironically, Wellsteps is also among the best-documented programs. Why they insisted on publishing their own self-immolation is anyone’s guess. No one can argue that programs violating the USPSTF guidelines and, as we’ll see, harming employees, could possibly be considered “reasonably designed to prevent disease.”
This is not just about the money.
Outcomes-based programs can and do harm employees. Sometimes wellness vendors — I’m looking at you, Wellsteps — even admit their harms.
Yale employees sued Yale, for example, due to the psychological and physical harms of their program. One Yale breast cancer survivor was almost forced into getting a mammogram, even though she had already undergone a double mastectomy. Had it not been for Yale’s union and the AARP’s support, she would have been fined $1250.
TSW has published many stories of harms, summarized here. Not to mention what happens when you fine your employees for not losing weight. Guess what — they respond in very predictable fashion, packing on the pounds before the weigh-in and then crash-dieting to take them off. And our #1 most-searched phrase? “How to cheat in a corporate wellness program.” https://dismgmt.wordpress.com/2019/01/07/breaking-shocking-news-employees-cheat-in-wellness/
Still, if you insist on keeping an outcomes-based program, the “hack” we’ve figured out of the new regs applies to outcomes-based programs as well. Seriously.
So if you have a program (and very few people with outcomes-based programs read this blog, or else they would have already dropped them), you’ll want to attend the webinar to figure out how to preserve it. And if you don’t have a program, you’ll want to attend just to understand what the EEOC tried to do with this massive loophole and how we got the better of them.