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.
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.
Dear They Said What Nation,
To celebrate Leapfrog’s 20th Birthday Week, Leah Binder posted 3 questions in our chat on Linkedin. One of the 3 remains unanswered…and I am personally upping the ante to $100 for the first correct answer!
So have at it. Here is a hint: this person was an overnight sensation before become the person with the most things un-named for him. The full question is in the interview.
Once again, Hppy 20th Birthday to Leapfrog!
Dear They Said What Nation,
Happy 20th Anniversary to The Leapfrog Group. In 20 years they have become arguably the most untainted healthcare not-for-profit in DC. It’s not easy to stay untainted for 20 years, but they have. By contrast, providers, PBMs and vendors “sponsor” other groups, and — get ready — the other groups advance their agendas instead of consumers and employers. Simply doesn’t happen with Leapfrog.
Even though it’s their birthday, you’re the ones getting the presents. Yes, members of TSW Nation can actually win prizes. Not for blowing the whistle on dishonest wellness vendors (though that too), but rather by answering a couple of general interest trivia questions right. If someone does the Mary Wells thing and guesses ahead of you, you can still at least be entered in a runner-up drawing
As of this writing, there are no correct answers yet…though everyone has heard of the two people and you’ll kick yourself for not guessing right.
Once again, here is the link. No time to waste, as the deadline is 4 PM today.
In the immortal words of the great philosopher Britney Spears: “Oops, I did it again.”
Another mistake caught! This time by the esteemed Scott Breidbart MD. I had written that the incidence of colon cancer in the 45-to-49-year-old population was 0.007%, having misread my own posting. I confused the total <50 incidence with the 45-to-49-year-old incidence, which is a whopping 0.035%, as Scott said.
I had cited the wrong number when Scott and I got into a kerfuffle about whether 45-to-49-year-olds should be screened for colon cancer. That is the new USPSTF guideline. Honestly, even at 0.035%, I still wouldn’t recommend that employers get involved in this decision. Here’s a wacky idea: let’s leave this one to the patient and the doctor! Oh, I know it sounds crazy but it just might work.
My logic would be that many folks in that 0.035% would already have had symptoms. So the percent findable with a screen is somewhat less than that. Further, the complication rate from colonoscopies exceeds 0.035% by at least one decimal point. Not to mention that, surely, as an employer, you can find better ways to spend your money.
Scott would say, quite correctly, that you don’t have to get screened using a colonoscopy. Cologuard and FIT testing are completely non-invasive. I myself recently did Cologuard. As instructed on the box, I took my “sample” to the local UPS store to mail back and as coincidence would have it, someone else was in the store doing the same thing. Maybe this is catching on, because the UPS rep said he was shipping a fair number of Cologuard samples these days. (Sidebar: as far as I’m concerned, UPS can’t pay these guys enough.)
I would then observe back to Scott that many non-Quizzify users don’t know about alternatives to colonoscopies, and (like with Silver Diamine Fluoride for cavities), the providers aren’t telling them, in order to protect their revenues. If you really want to get down and dirty on this topic, so to speak, here is the Quizzify writeup.
Still, we don’t go against the USPSTF. Color us neutral even though our gut, so to speak, says the opposite. As far as this decision is concerned, I’d say let’s leave it to the doctor and the employee.
Scott and I are in total agreement on that point and this next point. (I checked with him just now. I make enough enemies on purpose without making any accidentally.) Our advice to employers is, so to speak again, to butt out.
Or, for those who prefer visual mnemonics…
If anyone is keeping score at home, Part 1
This is the second mistake (or at least the second time I’ve been caught) in the last two years. At this rate, I will make 4 more mistakes during the 2020s, which will be a new record for me.
The leaders are tightly bunched for first place:
- Scott Breidbart – 1
- Keith McNeil – 1
- Tom Milan – 1
- Jeff Hogan – 1
- Entire wellness industry – 0
If anyone is keeping score at home (Part 2), here are the previous ones…
For the fourth time in as many decades, I’ve been caught! This is not to say that I’ve only made 4 miscues in the most recent 4 decades. Just that I’ve only been caught 4 times in these 4 decades. Not including the time I caught myself actually thinking disease management (DM) saves money. Until then, basically everything I said was a lie, however unintentional, because in my naivete I thought DM worked. Silly me.
Jeff Hogan joins the few, the proud, who have called me out for saying things that aren’t exactly accurate. I’m putting this blog on top of the previous one to make it easier to track my cumulative miscues, in case you’re keeping score at home.
In this case, he referenced a study in Health Affairs showing that bundled payments reduced the cost of surgeries by 11%. I saw that abstract and immediately assumed that, like many other bundled payments, the reason the cost per procedure declined is that the number of procedures increased, by surgeons adding more “easier” and hence less costly procedures. This would reduce the cost/procedure but total costs would increase due to more procedures.
I couldn’t link through to that study (nor can you, most likely) from that abstract, to test that hypothesis. But since it is Health Affairs I just assumed that their peer review for that article is as sloppy as it is for wellness articles. Ron Goetzel published a nonsensical article there, which, among other things, concluded that only about 5.5% of the cohort smoked because only 5.5% of the cohort admitted they smoked, on a risk assessment. Since the US smoking rate is more like 18%, the correct conclusion would have been that two-thirds of smokers lie on risk assessments. I would have caught that in peer review but Health Affairs allows authors to pick their own toadies as peer reviewers.
So, without actually reading the Health Affairs study, I assumed they applied the same lofty standard of peer review to this article as to Goetzel’s:
They don’t appear to have tracked the number of cases. A classic thing hospitals and doctors do when they get paid per case is to perform surgeries on people who may not have needed them. These people will have lower-than-average costs and complication rates…but be reimbursed the same.Or, in the immortal words of the great philosopher Claude Rains, “Owing to the seriousness of this crime I’ve instructed my men to round up twice the usual number of suspects.
Jeff wrote back:
Al: Did you read the same Health Affairs article that I did? The citations and case tracking is quite detailed in the report and appendix. Not only did they carefully examine the number of cases but they used some very intensive methodologies for doing disruption analysis.
He helpfully attached a pdf. It turned out they had indeed tracked the number of referrals not going to surgery, and almost a third did not, in fact, go to surgery. This factoid never made it into the abstract, but was buried in the article.
So kudos to Jeff and if he sticks around another 8 years, 9 months and 22 days, at my current pace, I’ll be due for another mistake.
Guilty as charged. Someone called me out on yet another mistake buried in my 500,000 words published to date.
Yep, the number of members in the most exclusive club in healthcare outcomes analysis just rose by 33%, as Tom Milam of TrueLifeCare joins Corey Colman and Keith McNeil in justifiably calling me out.*
To put this track record in perspective, Ron Goetzel has been caught 14 times. You might say, well, 14 isn’t that much different from 3 in absolute terms. (In percentage, it is, but we’ll let that slide.)
Except that I needed an entire decade to rack up 3, while Ron needed only 45 minutes to tally 14. Over the decade, his number would be more like approximately eleventy zillion. It depends how you count the ones where he doctored numbers that were phony to begin with and then doctored them back again to the original phony numbers, after insisting that the doctored numbers were real. If you’ve lost track on all the doctorings that I just now published a companion blog post on it.
So what was the mistake?
[SPOILER ALERT: The rest of this post is boring.]
It’s kind of anticlimactic, and quite obscure. By way of background, I routinely analyze wellness-senstive medical event (WSME) rate trends for large employers and health plans. It’s not rocket science, but it’s totally valid. Indeed, it’s the only population-based observational analysis that is valid. (RCTs are not observational. But you knew that.). It was even embraced by Ron Goetzel’s very own outfit: the Health Enhancement Research Organization — before they realized that valid measures are the wellness industry’s kryptonite.
The WSME tally is also the only observational methodology accepted by the Validation Institute for employers and health plans.
Here’s what the national WSME rate looks like. (I think there was a reporting or transcribing error by one of the reporting states in 2005-2006, to the extent anyone noticed the inflection in the graph, or cares.) This graph of WSMEs shows that, over the decade+ period of the greatest growth of workplace wellness, that there was no improvement in event rates relative to the US population that would not have had access to workplace wellness — Medicare, Medicaid and the uninsured. Obviously their raw rates were higher. This is a difference-of-differences analysis.
Quite the contrary, it appears that if anything the employer-insured cohort trended worse than the control.
Tallying this rate requires our data extraction algorithm to collect ER and IP events primary-coded both to the disease in question, or else are common complications of the disease in question. We pick common complications based on two factors:
- How likely is someone with the disease in question to get the complication?
- How likely is it that the complication in question occurs in someone with the disease?
Remember, we only tally primary codes because we want to simplify the analysis enough that we can be 100% sure of comparability between any given payor and other payors comprising the benchmark. So we look for an “80-20 rule” in what we include in the primary code data extraction.
Our diabetes rate includes quite a number of complications that fit that description., one of which is cellulitis. Diabetics are much more likely than non-diabetics to get cellulitis in their extremities — feet in particular — because they often can’t feel a cut. (Also the skin on their feet can be thinner than it should be.) Likewise, cellulitis of extremities is much more likely to be diagnosed in diabetics than non-diabetics.
If you can’t feel it, you won’t treat it. And therefore your odds of cellulitis in your foot are high. However, cellulitis in non-extremities would correlate much more loosely with diabetes, since diabetics can still feel and see skin issues elsewhere on their bodies. Therefore, not all cellulitis codes, by a longshot, are included in our analysis.
While we included cellulitis of the foot (and leg, also common enough), we somehow — despite having done these analyses 20 to 30 times a year for 15 years — omitted cellulitis of the toes. Sort of like the Matisse painting hanging upside down in the Museum of Modern Art for 47 days, no one else noticed either. Yet even the most intellectually challenged members of the wellness industry’s self-anointed awards committee understand the anatomical fact that, technically speaking, the toe is part of the foot.
Le Bateau, Henri Matisse
Honestly, when all is said and done, this won’t change anyone’s results much, and all the changes will be in the same direction vs. history (which is also going to be recoded) and vs. the benchmark/average, likewise recoded. This is especially true in the working-age population, which comprises most of our analysis. Nonetheless, kudos to Tom Milam for becoming the third member of this most exclusive club.
*Your chances of joining this club are quite remote, statisically speaking. They are even more remote if you didn’t notice the arithmetic error just now. n increase in membership from 2 to 3 is a 50% increase, not a 33% increase. And the painting is still upside down…
There is an old joke: “How can you tell if a vendor is lying about ROI?”
Answer: “They’re claiming an ROI.”
That’s not entirely accurate. Some vendors really do achieve savings. This is particularly true with vendors that just reduce the cost of something you need to buy anyway, like Quizzify for ER visits, where in most states 50% reductions in ER Bills are routine for employees using Quizzify2Go. Or Diathrive for diabetes supplies. Or any number of vendors for drugs, my personal choice being Drexi/AMPS, home of the $2.76 90-pill Ambien supply.
But, for behavior-change vendors, you need to be the judge to translate vendorspeak into English. Examples:
- “We retained independent actuaries to validate our savings” translates as “We paid off some actuaries to fabricate our savings.”
- “We reduced the risk level for many of the highest-risk employees” omits “…but they would have come down anyway due to regression to the mean.”
- “We achieved tremendous savings vs. trend” needs the asterisk: “because how we choose the trend determines the savings.” (This one, by the way, was a real quote from a well-known consultant.)
- “We compared participants to matched non-participants, and found that…” Hard stop. Invalid.
Fortunately, in the next 3 weeks, you’ll have four opportunities to learn how to distinguish valid from invalid measurement.
On August 31 at 2 PM EDT, I’ll be joining Virta Health on a webinar, kicking off the discussion with this very topic: Outcomes Measurement for Dummies…and Smarties. And you can learn why Virta is so valid that I am putting up $100,000 as a “Challenge” for anyone who thinks another vendor’s outcomes are better. Sign up here.
If you really want to dig deep, join Health Benefits Nation in Orlando, hosted by The Validation Institute. This September 14-16 conference in Orlando covers the gamut, but specifically, there is a two hour session on valid measurement starting at 1 PM on the 14th.
Besides digging deep, the Validation Institute is my forum for, uh, naming appellations and kicking posteriors. And of course, I invite people to sue me if they don’t like what I have to say about them.
We will also have case studies where you need to spot the lies, rather than have me tee the lies up for you. Because that’s what happens in the real world. Lies told by “independent actuaries” aren’t going to invalidate themselves.
Actually, they usually do, but only if you look hard enough…and that’s what this session is all about.
One more vendor is about to join the pantheon of validity, Medencentive. I’ve been over their numbers up, down and sideways, as have many others. They are a health literacy vendor. Not like Quizzify (though they are a Quizzify customer) because they go deep on literacy with people who have specific conditions already, whereas Quizzify is educating on all the points where employees and healthcare meet, as the four examples on the homepage show. They will be hosting a webinar on September 13 at noon EDT. You can sign up here.
Finally, if anyone is anywhere near Houston on the 21st of September and is an early riser, register for The Healthcare Digital Dilemma, where I and several of the leading lights of the field — Josh Berlin, David Carmouche and others — to discuss this “dilemma.” You want to do more digital health…and yet you know most of it doesn’t work. We’ll be discussing how to find the solutions that do.
If you were one of the almost 8000 people to read the post Virta Health becomes the first diabetes vendor to save money, you may be wondering what exactly they do that no other diabetes vendor is able to do, to get me to put $100,000 at risk for the first time for a vendor other than Quizzify.
Part of the reason is that Quizzify and Virta are the peanut butter-and-chocolate of diabetes.
Virta reverses diabetes, while Quizzify helps pre-diabetics and diabetics avoid hidden sugars. That’s no easy task because 74% of processed foods contain them. This even includes some products that claim to contain “NO ADDED SUGAR,” but in fact are bursting with added sugars. So that I want to encourage our clients to adopt Virta, and vice-versa.
The other part of the reason is that their savings are measured validly. While plenty of vendors claim to save money and some vendors measure validly, very few are in the intersection set.
Virta and I and the Validation Institute are doing a webinar on valid measurement generally, and you can attend that webinar both to learn about valid measurement and to learn about Virta’s own results using valid measurement.
It’s not news that diabetes vendors don’t really do anything. The larger the vendor, the less they do. One even earns an “F” from the Better Business Bureau.
Here’s what is news: Virta saves money! Really. I’ve been over their numbers up, down and sideways because I was so skeptical. And who can blame me? Generally, to paraphrase the immortal words of the great philosopher the Queen of Hearts, I can invalidate six impossible diabetes vendor claims before breakfast.*
So when the Validation Institute contacted me to say that Virta wanted me on a validation call, I said: “No, they don’t.” They dutifully reported back to the Virta folks, who said: “No, really.”
Which VI dutifully reported back to me. I replied: “Fine.”
“Fine” is one of those words whose meaning depends on the intonation. It could mean better-than-good, like in numismatics. Whereas in a marital argument, “Fine” means: “I know I’m right, but I just don’t feel like getting into it.”
My intonation meant: “Sure, if Virta wants to have their validation request eviscerated, I’ll join the call.”
However, I am pleased to report that “fine” in this case really did mean “better-than-good,” as in: “Virta has the most valid and impressive outcomes in the diabetes field.”
Quite the opposite. Virta did two studies, both using methodologies that met the highest level of VI validity. As a result, in addition to the $50,000 Credibility Guarantee offered by the VI in support of their results, I am offering a $100,000 personal guarantee in support of the following two statements:
- Virta Health has proven it can deliver more cost savings (measured PMPM) than any other digital health point solution commercially available today, using a valid measurement methodology. This holds true regardless of condition category, including but not limited to: diabetes management, diabetes prevention, weight loss, mental health, musculoskeletal disorders, heart health, substance abuse, women’s health, fertility care, and cancer care.
- No diabetes solution—other than Virta Health—has demonstrated positive net financial savings in-year, using a valid methodology.
Whoever can disapprove either statement to the judges (described as selected below) will receive $100,000.
Terms and conditions are listed at the bottom of this blog.
While it’s a layup to bet the farm to challenge vendor claims due to their inherentlly sketchy nature, my standards for putting my own money at risk in support of a vendor’s claims are extremely high. Quizzify2Go (ER visit cost reduction) and Sera Prognostics (prediction/prevention of premature birth) are the only entities I’d risk my hard-earned dollars on, and neither is disease-focused. Virta is and will likely remain the lead dog in savings amongst all disease-focused vendors.
Here are the Virta studies that gave me the confidence to offer this challenge with my own money at stake:.
- Parallel Assignment: Indiana University
A parallel study is one where would-be participants are randomly assigned to control or the study group. The randomized control trial (RCT) is one such methodology. In the case of drugs, the control group gets a placebo, so they don’t know whether they are getting the drug or not. This is called a “blinded” study. In many drug studies, even the investigators don’t know. This is called “double-blinded.”
Neither is possible in population health because you would know whether you are in a wellness/diabetes program or not. So studies must be unblinded.
Even unblinded RCTs are rarely undertaken in population health because (in addition to employers not hitherto having access to claims data) such studies need Institutional Review Board approval as an investigation before proceeding, as ERISA plans are otherwise required to offer the same benefits to every employee. (One easy way around this is to offer the intervention to all comers, but promote actively to some worksites but not others.)
Virta minimized that threat at Indiana University, because the parallel assignment took place in different sites, to minimize the chance that (though the consent included the possibility of being in the control group) one diabetic employee might demand the intervention that the others are getting, once they see how helpful it is. Take a look at some of the results for those completing two years with Virta as compared to the parallel control, with both arms experiencing a similar lost-to-followup:
- HbA1c was reduced by 0.9 points on average
- Weight loss averaged more than 10%
- Prescription medications were cut in half, including an 81% reduction in daily dose of insulin
- More than $3000 savings in prescription drug cost reduction between years 1 and 2
- Wait-List (Lottery) Control
Another valid design, also used by Virta, is a Wait-List, or Lottery, Control.
The most famous natural experiment in population health using this control is the Oregon Medicaid study. Medicaid was expanded there to a higher income level, but slots were limited. People who wanted coverage had to enter a lottery. Medicaid eligibility was assessed only after names were drawn – so only for the lottery winners who completed the Medicaid application forms. That’s one of the reasons it was so important to assess effects of insurance by comparing the entire control group to the entire treatment group, rather than the subset of the treatment group deemed eligible or actually enrolling.
The researchers still assessed the effect of insurance coverage itself (not just winning the lottery) by using instrumental variables estimation, but relying on only the variation of lottery selection to identify those causal effects. (The two-year finding was that being covered by Medicaid as opposed to being uninsured didn’t appreciably change physical health status, but did quite dramatically reduce both depression and financial strain.)
In Virta’s case, the Veterans Health Administration (VHA) signed on as a client, but with a limited budget that could not accommodate all who qualified and wanted to participate. Therefore, those who were wait-listed became the natural control group. The VHA, whatever its other controversies, excels at data collection amongst veterans who stay within its system, and was able to compare the results of the actual participants to the would-be participants.
Virta’s approach delivered significant reductions in HbA1c (-0.69 points) and reduced diabetes medications fill by 34.5%. BMI, blood pressure, and even the number of outpatient visits were all reduced. Read more at the full study.
Terms and Conditions of Challenge
Selection of Judges
There will be five judges, selected as follows:
- Each side gets to appoint one, drawn from Brian Klepper’s listserve with almost 1000 people on it, from all walks of healthcare.
- Two others are appointed objectively. That will be whichever health services researchers/health economists are the most influential at the time the reward is claimed. “Most influential” will be measured by a formula: the highest ratio of Twitter followers/Twitter following, with a minimum of 15,000 followers.
- Those four judges will agree on the fifth.
Using the criteria below, judging will be based on validity of the measurement. Measurements deemed invalid, such as those described on the Validation Institute site, is a disqualifying factor, i.e., any challenge by a vendor that is not validated by the Validation Institute.
If the challenging party/vendor is deemed by the judges to have an equally valid metric as Client, the decision is made on the impact of the program in drug use reduction.
Each side submits up to 2,000 words and five graphs, supported by as many as 20 links; the material linked must pre-date this posting to discourage either side from creating linked material specifically for this contest.
Publicly available materials from the lay media or blogs may be used, as well as from any of the 10 academic journals with the highest “impact factors,” such as Health Affairs, published within the last five years.
Each party may separately cite previous invalidating mistakes made by the other party that might speak to the credibility of the other party. (There is no limit on those.)
The judges may rule solely on the basis of the written submissions. If not, the parties will convene online for a 2.5-hour virtual presentation featuring 10-minute opening statements, in which as many as 10 slides are allowed. Time limits are:
- 30-minute cross-examinations with follow-up questions and no limitations on subject matter;
- 60 minutes in which judges control the agenda and may ask questions of either party based on either the oral or the written submissions;
- Five-minute closing statements.
The entry process is:
- Challenger and Service Provider deposit into escrow the amount each is at risk for ($100k for the Challenger, and $100k to the Service Provider). Each party forwards $10,000 to the judges as well, as an estimate of their combined fees and/or contributions to their designated nonprofits.
- If the Challenger or Service Provider pulls out after publicly announcing an application, the fee is three times the amount deposited.
- The escrow is distributed to the winner and the judges’ fees paid by the winner are returned by the judges to the winner, while the judges keep the losers’ fees. (This challenger fee goes to the judges.)
The competition is open to any wellness, diabetes or disease management vendor outcomes claim made before April 15, 2023. This date may be updated by Service Provider from time to time.
*Alice laughed: “There’s no use trying,” she said. “One can’t believe impossible things.”
“I daresay you haven’t had much practice,” said the Queen. “When I was younger, I always did it for half an hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast.”
Time to bring your dental benefit into the 21st Century. You may not look twice at it because it’s a small part of your spend, but it’s a big part of your employees‘ spend.
Further, unlike most of the stuff we cover in Quizzify, dental issues don’t go away on their own. Quite the opposite, they get worse in an exponential manner. An ignored 50% covered tooth issue can become a much larger 80%-covered medical issue.
Are your vendors making claims that aren’t passing your sniff test?
Have you read my books but want a refresh?
Do you want to be the smartest person in the room (um, assuming I’m not also in it) when it comes to outcomes measurement?
I’ll be speaking on that exact topic, in more depth than usual, at The Healthcare Innovation Congress, taking place May 22-25, 2022, in Baltimore, MD. Specifically, I’ll be leading two deep dive sessions for employer healthcare professionals and purchasers on Sunday, May 22.
Join this two-part workshop to gain expertise onaccurately measuring the outcomes and ROI on health benefits and wellness programs. (Successful completion of Part II qualifies attendees for the highest level of Critical Outcomes Report Analysis certification, CORA Pro.)
In addition to the usual hilarious examples of invalid measurement, presented via issue-spotters for you to find them, I’ll actually have several examples of – get ready – valid vendors. I mean there are thousands of vendors in this field so it shouldn’t be a surprise that just randomly a few get it right.
But wait…there’s more! Now how much would you pay?
Nothing, as it turns out. I have a limited number of complimentary VIP guest passes* for the Congress. Claim yours today by writing in AL2022 when you register.
I will also be speaking on the Employee Health & Well-being Track on Monday, May 23rd, 3:10 PM – 3:55 PM: “Do Your Employees Understand Healthcare?: Becoming Better Healthcare Consumers by Focusing on Health Literacy.”
Your guest pass gains you access to:
- 150+ sessions
- 12 comprehensive tracks
- 17+ dedicated networking events
- Pre-conference workshops
- 4+ days of in-depth sessions, panels, and roundtables
- 200+ speakers
Do not miss your chance to get a year’s worth of education in just four days. This is the most in-depth, comprehensive event you will attend all year!
Register today for The Healthcare Innovation Congress. I look forward to seeing you in Baltimore later this month.
When was the last time you even saw an ER bill <$1000, all-in?
The Quizzify ER Prevent Sticker Shock Prevent Consent does exactly that.
Here is one of the two best-known authors in healthcare using it for his son.
Go to the post and see for yourself. Say goodbye to high ER bills for you, your family and your company.
And here are some more.
Here is a Level 5 (the most expensive ER visit code, with the bill:
You can subscribe individually by entering FriendofQuizzify in the promo code for a 20% discount at https://2go.quizzify.com/.
Or you can contact AL@quizzify.com to subscribe for your company.
Occasionally we dual-post in Quizzify and They Said What, when we think an item is important to all of us. This is that situation.
Candy is bad for us. Your employees know that, so they don’t have to learn it in Quizzify. On the other hand, what seems to provide endless question fodder for our trivia quizzes is junk food marketed as health food. For example, we called out “Craisins” (dried cranberries) last month.
Everyone assumes that dried fruit is healthy. Well, dried fruit generally is healthy. Except when it isn’t. If, like cranberries, a fruit is so sour in its natural state that you have to smother it in sugar for it to taste good, well, that’s not healthy. Here is our question on it. Check out the nutrition label at the end:
1/4 dry cup, about 40 grams in total, has 29 grams of sugar, most of which is added. We were quite surprised to learn this (as I used to feed these things to my kids) and apparently so are your employees, as only about 20% get this question right.
We are shocked, shocked, to find that sugar is being added in here!
Just when we think we’ve seen everything, it turns out that one serving of the healthiest-sounding processed food on the planet, Naked Green Machine Juice (whose label touts “Goodness Inside”), supplies far more sugar (53 grams!) than we should be eating all day. (That latter figure would be, depending on who you believe, 35 grams for men and 25 grams for women.)
You can’t quite read it, but take our word for this: the label claims: “No added sugar.” But here’s a piece of nutrition trivia. Naked Juice is sweetened with concentrated fruit juice, and concentrated fruit juice is an added sugar. Nevertheless, the Naked Juice people don’t have to list concentrated juice as added sugar because that’s what they are selling – juice. It’s like maple syrup. Maple syrup doesn’t list any added sugar on its own label because it is all sugar. But a processed food that includes maple syrup must count it as an added sugar.
Regradless, fruit juice concentrate is added sugar, period. If it were added to any non-juice product, it would be listed as an added sugar. As far as your digestive system is concerned, there is no difference between fruit juice concentrate and sugar.
How much fruit-extracted sugar does Naked Juice concentrate into one serving? 2¼ apples worth, according to its own label. (Plus the sugary extracts of kiwis, bananas, pineapples, and pears.)
Naked Juice does supply lots of Vitamin A, B and C. But here’s the thing: for every American with a clinically significant deficiency of those vitamins, there are about 10,000 Americans with diabetes and another 20,000 on their way. Virtually every one of those 30,000, including many of your own employees, thinks they are doing their bodies a favor by drinking Naked Green Machine Juice.
Piling on, we’d also observe that the one nutrient we as a country are most deficient in is fiber. (Yes, that is also a Quizzify question.) Fruits are a good source of fiber. Even Craisins can at least check the fiber box. Yet, somehow, Naked Juice has managed to process all the fiber out of these 2 ¼ apples and four other fruits, so the label above lists 0 grams.
Verdict: Naked Juice is not a healthy alternative to vegetables. Heck, it’s barely a healthy alternative to dessert.
Chris Deacon is going to give us the inside scoop on the successes and challenges in managing the highest-visibility health benefit in the country north of Bentonville (That would be the state of New Jersey and its 820,000 employees!)…and what she learned and we can learn from her experience.
Specifically, she will cover three initiatives that we all agree should reduce spend and likely improve outcomes, but which come with their own set of hurdles:
(1) Enabling advanced primary care
(3) Compiling your data in-house and knowing how to use it
Then she will discuss the challenges of each. Sometimes your TPA, broker, consultant or (in the case of public sector entities) politicians will be supportive. Other times they won’t be. A lot of money is changing hands and suffice it to say not all of it is transparent.
But as an attorney, she knows how to use ERISA (and now also the Consolidated Appropriations Act) to demand data, transparency and value. And in this webinar, Chris will share those secrets with you!
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.