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Wellsteps accomplished the impossible: they got stupider.
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.
Perhaps disheartened by their loss of the uncoveted Deplorables Award to Angioscreen after having won or shared two of the last three, they have decided to take stupidity to a new plateau.
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.
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“New” EEOC wellness incentive rules now DOA!
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.
For these groups, Barbara and I are offering this webinar, to show how to do exactly that.
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.
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Answer Leapfrog’s 20th Birthday Trivia Question to win $100
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.
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I was caught making stuff up…again!
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…
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Review of “A Cure for the Common Company,” by Dr. Richard Safeer
Here’s something you don’t see every day: a book slamming wellness written by someone in charge of wellness at their organization.
In this case, it’s Dr. Richard Safeer, who is the Chief Medical Director, Employee Health and Well-Being for Johns Hopkins Medicine and its 60,000+ (formerly) soda-loving employees.
Eschewing and verily even dissing (“it’s a band-aid”) the old “pry, poke and prod” wellness model breathlessly promoted by fellow Hopkins employee Ron Goetzel before his own heart attack slowed him down, Dr. Safeer writes of his continuing and generally successful quest to create not just a culture of health at Johns Hopkins, but actually a healthy culture. The latter includes the former but goes much farther. You can have the healthiest employees in the country but if your culture is unhealthy, that won’t do you any good. And a poisonous culture will also impact the actual health of even the healthiest employees. (That happened to me three times in my earlier days.)
I would strongly recommend this book to anyone who wants to know what it’s like in the trenches, trying to nudge a (very) large organization into healthier habits. It’s not remotely as easy as all those smiling faces on wellness vendor websites would have you believe. As the person in charge of wellness, you have to do your job almost totally by the strength of your ideas and persuasion, since less than 0.1% of those employees report to you, and in any event you can’t force people to be healthy. (Although there is a saying: “Wellness programs will make employees happy whether they like it or not.”)
As with most of these books although more so due to his first-hand experience and observations, the strength is in the storytelling. Starting with his first week on the job, when he noticed a big red fire truck outside the ER. Only it wasn’t a fire truck. It was a soda truck, doing quite the robust business. (He also noticed that on campus, soda cost less than water. Reversing that was an early success.) And, later, there was a fundraiser for the American Diabetes Association – in the form of a bake sale.
It’s not just about the broccoli: It’s the “building blocks.”
Those are examples of nudging Hopkins towards healthier eating, building awareness of the perils of added sugar among people who should know better already. But two-thirds of the book is about the far more important task of creating a healthy culture through building blocks. This is a dramatically different approach than the typical flavor-of-the-month “challenges,” like who can crash-diet the fastest or drink the most water.
Quite the opposite, there is some behavior change science that when applied intentionally and methodically – and slowly enough to avoid pushback while building consensus – will be far more impactful in the long run. Pursuing wellbeing in the workplace is less about what an individual is doing for themselves (“challenges”) and more about what the organization, leaders and co-workers are doing together so that everyone feels supported and everyone benefits. Many of the stories and lessons in these chapters are about cultures, “sub-cultures,” peer cultures and “culture-killers.”
Some of the stories in these chapters are very relatable, at least for me, particularly the last. Three times I’ve fired people who were “culture killers,” as Dr. Safeer calls them – and three times the output from the remaining staff increased immediately. One of those people was so poisonous that when I prepared to fire him over the phone, I bought one of those recording apps and drove to Rhode Island, since I thought he might threaten me over the phone, and recording calls is illegal in Massachusetts. It took half a day to make a five-minute call. (On the other hand, the surf was up, so the other half-day was well-spent.)
His reaction was the opposite – that he was expecting the call. And that brings me to my own observation about culture and hiring and firing. HIring is like a civil trial–the weight of the evidence. Firing is like a criminal trial–beyond a reasonable doubt. We often wait too long to fire people who are disrupting the culture.
The overall message of A Cure for the Common Company: If we were each able to improve our own habits and maintain a positive outlook on our own, we would have done that by now. Yet it’s 2023 and our workplaces are still taking the same approach of telling the employee this is your problem because you weigh too much etc. A diametically different approach is needed, particular in an era when employees have so many choices of where to work…and that’s what’s laid out in these pages.
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Healthcare Heroes of 2022
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.
In 2022, we are not bestowing any Deplorables Awards because at this point most of the vendors who would otherwise qualify have crawled back into their holes. Nonetheless, anxious readers need not be walk away empty-handed. There are enough Deplorables Award winners from 2021 and previous years (separate links) that I think we’re gonna need a bigger basket. Yes, there are that many vendors striving to outstupid their competitors to win the Race to the Bottom in the quest to give cluelessness a bad name.
Healthcare Heroes of 2022
Last year, albeit with a less catchy moniker (“Healthcare Heroes”), we also started recognizing people and organizations that were doing the opposite, and helping to reduce healthcare waste, corruption and misinformation. Last year’s Healthcare Heroes can be accessed here, and would all requalify this year.
One addition to the vendors list would be Virta. I originally thought that all diabetes vendors were like Livongo, with their sleight-of-hand savings claims, and Better Business Bureau and Amazon ratings and reviews (“Obviously developed by people who are clueless about diabetes”) that could make Dr. Duntsch blush.
Consequently, I started out being totally skeptical of Virta’s claims…but now am quite literally putting my money where my mouth is supporting those very same claims.
This year, we are going to highlight winners in two categories we overlooked last year – government and unions – that have done the most to reduce healthcare waste and corruption.
From the government sector
We often say that we can’t rely on the government to tackle healthcare waste…until, apparently, we can. But that’s only because of the concerted efforts of a few committed people on both sides of the aisle, people who not just believe that the role of government is to curb corruption, but also do it.
First on that list would be Virginia McMillin, a longtime Senate HELP Committee staffer, when Sen. Alexander (R-TN) ran it. I first met Virginia in 2015. The circumstance was that Rep. Foxx (R-NC) was doing the bidding of the American Benefits Council to railroad the Preserving Employee Wellness Programs Act through her House committee. This bill would have given employers the right to, among other things, collect employee and family DNA in the name of wellness and fine people who didn’t measure up. I asked Tennessee resident and uber-concerned citizen Sally Pace to invite her to the World Healthcare Congress, where we were jointly able to convince her to make sure that bill – corrupt even by the standards of healthcare – died in the HELP Committee.
Ms. McMullin is recognized today because she was clearly the lead dog in the Consolidated Appropriations Act too. The full backstory is here, courtesy of Dave Chase. The highlights:
It wouldn’t have happened if Virginia Heppner McMillin and her Senate staff colleagues hadn’t done the hard work to understand the deep conflicts-of-interest and dereliction of fiduciary duty in employer #healthplans.
Upon reading the explosive Marshall Allen ProPublica expose about how benefits brokers had up to 17 undisclosed revenue streams, Virginia dug in to understand how this was possible and the devastating ramifications. In short, the perverse incentives are a key enabler of why healthcare became the #1 driver of inflation, debt, poverty and bankruptcy for over two decades.
It’s not only difficult to understand the #healthbenefits industry, they had to craft legislative language that would get a hearing, be durable against attacks during Senate hearings and survive legal challenges.
Through their success, every non-government employer in the U.S. is now legally required to report on direct and indirect forms of compensation. Failing fiduciary duties is a personal legal liability for CFOs, CEOs and board members not covered by Directors & Officers liability policies which gets their attention.
On the local politics side, kudos to Julie Menin, the New York City Councilperson (from the Yorkville district where, as coincidence would have it, I cast my first vote at Julia Richmond High School), who recently introduced legislation to find as much as $2 billion in savings by auditing exactly how much city workers are paying for their health care at various hospitals, and making recommendations on ways to lower the prices. All told, roughly 10% of New York City’s entire budget goes to employee healthcare costs.
Extra kudos for this Profile in Courage because the largest employer in her district is also the most rapacious hospital, New York-Presbyterian’s Weill-Cornell Medical Center. This is what elected representatives are supposed to do – stand up to the monied interests on behalf of their constituents. And yet very few do.
Rep. Foxx’s wellness scam was just the opposite: probably not one single person in her district was asking for a bill to let their employer collect their DNA. But her financiers were, and that’s what counts.
The Union Runner-Up…
As they generally enjoy much more generous benefits than others, union members have traditionally not considered wages plus benefits to be a zero-sum game. Especially in the private sector, the connection between the two has been so attenuated that the unions would be 100% correct in that conclusion. (There is also the tax issue. Wages are taxed. Health benefits aren’t.)
The corollary would be that unions would naturally distrust the idea that if they make concessions in benefits that are generally painless but save money, they could get much more back in wages. Management is largely to blame, because most proposals they put forward require that the union give up a significant benefit, as opposed to one such as the aforementioned Livongo, to get higher wages.
But when was the last time you saw management propose a reduction healthcare costs by adding a free benefit that demonstrably saves money?
One easy example: why not cover silver diamine fluoride for cavities at 100%, or even just cover it at all? Quizzify has posted at length about this. Everyone wins except the dentist. My wife’s plan doesn’t cover it at all…and yet the $39.92 I paid for my own cavity was half my 50% responsibiltiy for a drill-and-fill.
Or, as we covered last year, why not give pregnant employees free access to PreTRM, which (assuming the results are followed with a high-risk maternity program) achieves almost Nobel Prizeworthy increases in gestational age.
No, it’s always about us vs. them in healthcare negotiations.
Fortunately, there are two cases where unions and management are often on the same side of the table in health benefit strategies, and hence earn the awards for 2022.
The runner-up is New Jersey. The state runs and finances the health plan, with a commission comprised partially of representatives of several unions. The unions have put their most knowledgeable representatives on this Commission, representatives who are generally much better versed in healthcare financing than most benefits consultants, with none of the latter’s conflicts of interest. (The fact that certain vendors even exist is testament to the benefits consulting industry’s conflict of interest. Some choose instead to “partner” with vendors, so that they can collect money from both parties to a transaction.)
The magnitude of New Jersey’s spend is visible enough that the unions and management are generally aligned in demanding that the carrier and the hospital cartel (ER costs in New Jersey are #1 in the nation!) come to heel. I expect that 2023 will see them in the Winner’s Circle in this column.
…And the Envelope Please
But for 2022, the winner is the 32BJ Health Fund. By federal law, this Welfare Plan is run by Trustees with equal representation from management and labor. Along with the trustees, the directors who run this fund are very knowledgeable and conscientious. Most importantly, they realize that a dollar saved is a dollar earned, meaning every dollar they save gets back to the members.
There are two reasons for this realization.
First, savings specifically go back to the rank-and-file. They don’t line the pockets of management. And not just on a small scale. The 32BJ Health Fund was able to (among other things) return a $3000 bonus to all eligible members by (also among other things) removing the aforementioned New York-Presbyterian Hospital system from their network. (Groups that remove hospitals can avoiding overcharging with Quizzify’s ER Sticker Shock Prevent Consent, to pay a very reasonable 200%-of-Medicare price for all non-electives, even out of network.)
Second, because 32BJ consists largely of people at the lower end of the pay scale, benefits are an outsized portion of total compensation and hence get far more attention than, for example, at the United Auto Workers, which has shown no particular interest in looking for win-win opportunities to reduce cost. Nor have the auto companies proposed any.
Whether you are union or management looking for solutions that perhaps your consultants have overlooked, or if you want to nominate a vendor for a Deplorables Award, you can contact me directly through this blog.
Please put comments on Linkedin instead of here. I don’t moderate these posts for comments.
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Webinar: “The Answer” on the colonoscopy controversy (Nov. 10)
Register here to attend (or view the recording of) this November 10 webinar (1:00 PM EST).
No doubt you’ve seen the latest on colonoscopies, from the New England Journal of Medicine. The bottom line, so to speak, is that they don’t do anything…or do they?
It was a large, multiyear randomized control trial, which would normally be considered the Gold Standard. And it concluded that the rate of colon cancer cases was not much lower in the invited group than in the control group, while the all-cause death rates were almost identical. It was good enough for the leading medical journal in the world, so shouldn’t it be good enough for us?
However, the subset of the invited population that actually got the colonoscopies did enjoy a much more noticeable reduction in cases and colon cancer death rates. (All-cause death rates barely budged.)
But as we’ve learned in wellness, comparing participants to a reference or “passive control” group is not valid, because participants always outperform non-participants.
And we can credit Ron Goetzel’s brilliant analysis for that. He proved that participants will outperform non-participants even when there isn’t a program to participate in, as noted below, where the groups were separated in 2004 but the program didn’t start until 2006…at which point the participants had already dramatically outperformed the reference group.
And yet, this time the rebuttalists may have a point. Unlike in wellness, where there is clearly a state-of-mind difference between people who want to participate in a program and people who don’t, it’s hard to imagine that same amount of difference in a decision to get a colonoscopy. Some people just don’t want them, even if they are otherwise conscientious about patrolling their health.
Needless to say, we have deconstructed the pro and con arguments – and found the optimal solution for employers, a solution that we are pretty darn sure (and will poll the audience to confirm) you have overlooked…and yet are likely to implement once you see the webinar.
Once again, here is the registration link.
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Solving the colonoscopy controversy
No doubt you’ve seen the latest on colonoscopies, from the New England Journal of Medicine. The bottom line, so to speak, is that they don’t do anything…or do they?
It was a large, multiyear randomized control trial, which would normally be considered the Gold Standard. And it concluded that the rate of colon cancer cases was not much lower in the invited group than in the control group, while the all-cause death rates were almost identical. It was good enough for the leading medical journal in the world, so shouldn’t it be good enough for us?
However, the subset of the invited population that actually got the colonoscopies did enjoy a much more noticeable reduction in cases and all-cause death rates.
But as we’ve learned in wellness, comparing participants to a reference or “passive control” group is not valid, because participants always outperform non-participants.
And we can credit Ron Goetzel’s brilliant analysis for that. He proved that participants will even outperform non-participants when there isn’t a program to participate in, as noted below, where the groups were separated in 2004 but the program didn’t start until 2006…at which point the participants had already dramatically outperformed the reference group.
And yet, this time the rebuttalists may have a point. Unlike in wellness, where there is clearly a state-of-mind difference between people who want to participate in a program and people who don’t, it’s hard to imagine that same amount of difference in a decision to get a colonoscopy. Some people just don’t want them, even if they are otherwise conscientious about patrolling their health.
Needless to say, Quizzify has deconstructed the pro and con arguments. You can read about that here in Part One of our series on colon screening.
Or you can cut right to the chase and see our elegant solution here in Part Two. You’ll see in Part Two that our solution has, in the immortal words of the great philosopher Zero Mostel, something familiar, something peculiar, something for everyone. It’s…
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Outcomes Measurement for Dummies…and Smarties
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.
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Webinar: Find out why I am betting $100,000 that Virta saves money
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.
Please join us for that webinar at 2 PM EDT, August 31st.
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Virta Health Becomes First Diabetes Vendor to Save Money!
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.”
Most vendor claims incorporate some or all of the following fallacies: regression to the mean, participation bias, or “savings vs. trend.” Virta had none of those.
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.
Written submissions
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.)
Oral arguments
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.
Entry process
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.)
Other
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.”
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Bringing your dental benefit into the 21st Century
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.
Fortunately, there is plenty you can do about this at pretty much no cost. Read our article in Employee Benefit News, and then join the Linkedin conversation here (rather than comment below).
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How to De-Crapify Vendor ROI Measurements
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.
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Keep all your ER bills under $1000!
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.
They Said What? 