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Do you know whether heartburn pills are safe for long-term use?

Six Things You Should Know about Sleeping Pills

Better sleeping through chemistry? Your employees need to know the risks…

In case you missed the last edition of Six Things, it was all about sleep hygiene. We were originally going to lump sleep medications in with sleep hygiene, but, based on what Quizzify has learned from responses to its sleep quizzes, there is enough misunderstanding on the subject of sleep meds that we decided to create a dedicated “Six Things” post, rather than append it to the previous one.
Wellness programs need to recognize that employees live in the real world, and that real-world issues need to be addressed. (For that reason, we were the first vendor to address opioids https://www.quizzify.com/opioids-employer-quiz.)
For sleep, we need to go beyond “sleep hygiene” and directly address the 10% to 15% of employees who use drugs to get to sleep. As a special bonus, at the end, I will tell you how I use drugs to get to sleep. Stay tuned.

1. Benadryl is probably not safe for long-term nightly use
While Benadryl is one of the safest drugs around for occasional and short-term use, few employees are aware of the risk of nightly use of Benadryl. https://drugabuse.com/hooked-on-benadryl-its-much-more-than-a-harmless-dependency/ The feeling generally is, if it’s over-the-counter and it’s been around forever, it must be pretty harmless. However, as you will learn in our upcoming Six Things Employees Don’t Know About Heartburn Pills, there are very few drugs designed and labeled for short-term use that are safe for long-term regular use.

By way of background, Benadryl is an antihistamine originally developed, using technology older than virtually everyone reading this posting, to relieve allergies. Its sleep-inducing property was originally a bug but is now a feature.


2. Employees may be taking Benadryl without knowing it
Benadryl goes by the generic name of diphenhydramine. It’s contained in – get ready — 115 over-the-counter drugs. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541127/ Included in that list of drugs are popular products like Advil PM, Aleve PM, and Anacin PM. And that’s just the A’s. The list literally goes from A to Z, with the last entry being ZZZ-Quil.

3. Since they don’t think of Benadryl or these “PM” drugs as sleeping pills, employees may not realize the risk of dependence
Most employees can recognize a sleeping pill when it’s labeled as such. But when they see a familiar name, sold over the counter, they may not realize that it’s the “PM” (or “ZZZ”) part of the name to be concerned about, not the brand name. PM drugs can create a dependence. A dependence is not an addiction but many people don’t know the difference. Frankly, we didn’t know the difference until we started researching the subject.

4. Ambien may have a less concerning safety profile than OTC drugs containing Benadryl
Some people experience immediate side effects from Ambien, like short-term amnesia. Some side effects – like sleepwalking – are bizarre enough to get in the media every now and then. But the thing about short-term side effects is that you know whether you are experiencing them or not, and can discontinue a drug if you are.

 

 

 

Six Things Employees Should Know about Sleep

Wellness vendors tell employees that getting a good night’s sleep is important to overall health. Their sound observations include:

  • Avoiding caffeine later in the day
  • Keeping a consistent bedtime
  • Sleeping in a dark, quiet room, and
  • Turning off the computer 1-2 hours before bed.

Of course, Quizzify’s popular sleep quizzes include these Q&As because a few employees may not know them. But we also include 12 more things that many employees who have difficulty sleeping don’t know…and would benefit from learning because in every case, the required behavior change is as easy as screwing in a light bulb.

Speaking of which, that is the first of the Six Things we will cover in this two-part installment.

1. Energy-efficient light bulbs

Who knew? These give off far more “blue light” than conventional Thomas Edison-type incandescent bulbs. And blue light is probably one of the biggest causes of insomnia. Here’s an easy behavior change: screw one of the old-fashioned bulbs into your bedside table lamp. All you’d ever want to know about blue light can be found here.

2. Orange Soda

Everyone knows colas contain caffeine. Some folks know that most root beers and even cream sodas do too. But orange soda? Turns out that Sunkist Orange Soda contains more caffeine than Coke. Along with more sugar too. The good news is that, being orange-based, it provides some Vitamin C. (Not.) Here is a list of all popular beverages containing caffeine, including some you wouldn’t expect.

3. Over-the-counter headache relievers like Extra-Strength Excedrin

Yes, Excedrin. The irony is that caffeine is suspected as a migraine trigger. So the last thing you’d expect a headache remedy to contain would be caffeine. And yet it does. Some (but not all) medications labeled “non-drowsy” also contain caffeine. And while we’re on the subject of surprising sources of caffeine, let’s add breath mints, decaffeinated coffee, and any product that contains the word “energy.”

 

 

Six Things Employees Should Know about Antibiotics

Dear TSW Nation,

This month (meaning next month, but it already feels like December around here), we are donating this space to Quizzify, where we are reposting Quizzify’s Greatest Hits of their Six Things Employees Need to Know series. One a weekday for the next month, interrupted only by our annual awards.

As an alphabetical coincidence, we’ll be starting with Six Things Employees Need to Know about Antibiotics.


Antibiotics are America’s most overused prescription non-opioid. Here’s what your employees should know about them. [SPOILER ALERT: They don’t.]

(1) Do not demand an antibiotic if one is not offered

Americans get enough antibiotics without asking for more. Official statistics show that half of all antibiotics are the wrong dose, wrong duration, or wrong drug – including a quarter that should not have been prescribed at all.

My personal tally is probably 75% wrong, in one way or another, as in this harrowing example, one of the highlights of which is a dentist asking me; “So, what’s your favorite antibiotic?

There is nothing, nothing in Quizzify, that suggests the correct way to prescribe an antibiotic is to ask your patient what their “favorite” is. Quite the opposite, taking the same antibiotic multiple times is a good way to create antibiotic resistance.

Alexander Fleming himself predicted the rise of antibiotic resistance by using the same antibiotic repeatedly.


(2) Some specialties are worse offenders than others

Pediatricians often immediately prescribe these for earaches, when the best evidence clearly says this choice should be far from automatic.

Urgent care is the worst, with almost 50% overuse for respiratory issues. ERs, for all their faults in the billing department, seem to be much more responsible in this respect, with “only” 25% inappropriate.

Dentists, with Exhibit A being my former one as noted above, are major overprescribers. With a few exceptions, of course.

And if a telemedicine doctor prescribes one, consider this: how can they possibly be sure you have a bacterial infection? There’s no in-person exam and no culture. You guessed it – they are also major overprescribers.


(3) If an antibiotic is proposed, ask some questions

“Are you sure this is a bacterial infection?” is the best. If you get an answer like: “This is just to be safe,” or something similar, your best bet may be to get the prescription, but maybe only fill it once the culture is completed and is positive for bacteria. Or maybe whatever you have will go away on its own. Or ask (and call back if needed) what new symptoms might lead the doctor to think this is bacterial, and start taking the antibiotic then.

There is also a decent chance that whatever antibiotic the doctor guesses at before the culture is completed is the wrong one. Or is an overly powerful “broad spectrum” antibiotic when the culture reveals a specific organism that should be targeted.


(4) “Finish your entire course even if you are feeling better” is an urban legend

The one thing drilled into us when we are prescribed an antibiotic is that stopping early gives the hardier bacteria a chance to rebound.

Click Here for the rest…



Want more info on Quizzify?  Watch our video. Just to set expectations low enough that we can easily exceed them, this is the second-best vendor video ever produced.

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 as idiot-intensive as wellness. Yet transparently fabricating outcomes is their signature move, so I do like to make sure they get credit for it.

Even so, it’s impossible to do the “There’s nothing to see here. Move on” routine where Wellsteps is concerned.  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. 

Exhibit A is their C. Everett Koop Award, given annually to the friend of Ron Goetzel who is willing to submit his company and himself to the most ridicule.

This time, in a last-minute quest to win their third Deplorables Award in 5 years, their very stable genius CEO, Steve Aldana, attempted to doctor the evidence of their cluelessness that won them their second Deplorables Award. His plot was foiled because he hadn’t realized that technology had advanced to the point that a skilled hacker, equipped with state-of-the-art hardware, could take screenshots.

Here is a screenshot of the original evidence of the harms done to teachers in the Boise School District:


You might ask: “What harms done?”

You can’t tell at first glance, because their original display scrambles the people whose risk scores increased with those whose risk scores decreased.  Wellsteps does deserve credit for obfuscating outcomes in this manner, a brilliant application of their limited intellect that completely fooled the Koop Award Committee.

Unscrambling those datapoints to discern the actual net change in risk scores requires use of another application of another advanced technology – a spreadsheet.  

Unscrambling those increases and decreases revealed that, in fact, risk scores had dramatically deteriorated on Wellsteps’ watch. This spreadsheet copies the the three columns from Wellsteps’ version and then unscrambles the improvements and deteriorations, to create totals of both:

6397 risks (red) increased, while only 5293 (green) improved. Of the 5293 that “improved,” 2134 were people with normal glucose reducing it further, potentially making some of them hypoglycemic.  Nothing screams “productivity improvement” like hypoglycemic teachers trying to control a roomful of kids who’ve just finished their juice-and-cookies.

In all other cases – BMI, blood pressure, cholesterol – the average low-risk person (or even middle-risk person, in two instances) showed an increase in risk factors (in red), as would be expected due to regression to the mean. Our suspicion in glucose is that Wellsteps simply miscalibrated their equipment or misadded their figures. Or they made some other rookie mistake, rookie mistakes being another of their signature moves. The reason you can be fairly certain of this is that it is statistically virtually impossible that an entire cohort of 2134 people whose glucose was already low would go even lower, especially when all the other “normal” starting values spiked higher.

So instead of teachers suffering from hypoglycemia, the likelihood is that Wellsteps was suffering from hyperstupidemia.

Removing those 2134 glucose decreases from the calculation means, almost literally, that twice as many risk factors inreased as decreased.

This was major news, a full-page article in the Boston Globe, as the headline below shows. But the Boise School District wellness coordinators, either embarrassed because they hadn’t realized their teachers were being harmed at considerable cost, or because they were suffering from Stockholm Syndrome, never reported this to the Boise media.

 


Now here is Wellsteps’ new spin on their outcomes. Wellsteps decided the only way they could show results that weren’t a complete embarrassment was to omit the large majority of participants, because their risk on the whole increased. Instead they would just show the small minority whose risk decreased, riding the regression to the mean (“RTM”) train to hoodwink gullible prospects into thinking they actually accomplished anything other than killing a few billion electrons. 

Ironically given their level of overall ignorance, they can’t claim ignorance of RTM.  Mr. Aldana himself, – whom epidemiologists have determined is Patient Zero in the wellness industry’s epidemic of cluelessness – actually admitted that he understands the concept of RTM and how it applies here:

“In just one year, many employees will move from one [risk] group to the other,” he explained, “even though they did not participate in any wellness programs or any intervention whatsoever.” That movement, he continued, “reflects changes in health risks that occur naturally,” making it possible that some high-risk people become low risk “even though your program didn’t do anything.”

He called the author of the article citing this quote, the late, esteemed, highly respected health/science writer Sharon Begley, a “lier.” Though he never said exactly what she was lying about, of course. 

He also accused Sharon and me of violating the Law of Conservation of Mass, “creating BS out of thin air.”


To close on a conciliatory note, in that very same article, Mr. Aldana made an observation which with I and readers of this column would concur: “I agree there is some real crap out there being sold under the guise of wellness.” 

Hear, hear! So I think we can also all agree that it’s time to rid the industry of “liers” that sell “real crap.” And we can also agree to apologize to all who have been victims of Wellsteps’ schemes or invectives: teachers, Boise taxpayers, Sharon Begley, honest vendors, relatives of the deceased electrons, and, of course, our collective 76 million dogs.

Teaching Employees how to be Patients

Ever visited a doctor and forgot what questions to ask? Or didn’t know? Or were too embarrassed to ask?*

If so, you’ll want to join our webinar tomorrow (Tuesday) at 1 PM EDT Quizzify has created a new product, Quizzify2Go, that solves those exact problems. Basically, we teach and encourage employees to be patients.

Quizzify2Go supports fifty common doctor/dentist conversations covering everything from abdominal pain to wisdom teeth with a “Cheat Sheet,” with a heading for context. Beyond that heading are 4 to 10 questions to ask.


Here is an example, for kids’ earaches:

The headings and questions often come with links to authoritative sources. And you can share particular questions with friends-and-relations using the “share-by-email”feature.

Before the formal January introduction date, Quizzify2Go will be linked to and from Quizzify quizzes, and will include almost twice as many Q&A Cheat Sheets, now in the works. Quizzify2Go will be the left shoe to Quizzify’s current right shoe, quite literally bringing the Quizzify knowledge right into the doctor visit, where it would be most helpful.

Even though we know the “right answers,” most of the material is in the form of questions, in order to enhance the doctor-patient relationship rather than threaten it. As you know, doctors get annoyed when patients think they are experts on a topic because they’ve searched it.

All this will be covered in our Tuesday webinar, so sign up now. Attendees will receive Quizzify2Go gratis through year-end.



*You may wonder, how does Quizzify2Go solve the problem of “feeling too embarrassed to ask”?

Simple:

 

 

 

Critics slam award-winning McKesson wellness program

Wellness programs are designed to make employees happy whether they like it or not.

And, using that criteria, McKesson’s is the best of the best. Let’s review some of the accomplishments of McKesson’s program:

  1. Employee weight increased and decreased at the same time;
  2. The program did not noticeably improve biometric risk factors among active participants (dropouts and non-participants aren’t counted, of course);
  3. A whopping 27% of their employees use tobacco;
  4. They set a record for the largest penalty ever paid for illegal opioid distribution.

Those accomplishments naturally won them a C. Everett Koop Award, given annually to the company whose application best exemplifies the IQs of the award selection committee. It also got them some great publicity in Employee Benefits News, where they explained how weight could increase and decrease at the same time:

“Health indicators in 2013 and 2014 were adjusted in the analysis, while several sensitivity analyses of the ‘inter-individual’ impact that used a matching approach confirmed the results.”

Of course, how silly of me!  This makes perfect sense, as explained here!


Lately, though, McKesson’s award-winning program has come under fire, with horrible things being said about it:

  • “Low participation rates”
  • “Inconvenient blood tests”
  • “Unsustainable results”
  • “Minimal health improvement”
  • “Silo’ed, inefficient programming”
  • “Unmet employee needs”
  • “Confusion of available services”

Who is responsible for such horrible, libelous insults, insults that would make us blush?

Why, McKesson, that’s who. Apparently, one of McKesson’s divisions, Canada, didn’t get the memo that their program is good:


So McKesson Canada switched to an outfit called “Sprout,” featured here:

Thanks to this picture, I’m sold on them already! That’s because they’ve apparently achieved the vaunted and elusive triple aim of wellness: reducing employee costs, increasing employee productivity, and poking employee cheeks.


Sprout also features REAL TIME DATA:

This is one of those “What is wrong with this picture?” pictures.  Review the caption, curiously juxtaposed with the laptop. Perhaps McKesson puts their employees on camera so the wellness coach can get REAL TIME DATA of employees doing situps because, without REAL TIME DATA, their “program won’t survive.”

This particular employee might not survive, either. Unless the coach is miked too — in which case this employee can be “coached” to move his water bottle before he impales himself on it.


Let’s dig a little bit deeper into these Sprout people, the wellness industry’s newest entrant in the competition to win the 2021 Deplorables Award, bestowed annually on the company that best reveals the IQs of their own customers.

Here’s their official description: [SPOILER ALERT: Contains cliches]

Sprout At Work is built using cognitive behavioural science, game theory, and behavioural economics to empower lasting behaviour change.

Two things come to mind. First, to raise money, Sprout could go on Wheel of Fortune to sell their surplus vowels. 

Second, speaking of coaches, perhaps they can use the proceeds from those sales to buy a coach. That coach could coach their coach to coach employees to [SPOILER ALERT–contains stupidity] stop doing situps.The 1980s called. They want their exercise back. Sit-ups are out, and have been out for years. 

Planks, of course, are the new situps.


Second, before they brag about using “game theory,” they need to google on what game theory is:

The branch of mathematics concerned with the analysis of strategies for dealing with competitive situations where the outcome of a participant’s choice of action depends critically on the actions of other participants. Game theory has been applied to contexts in war…and biology.

Biology???  Mathematics???  The only thing biology and mathematics have in common with wellness is that Sprout knows nothing about them.  We suspect they meant “gamification,” which has about as much to do with game theory as Sprout has to do with competence.

Luckily for Sprout, unlike real industries, wellness has very little to do with competence. And wellness vendor outcome data, REAL TIME or otherwise, is invariably wrong, so unlike this poor employee about to complete perhaps his last-ever rep of his last-ever exercise, Sprout will survive.



Please post all comments on Linkedin. I’m closing this comments section in order to have them all in one place. 

Can a mere vendor change your own health behaviors in an hour?

Most behavior-change vendors take months to show any impact at all anywhere in your population, so how can a vendor be so impactful, so innovative, that it can change your own health behaviors in an hour? Join our 9/28 webinar (1:00 PM EDT) and see for yourself. 

We often achieve behavior change even before people sign up for Quizzify, starting with webinars like this one. One of our favorite closing lines is: “See, you haven’t even signed up yet and we’re already saving you money.”

We’ll show plenty of examples, starting with our newest and most dramatic immediate savings opportunity. [SPOILER ALERT: Reducing ER expenses by 50% or more, cash on cash.] We’ll cover categories as diverse as screenings, fusions, pregnancy, scans, and of course: Cavities.

Cavities? If you haven’t seen our cavities material, it alone is worth the price of admission. Why submit to a century-old procedure when you can get one that is $30, painless, fast and more effective?

We even have a partner vendor whose own guaranteed savings increases if implemented alongside Quizzify!

In each case when we show what Quizzify teaches, we’ll do some “before and after” polling…and you can watch as the plurality of the webinar audience shifts attitudes and likely behaviors on the spot.

We’ll close by noting that you don’t even have to believe your own eyes: everything we say is 100% guaranteed.

Quizzify’s “Jeopardy-meets-health education-meets-Comedy Central” approach takes both employee engagement and cost savings to a new plateau. It’s so powerful that it simply isn’t believable unless you participate in it. Now is your chance.

Register here for our 9/28 1:00 PM webinar.

Please wish Tom Emerick a nice retirement


This is Tom’s last week on Linkedin and other work-related social media. He wrote me this note and asked me to post it.

Adding something of my own to the note below, it was great to work with him. We wrote an entire trade-bestselling book together, Cracking Health Costs, without ever meeting until it was published. He was disruptive before disruptive was a thing, and was the first champion of Centers of Excellence, back when everyone else thought they could save money by just “doing wellness.”

Dear Al,

As I am retiring from the industry today, I would like to ask you, as my best friend in healthcare, to post this note and send thanks to the many people who have also been great friends and supporters through the years.

First, at Walmart, I’d like to thank Sally Welborn for rolling out our Centers of Excellence model before it was a “thing” – during a time when everyone wanted employees to “do wellness” instead. I would also thank Adam Stavisky for taking it to the next level at Walmart.

And while we are on Centers of Excellence, thank Dr. Fred MacQueary and Dr. Alan Sparrow and especially Dr. Mary Bourland at Mercy Hospital in Springfield for avoiding so many unneeded and harmful spinal fusions. They are the classic Center of Excellence.

Next, special thanks to Leah Binder for the great work that Leapfrog Group does, and for introducing us. Without Leah there is no Cracking Health Costs, and that book launched my post-Walmart career. And thank you for graciously allowing my name to go first even though you did most of the writing.

So many other people to thank and support that I am only going to mention a few and hope they tell the others. Sandra Morris, Scott Haas, Mark Kendall, Rick Chelko, Paul Levy.

If you would like to write Tom a nice sendoff, please don’t do it in the comments here. Instead, go to linkedin https://bit.ly/3xRvxIB so all the comments can be in one place.

 

Are Accolade’s savings claims real? You make the call.

Attention, They Said What Nation:

We are available for forensic consulting (taking appellations and kicking posteriors), recoupment of fees, and expert witness work, hourly or on contingency (except for expert witness, where it is not allowed). So if you think a vendor has snookered you, who you gonna call?

We. Never. Lose.

And here is an example of why vendors fold… 


Accolade recently announced that they had paid Aon a zillion dollars for their actuaries to decide how much savings they could claim without leaving too many clues that the claimed savings figure is fabricated.

They drew that trendline at 8.3%, and decided the savings was also 8.3% in 2019.  Could this be an example of “trend inflation,” where, as Optum’s Seth Serxner says: “The choice of trend has a large impact on financial savings”?

Nah, an actuary would have to be both stupid and dishonest to inflate a trend willy-nilly. it would be too obvious a ruse. You’d show savings in:

  1. every single disease category
  2. every single comorbidity/risk category
  3. every single resource use category

To begin with, here is Aon’s trend vs. the sample Accolade clients:

We’re not calling Aon liars, or saying that Accolade’s payments to Aon create a conflict of interest for Aon’s consultants, or saying that Accolade chose Aon instead of the much less expensive and more credible Validation Institute, which backs its validations with a unique Credibility Guarantee, because they wanted Aon’s actuaries to fabricate savings. (The Validation Institute would have to pay out on a ton of Credibility Guarantees if they fabricated savings.) 

Quite the contrary, we’re sure that Accolade wanted Aon to publish results that were completely on the level. That’s why they paid them so much money, to check and double-check their work.


Every single disease category

Even so, as we pore through Aon’s report, we can’t help but see some questions that you might want to ask, just out of idle curiosity. By way of background, Accolade is a care coordination/navigation company. If you have an issue, like whether something is covered (benefits questions being the majority of the incoming phone calls), you could call them. They might be helpful. Come to think of it, they are so helpful that — get ready — they save money in every single disease category:

Accolade seems to save substantial sums of money in mental categories — “mental anxiety” and “mental mood” (as opposed to physical anxiety and physical mood, I suppose) — because massive numbers of mentally anxious and mentally moody employees are apparently calling them.

Hmmm…

Just suppose for a minute that you were mentally anxious or mentally moody? Would your first impulse would be to call a random number on the back of your insurance card and take a stranger’s advice to save your employer money? That course of action wouldn’t jump to my mind in that situation. But maybe that’s just me. So your question might be:

What do you tell these mentally anxious and mentally moody callers that saves all this money?

Maybe they advise these anxious and moody callers to stop spending money on therapists or meds, and instead just tell them to, respectively, calm down or cheer up. A few other categories might raise questions too, like:

How do you save money in “Upper GI/Esophagus”? Do employees call you and say: “My esophagus is acting up again”? 

And that brings us to cancer, where the mind-blowing 18% savings explodes still farther, in another chart showing 2 years of data, to 26%. How do you save 26% in cancer? On average you would be telling every employee — including the 38% to 50% who (according to Accolade) never call even with minor administrative claims issues — not to bother with that fourth round of chemo.  And I’m sure they’ll trust Accolade’s judgment on that.  


Every single comorbidity/risk category

Aon’s actuaries also sliced the data by number of comorbidities. Initially, they did not show savings in every single comorbidity category. For some reason they struck out with employees who have 3 comorbidities.

We’ll blow up the right-hand “Cost Ratio” column — meaning the % savings — for you:

You could ask:

Why do your phone-answerers do such a great job on people with two or four comorbidities, but strike out on people with three? 

And, my personal favorites are about people with, respectively, 0 or 1 chronic conditions:

How do you save 8% on people with (1) zero chronic conditions, (2) no reason to call Accolade, and (3) who already spend less than $2000/year on healthcare to begin with?

How do you save 9% on people with only 1 chronic condition, like maybe mental anxiety or mental moodiness, or perhaps a cranky esophagus?

Accolade/Aon’s answer to these questions on page 15 of their report is:

Only the results for members with 0 or 1 chronic conditions represented statistically credible reductions vs. market controls.

Wait…are they claiming savings only in the cohorts where there was basically no savings to be claimed? Surely not even Aon’s actuaries could be that stupid.

And yet, when you combine the 2,3 and 4 condition categories into one bar, and do the same with the 0 and 1 condition categories, it turns out that they are saying there is no difference at all between the cohorts who could have benefited from a call to Accolade, vs. the ones with no reason to call. (OK, there is a difference – 0.1%.)

Before you assume this is a textbook example of trend inflation, you might ask:

How is it that you save roughly the same amount on the healthiest employees as on the sickest employees?

Surely the data is accurate — if you pay actuaries that much money it should be — but a cynic might expect that care coordination/navigation would be more effective where there is actually the need/opportunity to coordinate/navigate care. Just sayin’…


Every Single resource use category (almost)

Finally, Aon cut the data by resource use. 

The good news is that Accolade is keeping patients from using healthcare services, thus saving money in every category of utilization. There is 11% less inpatient use. Outpatient and physician expense declined as well.  So another question might be: 

Where are you sending employees to get their care?

By contrast, check page 147 of Why Nobody Believes the Numbers. There is an example from Quantum Health where inpatient use declined, but lower-cost resources like doctor visits increased. That increase is a “plausibility check” on Quantum’s shockingly valid claim to have reduced overall spending.  Their claim would not have been plausible if every category of resource use declined. As the book says: “if you insulate your house, you’ll save money, but not on insulation.” 

The best news?  At the very end, Accolade broke their streak of 16 diseases, 4 comorbidity categories, and 5 resources showing savings –by getting a whopping $13 more generic drug use per employee.  So, to paraphrase the immortal words of the great philosopher BIll Murray, they’ve got that going for them.


What does Aon have to say about all this?

Initially, they proudly announced the initial “savings” on the Healthcare Hackers group. (Ping me at al@quizzify.com if you want to join that group.) When I and others humbly pointed out just a few of these questions about their analysis, Aon’s Jim Winkler replied that they “stand by” their results. 

I learned long ago with the wellness industry not to bother to try to argue with these people because you can’t prove something to someone who just got paid a zillion dollars to “validate” the opposite. So I simply offered to bet a million dollars their results wouldn’t stand up to scrutiny from a panel of reputable health economists. 

And that’s when they folded. Not a peep out of them, though other people on the Hackers also asked. And then I noticed that Aon’s chief actuary looked at my linkedin profile.

Never heard from him either, to collect his $1 million. I guess he decided that instead of “standing by,” he should swallow hard and tacitly admit he goofed. (We will assume for now these were all honest mistakes. The way you’ll know is that, having now seen this posting, they will correct their errors.)

Speaking of swallowing hard, if you’re finding Aon’s analysis tough to swallow, you may be right. And you should also call Accolade to fix your esophagus.



Want a vendor that validly puts its fees 100% at risk for any combination of valid savings and employee engagement you choose? Who you gonna call?

Never Pay the First Bill, by Marshall Allen

Never Pay the First Bill is the best health policy book ever (maybe tied with The Price We Pay), largely because it’s not about health policy. It’s conclusion: we can’t depend on anyone to look out for our interests. Instead, individuals and employers are going to have to make our own “policies.” (I’m sure it is just coincidence that Quizzify is the only vendor featured in both, since we show people how to make their own “policy” on not getting surprise bills.)


SPOILER ALERT: When you read this book to truly understand this industry, you’ll be shocked, shocked to find that lying is going on in here!

And lest you think that this is for-policy-wonks-only, it’s quite the reverse. It is specifically written for “anyone who has been pushed around by the healthcare system.” This cohort of “anyone” would include me, before Quizzify taught me how to push back.

The first eight chapters are specifically for individuals. They act as how-to’s for winning appeals, dealing with collectors, and, of course, avoiding surprise bills using Quizzify’s consent language. As coincidence would have it, this surprise bill example involved a United Healthcare subsidiary called Golden Rule Insurance.  This is the same outfit that “negotiated” the in-network price of 28x Medicare (plus a $1700 tip for a no-show doctor) for the guy featured in our own surprise bill webinar in March.

One surprising lesson in the first eight chapters?  Find out what the cash price is. Frequently, it is quite a bit lower than the price that your national insurer, with tens of millions of lives, has negotiated on your behalf.


Employers are getting snookered too

These are followed by three chapters specifically for employers. SPOILER ALERT: employers get snookered without even knowing it. How true that is!  In addition to the multitude of examples in these chapters, I would cite my own experience with surprise bills and employers.  When I suggest that employers teach employees how to avoid them, an employer will often say: “My employees aren’t having a problem with surprise bills.”

What I then reply is: “Oh, OK.”

What I want to reply is: “The reason they aren’t having a problem with them is that you’re paying them.”

It’s not like these hospitals are saying: “Oh, this guy has good insurance. Let’s charge him less.”  

One thing you’ll learn as an employer is that the insurance company is not your friend. They auto-adjudicate bills that should never be paid, and then throw up roadblocks when you try to dig into these bills to identify the fraudulent ones that shouldn’t be paid.

Sometimes, they “find” the fraud themselves, congratulate themselves for finding it, and then take a big chunk out of the “savings” from reducing the bill that they themselves paid.

Further, each chapter ends with a summary of what you as a person or an employer can do. It is not just an exposé, but also a how-to.

Never Pay the First Bill (Random House) is available now on Amazon.

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