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Yesterday’s Harvard Business Review blog considered the economics of the now-infamous Preserving Employee Wellness Programs Act (HR 1313). It had been previously analyzed from the perspectives of privacy and employee recourse. One would think that a measure which failed the latter two tests so miserably would at least show a favorable ROI.
Here is how the economics stack up. Genetic testing costs about $500 per employee (and dependent — don’t forget that children can be tested too). In the best-case scenario $1.44 can be saved, in about two years. That yields an ROI of about 0.0288-to-1. In other words, out of every dollar spent, more than $0.97 is lost. Even by the standards of wellness, these numbers don’t add up.
However, genetic testing makes a ton of economic sense using the strategy made famous by Bravo Wellness, in which a program “provides options for immediate employer cost savings” by being so ridiculously unattractive that employees would rather pay the fine.
Please go to the HBR blog — which is read by exactly the people who would be implementing this program were the bill to pass — and tell them what you think. No need to leave a comment here — everyone who reads this blog has basically the same opinion, differing only in their amount of outrage.
This afternoon STATNews followed up with more criticism of HR 1313, the Preserving Employee Wellness Programs Act. As measured by comments to their previous article and the Washington Post’s article, public opinion is running about 999-to-1 against it. That’s a lot even for wellness.
Ryan Picarella, of WELCOA, jumped on this and got way ahead of HERO, which is not opposing it. They can’t. Aetna is a major dues-paying supporter, and Aetna loves genetically screening employees for defects. Naturally they fabricate their outcomes. This time we mean it literally when we say: “Lying is part of wellness vendor DNA.” Aetna even invested in a company to further their dystopian vision, a company ironically named Newtopia.
By contrast, this is the kind of leadership we’ve come to expect from WELCOA, filling the ethical vacuum created by HERO.
But, more importantly, this article is the first media mention of Ethical Wellness, our new website dedicated to putting the wellness back in wellness. You might recall the original Workplace Wellness Code of Conduct. Ethical Wellness has updated it. You can sign on to the website, join and endorse, all at no cost. You can also contribute, separately, and be highlighted as a contributor. Scott Life and Dan Keith have both pitched in $500, as compared by to my $10 (to test the donating mechanism — that’s my story and I’m sticking to it). I’ll be putting in the other $490 shortly. Really. There is also a linkedin group. No mass postings — a true discussion group.
We’ll be talking more about Ethical Wellness in the coming days. for now, it’s about not fining employees for refusing to have their children genetically screened for defects.
We cannot make this stuff up. HR 1313, The Preserving Employee Wellness Programs Act, has a provision specifically designed to screen children for genetic defects. Don’t take our word for it. Here is the language of Section 3(b):
Notwithstanding any other provision of law, the collection of information about the manifested disease or disorder of a family member shall not be considered an unlawful acquisition of genetic information with respect to another family member as part of a workplace wellness program.
This wasn’t an oversight due to some obscure language — the entire bill fits on a page. It just passed the House Education and Workforce Committee and is headed to Ways and Means. We need to stop it now. It basically says, you can ignore the Genetic Information Non-Disclosure Act as long as the genetic testing is part of a wellness program.
The English language contains 450,000 words, the most of any language, but apparently it needs a 450,001st. Why? Because whoever invented the first 450,000 words had obviously not reviewed HealthFairs USA’s wellness program, which no existing word comes close to describing.
First, they test for cancer — with 99% accuracy! This precision may seem impossible but their claim is correct in that 99% of the words in the clipping below are indeed spelled accurately. (This is actually a better track record than the rest of their website, in which they describe their “unparallelled” customer service and how they “minimize your companies risk” and “build company moral.” They also advertise “less call-outs for sickness,” by which I suspect they mean “fewer absences.”)
Besides the slight problem that this statement is beyond absurd about a zillion different ways, Preventest lacks FDA approval (and — equally surprisingly given their accuracy — a Nobel Prize). That doesn’t stop HealthFairs USA from submitting claims to insurance companies and promising “no out of pocket cost” in most cases:
By the way, there is no FDA-approved genetic “check swab,” or test of any kind, let alone one with 99% accuracy, for any cancer. And few cancers on this list even have a genetic component. (Bladder cancer, for example, is 100% environmental.)
But wait…there’s more. Now how much would your insurance company pay? HealthFairs USA is selling worthless nutritional supplements and submitting insurance claims for those as well:
Let’s review what they’ve told us so far: they perform useless, non-FDA-approved tests and sell useless, non-FDA-approved supplements to employees who don’t need them, and then submit bills to third party payors. Can anyone spell insurance fraud? I doubt they can, since they can’t even spell “alleviates.” (So much for their 99% accuracy target.)
How does this benefit employees?
Lots of ways. Employees can submit to more frequent screenings. And I’ve always said the problem with the US healthcare system is that employees don’t get screened enough. (not!)
Or, they can take medications. It’s not clear which ones, and there aren’t any “medications” that are FDA-approved for preventing most cancers in any case. But whichever ones you take, I’m sure they’ll figure out how to bill the insurance company for them. Most importantly, you can “have risk reducing surgical procedures.” Hmm. What word can describe a wellness vendor recommending surgery for employees tagged by non-FDA-approved cancer screens for a possibly elevated risk of cancer?
Make that 450,002.
Indeed, a true wellness program might consist of warning employees not to get anywhere near HealthFairs USA, so clearly these people don’t have any accounts of any sophistication, right? Right?
They claim a household name company as one of their accounts. That means they are submitting insurance claims to their insurers on behalf of their employees, as directed and incentivized by their human resources department. I’m not a practicing attorney, but I am a practicing non-idiot, and as such my opinion would be that they look into this posthaste.
Yes, I know it’s not like me not to name names…but any whistleblower fee is not applicable if the information is already public. And, incredibly given the rather modest readership of this blog, being in TSW counts as public information.
And plus, it’s not like they’re completely fraudulent. They have references from stellar companies with outstanding reputations:
Full disclosure: I’m not 100% sure that it is actually illegal to submit insurance claims for useless, unapproved, possibly harmful, USPSTF D-rated screens and useless, unapproved, probably harmful, supplements for employees who have no diagnosis, no recognized medical necessity and aren’t seen by a real doctor.
Quite the contrary, my opinion may only be 99% accurate.
We often say on this site that “lying is part of wellness vendor DNA.” However, we didn’t mean that literally–until Newtopia came along. You see, Newtopia, like most vendors, lies — but they also actually collect employee DNA.
You might observe: “Wow, they collect your DNA? What an incredibly intrusive wellness program! This sounds like something Aetna would do.” This would be a reference to Dr. Aetna Will See You Now and its sequel. Yes, Aetna is Newtopia’s biggest fan, but the particular numbers below are made up by Newtopia, not Aetna. In all fairness to Newtopia, many of what could be termed “lies” could charitably be characterized as “very misleading but technically accurate statements,” So ironically it would be us who would be lying if we said these were all lies. Hence we will call them “gaffes,” a category which includes lies but also includes situations in which the truth shocks the conscience as much or more than a lie would.
Gaffe #1: Engagement:
To Newtopia’s credit (not unlike HERO, which did the same thing in its report), they put the invalidating information about their engagement right on their website. This again proves our mantra from Surviving Workplace Wellness that: “In wellness, you don’t have the challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
Specifically, for some reason Newtopia provided a link to an Associated Press story, which they called a “profile,” but obviously we wouldn’t be linking to a puff piece “profiling” them. They Said What? only links to real reporting, which is invariably unflattering to wellness vendors and which would never be considered “profiles.” Puff piece or real reporting? You make the call — We can’t both be right.
Among other things (and there are plenty of other things, which we will get to) the AP reported that of 130 employees of the profiled customer organization, Jackson Laboratory, invited into the program, only 15% remain one year later,
However, the website itself proclaims:
Maybe “unheard of engagement” technically isn’t a lie. Maybe they meant: “unheard of” in that an engagement rate as low as 15% would be unheard-of. We doubt that because elsewhere they cite their use of “engagement science,” whatever that is. (Funny thing, Quizzify, the only company to literally financially guarantee increased engagement, doesn’t use “engagement science.” Instead Quizzify simply offers employees a tool they will want to use.)
Gaffe #2: Success
On its website, Newtopia’s case study for this customer, Jackson Labs, states:
However, the AP’s Tom Murphy borrowed a trick from Reuters’ Sharon Begley—and actually did reporting. They asked Jackson Labs itself for some statistics. They learned that of the 28 employees who submitted to Newtopia, only 19 remain. So even if every single one of those 19 lost weight, only 68% — not 92% — would report weight loss. (Newtopia might respond that their website’s 92% statistic was after six months whereas the 68% was after a year, thus begging the question of why they decided not to update the statistic on their website. It’s also a window on the truism that the longer the measurement period, the more people regain the weight.)
Whether 68% or 92%, Newtopia credits its results to “science.” Indeed their website loudly proclaims:
Gaffe #3: Made-Up Facts
One of the darnedest things about science is, it is a fact-based discipline. You can’t “drive” your own facts. For instance, their website proclaims:
Productivity is defined as “output per man-hour.” Therefore in a company that is “3x more productive,” each employee gets 3x more work done.
If Newtopia’s statement is accurate, and if Walmart promoted health, their cashiers could ring up 3x more customers. Doctors could see 3x more patients. Pilots could fly planes three times faster. Teachers could teach three times more classes. The recorded messages on hold would tell us that customer service thinks our calls are three times more important to them…
Another made-up fact:
Quite the opposite of “failing to control the incidence,” current approaches have in fact dramatically reduced the rate of heart attacks and strokes. Don’t take our word for it. Here are the federal government’s statistics for heart attacks:
During most recent available period, in which the population over 50 grew close to 20%, the number of heart attacks fell 19%. Not bad for “failing to control the incidence.” The wellness industry, of course, had nothing to do with that decline, which encompassed all age categories and payers.
Strokes also declined quite a bit. Curiously, strokes increased significantly in the age categories in which wellness programs were supposed to prevent them, paralleling the dramatic growth of the wellness industry from 2001 to 2012. They declined dramatically in the >65 population, which doesn’t have access to workplace wellness and which grew close to 20% over this period. So it looks like the only industry that “failed to control the incidence” was: the wellness industry.
Gaffe #4: Unsupported Statements
Another thing about science? Credible scientists don’t make statements that aren’t “driven” by evidence. Note this statement:
Besides being uncited and disputed by its largest customer (Aetna, which “collaborated” on the HERO report admitting wellness loses money), note the wording. It makes it sound like the more you spend on wellness, the more your costs fall. The implication is that spending an extra $500 on Newtopia’s genetic testing (over and above the cost of a regular wellness program) will then save even more.
If only this were a lie!
Newtopia also admits they could make a mistake with it. OK, they don’t exactly admit it. They imply it. They say your DNA could be used in “error management,” and by definition there is no need for error management unless you make errors. And with the full list of people who have access to it — eight categories of occupation including “naturopathic doctors” plus unspecified “other persons” — errors are inevitable.
People sometimes complain that all we do is criticize wellness vendors. Newtopia is Exhibit A in why that’s often not such a bad idea. Even Newtopia doesn’t seem to mind–we gave them the opportunity to fact-check, rebut or comment on this, and they didn’t.
Our colleague, privacy expert Anna Slomovic, has put up at her blog an excellent essay on the emergence of genetic testing in workplace wellness programs.
We need to question the voluntariness of participation in wellness programs, the value of the testing being offered, and the appropriateness of wellness vendors exploiting the information they collect. This is even more important when genetic information is involved.