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Vivify Brings Incompetence to Life

The population health industry never ceases to delight us with its creativity.  Vendors come up with ways of demonstrating their incompetence that are so creative we are compelled to use screenshots to back up our observations.  Otherwise no one would believe us.

Consider Vivify.  They reported on a study of in-home post-discharge telemonitoring led by a:

vivifyprincipalinvestigatorlessname

Not being able to spell the name of his own occupation is the good news.  The bad news is, the “principle investigator” also can’t write, can’t do simple arithmetic, and – most importantly for someone who claims to be a “principle investigator” — can’t investigate.  (Those shortcomings aside, this is a very impressive study.  For instance, the font is among the most legible we’ve ever seen.)

The Writing

There is some redundancy in the writing, but, giving Vivify the benefit of the doubt, perhaps the extra verbiage reflects the principle investigator’s concern that someone might miss the nuances or subtleties in his exposition.  Examples:

  • Vivify’s home monitoring system is “simple and easy”;
  • The patient receives a “weight scale”;
  • They had an “ROI of $2.44 return for every dollar invested”, and…
  • “With appropriate connectivity, patients could engage in real-time interactive videoconferencing.”

Needless to say, these product attributes are very intriguing, so intriguing that you may want to learn more about the company. They are only too happy to oblige, making sure we catch yet another nuance:

vivify about us

The Arithmetic

The study claims the average patient’s cost declined $11,706, for a 2.44-to-1 ROI.  Doing the math, that means Vivify’s post-discharge in-home self-care tele-monitoring costs…let me just get my calculator out here…$4797/patient?   At that price, why rely on self-monitoring?  Why not just move a nurse in?

vivifyROIandsavings

(Note for the literal-minded:  the ROI language is slightly different here than the passage we quoted, which appears elsewhere in the case study.)

The Principle Investigation

In general, Vivify targets patients with “specific chronic illnesses,” including pneumonia.  (Vivify, I don’t know how to break this to you gently, but: pneumonia isn’t a chronic illness, specific or otherwise.  No one ever says: “I was diagnosed with chronic pneumonia a few years ago, but my doctor says we’re staying on top of it.”)

vivify penumonia

However, for this investigation, only CHF was targeted: a cohort of 44 recently discharged CHF patients with an average age of 66.  This raises the question: How did the principle investigator scrounge up a cohort of 44 discharged CHF patients with an average age of only 66?  More than half of CHF discharges are over 75.  It’s statistically impossible to randomly select 44 CHF discharges with an average age of 66.   And – isn’t this a lucky coincidence – the study claimed a large (65%!) reduction in readmission rates but readmission rates are already much lower for younger patients.   Once again, not a word of explanation.

Because Vivify’s apparent level of misunderstanding of basic arithmetic and study design boggled even our minds (which is difficult to do, given that we mostly blog about wellness), we decided to give them a chance to explain directly that we might have missed something. Further, because these explanations would have taken them 15 minutes if indeed we were missing something obvious, we offered them $1000 to answer them, money they decided to leave on the table.  (Anyone have questions for me? Send me $1000 and I will happily spend 15 minutes answering them.)

This email to Vivify is available upon request.

We don’t even know what the 65% reduction is compared to.  Usually – and call us sticklers for details here – when someone claims a 65% reduction in something vs. something else, they tell us what the “something else” is.  Are they saying 35% were readmitted?  Or 66-year-olds are readmitted 65% less than 75-year-olds?

Savings Claims

My freshman roommate was like the bad seed in the old Richie Rich comics.  Among other things, he would have a snifter of cognac before bed, whereas I had never tasted cognac and thought a “snifter” was for storing tobacco.  We didn’t get along and at one point I accused him of being decadent.

“Decadent, Al?  Let me tell you about decadent.  I spent last summer at a summer camp – everyone was there, Caroline Kennedy, everyone – where we played tennis on the Riviera for a month and then went skiing in the Alps.”  I had to admit that was indeed decadent.

“Al,” he replied.  “I haven’t even gotten to the decadent part yet.”

Likewise, we haven’t even gotten to the best example of arithmetic-gone-wild:  the savings claim.  Remember that $11,706 savings claim above?  Well, read that passage again–it turns out that represents a “90% decrease in the cost of care.”  Apparently, the patients cost $12,937 when they were in the hospital, but after they went home, they only cost $1231.  (We have no idea how that squares with the other finding, that the Vivify system itself costs $4797, based on the ROI of 2.44, or, as they put it, “an ROI of $2.44 return for every dollar invested.”.)

 

Quizzify 3

We can spell “guaranteed savings” and other words too.

The irony is that other vendors in this space really do save money and really do measure validly.  It’s one thing to make up outcomes in wellness. That’s a core part of the industry value proposition. But, unlike wellness vendors, tele-monitoring vendors other than Vivify typically know the basics: what they are doing, how to measure outcomes, how to save money–and how to spell.

Pharos Innovations Produces Wellness Savings On Day One

Pharos Innovations

Short Summary of Intervention as described by company:

“Today, Health Systems, Physician Groups and Accountable Care Organizations are utilizing Pharos programs to:

  • Reduce health care costs and increase care quality
  • Increase care coordinator case loads and population penetration
  • Increase care plan and treatment compliance and improve clinical outcomes
  • Drive reduced readmissions and increased gain share bonus participation”

Materials Being Reviewed

Evaluation of Tel-Assurance Heart Failure Module

Summary of key figures and outcomes:

Pharos All-cause Inpatient Admission

79% reduction in admissions, and an 85% reduction in total costs ($4458 per patient per month falling almost immediately to $652).

Questions for Pharos Innovations:

Your savings happened immediately after the program began. No other disease management program claims that its savings are immediate and yet many programs have interventions similar to yours. What did you do differently to make you so successful?

ANS: Refused to answer

You write that to be included in the analysis during this 18-month study period, a member need only have participated for 15 days. How were you able to achieve such dramatic results over such a long period with only 15 days’ required participation?

ANS: Refused to answer

The most dramatic decline in admissions – about 90% — happened the first month (February) of the program. Are you saying that you were able to find all these members’ contact information, schedule the phone calls to the members and their caregivers to convince them to join the program, schedule initial followup calls to start trying to manage the members, make the scheduled phone calls, collect the information, get members to visit their doctors, and adjust lifestyles and medications — all by February 1 for a program starting January 1?

ANS: Refused to answer

Your “unchanged” matched cohort seems to have declined by 25% over the course of your intervention. How are you defining “unchanged”?

ANS: Refused to answer

Why did Wellpoint ask you to take their name off this study?

ANS: Refused to answer

Can you get someone at Wellpoint to endorse this program in the space below?

ANS: No one from Wellness endorsed the program in this space

If admissions declined 79% but total costs declined 85%, wouldn’t the use of physicians, labs, drugs, home care and all other services have to decline by much more than 85% in order to have the average decline in costs be 85%?   Very conservatively assuming that admissions account for only half of all costs for CHF patients, wouldn’t all other costs need to decline to about $200/month, which is much lower than a typical commercially insured person spends and far lower than a Medicare member spends?

ANS: Refused to answer

Wouldn’t such a low non-admissions spending figure mean that most patients would no longer be taking most meds or insulin, seeing doctors regularly, getting tested, participating in therapy, etc.?

ANS: Refused to answer

What did the New England Journal of Medicine get wrong when they tested your intervention and found no impact at all, which is much different from an 85% cost savings?

ANS: Refused to answer

Pharos isn’t just validated, but rather it is claimed to be strongly validated. Can you distinguish being “strongly validated” from garden-variety validation?

ANS: Refused to answer

Who did that “strong validation” and can they explain their rationale below?

ANS: Refused to answer

Why, if you can’t answer these questions that have been asked for several years now and Wellpoint has withdrawn its name, is this study still on your website?

ANS: Refused to answer

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