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Did Fitbit just do something, um, illegal?

In wellness, it is perfectly legal to lie to customers and prospects. That’s in most vendors’ DNA.*  (Not all vendors — we will soon be publishing an expanded list of honest ones, and for now would direct readers to http://www.ethicalwellness.org for the original list of honest ones.)

However, if you are a public company, it is quite illegal to lie to shareholders. It’s possible Fitbit did just that. If they did, they could face major SEC sanctions.

Did that just happen? Read this link and then you make the call.

PS This is the sequel to Springbuk Wants Employees to Go to the Bathroom, which should be read in conjunction with this link.


*The irony is that one of the biggest liars specializes in collecting employee DNA and then pretending that they can save a ton of money by getting employees to lose weight by telling them it’s pretty darn impossible to lose weight, because they have a gene for obesity. Yes, you read that right and, no, it doesn’t make any sense.



Update: The link was removed at Fitbit’s request.  In a couple of weeks they will defend this report and explain why they or Springbuk never responded to the requests I made for more information before publishing it.  Good luck with that.

Springbuk wants employees to go to the bathroom

Oh, so lovely sittin’
Abso-bloomin’-lutely still
I would never budge till spring
Crept over me window sill

–Eliza Doolittle


Springbuk has found the key to dramatic reduction in healthcare spending: getting out of bed. It doesn’t matter whether it’s to eat, find the remote, or, of course, pee. Just do something, anything, other than lie in bed all day — and you count as an “active” person who saves a ton of money, as compared to people who never get out of bed. Yes, Springbuk classifies you as “active” if you take at least 100 steps a day:

My question, for now, is not about how all this money was allegedly saved. Rather, my question for now is:  how did these “less active” people — a huge chunk of the total population studied –manage to take fewer than 100 steps a day in the first place? Consider this random floor plan:

Now overlay the steps you take just in order to get up in the morning. A one-way trip to the bathroom and then to the breakfast nook appears to require about 20 steps. You haven’t even had your coffee yet and already you are a fifth of the way to your daily goal.

Speaking of coffee, add in a few more trips to the bathroom and <voila> you’ve reached your steps goal.  Conclusion: it is impossible not to walk 100 steps a day, unless you want to starve to death, burst your bladder, or work at Spacely’s Sprockets. We wouldn’t recommend any of those three, especially the last, a very high-stress environment.

As a sidebar, I would note that George Jetson ironically has a lower BMI than Fred Flintstone, thus showing that taking more than 100 steps a day doesn’t reduce weight. Nor does a paleo diet, apparently. (Portion sizes might have something to do with it.)  On the other hand, Fred can power his own car, thus showing the value of maintaining health at any size.


The Economics of Getting out of Bed

And needless to say, Springbuk provides some very compelling economics about the cost savings impact of getting out of bed.  100 steps a day for only 274 days a year (meaning you can take a well-deserved breather on weekends, holidays, vacation days and Beethoven’s birthday) generates a dramatic 28% reduction in costs. Wow! Who knew that peeing, eating, and looking for the remote (try your fridge or dresser drawers) could be so beneficial to your health?


Springbuk has additional bad news and good news.

The bad news is that taking 100 steps a day for more than 182 days  (as opposed to more than 274 days) makes only a 3% differential impact on health spending, vs. taking 100 steps a day for less than 182 days. Still, there is some good news, which is that staying in bed for half the year also generates a huge reduction in costs, 31% to be exact.

Springbuk didn’t mention this, but the only way both these findings could be consistent would be that people –we will call them “semi-active” — who take 100 steps on more than 182 days but fewer than 274 days must have ridiculously high, off-the-charts healthcare spending and presumably morbidity.  Apparently, moving those semi-active people between “less active” and “active” swings overall healthcare spending for the entire population by 25%.

The implication, as any exercise physiologist would tell you, is that starting in January, you need to track the number of days on which you take 100 steps. If you get to 181 such days by late summer, but don’t think you can make it to 274 days by the end of the year, then your best bet, statistically speaking, is to stay in bed until the ball drops in Times Square. Your bosses will love you for it, because you’ll be saving them 31%.


Naturally, Springbuk’s findings contradict all the other findings on wearables showing trivial changes in activity due to wearables after a short burst of interest. These trivial changes predictable show only trivial improvements in health and costs.

And someone should tell the Einsteins at Springbuk what anyone with a triple-digit IQ could intuit and what every other study shows: that a typical American takes many times more than 100 steps a day.  6886 steps per day, according to one study. So Springbuk’s study is wrong, making them eligible for a Koop Award.

Springbuk’s analysis may be wrong for another reason too:  It does not account for the health hazards of taking too many steps.  (Yes, you need to click through for the punchline.)



An accurate line in this report

I can’t believe I missed this, but Pete Aren didn’t, and pointed it out on linkedin.  There is indeed one accurate line in their report, buried in the footnotes:

Is Wellness-Driven Life Insurance Hancock’s New Coke?

John_Hancock_Envelope_SignatureJohn Hancock Insurance recently announced a plan to sell life insurance based on healthy behaviors. You get a discount on life and disability insurance for exercising and reporting good blood values on an ongoing basis, not just once when you sign up.

While we have been quite vocal in saying wellness is a waste of money and potentially injurious to health and morale (and lately the two wellness trade associations themselves have candidly supported that position), we find Hancock’s strategy to be a shockingly good idea.

There are many distinctions between Hancock’s offering and health insurance. First, life and disability insurance are opt-in products. No one is forcing you to buy them in order to get health insurance at work, or fining you if you don’t. No one is violating USPSTF guidelines, screening the entire workforce, or making you get checkups that are worthless at best.

Second, the same numbers that don’t remotely add up for wellness add up quite elegantly for life and disability.  Cut 50% out of your heart attack rate for the latter and you probably reduce overall claims payout by 5%. Cut 50% out of your heart attack rate for health insurance and you reduce overall claims payout by less than 1%.  Additionally, Hancock can possibly accomplish that goal through underwriting. An employer doesn’t have that option.  So besides being worth more, a 50% reduction is achievable.

Finally, they should be able to generate some good self-selection into this product.  People have to be willing to give up some privacy, and our colleague Anna Slomovic is quoted on this topic in the article in the New York Times, but as long as you know what risk you are taking and as long as there is some recourse, it isn’t the same thing as being forced to reveal personal information for a wellness program.

Declare your independence from wellness intrusion. Quizzify.

Declare your independence from wellness intrusion. Quizzify.

One asterisk:  the article says they are relying on Vitality to come up with the risk adjustments. I doubt seriously that is the case.  Hancock has real grownup actuaries whose job it is to price these risk adjustments. We assume the article is wrong — Hancock isn’t going to rely on a vendor that can’t even quote Dee Edington correctly and doesn’t understand how to design a study.

Absent that asterisk, we are confident that they will be successful and wish them the best of luck.

 

Dee Edington Drains The Life Out Of The Vitality Group’s Distortion Of His Work

The Vitality Group

Short Summary of Company:

“Vitality is an active, fully integrated wellness program designed to engage your employees on their Personal Pathway to better health. Employers can choose to introduce the Vitality experience with one of our comprehensive plans. Activate is designed to bring wellness into the workplace. Elevate includes all the components of Activate, plus additional engagement features.”

Materials Being Reviewed

The Vitality Group “wearables at work” presentation. This presentation describes the health risk reduction achievable through engaging members at workplaces by wearing activity trackers.

Summary of key figures and outcomes:

Vitality members engaged in their program

Questions for Vitality Group:

You appear to be claiming that people who are “not active” reduced their risk factors simply by being engaged, without actually doing or reporting anything. A health services researcher might say that instead of taking credit for both the 6-point decline in the study group and the 5-point decline in the de facto control group risk, in reality only the difference between the two groups (1 point) could be attributable to fitness activities. If you disagree, can you explain exactly what it is that makes people in the inactive group so successful even if they don’t do anything?

ANS:

The amount that could be attributable to fitness activities is the difference between the two groups compared. For clarification, we compared (1) individuals who were engaged in fitness activities with the Vitality program (who might also be using other program elements), with (2) those who were engaged in the Vitality program on other elements but were not recording fitness activities directly with us.

So the graphic focused only on the incremental difference between the described fitness and non-fitness cohorts. Both the fitness and non-fitness cohorts were participating in other aspects of the Vitality program to track and improve their health, but the non-fitness group did not record their fitness activities through Vitality. Individuals in the non-fitness group may also have engaged in some fitness activities but simply did not log any of these activities through the Vitality program.

Observation::

Thank you for that clarification. When I look at the “difference between the two groups compared” I am seeing a 5-point decline in the first group and a 6-point decline in the second group, netting out to 1% as an “incremental difference,” rather than the 13% and 22% declines you claim,, but perhaps readers will see it differently.

How does your claim of success adjust for dropouts, and the likelihood that dropouts would have worse performance than people who were willing to be measured twice?

ANS:

This analysis did not include an adjustment for dropouts as the intent was not to make assumptions about unknown risk factors. A more detailed investigation could include this as a refinement.

Are you familiar with the concept of the “natural flow of risk” described on this slide researched and prepared by the “father of wellness measurement,” Dee Edington?

Dee Edington's Diagram

Edington’s research shows that nearly 50% of people with >4 risk factors will eventually move to a lower risk category on their own.   Having been exposed to this “natural flow of risk” data, do you still believe that the non-active and active members (both groups were selected on the basis of having >4 risk factors) declined in risk due to the program, or else could some or all of the decline be due to (a) self-selection into the active group; (b) ignoring discouraged dropouts; and (c) the natural flow of risk?

 Response:

Yes, we did allow for this effect by looking at the net changes in overall risk groupings by level of activity in the Vitality program. In other words, the percentages shown account for the overall flow of risk, including those who improved over the period but also those who deteriorated. The graphic focused on the proportion of high risk people in each group, but did allow for people moving into the group over the period.

Dee Edington’s work found that expected natural migration is actually a deterioration in risk groups as people naturally flow to high risk.

Often there is a tendency in wellness to compare consistent cohort risk transitions to these expected natural migration increases. Although both cohorts in the analysis saw an overall net improvement in risk groups, this comparison to natural migration was not the intent of this analysis. Instead the intent was to compare the relative changes in the two cohorts. This analysis showed that the cohort who engaged in fitness activities through Vitality had a lower proportion of high risk individuals as of their first risk measure, but had a greater net improvement in risk groups as of the last measure than those who did not engage in fitness activity through Vitality

Observation:

Hmm…well we can’t both be right.  I’m looking at the exact same Dee Edington slide you are, but I am seeing the population’s risk “naturally flow” in both directions, not just “a deterioration in risk groups as people naturally flow to high risk.”  Obviously the validity of the alleged declines in your cohorts is dramatically different depending on whether one uses your interpretation of Dr. Edington’s work (in which case your results are outstanding) or mine (in which case except for 1%, they are due to the natural flow downward of the highest-risk segment).

Like Alvy Singer did with Marshall McLuhan in Annie Hall, I took the liberty of asking Dee Edington himself to referee our disagreement. This is his response:

“The correct interpretation of that slide and of my work is that the natural flow of risk in a population moves in both directions, and must be understood in order to gauge impact of an intervention.  It is not valid to simply start with people who were high-risk and claim credit for all risk reduction in that cohort while ignoring people who migrate in the other direction.”

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