The Golden Squirrel Awards are lovingly bestowed on studies and success claims about halfway in between the dishonesty of Smoking Guns and the hilarity of “On the (even) Lighter Side.” The squirrelliness of all these claims means readers who accept them at face value are nuts.
Kudos and thanks to author, Forbes columnist, and general really cool guy (by non-Millennial standards) David Shaywitz for coming up with the name.
Multiple people have asked us to evaluate Healthiest You. They said: “Brokers love Healthiest You.” You didn’t exactly need Sherlock Holmes or Encyclopedia Brown to figure out why. Even Inspector Clouseau would have noticed their “market-leading commission structure.”
As is our wont, we retained a team of crack investigators and hackers willing to skirt the edge of the law to “go behind the scenes” by actually looking at the website. Leaving aside both the trademark violation — that’s between them and Will Ferrell — and the GINA violation (you aren’t allowed to ask employees about family history)…
…there appear to be quite a number of violations of the actual rules of arithmetic, which are strictly enforced. Last I checked, if you have 500 insured people averaging 3 doctor visits a person, that would be, hmmm…let me see…carry the “1”…1500 doctor visits. Healthiest You prefers a different answer. On their planet, 500 people averaging 3 doctor visits a year (12 visits for a family of four) yields 1250 doctor visits.
And for some reason even though they give the average for a “family of four,” the example population is a family of about three.
Next, they say:”70% of doctor visits can be safely handled over the phone.” Sure, “safely,” in that a telephonic patient won’t choke on a tongue depressor. But effectively? Perhaps not. (“Now open your mouth, say ‘ahhh,’ and look down your throat. Is it red? Hello? Can you hear me now?”)
Then Healthiest You calculates the “redirection” they accomplish, with uncanny precision: “20.00%.”
So just to be generous, let’s assume a “redirecting” phone call is as likely to avoid an $1100 ER visit as a $120 doctor visit. Using their figures with that generous assumption, reducing each of those categories by an equally generous “20.00%” yields: $11,000 in ER savings, $8000 in urgent care savings, and $2400 in avoided doctor visits. And let’s also very generously assume that no extra phone calls are generated, meaning there is no situation in which a doctor is one free phone call away and nobody calls them. That extreme generosity yields savings of $21,400. Once again, math works differently on their planet, where the savings are $43,000–and zero cents.
Coincidentally, their program costs just about as much as it “saves.” So if indeed their math were right, the ROI would be slightly more than 1:1, or 0.94% as they put it (ROIs are also expressed differently on their planet). All told, their actuarial department found a 0.9% reduction in costs.
And it would be good if their actuarial department checked in with their marketing department (after they check in with their fifth-grade math teacher) because their marketing department says:
Meanwhile, back in the sales presentation…
There are asterisks flying all over the slide, so we are having a hard time following it. Here’s what we can discern: somehow even though there are only 146 covered lives, 291 of them filed claims, representing a good “% of change” from the previous year’s 459. And we don’t know what industry this company is in (maybe they are an NFL team), but their employees and dependents seem to get sick or injured at a prodigious rate: 146 people generated 915 ER and urgent care visits (about 1 every 8 weeks). And no one can say that was because they didn’t have PCPs–they also visited the doctor about once every 7 weeks.
Nonetheless, we are giving them a Golden Squirrel rather than naming them a Smoking Gun because unlike wellness, we think there may be a pony in this pile, keeping the squirrel company. It should be the case that access to doctors on the phone solves some problems, and other telehealth companies show modest savings, measured using actual arithmetic.
No one has ever accused Keas of understanding the way statistics work. And like a good wellness vendor, they aren’t much for learning things they don’t know, so being “outed” for making up numbers didn’t affect their game plan, which apparently involves making up even more numbers:
Take out preventive care, rare diseases, accidents, transplants, and birth events–and employers don’t even spend $700-billion on healthcare. Hence it is impossible to save that much. (So as not to embarrass themselves further, I hope they have the good sense to keep their press release “embargoed” for much longer than a week.)
Still, they are right about one thing: a good way to save money is by eliminating failed workplace wellness programs. If Keas’ refusal to explain the seemingly impossible statements in their other entry on our blog is any indication, this would include theirs.
As is the case in the wellness industry, Upton Sinclair was right: You can’t prove something to someone whose salary depends on believing the opposite. Likewise, J.K. Galbraith had it right too, saying that 90% of people whose belief is proven not to be true will get to work defending that belief. Exhibit A is Dean Ornish.
This site was prevously agnostic in the “diet wars,” even though the votes seem to be coming in overwhelmingly in favor of high-fat low-carbs. We don’t challenge science, which is an evidentiary standard of truth. We challenge arithmetic, which is a proof standard of truth. Our Smoking Guns, and Lighter Sides all invalidate things on their faces. Golden Squirrels are a little more open-ended. Things just have to be, well, squirrelly. And Dean Ornish’s op-ed in the New York Times fits that description to an “s”. At this point, if this is the best that the high-carb crowd can muster, we’re ready to declare our allegiance to the high-fat caucus.
First, how does one reduce a number by “2.5 times” ?
His defense might be that this “2.5x” figure is versus a control group of sorts. Even so, that “defense” also demonstrates innumeracy on Dr. Ornish’s part, as he has mixed up two absolute changes with one relative reduction.
Second, he seems to have done exactly what wellness vendors do, in several ways. Clicking through to the studies reveals many old ones, including one from 1983. (I thought I had accidentally linked to the wrong article, or else “1983” was the page number.) Wellness true believers love to do that. Ron Goetzel referred to a 1990s Procter & Gamble study as “recent.”
Wellness vendors also like to draw sweeping conclusions from very small sample sizes, as does Dr. Ornish. Also, wellness vendors compare active motivated participants to non-participants, a methodology they themselves showed to be invalid. It’s hard to tell, reading these studies whether he got volunteer participants and denied half of them the program, or whether he simply used non-volunteers as the control. We suspect the latter — it’s unlikely that someone would say to his paying clients: “Sorry, you’re not going to have access to the same great intervention these other guys get.” Particularly when clients pay as much as his do.
The final mistake that wellness vendors make is to create an intervention that requires an incredible amount of effort to succeed at (like losing weight) and then credit their own magic dust, rather than the participant’s effort, with the success. Just reading about the requirements to be in his study group tires me out.
(1) Cone Health and (2) Cerner: Putting the Hype in Hypertension
What is it about being a healthcare company that causes people of presumably at least average intelligence to channel Forrest Gump?
First, these Cone-heads just set a new record for innumeracy by breathlessly hyping their claim that they reduced the annual costs of their hypertensive employees more than 95%, from $5145 to $241. (Diabetes wasn’t far behind, with a 90% decline.)
We’re not quite sure how Cone even knows these employees have hypertension, since at those claims levels they wouldn’t be filling their prescriptions or submitting any other claims that could be traced to their blood pressure.
Next on the list is Cerner. (If you like this one, visit On the (even) Lighter Side.) They diagnosed an employee basically without a pulse as “blood pressure higher than what is ideal.”
Yeah, I know, I shouldn’t enter phony numbers into HRAs to get a good laugh by showing how vendor models are fabricated. But I didn’t. This is the screenshot from their own brochure.
PS We don’t know if this employee survived. A few people with “pulse differentials” of 20 (systolic minus diastolyic) are lucky enough to leave the hospital alive. Thank goodness Cerner’s HRA caught it. That borderline hypertension’ll get you every time.
Al, as usual good stuff. I look forward to your writings on the telehalth vendors, as to your point some of them can generate savings. Though I suspect not what they claim.
Thanks. Data is not the plural of anecdotes but I’ve certainly had several occasions where a simple phone call would have done the trick. On the other hand, once I tried a “simple phone call” to my healthplan’s 24-7 triage line and ended up in an ambulance to the ER.
Completely agree on the HealthiestYou observations. Note that they charge $11 PEPM which is outrageous for a white labelled solution that only costs a $1 or $2 PEPM at most.
But also note that their website talks about “proactive wellness coaching”, whatever that means. Unsuspecting users are also proactively paying for proactive coaching.
They also claimed to have signed 2,000 customers in Q4, which, if true, would make them one of the hottest companies in HCIT. IPO next?
And yes, they also claim to have “expanded” to a location in Arizona, which a simple google search indicates is the location of an architectural firm.
You sound more like us than we do. I look forward to your nominations of other companies.
OK my guess is that the Cone Health one is a misprint…probably meant they saved $241 off the $5K cost. And it may not even be their typo
The Keas one is totally reasonable. I agree with their CEO that we spend at least $700 billion too much on health care, therefore it’s wasted. And i agree that Workplace Wellness wont help us reduce that $700 billion. And so do you. So what’s wrong with agreeing with them?
So Dean Ornish can’t do statistics. a) the guy is busy and b) (and pay attention as it’s the only serious thing I’m going to write in this comment) his competition–every interventional cardiologist, cardiothoracic surgeon, cath lab and hospital with a cardiac program waste WAY WAY more money than all wellness vendors combined by a factor of 237.36*
* delineated precisely using the same calculator as Healthiest You
So Cerner’s HRA doesn’t have standard guidelines/thresholds/business rules built into it. The question you want to ask is, does their EMR? After all we’re about to spend $12 billion on it for our brave fighting men and women.
As for Healhiest You, while they may seem challenged at math, they didn’t tell you the step they took to reveal the true savings. You’re assuming because they didn’t tell you that all visits were reduced proportionately. I’ll take their word for it that all ER visits were eliminated–woosh just saved 50 x 1,100 ($55,000) and the other 200 urgent care visits @ $200 is another $40,000. So by my math they’ve saved $95,000 for a very modest investment of $43,000. A bargain.
OK even I am at a loss for how to deal with the sales slide of the 146 people in Ohio, but I think I’ve busted you in a math error (throwing stones in glasshouses). If there are 146 people and they had 490 odd PCPC visits (down 55% from the previous year which sounds a stretch) that mean they had 3.4ish visits each–or roughly one every 14 weeks not every 7 weeks
You know where to send the $1m!
Hi Matt, thanks for your comment(s).
First, I do agree that the Ornish thing is not squirrelly enough for the Golden Squirrels, so I’ll take it down. I mean, it’s not exactly Nobel Prizeworthy in the statistics department, but it’s not up there with the others. (Your math might be off — I get 237.37, not 237.36.)
Cone isn’t a misprint. They made a similar claim about diabetes. Also, even if they meant to say something else, this is what they said. When I was on Jeopardy there were several instances in which I knew the right answer, but Alex only added money to my score if I actually said the right answere.
I’ll write more on the others later.
Hi Matthew, me again. Keas didn’t say we as a country spend $700B too much on health care. If they had said that, I would certainly agree with them. They said that workplaces (meaning employers) spend $700B too much on health care. But they don’t even spend that much on healthcare one those aforementioned items are removed, making it impossible to save that much. Remember, this is a company that says workplace stress is so bad that no one has below average levels of stress. No idea how their fifth grade math instructor obtained a teaching certificate.
And I thought it was generous of me to assume that Healthiest You’s ER visits were avoided in the same proportion as PCP visits, even though by definition most ER visits are for much more serious items and are therefore less avoidable. In the last 30 years I’ve visited the ER maybe 8 times. Unless someone could suture me over the phone, I doubt those visits were avoidable with a 1-800 number. You’re assuming they avoid way more ER visits with phone calls. Seems like a stretch…and doesn’t explain all their other squirrelliness.
I wouldn’t be spending your million bucks just yet.