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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.
For this year’s Deplorables Awards, I think we’re gonna need a bigger basket. As a result, this will be a two-part series.
Why? Because we need to accommodate all the bad hombres and nasty women who have subverted the perfect elegant philosophy of wellness into nothing more than a profit machine, with no regard for integrity, customers, or employees.
Yes, 2016 was a year in which a record number self-anointed industry leaders gave lying and cheating a bad name. In that sense it was no different from any other year, though 2016 offered even more good news and bad news:
- The bad news: not content with merely lying and cheating, this cabal branched out into harming employees, fat-shaming, and pure misanthropy;
- The good news: wellness did succeed in one way, as a “natural experiment” showing what happens in healthcare if being a provider requires no credentials beyond a GED, a driver’s license, and a pulse.
Indeed, whatever mathematician first postulated that everyone can’t be worse than average had apparently never experienced the wellness industry. (Exceptions of course, being the few that, like Quizzify, are validated by the Validation Institute or have accepted the Employee Health Program Code of Conduct.)
#10 Optum and Wellsteps (Runners-Up); Healthmine (winner)
What do you do when you need to defend your blatant disregard of the US Preventive Services Task Force guidelines? Simple — you blame your customers. Optum’s Seth Serxner said: “Customers make us” do this. Optum’s PR hack said I was making Optum “look bad.”
I said: “Sure, I’ll apologize. Just name one account that will admit to insisting on paying a higher price than you wanted to charge, in order to screen the stuffing out of their employees.” Never heard from them again.
Healthmine trumps them both, though. They wrote an entire anti-USPSTF rant based on such elementary misconconceptions about the benefits and costs of screening that I’ll be using this as a teaching tool in my course on Critical Outcomes Report Analysis. Not the advanced class. Not even the standard class.
More like the remedial one, where, unlike Healthmine, all you have to do is spell “US Preventive Services Task Force” correctly.
#9 The Johnson & Johnson Fat Tax gives misanthropy a bad name. (Honorable mentions to Vitality and Ron Goetzel.)
Misanthropy, greed, and weight-shaming provided the wellness industry with its key “talking points” in 2016. And nothing combined the three like the Johnson & Johnson Fat Tax fiasco. The point of the (apparently stillborn) Fat Tax was to stigmatize overweight employees, by “pressuring” (their word) companies into disclosing to shareholders how many fat employees they had. That in turn would somehow pressure these employers into spending more money on wellness vendors.
It’s not altogether clear what that disclosure would do for the actual overweight/obese employees, but somehow this disclosure was supposed to allegedly benefit shareholders. Indeed, the Fat Tax cabal is right about that in one respect: this disclosure would benefit shareholders — it would indicate to shareholders that they ought to unload their shares in a hurry, because management just disclosed it is stupid.
Vitality was a co-conspirator in hatching this scheme, which is ironic because they admitted they couldn’t even get their own employees to lose weight. And where you hear the word “stupid,” can the name “Goetzel” be far behind? This whole thing was his idea, based on the notion that “playing doctor” with employees makes stock prices increase. However, his claim that companies with Koop Award-winning wellness programs outperformed the market can easily be invalidated by anyone with a calculator and a triple-digit IQ.
#8 IBISWorld: How is wellness different from King Midas and Gold?
Here are links to the postings on the most hilarious report we’ve ever read about the wellness industry:
- New wellness industry report costs $5400 (but that includes shipping)
- New report raises the bar for cluelessness in wellness
- How is wellness different from King Midas and gold?
The answer to the question in the header? Everyone who touches wellness turns to stupid. Not just garden-variety stupid. More like fifty shades of stupid.
Mind you, most wellness industry leaders don’t need to touch anything first before reaching that endpoint, but occasionally a company like IBIS, with no prior experience in wellness, ventures into this field — and that’s where the fun starts. These IBISWorld Young Turks (literally–the writer is named “Turk”) are so excited about this industry, they practically speak in tongues:
Wellness firms may offer employers stress management courses and sessions that offer music therapy, aromatherapy, Tai Chi, and post disaster stress reduction through coaching.
Government-funded initiatives that promote wellness to cut costs related to chronic ailments (e.g., obesity and diabetes) has further exacerbated many businesses movement toward purchasing corporate wellness services.
And my own personal favorite:
The industry provides wellness programs to businesses across the United States, including small, medium and large businesses in the private sector and businesses in the public sector.
“Businesses in the public sector”? I knew that many of our legislators are for sale but I didn’t realize they had incorporated.
Healthfairs USA doubled down in 2016 on lying and cheating with an elegant new strategy: insurance fraud. They not only harm employees, but bill insurance companies directly for the privilege of paying for those harms. They offer cancer tests that are “99% accurate” (hence their multiple Nobel Prizes), and over-the-counter nutritional supplements…all of which are covered by most insurance companies because they get a doctor to sign a claim form.
Disclosure: we aren’t entirely sure that billing insurance companies for USPSTF D-rated screens and worthless, possibly harmful, pills constitutes insurance fraud. Our opinion is probably no more accurate than their cancer tests.
In 2014, Aetna decided to “play doctor” with obese members of self-insured customers by telemarketing their employees to pitch very controversial high-priced drugs whose sales are “flailing” because almost no patients seem to want to take them. Among other things, Aetna said these drugs increase productivity even though right on the label, the drugs warn that they could reduce productivity (attention span and language facility).
Not content with the warm welcome that scheme brought them, in 2015 they introduced a DNA-based wellness program and claimed a whopping $1464/participant in savings. What put the whop in that whopper were these two tidbits. These savings were achieved:
- in the first year alone;
- on participants who were not actually sick to begin with. (You couldn’t qualify for this study if you were already sick.)
The reason Aetna needed to fabricate such a high savings figure is that the wellness field requires ROIs greater than 2-to-1, and this DNA test sells for $500/employee. So you need to show savings between $1000 and $1500.
Also, in 2015, we were able to show the program was completely ineffective, a convincing enough demonstration that one of the board members of the journal that published the study with the $1464 claim publicly apologized.
What do you do when it turns out your science is all wrong (news flash: being told you have a gene for obesity doesn’t motivate you to lose weight) and your math is all wrong? Of course, you apologize and retract the study, and offer to return the money to the lucky few companies that signed up for your program.
Haha, good one, Al. Obviously, like all the other Deplorable Award-winners on this list, you sell your snake oil harder than ever, and that’s what gets them on the 2016 list. Whereas in 2015, they could use the dumb-and-dumber defense, this year they know the numbers don’t add up and yet they are still flogging it.
Don’t miss the slam-bang conclusion as we count down to #1. Will Ron Goetzel retain his crown, or will he be unseated as the wellness industry’s #1 Deplorable?
Yes, we realize he has already appeared on this list at #9, but many lists feature the same entities making multiple entries. For instance, the Beatles once held positions #1 through #5 in Billboard’s Top 40, so it can be done.
Not that I want to put any ideas in his head.
Us. Bestselling author Nortin Hadler MD. And now RAND’s wellness uberguru, Soeren Mattke PhD.
What do we all have in common? Calling Aetna out on its phony savings from collecting its employees’ DNA to predict their future health. (Curiously, insured members who want a DNA consultation with a real doctor will find that it is not a covered benefit.)
Let’s make one thing clear: Aetna’s DNA program savings are invalid, period. It is not possible to save $1400/person (or any amount) in the first year (or any year) of a wellness program. And especially not if the people in the program were healthy to begin with, as these employees were. The cohort had a couple of risk factors for metabolic syndrome, which itself is a grouping of risk factors that might lead to a cardiometabolic disease. In other words, they were at risk for being at risk. You and I should be so healthy.
I suspect the reason Aetna picked $1400 as the fabricated first-year savings figure is that the program costs $500, and when HR people ask: “What’s your ROI?” you want to be able to respond: “Between 2-to-1 and 3-to-1” — and hope you are dealing with people who will actually believe whatever they are told. Where are these people? Trump rallies? I can’t find any. When we market Quizzify, even though our savings are 100% guaranteed, our prospects still make us demonstrate exactly where the savings will come from and how they will be measured. And the only thing guaranteed about this Aetna program is that it will lose money.
If you read the article carefully, as we did (unlike the peer reviewers), it actually self-invalidates, just like most other wellness vendor studies. There is no meaningful difference in health indicators between the control and study groups at the end of the period. Hence there can be no savings attributable to the program.
The logic is also rather twisted. Literally, they claim that if they tell you that you’ve got a gene for obesity, you’ll try harder to lose weight. Come again? When I was a kid, I saw a horserace on TV and told my mother I wanted to be a jockey. But my mother pointed out that at my growth trajectory I was likely to reach 6’5″. (I did.) So I immediately gave up that dream. Had I applied Aetna’s logic instead, I would have doubled down on riding, and maybe put a brick on my head.
Highlights of Dr. Mattke’s Criticism
Along the same themes as myself and Dr. Hadler, Dr. Mattke wrote a Letter to the Editor of the Journal of Occupational and Environmental Medicine (JOEM). Keeping in mind that because Dr. Mattke is employed by a nonprofit whose entire credibility depends on its reputation for neutrality and objectivity, it’s fair to infer that, however critical his comments, he is being very muted in his critique.
Also–though fairly discredited due to this and other obviously invalid articles — the JOEM is an “academic” journal, with standards for decorum that preclude calling people “losers” or accusing them of having small hands. So Dr. Mattke is doubly constrained in this letter. One can only imagine what he really thinks.
Four key points:
(1) He “congratulates” Aetna on designing a rigorous randomized control trial (RCT) to begin with (they did), but “wishes they actually applied that rigor to the analysis”;
(2) He points out that instead of following through on that design, they compared participants to non-participants. He says they need to look at “the eligible population, not the cohort of the eligible population that volunteered to join.”
(3) Only 11% of the invited employees joined (would you give your DNA to your employer?). “This highly selected group may differ in important observable and unobservable characteristics from the population, posing a substantial threat to validity.”
(4) “The study didn’t report the cost of the intervention.” Hey, if my wellness program cost $500 per participant, I wouldn’t either. ( I know it’s not always about us, but Quizzify costs $38 or less.)
He has other points as well, but with my 60-year-old eyes, they are hard to discern from the free online version of the letter, and I’m sure as heck not going to pay for it. Now that I’ve seen enough examples of what they use it for, the idea of sending money to these JOEM people is about as appealing to me as donating to Trump’s campaign.
Time for Aetna to Fess Up
Aetna is a fine organization in other ways. They do a lot of good things and have other excellent initiatives, in other divisions of the company. They should just call this DNA fiasco a mistake and move on. Instead they’ve been insisting that the figures are real. At some point a “mistake” becomes a lie, and Aetna is rapidly reaching that point.
Aetna’s Employee DNA Collection Obsession Combines Junk Science, Junk Arithmetic, and Junk Integrity
It seems like most of my columns should or do start with a line like: “Just when you thought it couldn’t get any worse…”
Well, this time it really can’t get any worse. Aetna’s obsession with collecting employee DNA has truly reached the pinnacle of junk science, junk arithmetic, and junk integrity. (Not to mention junk privacy, as our guest-posting privacy expert noted.)
Junk Science and Junk Arithmetic
By way of background, we have already chronicled not just the junk science of using employee DNA to predict and prevent diabetes, but also the inability of their partner organization, Newtopia, to understand fifth-grade math. Nonetheless Newtopia wants us to trust their understanding of PhD-level science — and also trust them to store our DNA. (Like many vendors who were absent the day the teach taught arithmetic, they took their fuzzy math off their website following our instructional posting. We never received a thank-you note for this free consult, in case you were wondering.)
That same posting covered their reference site-from-hell, in which only a small fraction of employees participated, and the customer complained about the price tag, which is the wellness industry’s highest, @$500 per employee.
That price tag means claiming an ROI at the industry standard level of 3-to-1 requires fabricating far greater savings than wellness vendors usually fabricate. For instance, Ron Goetzel says programs should cost $150 and save $450. (Note: in all fairness he doesn’t say that any more. After our initial exposes, he retreated to a 1-to-1 ROI, as he admitted during our debate. Most recently he’s even backed off that. Now he says most programs fail.)
But showing that industry-standard ROI on a $500 program requires concocting savings approaching $1500/employee in the first year alone, an industry record. And did we mention that ROI was achieved on employees who were specifically selected for having nothing wrong with them to begin with, other than the possibility of getting metabolic syndrome at some point later in their lives? (Or as we originally wrote, these employees were “at risk for being at risk”.)
Oh, yes, and there was no clinically or statistically significant improvement in the set of health indicators that Aetna measured? And that Aetna was a co-author of the HERO study showing wellness loses money?
We said all this — posted it right on The Health Care Blog. Then the most amazing thing happened. One of the members of the editorial advisory board of the Journal of Occupational and Environmental Medicine (JOEM) –a trade journal with a long and glorious history of publishing suspect claims about the wondrous world of workplace wellness — essentially apologized in the comments. Specifically, he agreed the study never should have gotten past peer review. This wasn’t just any member of their board. This was the only member, Nortin Hadler, who has an actual national reputation in population health, having written many successful, influential and well-reviewed books on screening, overtreatment, and the harms of pushing people into the medical system.
So far, all we have noted is that Aetna has combined junk science with junk math. Next is where the junk integrity comes in. Just to set the stage by recapping the points above:
- Aetna must have already known their outcomes are made up because no one in population health –and very few people not in population health — could possibly think you could save $1400/person on healthy people in 12 months without doing anything other than assigning an “inspirator” to tell them to eat more broccoli, DNA or no DNA;
- They did already know wellness loses money because they co-authored the HERO report saying wellness loses money;
- If they genuinely had no idea their outcomes were made up, they would have learned that when they read my proof — a mathematical proof, not open to dispute like a scientific proof;
- And if they still doubted it, they could have read the comment by Nortin Hadler.
What does a wellness vendor do in these situations? Simple. It recalls the words of the French General Ferdinand Foch: “My left is collapsing. My right is in retreat. I shall attack.”
Their PR department called Bloomberg, had them assign a reporter completely new to the wellness beat, and then wheedled a complete puff piece out of her, crossing their fingers that the reporter wouldn’t google this thing, which would have created a front-page story.
In the Bloomberg paean, Aetna’s thesis is that best way to motivate people to lose weight is to tell them their genes make it very difficult to lose weight. If that logic doesn’t resonate with you, you have company. Here is a quote from that article — one single quote — that basically invalidates the entire remainder of the story, puff piece or not:
George Annas, a bioethics professor at Boston University, cautions against reading too much into DNA tests. “The chance that they have a genetic test that can determine if you’re prone to be fatter than other people is very, very unlikely,” he said. “What [Newtopia] really seems to be saying is that if you tell people that you have a genetic condition that may predispose you to be overweight, that may motivate people.” For some, he said, DNA testing could have the opposite effect: If someone is predisposed to gaining weight, then why bother dieting or exercising?
Speaking of things which have almost no chance of happening, here are two more. First, we’ve asked JOEM for a formal retraction, given that the study was admitted by Dr. Hadler (who hadn’t seen it pre-publication) to be blatantly wrong. Second, Aetna isn’t likely to apologize either, any more than they did for their last foray into wellness, which involved pitching some of the most controversial drugs on the marketplace to patients who weren’t even sick and didn’t ask for them. Instead, they will probably double down on DNA.
The behavior of both JOEM and Aetna can be explained with an old Chinese proverb: “When you are riding a tiger, the hardest thing is getting off.”
Our year-end jubilee has so far featured lists of the worst vendors and the funniest vendors. To close out the year on a more serious note — if for no other reason than to show we are indeed capable of treating the extremely serious topic of wellness with the Extreme Seriosity it deserves — we’ll list the most influential posts of the year.
In terms of views, the top spot is shared by our two smackdowns of worthless employee weight control programs. Our peer-reviewed smackdown, in the American Journal of Managed Care, should end the year at #1 on their list too, of the most-viewed articles. I say “should” because a lot will depend on people clicking through on it today or tomorrow (hint) and at least pretending to be enthralled by it, even though it is a bit dry.
The Reader’s Digest version got picked up on Huffpost. Absent the constraints of peer review, we took the gloves off. Our reward is that we are the most-widely read Huffpost of the year on wellness.
If “most shocking” is the criterion, the winner is our recent evisceration of Aetna’s employee DNA collection program. This one is best viewed here, at Insurance Thought Leadership, but was also picked up by The Health Care Blog. You know the old Woody Allen joke about the two ladies in the Catskills? One of them says: “You know the food here is terrible.” The other replies: “Yeah, and the portions are so small.”
Collecting employee DNA is a shockingly stupid idea on many levels — the kind of program that someone would make up in order to make wellness look bad, but we didn’t have to. As if that weren’t enough, Aetna also decided to fabricate outcomes. And because the program was so expensive, to show a 2-to-1 ROI they had to concoct $1464/person in savings in the first year alone–on employees who, by Aetna’s own admission, weren’t even sick. One of the editorial board members of the journal that published it wrote that it should never have passed peer review.
The biggest category — and the one where it would be hardest to pick a winner from among the many worthy entries — would be: “Most likely to show Ron Goetzel making things up.”
You might vote for yesterday’s post on how Ron said wellness programs increased stock price valuations when in reality they reduce stock prices. (Ron also misused the word “valuation”. It is not a synonym for “stock price.” In all fairness, the only people who would be expected to know the distinction would be people who write articles about stock valuations that are actually intelligent and insightful.) However, he probably didn’t make up that conclusion. I reviewed 5 years and compared each company to its relevant sector index. By contrast, he reviewed a longer period and has probably never heard of a sector index. We reached opposite conclusions about the correlation of wellness programs and stock prices. The real answer, though, is that wellness programs have absolutely no meaningful effect on either stock prices or stock valuations. If they did, one securities analyst somewhere, writing a report on one company anywhere, would have noted it. Not to mention that a hedge fund would have made a business out of buying shares in companies with the best wellness programs.
Another candidate would be our expose of the HERO report, in which we observed that HERO and their cronies accidentally admitted — a la Robert Durst — that wellness loses money. Despite co-signing this document — a document that required “two years and countless hours” of collaboration, and in which the word “consensus” appears 39 times, Ron insisted during our debate that he had nothing to do with anything in this document that he himself didn’t write. (Of course, in the debate he also insisted that he had nothing to do with Penn State — meaning he just wandered into their press conference by mistake, or maybe I am confusing him with another Ron Z. Goetzel.)
Nonetheless our vote goes to the Unified Theory of the C. Everett Koop Award, in which we reverse-engineered the mathematically impossible formula (the “Goetzel Factor”) that Ron and his integrity-challenged cronies use to anoint award winners, whose programs are almost invariably hilarious and show a complete lack of understanding of the way healthcare and healthcare math work. To paraphrase the immortal words of the great philosopher Samuel Goldwyn, “If Dr. Koop were still alive, he’d be rolling in his grave.”
Whoever concluded that more is learned from one bridge that falls down than 100 that stay up did not included Aetna’s data in their calculations: 2 major bridge collapses, nothing learned.
Aetna first gained notoriety in these pages — and in our book, Surviving Workplace Wellness, and on The Health Care Blog — for being the first health plan to pitch expensive name-brand drugs to its members. Not just any members, but members who weren’t sick — and that someone else was insuring, since there wouldn’t be any savings.
And not members who requested them, but members who Aetna pitched them to, members who mostly didn’t want them. And not just any drugs, but drugs that were/are so controversial that they became the subject of an essay in the Journal of the American Medical Association concluding they never should have been approved. (As a sidebar, while all of wellness is claimed, mostly falsely, to increase productivity, one of these drugs says right on its label that it reduces productivity, specifically impacting memory, attention and language. And yet Aetna insisted productivity would increase. Using a drug that reduces productivity to increase productivity truly puts the “off” in “off-label” use.)
So what did they learn from a failed wellness program that was expensive, intrusive, ineffective, and incredibly unpopular using a third-party that doesn’t seem to know what it’s doing? Their takeaway was: “Let’s come up with a program that’s even more expensive, intrusive, ineffective, and incredibly unpopular using another third-party that doesn’t seem to know what it’s doing…and, for added measure, let’s lie about the outcomes.”
And thus they hatched their scheme to bring DNA surveillance into the workplace. Not to identify possibly useful mutations, but to estimate the risk of diabetes and heart attacks. And not: “We’ll cover this testing if you go to the doctor and together decide whether to order it.” Rather: “You’ll forfeit money if you don’t agree to this, and our partner gets to keep your DNA and re-sell it.”
We’ve already covered the intrusiveness, and fact that their partner, Newtopia, seems unable to understand basic arithmetic and science. We’ve also covered their reference-site-from-hell, which didn’t exactly embrace this program.
Most recently, we’ve covered the lying-about-outcomes angle. Because the program is going to sell for up to $700, Aetna had no choice but lying– they needed to “show” $1400 in savings to achieve a 2-to-1 ROI. Scroll down to the comments — the most respected member of the editorial board of the journal that published their outcomes now says they never should have published the study. (He himself hadn’t reviewed it.)
But all of our exposes are trumped by David Shaywitz. Writing in Forbes, he points out that the entire idea of using genetics to predict and manage obesity-related illness is, to use a technical genomics term, stupid.
We’d urge reading the whole posting (though he doesn’t get into Aetna/Newtopia until page 2), but here are the takeaways:
(1) “The three variants examined by Aetna/Newtopia explain a very very small fraction of genetic risk;”
(2) “Even if you carry the harmful genes, there is no obvious course of action” different from standard diet-and-exercise.
Shaywitz — who may have done more research before writing this column than Aetna did before starting this program — also clearly distinguishes this type of genetic information from identifying (for example) the BCRA1 mutation, which might actually be useful. “Useful” is not a term found often in wellness programs so you won’t be surprised to hear that Aetna doesn’t include BCRA1 mutations in theirs.
What are the takeaways?
First, Aetna’s wellness programs need some adult supervision. Programs like these should never be allowed out the door. Of course, not offering wellness is not an option. It is way too profitable, and if they don’t, someone else will. However, there are plenty of other ways to rip off employers and humiliate employees that are less expensive and less intrusive than the two Aetna has come up with.
Second, Quizzify is making a bet that — especially because Aetna is not hiring any of them — there are a lot of smart people still out there, people who would prefer to pay a low price for an employee health program that is non-intrusive, fun, guaranteed to save money, Intel-GE Validation Institute-validated, and carries a Harvard Medical School imprimatur than pay a high price for programs that don’t work and employees don’t like.
Yes, we know it’s not always about us, but we appreciate Aetna’s efforts to make us look good by comparison.
If corporate wellness didn’t already exist, no one would invent it. In that sense, it’s a little like communism, baseball, pennies, or Outlook.
After all, why would any company want to purchase programs that damage morale, reduce productivity, drive costs up…and don’t work 90%-95% of the time? And that’s according to the proponents. What the critics say can’t be repeated in a family publication such as ours.
Still, those are the employers’ problems. However, the employers’ problems become the employees’ problems when employees are “voluntarily” forced to submit to programs that are likely to harm them. (As the New York Times recently pointed out, there is nothing voluntary about most of these programs.)
Recently, the head of United Healthcare’s (UHC) wellness operations (Optum), Seth Serxner, admitted that Optum’s programs consciously ignore US Preventive Services Task Force (USPSTF) screening guidelines. Lest anyone was expecting a wellness vendor to actually apologize for bad behavior, Mr. Serxner went on to blame employers for insisting on overscreening and overdiagnosing their own employees…and (by implication) overpaying for the privilege of doing so. “Our clients make us do it,” were his exact words.
Funny thing, we first asked our own clients who use Optum about why they turned down Optum’s generous offer to do more appropriate screenings at a lower price. None of them remember receiving this offer. Go figure. Then a UHC executive wrote and said we were making them look bad. I softened some of the language (like the paragraph below), and said I would happily retract the whole thing if indeed they could introduce me to just one customer — one out of their thousands — who recalls insisting on overscreening and overpaying. Never heard back…
United Healthcare isn’t alone in harming employees. They are just the first company to admit it, and far from the worst offender, as the harms of overscreening for the usual suspects (glucose, cholesterol etc.) don’t hold a candle to some of the more creative ideas listed below. Here, in order, are the ten vendors most likely to harm employees in the name of wellness.
Healthmine’s CEO, Bryce Williams, isn’t blaming the victim like United did. He has publicly announced that Healthmine flouts clinical guidelines. He says he is right and everyone else — specifically including the “US Preventative [sic] Services Task Force” — is wrong. A real doctor acting on this pronouncement might be risking his or her license. Fortunately for Mr. Williams, being a wellness vendor doesn’t require a license, so regardless of the harms a wellness vendor inflicts on employees, no one can confiscate it because there is nothing to confiscate..
In addition to not misspelling the name of the group he is attacking, we might also recommend that he not misquote the sources on which his faulty argument is based. We’re just sayin’…
For starters Mr. Williams declares: “One out of every two people in America has at least one chronic condition according to the CDC…”
Here’s what the CDC really said: “One out of every two adults has at least one chronic condition.” And if you dig deeper, you’ll see that this list of chronic conditions cited by the CDC includes arthritis, mental illness, eye disorders and asthma, none of which Healthmine’s hyperscreening is going to reveal.
He also claims that “chronic diseases account for $3 out of every $4 spent on healthcare.” Here’s what the CDC really said: $3 out of every $4 “is spent on people with chronic conditions.” That is a much broader statement. It would include someone with borderline hypertension giving birth. In any event, we long ago eviscerated Mr. Williams’ cherished myth and just this week showed that essentially none of the top 25 hospital admissions has anything to do with screening, broccoli, or Fitbits.
The employee who recorded this blood pressure is essentially dead. Cerner’s diagnosis? Blood pressure “higher than what is ideal.” Cerner’s recommendation? “Talk to your healthcare provider.” A real doctor’s recommendation? “Call an ambulance. The guy barely has a pulse.”
This is not a random mistake. This is the front cover of their brochure.
USPSTF Screening age recommendations aren’t minimums. They are optimums, the ages at which screening benefits might start to exceed harms, even if they still fall far short of costs. Otherwise you are taking way too much risk. This is especially true for colonoscopies, one of this program’s favorite screens — complications from the test itself can be very serious.
Your preventive coverage is not supposed to be “greater than health care reform guidelines.” That’s like “rounding up twice the number of usual suspects.” And you aren’t supposed to waive “age restrictions.” That’s like a state waiving minimum “age restrictions” to get a driver’s license.
Yet despite or perhaps because of this and other examples of total cluelessness and pure dishonesty, this program won a C. Everett Koop Award for excellence in wellness, not to mention the unwavering support and admiration of leading wellness apologist Ron Goetzel.
Both these outfits pitch exactly the opposite of what you are supposed to do in weight control: unhealthy crash dieting. Attaching money to this idea and setting a start date makes it even worse: along with crash-dieting during these eight weeks, you’re incentivizing employees to binge before the initial weigh-in.
Here is ShapeUp:
Here is Wellness Corporate Solutions:
Both also made up outcomes. In ShapeUp’s case they had to rescind their “findings” after their customer, Highmark, skewered them in the press. And neither seems to care that corporate weight control programs are proven not to work.
In addition to its dystopian wellness program that collects employee DNA (partnered, ironically, with a company called Newtopia) and then makes up savings, Aetna owns the distinction of launching the only wellness program whose core drugs are specifically editorialized against in the Journal of the American Medical Association. This would literally be the most harmful wellness program ever, except that the only employees being harmed are (1) obese employees who (2) answer the phone when their employer’s health plan calls them to pitch these two drugs; (3) have a doctor who would willingly prescribe drugs that almost no other doctors will prescribe due to their side effect profile; and (4) not google them. Presumably in combination this is a very low percentage of all employees.
The good news is that these drugs, Belviq and Qsymia, should be off the market in a couple of years because almost no one wants to take them, so the harms of this Aetna program should be self-limited.
Star Wellness offers a full range of USPSTF D-rated screens. “D” is the lowest USPSTF rating, and means harms exceed benefits. Star gets extra credit for being the first wellness vendor to sell franchises. All you need is a background in sales or “municipal administration” plus $67,000 and 5 days of training and you too can poke employees with needles and lie about your outcomes. Is this a great country or what?
Also, their vaccination clinic features Vitamin B12 shots. We don’t know which is more appalling–routinely giving employees Vitamin B12 shots, or thinking Vitamin B12 is a vaccine.
Angioscreen doesn’t have the most USPSTF D-rated screens. In fact, it offers only one screen in total, for carotid artery stenosis. That screen gets a D grade from USPSTF, giving Angioscreen the unique distinction of being the only vendor 100% guaranteed to harm your workforce.
Angioscreen’s other distinction is that they admit right on their website that this screen is a bad idea. This is probably literally the only non-tobacco company in America to admit you are better off not using their product.
Total Wellness loses the wellness industry’s race to the bottom only because the winner, HealthFair, has out-stupided them. However, in addition to the usual assortment of D-rated tests, they offer screens that the USPSTF hasn’t even rated, because it never, ever occurred to them that anyone would ever use these tests for mass screening of patients or employees. Criticizing the USPSTF for not rating these “screens” (CBCs and Chem-20s) would be like criticizing Sanofi-Aventis for not warning against taking Ambien after parking your car on a railroad crossing.
Let’s leave aside for a fact that the majority of their other screens are harmful too, and focus on their screening for H.pylori, the strain of bacteria associated with ulcers. To say it is a stupid idea would be an understatement. As Clarice Starling replied when asked if Hannibal Lecter was a sociopath: “They don’t have a word for what he is.”
Likewise, this idea is too stupid for words, certainly for the small number of words we can allot to this overview blog. Visit our full treatment here. In a nutshell, the majority of us harbor H.pylori–without symptoms. It may even be beneficial. The screening test is expensive and notoriously unreliable, and the only way to get rid of it is with some very powerful antibiotics, a treatment rarely even used on patients with symptoms due to its inconvenience, ineffectiveness and potential long-term side-effects.
A Modest Proposal
So how should we as a country protect employees from these harms? Our policy recommendation is always the same, and very non-intrusive. We aren’t saying wellness vendors shouldn’t be allowed to harm employees. That would be too radical to ever pass Congress. If it did, the Business Roundtable would pressure the White House again, to preserve their hard-earned right to medicalize the workplace, and literally and figuratively, show employees who’s boss.
Instead, we recommend merely a disclosure requirement. The harms of screens or (in United Healthcare’s case) screening intervals that don’t earn at least a “B” from USPSTF should be disclosed to employees, and employees should get a chance to “opt out” into something that isn’t harmful (like Quizzify, perhaps?) without suffering financial consequences. Call us cockeyed optimists, but we don’t think employers should be able to force employees to choose between harming themselves and paying fines.