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Is Bravo Wellness Running Out of Money?

USA Today and Kaiser Health News just published a terrific story on the hazards of overscreening, overtesting, and pry-poke-and-prod programs.

It revealed how screening all employees every year–and then sending them in for checkups –makes no sense on any level, and is contrary to all guidelines and literature.  All it does is lead to hyperdiagnosis.  Hyperdiagnosis is overdiagnosis on steroids.  Instead of being the unfortunate result of good-faith efforts to figure out what is wrong with a patient (that’s “overdiagnosis”), hyperdiagnosis is the breathless reporting by wellness vendors on how many sick employees a company has, and how they will have an “epidemic” of something-or-other unless they force employees to get coached etc.

Hyperdiagnosis is also, however, the wellness industry’s bread-and-butter, so naturally wellness vendors defend this practice.  In this article, Bravo Wellness CEO Jim Pshock was quoted as saying:  “The hope is that the program will get people to proactively see their physicians to manage their health risks. Yes, this will, hopefully, mean more prescription drug utilization and office visits, but fewer heart attacks and cancers and strokes.”

The only innocent explanation for this comment is that Bravo canceled its subscription to the internet to conserve cash.  Seems that all the literature, easily searchable online — plus Choosing Wisely — says that “proactive” annual checkups are a waste of time and money and will not prevent heart attacks and strokes, and certainly not cancers.  (They will, however, make drug use and physician office visit expense increase.  That much he got right.)  A quick Google search would have revealed that to him…if only he had access to Google.

This whole thing would be pretty amusing except that Bravo’s business model includes fining employees for not getting checkups that are more likely to harm them than benefit them, according to the New England Journal of Medicine.  Harming employees is where the joke ends.

Otherwise, the only other explanation for this comment is that he is — heaven forbid — lying.  And we would be pshocked, pshocked to learn that lying is going on in here!

Quizzify Q in B and W

Why would any smart person waste time & money on low-value medical care? Better not ask Bravo.

Therefore, since a wellness vendor would never lie, Mr. Pshock must have allowed his internet subscription to expire.  We’d urge all readers to donate early and often to Bravo Wellness to help them keep the lights on.

 

 

The Graco-Goetzel-Bravo plot thickens…more twists and turns

The Graco-Goetzel-Bravo-Hopkins case study is turning into another Nebraska fiasco.  As with Nebraska, the numbers all contradict one another.  But unlike Nebraska, there has as yet been no admission of deliberate lying in the Graco case study. That’s why Graco only earned an honorable mention in the Koop Awards, instead of winning one outright like Nebraska did.

Consider Bravo’s case study on Graco covering the exact same population over the same period as Ron Goetzel’s study.  Let’s assume Ron Goetzel is right in that the wellness program should be measured from 2009 rather than 2008, when the program started.  (Bob Merberg’s brilliant analysis points out the cherrypicking of the date has a huge impact on claimed success, but let’s concede this start date choice to Ron, and use 2009 according to his wishes.)

Bravo’s case study displays the PMPM costs by year.  The first thing to note is, they list employee healthcare costs at $328 PMPM, which actually makes sense, instead of the $190 PMPM in the Hopkins report.  I don’t know why these two figures, purporting to cover the exact same population in the exact same period, are completely inconsistent, but I do know that $190 PMPM is an impossible figure, as any population health expert knows.  (“Plausibility checking” would have caught that error but Ron has never taken our course in Critical Outcomes Report Analysis, which would have covered plausibility-testing and likely prevented him from making such a rookie mistake.)

Second, Bravo lists children’s healthcare costs in this report as well.  Funny thing:  over the same exact period in which Mr. Goetzel was claiming that the wellness program was responsible for controlling employee participant costs, children’s healthcare costs trended better than wellness participants’ costs.   Mr. Goetzel obviously had access to this children’s cost trend data (we had no trouble finding it, thanks to Bob Merberg) but elected to — get ready to fall out of your seats — ignore it.  The wellness ignorati rarely step out of character.

This children’s cost trendline appears to invalidate the entire Goetzel-Johns Hopkins conclusion that the healthcare cost trend was due to the wellness program, since not one single child participated in the wellness program.

graco childrens

For some reason Graco’s spouses cost about $7000 apiece a year.  We’ll leave that for someone else to dissect.

As an aside, if anyone thinks they recognize the name “Bravo Wellness” from an earlier posting, it’s because they do.  Bravo is the outfit that brags about their ability to save employers money by fining employees.  Their website is disproportionately about their appeals process when those fines are levied.  This sounds like a company that does wellness to employees instead of for them.

Not sure how bragging about fining employees is consistent with the positive culture that Mr. Goetzel says Graco has, but maybe I’m missing something here.

 

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