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In Kansas City, yet another candidate runs against forced wellness

No sooner did I post Congressional Candidate Runs Hard Against Forced Wellness than I found another candidate doing exactly the same thing.

This candidate, Paul Kramschuster, is running for a school board in Kansas City.  Here is his website.  Teachers in that city’s Center School District have been harassed and forced into wellness, at considerable expense to their school district — which has nothing to show for it other than bills and annoyed employees. Neither Blue Cross of Kansas City nor Healthmine nor their broker, CBIZ, has been able to demonstrate any outcomes.

While a Republican won an election running against wellness in Pennsylvania and a Democrat is running against it in North Carolina, this Kansas City election is nonpartisan. No party affiliations involved. It appears that independents feel the same way about wellness as Democrats and Republicans.

Here are some tidbits from Mr. Kramschuster’s website:

Another argument made by the district’s insurance broker, which is accepted uncritically by the district, is the recommendation that the district purchase a $70,000 wellness program for the district.  The main feature of this program is a blood test and questionnaire asking employees about their drinking habits, their history of disease and what medical tests they have had or plan to have.  Most employees do not want this program and would prefer not to have it. 

The broker, CBIZ, is collecting a nice fee from the district’s taxpayers, who might have otherwise assumed that their school taxes were being spent on educating their children:

In the early years of this program, employees did not participate, and so in order to induce more employees to participate (by giving up their medical privacy), so as to increase the broker’s profit, the broker recommended the district to pay each employee that gives up her medical privacy 

Even the prospect of a bribe doesn’t excite the teachers…

The amount of the payment is $600.  In order to receive this payment, many more employees do participate, but they are very unhappy about it.  It feels mandatory/coercive, and it feels morally wrong.

…and of course the school board has been completely unaccountable:

No one on the board, or in central office, is asking the critically important question: “How does paying teachers to give up their medical privacy serve students?”  The answer, of course, is that it doesn’t — the district is serving its broker, rather than expecting its broker to serve it. 

The school board was given the option of swapping out this onerous program for Quizzify, which teachers love (and they would still earn their $600 by learning how to purchase healthcare more wisely) because of its Q&A format.

However, because it would have cost the District only about 1/7th of what the Healthmine program costs, the broker would have made much less money. It was turned down. Taxpayers are now on the hook for the full $70,000, plus the cost of potential lawsuits…

…I did do some checking: the CBIZ/Healthmine program is not validated by the Validation Institute, neither Healthmine nor CBIZ has signed the Ethical Wellness Code of Conduct, and no member of the school board seems the slightest bit aware that this is exactly the type of program that has been proven to be a complete waste of money.

Or that this is exactly the type of program which, on January 2nd, will be disallowed…and will open up the district and its taxpayers to lawsuits from these very same harassed and demoralized teachers.

Did Healthmine’s Credibility Just Collapse?

A good rule of thumb: people who challenge the US Preventive Services Task Force — but lack the requisite knowledge, credentials, relevant education, support in the literature and any rationale to do so other than protecting their own revenues — should at least spell its name correctly.

Overscreening is central to the wellness vendor business model.  If screenings were to conform to US Preventive Services Task Force (USPSTF) guidelines designed to balance harms and benefits in the best interest of the public, the whole industry would collapse.

There are three ways wellness vendors can preserve their overscreening revenue stream against this onslaught of the USPSTF’s scholarship and research. The first is simply to shut up and hope no one notices.  That strategy works quite well, because when it comes to screening recommendations, many human resources directors trust their advisers, often an Animal Housetype mistake  [WARNING: hyperlink rated PG]

The second is the blame-the-victim strategy embraced by Optum’s Seth Serxner.  According to him, vendors like Optum really, really want employers to send them less money to do less screening (perhaps their salespeople are on a negative commission schedule?) — but employers nonetheless insist on screening the stuffing out of their employees. His specific statement: “Our clients won’t let us screen” appropriately.  Employers “deliberately” want to overscreen.  Of course, neither he nor Optum, in followup conversations initiated by Optum (saying I made them “look bad” by quoting Mr. Serxner), shared any examples of this despite repeated requests.  (The unabridged statement is on the “Great Debate” tape, which hasn’t been posted yet.)

Healthmine’s Bryce Williams has a third strategy, which is to publicly announce Healthmine’s decision to flout the USPSTF guidelines.  He says he is right and everyone else — specifically including the “US Preventative [sic] Services Task Force” — is wrong.  A real doctor making 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 take it away.

In addition to spelling the name of the group he is attacking correctly, 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, and many more are at risk for developing one.”

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 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.  That figure also includes the retiree population, where chronic disease is far more prevalent than in the working-age population relevant to wellness.  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.

Most importantly, Mr. Williams was apparently absent the day the teacher explained arithmetic.  Suppose you screen 1000 employees for a 1-in-1000 hidden pathogen or disorder and your test is 90% accurate. 900 employees will test negative, as they should, and the remaining 100 employees will test positive. Since only one of those hundred employees actually has whatever you are screening for, your false positive rate is:  99%. In addition to costing a fortune to follow up on all those false positives, imagine the angst and harms from overtreatment that can befall those 99%.

If you do work out the false-positive math, you’ll see it costs at least $1 million to find and prevent a heart attack via a workplace wellness screen.  And that assumes half the at-risk employees identified in the screen change behavior, whereas the last company to win a Koop Award, McKesson, had roughly 1% do those things.

None of this is to say that the USPSTF can’t be challenged.  But a challenge shouldn’t be based on misspellings, misquotes, and misunderstandings of the way arithmetic works.

Mr. Williams closes with a quote that hopefully someone can explain to us because we can’t decipher it. He asks:  “Which is more expensive: Over-testing or over-screening? We don’t have a definitive, quantitative answer. But let’s make sure we are asking the right question.”

We have no idea what the “right question” is, except that it’s not the one he’s asking.  My vote would be: “Why are these people allowed to deliberately harm employees and there’s nothing anyone can do about it?”

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