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Let’s Raise a Glass to the Pittsburgh BGH and Others

I recently attended the annual meeting of the Pittsburgh Business Group on Health.  it was a great session, and I am not just saying this because (future exhibitors and sponsors take note!) Quizzify got about 25 inquiries in the subsequent week, and the Pittsburgh Post-Gazette did a great follow-up article.  It was very favorable coverage because, as we had predicted to the reporter, WELCOA refused to challenge/rebut/comment. WELCOA doesn’t engage in intellectual or analytical debate for reasons that would become apparent if you read this write-up, which might cause a cynic to conclude that a beam of light leaving intelligence might not reach WELCOA headquarters for several seconds.

However, to WELCOA’s credit, they have finally learned how to spell their founder’s name. Hey, it’s a start.  Those who would like to see the original spelling (as well as many other greatest hits of WELCOA and their brethren) might want to visit This Is Your Brain on Wellness.

With uncharacteristic humility, I’ll admit I learned a lot at this conference.  In particular, I was very impressed by the wellness program at First Commonwealth Bank.  It was the best example I’ve ever seen of a CEO embracing a culture of wellness…and walking the walk by doing wellness for his employees instead of to them, for the most part.  One of the tests I recommend to see if a wellness program is valuable is to ask if you can brag about it in recruiting.  First Commonwealth Bank clearly can.

The Integrated Benefits Institute’s Tom Parry also gave a very insightful presentation on wellness economics, though I am not sure the opinions he intended to convey aligned 100% with the data on the slides, to put it gently.  Kudos to Nicole Ausmus for finding a head-scratcher in this presentation that I hadn’t even noticed — read her comment on this post.

In addition, the PBGH event was very well-produced in every respect…and the place was packed.

And I’d like to take a minute to — once again, with uncharacteristic humility — thank other organizations that did not buy into the wellness industry’s blacklisting of me following publication of the emperor-is-buck-naked best-seller Why Nobody Believes the Numbers.  The blacklisting made it possible for wellness to keep snookering customers, who (unless they attended conferences hosted by the folks listed below) had no way of knowing their vendors were making stuff up.

Two groups that never bought into the blacklisting, and for that I am disproportionately grateful, were the Population Health Alliance (which is hosting the Great Debate) and David Nash’s/Peter Grant’s Population Health Colloquium.

Next is the Silicon Valley Employers Foundation, whose Lauren Vela stepped up early.  Our presentation wasn’t popular, but we have gotten a lot of follow-up inquiries since then from attendees, including one apology for publicly disbelieving our conclusion.  Lauren took a lot of flak for the crime of being ahead of her time, but, Lauren, if you’re out there, thank you.

The National Business Coalition on Health (NBCH) was right out in front too, as were their affiliated organizations in the Northeast, Philadelphia, South Carolina and now Pittsburgh.  Note:  I know this is confusing (so don’t try to explain it to WELCOA), but the regional business groups/coalitions are loosely affiliated with NBCH, even if their name includes the phrase “Business Group on Health.”  They are NOT affiliated with the National Business Group on Health.

Still, even the moribund National Business Group on Health is making progress in understanding the need to present facts about wellness.  Example: the previous voicemail I left for them has gone unreturned for two years whereas the most recent has only been ignored for two weeks. (So much for my uncharacteristic humility.)


Integrated Benefits Institute’s Tom Parry Guilty — Of Honesty

Next to facts, integrity is the wellness industry’s worst nightmare.  Like if one of their brethren were to actually say something honest.  Tom Parry of the Integrated Benefits Institute just did exactly that.  And unlike the HERO Report, where the self-immolating honesty was accidental (and at odds with the propaganda in the text itself), this slide might actually have been honest on purpose.

***Please read this post all the way through including the new postscript***

I also checked with him, and he is quite clear that you can’t get an ROI on health savings from spending money on “pry, poke, and prod” wellness programs.  His exact words are: “It is difficult to spend medical dollars to save medical dollars, particularly in the short term.”  (This is at odds with Ron Goetzel’s giving out awards to Eastman Chemical and Health Fitness Corporation, for a program that “saved medical dollars” two years before it started.  Mr. Goetzel, unlike Mr. Parry, does not appear to be constrained by self-evident facts.)

And Tom Parry is indeed right.  But — as we’ll see — his valid insights don’t stop with healthcare ROI.  His slide makes excellent points about absenteeism, “presenteeism” and wellness — even if perhaps they weren’t the points he intended to make.

First, let’s look at the actual slide, the top ten health-related drivers of expense.

ibi presentation

Only two “wellness-sensitive” items make it into the top-ten drivers of ill health: obesity and hypertension.  Estimating off the y-axis (and dividing by 1000 to come up with costs per employee), it appears that the cost of each of those two is about $10 per employee per year.  We already know that employers can’t reduce obesity–that’s in our peer-reviewed article.  And let’s say you could reduce hypertension by 10%.  That’s a $1 savings per employee per year–before adding back the (much higher) cost of the hypertension drugs.  (Presumably extending this top-ten list would eventually reach the other diseases that wellness vendors love to hyperdiagnose, so add a couple of dollars of potential savings there, for a total of maybe $3 per employee per year in savings before adding back costs.)

This being the wellness industry, even the “honest” slides are full of head-scratchers.  For instance, how can there be so much absenteeism due to hypertension, which has no symptoms in 99.9% of cases?  Do you even know anyone who doesn’t go into work because their hypertension is acting up?  And how can HR even track absences due to hypertension, assuming there are any?  Absences aren’t coded by ICD-9s (and are rarely even coded by sickness vs. vacation).

Back to the top of the slide, if your biggest problem is depression, why would you institute a wellness program which — according to the HERO report which Tom Parry co-authored — is bad for morale?  We don’t mean to make trouble here.  We’re just askin’…

And this slide is actually the best argument against “pry, poke, prod and punish” wellness I have ever seen:  the nine most expensive items either have nothing to do with screening or HRAs, or in the case of obesity, aren’t fixable by wellness.

Quizzify Q in B and W

Do you know how much radiation there is a CT scan vs an xray? Do your employees know? We know the answer. Click to find out.

We look forward to many more presentations in “support” of wellness.  In the immortal words of the great philosopher George W. Bush, bring ’em on.

POSTSCRIPT: Explanation from Tom Parry.  We, as you know, are unlike wellness vendors in that we are in the “integrity segment” of the market, which means we print all responses.  (We used to seek responses prior to publication but never got any, so we gave that up.)  Tom explains below.  Albeit not as funny as the “insights” we gleaned, it is the right answer, so here it is.  (It doesn’t change the overall narrative or conclusions about the money — and it doesn’t address Nicole’s comment — but it does describe how the findings on the slide can be accurate and can logically have come out of IBI’s research.)

Al – one clarifying point on the research graph (and I’d be happy to send you a copy of the research paper if you like). It is a person-centric analysis rather than an analysis of the marginal impact of individual diseases (parsing out the marginal impact in this kind of data is extraordinarily difficult). We wanted to look at the experience of PEOPLE with different conditions (and because of the prevalence of co-morbidities tend to have other conditions as well). So as you point out, you don’t miss work because of high-cholesterol but those with high cholesterol often have other conditions that together cause them to miss work. Tom


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