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Interactive Health gives clueless wellness vendors a bad name

Someone suggested that I call my Congressman to pass a law against Interactive Health, but I think the Justice Department is the more appropriate route. No, not because they’re harming employees — there is no law against employers harming employees in the name of wellness. Quite the contrary, the most recent Koop Award went to a vendor, Wellsteps, which did exactly that.

Rather, I would propose an antitrust action, because Interactive Health is attempting to create a monopoly on stupidity.

Yes, it seems like hardly a day goes by without the irresistible force of Interactive Health’s corporate IQ colliding with the immovable object of reality.  The thing is, their moles pop up faster than I can whack them on Linkedin, so here is a tasting menu of their greatest hits. You can’t find most of these observations on Linkedin for the simple reason that they delete them.

This was originally going to be a comprehensive retrospective of all their nonsense (Exhibit A for the Grand Jury to review), but in the two weeks since I started writing it, yet another mole popped up. This one could top the list if not for their “smoking recession program.”

  • An analysis of 2017 member data revealed that those clients who test all employees for Hemoglobin A1c identified up to 3 times more individuals at risk for pre-diabetes versus other testing. As a result, inclusion of Hemoglobin A1c testing for all employees is often a strategic recommendation for our clients. 

Since pre-diabetes is a risk factor for diabetes (and only a fraction of pre-diabetics become diabetic, after 5 to 10 years), they are hunting for employees who are “at risk for being at risk.” Who amongst us is not at risk being at risk for something? But that doesn’t mean they’ll end up with diabetes, any more than every kid who steals a cookie from a cookie jar becomes a bank robber — even if every bank robber did in fact at some point in their childhood steal a cookie from a cookie jar.

Using testing guidelines so contrary to the US Preventive Services Task Force that a beam of light leaving USPSTF guidelines wouldn’t reach them for several seconds, Interactive Health takes great pride in “identifying 3 times more individuals” than companies that test employees according to guidelines. Cue Inspector Louis Renault: “Owing to the seriousness of this crime, we are rounding up twice the number of usual suspects.”

One might be excused for assuming that the point of screening would be to “round up” the most appropriate employees, rather than the largest number of employees. One might also be excused for thinking Interactive Health is simply stupid, when in reality they are fully aware they violate guidelines, recognizing that their typical customer doesn’t realize this and is willing to, in the immortal words of that great philosopher the Queen of Hearts, believe six impossible things before breakfast.

Image result for queen of hearts alice in wonderland

in case anyone else is interested — we know Interactive Health isn’t — the USPSTF recommends screening only overweight/obese 40-to-70-year-olds for HbA1c. That’s to prevent exactly the kind of hyperdiagnostic employee harassment that comprises Interactive Health’s signature strategy: more tests = more revenues. They make Wellsteps look like an honest, intelligent vendor, which is no easy feat.

We also thought of contacting the Health Enhancement Research Organization (HERO), to let them know there was a vendor making the industry look bad (or look even worse), but it turns out that for HERO, cluelessness is a feature, not a bug.  Specifically, HERO has highlighted a case study by Interactive Health, which would be like Bernie Madoff highlighting his investment in Enron.


Update. Alas, I’m afraid there won’t be an investigation into their stupidity. At this point, they are so far ahead in the race to the bottom that it would be impossible to empanel a jury of their peers.

 

 

Interactive Health breaks its own record for stupidity

In the wellness industry, 2018 is ending just like it began: Vendors Behaving Stupidly.


Along with about 12 other need-a-lifers, we traditionally attend a “Nerd-a-Thon” on New Years Eve (tonight), where we play board games, including home Jeopardy. One Jeopardy answer might be:

A: “Roughly 3 seconds.”

The correction question would be:

Q: “What is the length of time required for a beam of light leaving intelligence to reach Interactive Health?”

Yes, Interactive Health is ending the year just as they began it, by setting new standards for cluelessness. They started the year by offering unsuspecting and no doubt somewhat befuddled employees a “smoking recession program,” and are ending it by proving that their 2017 and 2018 Deplorables Awards were well-earned.

Here is their posting:

Let’s look at it carefully. They crammed four mistakes/fallacies, plus a unique hashtag (#HealthareCosts) into two lines. First, anemia is not “33% more likely” among women under 45. To the contrary, if they had wanted to step out of character and make an actual true statement, it would have been pretty much the opposite: “Women 15 to 40 are 26% less likely to be anemic than women 40 to 69.”

Perhaps this information will come as much of a surprise to them as it did to me — the difference of course being that I didn’t just post the opposite to 12,162 chronically misinformed followers.

There is an asterisk in case anyone is keeping score at home — pregnant women of any age are at higher risk for anemia. That is the most clinically significant factoid about anemia in the working-age population, a factoid which naturally Interactive Health overlooked. One of their specialties is finding issues that don’t exist while overlooking issues that do. Another one of their specialties is posting random statistics on Linkedin that even a college intern could debunk.  Or hyperventilating that the number of cases of Alzheimer’s is expected to double by 2060 without mentioning that the senior population as a whole is expected to double by that year as well. They also claimed that there was a dramatic increase in heart attacks, but in reality the actual rate is about half what it was 40 years ago.

Another possibility is that this anemia data isn’t a surprise at all to them. They are aware of it (it is pretty easy to come by), but telling the truth would have undermined their new revenue enhancement strategy, which is to convince companies to screen the stuffing out of millennials, by “debunking” the “commonly held misperception” that you should adhere to well-resesarched, widely accepted, official US Preventive Services Task Force (USPSTF) clinical guidelines, guidelines which say, unsurprisingly, that you should definitely not screen the stuffing out of millennials.


Second, it doesn’t cost $10,000/year to treat iron-deficiency anemia. It costs about 5-10 cents a day, or $36.50 a year. So Interactive Health is off by a factor of 300. That’s a lot even for them.

Oh, wait, maybe they were talking about hospitalizations for anemia, not garden-variety anemia. Hospitalizations would cost $10,000 or more. However, in the immortal word of the great philosopher Rick Perry, Oops. Looks like young women have far fewer hospitalizations than older women:

Previewing IMG_0099.jpeg

To help Interactive Health interpret this data since apparently they could use some assistance, 32.1 admissions per 100,000 women 18 to 44 means 0.3 admissions per 1000 female employees in that age bracket.

In other words, nobody.  The average company with 20,000 to 40,000 total employees of normal age and gender distribution would probably have 1 admission for anemia.

And we would bet that whoever is hospitalized for anemia already knew they had anemia before Interactive Health started harassing them. My guess is most of these admission longshots would be either complications of pregnancy or anemia of unknown origin, or a rare disease.

Third — no surprise given that statistic — the USPSTF does not recommend lining up women to be screened for iron-deficiency anemia. (Even for pregnant women, who are at much higher risk than non-pregnant women, they find insufficient evidence to screen them.)   “Hunting for disease,” which my colleague Alan Cassels has written extensively about, is rarely a good idea, and this is no exception — which is one reason it isn’t recommended.

Finally, why screen for something that you can’t easily address if someone fails the screen? The other reason it isn’t recommended is that iron supplements for women who are technically anemic but have no symptoms also aren’t a good idea.  Liquid iron, like this…

…can, among its many other charming attributes, blacken your teeth. (The good news is that, as the label says, this supplement is gluten-free!) Iron supplementation in general can cause side effects like nausea, vomiting, and diarrhea, while high doses are so downright dangerous that iron pill overdoses are the #2 reason for emergency room visits among all vitamin and mineral supplements.


The good news is, here is another Jeopardy A&Q:

A: “High.”

Q: “What is the likelihood that in 2019 Congress is going to pass a law preventing vendors from penalizing employees who refuse to participate in non-USPSTF-recommended wellness screens like Interactive Health’s?”

 

A tie! The 2018 Deplorables Award goes to Interactive Health and Wellsteps

For this year’s Deplorables Award, the winners were given a chance to fact-check in advance, and declined. No need for them to have wasted the effort — only one person, Keith McNeil, has ever found a material mistake in any They Said What posting


As in past years, we convened our panel of distinguished judges to address the age-old question about “pry, poke and prod” wellness programming: how is this stuff even legal?

After they get done contemplating that — and wondering why they’re the only people in the industry who seem to have ethics, an internet connection, and a triple-digit IQ — the judges reviewed the candidates for the coveted Deplorables Award.  While any wellness vendor is eligible, they ruled out It Starts with Me, and US Preventive Medicine, since those vendors, whose claims are validated by the Validation Institute, apparently didn’t get the memo that you can’t succeed in this business without lying.

Ruling out those two dramatically narrowed the field down, to only about 1000. Narrowing the field even more, a few, like Provant, took themselves out of the running by going bankrupt. (Individuals are not eligible for the Deplorables Award, so we also need to rule out Ron Goetzel, despite his best efforts to make a late run at the trophy.)

This year, as in previous years, it boiled down to a battle between the very stable geniuses at Interactive Health vs. the people with very good brains at Wellsteps — more than coincidentally the 2017 and 2016 winners respectively. It was a close one. There are very fine people on both sides. Together with Mr. Goetzel, they constitute the wellness industry’s Axis of Genius.They both fabricate outcomes, flout guidelines, and harm employees, so it came down to a simple race to see who, in the wellness industry’s epidemic of very stable geniusitis, would be Patient Einstein.


Wellsteps

The case for Wellsteps is compelling. To begin with, after a few proud possessors of high school diplomas observed that their fabricated ROI model will always return a “savings” of $1359 if you zero out inflation even if the smoking and obesity rates go from 0% to 99%, in 2018 they reprogrammed the model so that instead of always returning a “savings” of $1359 in the final program year regardless of what assumptions you input, an obvious rookie mistake that only an idiot wouldn’t notice when designing an Excel spreadsheet model, the model will always returns a “savings” of $1356 in the final program year, regardless of what assumptions you input.

Ah, much better, thank you.

Don’t take our word for it. Here it is. Note that for some reason the actual trendline on the graph doesn’t show up any more.  You need to read the fine print instead. Here is what happens if you reduce smoking and obesity from 99% to 0%…

…and here’s what happens if your population already has 0 smokers and no obesity, so no improvement is possible:

If those columns of numbers at the bottom of each chart look identical, it’s because they are. This happens no matter what numbers you enter. (You are no longer allowed to enter increases in smoking or obesity like I used to do, so don’t even try. SPOILER ALERT: If you could, you would still get $1356 in savings.)

And, almost a decade after they first posted their ROI model, it still doesn’t calculate an ROI. Hello, do you see an actual ROI on this screenshot? At this point we’d settle for a phony one. (A real ROI estimation model can be found here.)

Their CEO has been featured on They Said What this year, with his take on the National Bureau of Economic Research’s invalidation of wellness outcomes. He accidentally admitted it was valid.

He claims to have spent “11 years in college.” Yet, even though that’s 4 years longer than Bluto Blutarski, he still can’t add the two columns of numbers he published that showed how badly his Koop-award-winning program for the Boise School District failed.  Here are those two columns, a comparison of risk factors in the baseline year vs. one year into the Wellsteps program:

Here’s what happens when you actually add his two columns up — turns out there was a dramatic deterioration in Boise schoolteacher health status.

So it looks like that was, to paraphrase the immortal words of the aforementioned great philosopher Bluto Blutarski, 11 years of college down the drain.

Image result for Bluto Blutarsky food fight


Interactive Health

The case for Interactive Health is equally compelling. After winning the Deplorables Award last year, they decided to double down on cluelessness, and so in 2018, they started a “smoking recession [sic] program.”

No one could figure out what they were talking about — apparently including the creators of their smoking recession program, who eventually took it off their website. My hunch was that they were trying to get smokers to switch to Parliament, which features a recessed filter, on the theory that the smoke would take longer to get into people’s lungs.

Later in the year they solidified their front-runner status with three more postings.

  1. college intern was able to invalidate their claim that younger workers had more mental health issues than older workers, and that therefore you needed to pay Interactive Health to screen them;
  2. Next came Interactive Health-meets-Barbie, where they told someone whose HRA showed her to be severely anorexic that she was in a “healthy range.” We noted the irony that this is a company that wants to send almost half your employees to the doctor to treat “newly discovered conditions”…and yet here was someone who appeared to really have a condition that needed attention…and they missed it altogether;
  3. And just last week they cemented their candidacy by providing a cornucopia of misinformation about the EEOC.

That brings us back to the original question: how is it even legal to harm employees and completely disregard clinical guidelines, as these two companies are wont to do? Well, it turns out that, starting in 2019, it may very well no longer be. No, I’m not referring to the EEOC rule change. That will make companies liable to their employees for fining them, but it will still be legal to screen the stuffing out of them.

The good news is that apparently there will be a move afoot in the next session of Congress to prevent wellness companies from attaching penalties to screens that violate US Preventive Services Task Force guidelines — which is to say, most of Interactive Health’s and (according to Wellsteps’ CEO, Steve Aldana, himself), Wellsteps’.

If this bill were to pass, three things would likely happen:

  1. Employees would improve on health status;
  2. Employers would save money on wellness;
  3. Wellsteps and Interactive Health would throw up on Dean Wormer.

Image result for flounder throws up Animal House

The very stable geniuses at Interactive Health once again put their very good brains on public display

Interactive Health is well on its way to disproving the law of averages.

I’ve never, ever, seen them get the facts straight. This is a very hard feat to accomplish. Just randomly — or by hiring someone who might know a friend smart enough to do searches on the internet — you’d think they could stumble into an accurate statement every so often. In the immortal words of the great philosopher Rick Perry, even a stopped clock is right once a day. But we’re talking about an outfit that can’t tell the difference between a chair and a cigarette, and, speaking of cigarettes, ran a “smoking recession program.”

They also recently wrote that employers should run batteries of medical tests on their youngest and healthiest employees. Due to the likely harms of overdiagnosis and overtreatment, this “protocol” is directly contrary to what the US Preventive Services Task Force, Society of General Internal Medicine, Choosing Wisely and most recently Consumer Reports advise.  But what do all those organizations know? Have they ever diagnosed an 80-pound adult as having weight in a “healthy range”? No, but someone at Interactive Health was able to figure that out without even needing to consult any outside experts.


Can Interactive Health spell EEOC?

On Tuesday (12/11), I conducted a very successful and extremely well-attended webinar for the Pittsburgh Business Group on Health, on the upcoming EEOC wellness rule change, and how to make lemonade out of that lemon, which turns out to be spectacularly easy.

An attendee wrote to me to note that a vendor had said exactly the opposite of what I said about the EEOC rule change — that it was no big deal and that employers need only be “compliant with existing regulations.” I replied that, with everything that has been published by me and others explaining the decision in lay terms, no vendor could possibly be that stupid. But after the person disclosed that the vendor in question was Interactive Health, I immediately apologized and asked for the link, which he sent:


Here is a line-by-line deconstruction of their misinformation:

“The EEOC could…reissue the same regulations but provide more appropriate justification for why a 30% incentive is reasonable and voluntary…”

The judge said the opposite: “AARP vs. EEOC’s decision means that the Equal Employment Opportunity Commission must rewrite its definition of “voluntary” to achieve consistency with the dictionary definition.” He was quite clear that forcing employees to choose between (1) suffering a 30% financial forfeiture and (2) having the stuffing screened inappropriately screened out of them by an unlicensed wellness vendor isn’t the slightest bit “reasonable or voluntary.”

Further, if anyone at Interactive Health could find someone smart enough to actually read the EEOC’s January motion, that person could explain to Interactive Health that the EEOC eventually acknowledged that the judge was right. (“The ADA regulation will still require that participation in wellness programs to be voluntary.”)

Even if they hadn’t agreed, it wouldn’t matter. If the judge says you can’t write rules allowing 30% penalties, it’s not OK to then write rules allowing 30% penalties. That’s why we have a judicial system. To determine what is OK and what’s not OK. A simple concept, covered in eighth-grade civics. Surely someone at Interactive Health has a friend somewhere who is smart enough to find someone who can explain that concept to them.

Interactive’s very stable genius is most on display with this advice:

Generally, employees must be offered choices for earning financial incentives. This includes the opportunity to pursue a reasonable alternative if the individual can establish with their personal physician or an allied health professional that the choices offered by the program are not reasonable for the employee due to a health condition.

They say in the stock market, no one is as valuable as the person who is always right except the person who is always wrong, and indeed Interactive Health has inadvertently created a teachable moment.

Here goes. The “reasonable alternative standard” is an Affordable Care Act construct. It has nothing whatsoever to do with the decision in AARP v. EEOC, which defined “voluntary” as written in the Americans with Disabilities Act (and the Genetic Information Non-Discrimination Act). If you did exactly what Interactive Health is suggesting to “comply” with this ruling, you shouldn’t even bother showing up at the trial if you get sued. Just send a check to the plaintiff.

The reason? The decision in AARP v. EEOC — and the ADA and GINA themselves– address specifically involuntary clinical wellness programs. According to those statutes, any “clinical exam or inquiry” must be voluntary. Large fines (or withheld incentives) are anything but voluntary. In their language above, Interactive Health is proposing replacing one involuntary clinical exam (by them) with another involuntary clinical exam (by a doctor) to determine that the first involuntary clinical exam would not be appropriate, and therefore the employee needs to be presented with yet another type of involuntary clinical exam as an alternative. Wrong, wrong, wrong and wrong.


To summarize, someone at Interactive Health needs to find someone smart enough to explain to the company’s employees that replacing one inappropriate test with another will not suffice to comply with a court order that says you can’t perform inappropriate tests.

Someone needs to step up. The good news is, we know there’s at least one adult in the room — that big, strapping 80-pounder.

 

 

Move on. Nothing to see here. Except…

…a cover story in one of the most respected magazines in the US which spells the end of Interactive Health, Wellsteps, Total Wellness, Star Wellness, Wellness Corporate Solutions and every other vendor whose business model is to screen the stuffing out of employees.

Meanwhile, I know of one company where the staff is popping champagne corks. Wonder what that company could be?

 

False positives for dummies (and smarties)

Wellness vendors love to brag about the number of sick employees they find through their screenings. Screening employees against their will, overdiagnosing them, then bragging about how many of them are sick is called “hyperdiagnosis.” Most of those “newly discovered conditions,” to use Interactive Health’s phrasing, are false positives.

No surprise here, given they perform about 40 tests. Doctors, as it turns out, don’t understand how to interpret lab results. If doctors — with four years of pre-med math and science requirements, four years of medical school, and likely four more years of residency – can’t do this, it is a very safe bet that unlicensed, unregulated, unsupervised wellness vendors would demonstrate even less ability to distinguish false positives from true ones. We’re talking about outfits that can’t even distinguish the words “cessation” and “recession.”

And speaking of not being able to distinguish things, if you haven’t already done so, take the Interactive Health IQ Test.


Here is another quiz: what is wrong with this list of vaccinations from Star Wellness:


Yet another quiz, from Cerner:

This one might be a little harder, since Cerner was so oblivious that they put this screenshot right on their brochure. This person’s blood pressure is 110/85, which Cerner says is “in the moderate risk category of pre-hypertension.” They overlooked the ever-so-slight detail that the “pulse pressure” of this unfortunate employee is only 25, a level typically found only in ICU patients with DNR orders.  More likely, Cerner’s employee simply didn’t take the reading correctly, and no one at Cerner knew enough about blood pressure to realize the error before the brochure went to press.

…And yet we are trusting this industry — whose ethical and competence lapses consume 50 pages in the leading law-medicine journal — to interpret our lab results?

These examples illustrate two realms in which wellness vendors can mess up. The first is in the actual testing, as with Cerner. The second in the interpretation, as with Interactive Health. Star Wellness is in a league of its own, having outstupided virtually every other vendor in wellness, which is stiff competition indeed.


Lab test science for dummies and smarties

Scientific error is largely but not entirely based on the innate inaccuracy of finger-pricks. Wellness vendors like to tout these fairly painless blood draws because they don’t scare employees away, hence creating more revenue potential. However, finger pricks are somewhat unreliable. First, there isn’t a lot of blood to begin with. Measuring multiple blood values requires diluting the specimens so that each reagent has enough to work with. And it’s Labs 101 that every manipulation of the blood – dilution being a prime example — increases the potential for error.

Another “manipulation” is the very fact of pushing the blood through the skin. This can contaminate the blood, and also causes something called hemolysis, the rupture of red blood cells.  Hemolysis can seriously skew results for many blood values. And yet it’s extremely doubtful that your vendor has figured out how to mitigate hemolysis, largely because they’ve never heard of it. Test this hypothesis simply by asking a vendor how they mitigate hemolysis in a finger-stick test.

Don’t be surprised if you get a non-answer. Remember, wellness vendors are not trained in screening–or in anything else for that matter. One of the attractions of becoming a wellness vendor is no one is tasked with educating, licensing, regulating or supervising you in any way.  Becoming a wellness vendor is the healthcare industry equivalent of applying for a zero doc loan, except with a lower chance of being turned down.

Venipuncture is more accurate than finger-sticks, but even so, the level of training that wellness vendors receive – as little as five days, provided you have a background in “municipality administration, finance or sales” – does not inspire confidence that they will get this right.  Many variables are involved, in collection, handling, storage, transport and interpretation of the specimens.  Each sample is like a little lab experiment, one that’s been repeated many times and has a standard protocol, but is not a pure algorithm. Technique, time of day, employee activity and diet before the test, elapsed time between collection and analysis, and even ambient temperature during transport influence the outcome.


Lab test arithmetic for Interactive Health and smarties

Nonetheless, let’s give the vendors the benefit of the doubt and assume their tests are 90% accurate, because in all fairness, most finger-stick tests don’t purport to measure values that specifically involve red blood cells. Glucose is one such accurate-enough test – assuming the employee has really fasted.

Yet accurate or not, glucose is one of the least cost-effective blood values to measure. An employee in the lower part of the diabetic range now (meaning most of them) wouldn’t crash for years no matter what you do. Sure, you can find them, treat them, and get them to check their glucose daily, but it’s doubtful you’ll change anything other than how much money you spend on preventing a complication or hospital admission likely not to occur until after retirement. (Annually, only about 1 in 1000 <65 insured people end up with the hospital with a primary diagnosis of diabetes.) It also turns out that for the vast majority of diabetics (those who are not insulin-dependent), daily glucose testing is a waste of time and money.

And do you really want employees to obsess with keeping their blood sugar down? Does it increase productivity if employees have low blood sugar?

But at least the science of the glucose test itself is accurate enough, assuming the employee has fasted and assuming you retest several times before coming to a conclusion. Let’s look at some predictive tests (including mammograms) whose accuracy is more like the mainstream 90% and see what happens when you apply lab test math in those circumstances. Heart attacks are the best example. If you, as an employer, could predict and prevent a heart attack, that would be cost-effective…or would it?

Maybe 2 in every 1000 employees will have a heart attack next year. Of those, at least 1, if not more, fit one of the following descriptions:

  • already have a known CAD diagnosis, diabetes, or metabolic syndrome (and hence screening won’t yield any new insights) or
  • are among the many people whose heart attacks are completely unpredictable from a standard blood test.

Optimistically, then, you’re looking at a 1-in-1000 chance of actually finding someone this year who would otherwise not be found and would have a heart attack unless it is predicted and prevented. It doesn’t help your accuracy that the Genetic Information Nondiscrimination Act does not allow inquiries about family history, which is a very major risk factor.

Let’s further assume that — highly optimistically and despite not being able to inquire about family history — the cardiac tests that a wellness vendor runs on an employee can predict a heart attack with 90% accuracy. Anyone who could predict heart attacks with 90% accuracy would win a Nobel Prize, so this is a very generous assumption.

Watch what happens when that 90%-accurate test is performed on a population of 1000 employees. First, the good news: there is indeed a 90% chance that the employee who would infarct can be found. That’s 1 positive. Next, the bad news. A 90%-accurate test is also 10% inaccurate, which means about 99 of the other 999 employees will have a phantom heart attack “predicted.” We can send this Excel spreadsheet on request:

100 employees in total will test positive. 99 of those will be false. And yet all 100 will be sent to the doctor, and likely given a barrage of further tests and possible stents. Lab test arithmetic explains why it costs about $1-million for an employer to prevent a heart attack assuming it can be prevented at all.


What does this mean for employers and employees?

Simple: testing decisions should be left to employees and their doctors. Employers should not play doctor with their employees.

Overtesting creates overdiagnosis, which in turn requires overspending on overtreatment. Example: A bank sent its top executives to a hospital for testing. The 16 executives tested were informed of a total of 18 new diagnosis, in addition to diagnoses they already had. The bank spokesman admitted “it’s still too early to see savings,” while the hospital spokesman candidly admitted that this executive screening program “offers another source of income” to the hospital.

Next is one of the wackier ideas to come down the pike, the celebrity-fueled myth that employees should get tested for ovarian cancer. This test doesn’t approach any baseline level of accuracy, so the USPSTF rates it a D.

Even the wellness vendor that advertises it the most, Star Wellness, admits it is “notoriously difficult to detect in its early stages.”  Insurance won’t pay for the test, and as Star says, it is “not readily available from doctors.” Perhaps there might be a reason for that?

It also means that you shouldn’t encourage mammograms for the <50 population, following USPSTF guidelines. That decision can be between them and their doctors. Mammograms in younger women are notorious for generating false positives.  In one well-regarded study, of 2100 women screened for 11 years starting at age 45, 690 received a false-positive along the way, and 75 underwent an unnecessary biopsy.

On the other hand, you don’t want to discourage mammograms, on the off-chance that an employee really does have cancer. Staying out of a conversation in which you have no expertise is the best idea.

Another good rule of thumb in these situations is, look at what Interactive Health does…and then do the opposite. This is their result from testing the generally healthy population of young employees, testing them for 40 things, 39 of which (except blood pressure) are not recommended for young employees due to the preponderance of false positives. So their rate of positives is not much lower than their 45% rate overall.

They are, of course, fully aware that most of their positives are false. I know this for two reasons.

  1. Here is a list (scroll down) of the top 25 hospitalizations for people insured by employers, in order. Obviously, if 38% or 45% or whatever huge percent really had these “newly discovered conditions” and the employer didn’t discover them, they’d crash, right?  Do you see anything on here that could have been “discovered” and prevented by a wellness vendor?
  2. They also follow my postings, where I have made this quite clear, Exhibit A being this one. And as Confucius said: “If you don’t correct a mistake after it is pointed out, you are creating a lie.”In that case, Interactive Health’s “mistakes” could make a White House correspondent blush.


Update October 30

Yes, Interactive Health is that stupid.

 

Interactive Health meets Barbie

This just in.

Probably the easiest $1040 ($20/week for 52 weeks) anyone ever made, so I think this person owes a debt of gratitude to Interactive Health.

I just completed my Interactive Health health assessment. I didn’t want to, but $20 a week off my insurance premium is $20 a week. I entered 80 pounds and a waist circumference of 15 inches, because it’s none of their business. My dashboard says my BMI is “Underweight” (no kidding! 5’8” and 80 lbs!) but my waist circumference is “Healthy Range”. If I was a living Barbie doll maybe! I don’t think even Scarlett O’Hara had a waist that tiny.

Yes, Interactive Health is wrong, as is their wont. This time it’s because someone who weighs 80 pounds and is 5’8″ is not in a “healthy range” and should be referred for medical assistance immediately.

The irony, of course, is that Interactive Health loves to send employees to the doctor, bragging about their 45% rate of “newly discovered conditions” that need medical attention, following one of their hyperdiagnostic screening crusades.  And, yet here is someone screaming for medical attention, but frankly, Scarlett, Interactive Health doesn’t give a damn.


Addendum: Someone asked me: “Why don’t the grownups do something about these people?”  The answer is they are: “doing something” The NCQA is giving them highest honors.

 

PS  Yes, there is a thing called a Scarlett O’Hara Barbie.

We interrupt this program…

I have several new posts ready to go — the usual suspects acting out in their usual hilarious fashion — but this is a serious post.

It is time for wellness vendors to stop harassing employees about their weight.

A new article summarizing the voluminous data on the futility and harms of weight-shaming just appeared. It doesn’t contain new data, but rather presents the existing evidence in a clear and compelling format.

This article finds fault in the physician community, but the wellness industry (the outcomes-based companies and their enablers at the Health Enhancement Research Organization (and their enabler-in-chief, Ron Goetzel) is even worse because they tie money to weight loss. They give employees a financial reason to binge before the first weigh-in and then dehydrate themselves and crash-diet before the last one.

This does nobody any good, except of course the outcomes-based wellness vendors — like Interactive Health, Wellsteps, Wellness Corporate Solutions, Staywell, Bravo, Total Wellness, Star Wellness, Health Fitness Corporation and probably a host of others.  And there is a special dishonorable mention for HealthyWage, whose entire business model is corporate crash-dieting contests.

They aren’t going to agree to stop on their own, any more than Monsanto stopped making DDT on its own volition. They need to have it made clear that this behavior won’t be tolerated any more.

Action Steps

A starting point is this linkedin post.  Like it, comment on it, share it.  Once we get to 100 likes and comments, and we’re already more than halfway, I can probably generate media attention.

 

 

https://www.linkedin.com/feed/update/urn:li:activity:6448329478551719936/

 

Is your wellness vendor snookering you? Take this quiz to find out.

Is your wellness vendor snookering you? There are certain facts that vendors are not exactly forthcoming about. This is because facts represent an existential threat to the “pry, poke and prod” industry. See how many facts you know — and how many they’ve suppressed — by taking this quiz.

You’ll earn more points, the closer you are. You don’t have to be exact — and honestly I’d worry about you if you got the exact answers to every question. I’d love you for it, but I’d still worry about you.


  1. Wellness vendors claim they can save significant money by reducing hospital admissions for diabetes and heart attacks, because those admissions are very common. How many admissions per 1000 covered lives does the average employer incur in a typical year?

  2. The Health Enhancement Research Organization claims a certain savings figure for wellness PEPM. But that’s before taking into account vendor fees, extra doctor visits, tests, and prescriptions, compliance issues, employee time needed, overhead and basically anything else. In other words, what is the PEPM savings figure that at Bain & Company we used to refer to as “profit before cost”? Answer to the nearest one dollar. Hint:  the answer is somewhere in this quiz.


  3. To eventually save money someday, you first need to improve/reduce the risk profile of your population. According to eternal optimist and wellness promoter-in-chief Ron Goetzel, what is the maximum percent improvement in a risk profile that a company can expect after 2 to 3 years of wellness programming @$150 PEPY?


  4. Speaking of Ron Goetzel, he said “thousands of wellness programs” fail to get good outcomes. What round number did he claim have succeeded?


  5. And speaking of Ron Goetzel again, he finally admitted it was “hard” to force employees to change behavior. How many “very’s” did he put in front of the word “hard” in that admission?


  6. The Wishful Thinking Factor, totally coincidentally abbreviated as WTF, is defined as: Total claimed cost reduction/total number of risk factors reduced. What is the average WTF for the last six Koop Award-winning programs, on average? (Hint: the real ratio of savings to risk reduction is about 0.05x, since even if savings does not lag risk reduction, a maximum of 5% of spending is wellness-sensitive.)


  7. Speaking of risk reduction, employees in the most recent Koop Award-winning program, Wellsteps/Boise, originally tallied 5293 risk factors. Approximately how many risk factors did those same employees tally after participating, excluding dropouts?


  8. In a participants-vs-non-participants study design, what percent of the perceived savings is due to the invalidity introduced by the study design itself in which unmotivated employees are used as the control for motivated employees, rather than health improvements attributable to the actual program itself, according to all four studies conducted on this topic, including three by wellness promoters?


  9. If you use Interactive Health as a vendor hyperdiagnosing the stuffing out of your workforce, what is the annual percentage of employees that will likely be told they have “newly discovered conditions”  that “require” a doctor’s intervention?


  10. Of 1000+ wellness vendors, how many are validated by the Validation Institute?


Answers:

  1. 2. Yes, only 2. All this wellness fuss is about 2 admissions per 1000 employees. Derivation: the roughly 150,000,000 employees and dependents covered by commercial insurance (mostly from employers) generate roughly 150,000 heart attacks and 120,000 diabetes events.  See the HCUP database and enter “410” for heart attacks and 250 for diabetes admissions for the ICD9 for the most recent full year (2014). Scoring: Give yourself 1 point for guessing 4 to 10 and 2 points for guessing fewer than 4.  

  2. One dollar. $0.99 PEPY. As is well-known, they tried to walk this figure back once they realized they had told the truth. Scoring: Give yourself 1 points for guessing $1.00, since the answer in the hint was on that very same line.

  3. 2%. That’s a few dollars PEPY in savings. (Looks like the HERO report was pretty close, its own protestations notwithstanding.) And you paid $450/employee over 3 years to achieve it.   Actually it was 1% to 2%, but we asked for the maximum. Scoring: Give yourself 2 points for 2% or less, 1 point for 4% or less. 

  4. Only 100. Besides Johnson & Johnson, Mr. Goetzel has never disclosed any of the other 99 without others making the observation that they self-invalidate according to their own data. Scoring: 2 points for 200 or fewer, 1 point for 400 or fewer.

  5. 4. In The Healthy Workplace Nudge, Rex Miller gets Ron Goetzel to admit that “changing behavior is very very very very hard.” Gosh, Ron, do you suppose this might explain why an employer population’s risk factors never noticeably decline? Scoring: 2 points for 4, 1 point for 3 or 5.

  6. Infinity. That’s because of the next question. The 21% risk factor increase for Wellsteps more than offset the trivial risk reductions achieved by the previous years’ winners. The actual WTFs for the previous years will be the subject of a future posting. Scoring: give yourself a point if you guessed that the WTF was 5 or higher. That would be 100 times the actual figure and still way below the wellness fantasy-league figure.

  7. 6397. Risk factors rose 21%. And yet somehow, even though the risk profile was deteriorating sharply, the risk profile of the population was also improving enough for Wellsteps to claim that healthcare costs declined 30%. 30% is enough to wipe out wellness-sensitive medical events for the entire Boise teacher population and about 30,000 of their closest friends. (Wellsteps originally admitted that costs increased, but took that slide down when it occurred to them that telling the truth would be inconsistent with their marketing strategy.) Scoring: 1 points for 5500 to 6000 or 6600 to 7000, 2 points for 6001 to 6599.

  8. 100%. It turns out that the participant-vs-non-participant study design is responsible for all the perceived savings that wellness vendors claim for programs. The New York Times just explained how, in the landmark University of Illinois study, both the “gold standard” RCT methodology and the invalid par-vs-non-par methodology were used and had completely different results. This also happened three other times (summarized here) — with Newtopia, Health Fitness Corporation, and a study done by the chairperson of the Koop Committee showing how feeding diabetics more carbs would reduce their costs by improving their health. Literally, 4 studies — all of which were run by people trying to show savings — showed exactly the same thing. Scoring: all or nothing — 1 points for 100%.

  9. 45%. This is because running 40 inappropriate tests on every employee makes it inevitable that at least 1 or 2 of those tests reveal a false positive. Scoring: Give yourself 2 points for guessing between 40% and 50%, 1 point for 30% to 39% or 51% to 60%.

  10. Four. All four are honest and make modest claims they can defend or valid contractual representations.  AND, they actually screen according to guidelines! (In the wellness industry, doing something appropriate merits an exclamation point.) They are: It Starts With Me, Splashlight, Sustainable Health Index, and US Preventive Medicine. That’s <1% of all wellness vendors. Scoring: give yourself 1 points for 8 or fewer.


 

Scoring:

0-2 points. Has your wellness vendor sold you a bridge too?

3-5 points:  Your wellness vendor is blocking your internet connection

6-9 points:  Nice work!

>9 points:  Send your fifth-grade math teacher a thank-you note for doing a better job than the wellness vendors’ teachers did.

 

Interactive Health fails fact-check by…college intern

A long-since forgotten essay on the history of hospitals by Lewis Thomas includes the story of a doctor who claimed he could diagnose typhus by examining inpatients’ tongues. He would examine their tongue…and a few days later they would indeed develop typhus. Turned out the doctor was spreading the typhus pathogen by feeling all the patients’ tongues without washing his hands.

Keep this anecdote in mind as you read the following.


Seems like I’m not the only one to show that Interactive Health’s numbers never, ever, ever, ever add up. And it looks like you don’t have to have taught economics at Harvard to do it, or even be old enough to rent a car. Rather, a triple-digit IQ is all it takes. Tom Rosenbaum, a “data analytics intern” at AP Benefit Advisors in Maryland, completely invalidated one of Interactive Health’s more headscratching claims.


By way of background, Interactive Health’s strategy is to convince HR departments that their company is simply overrun with ridiculously unhealthy employees whose medical spending will explode at some point in the future…and send almost half of the employee population to the doctor to allegedly prevent that from happening. That, of course, requires screening the stuffing out of them today, at considerable expense.

I’ve asked them repeatedly on Linkedin to please explain:

  1. how the US Preventive Services Task Force can be so misinformed about so many Interactive Health screens being so inappropriate and
  2. how their own panel of 43(!) tests is clinically proven to somehow save money by increasing (not a misprint) the number of employees who think they are sick, and the corresponding number of doctor visits.

Their “response” is invariably to delete my comments. Here is one example:

Quite the contrary to “the impact of heart disease growing by the minute,” heart health is actually, shockingly, one of the major public health/medicine success stories of our generation.  Deaths due to heart disease, and heart attacks themselves, are down by about 2/3 since 1969. I merely tried to inform their posting with a fact, but by the time you see their posting, facts will have been deleted. [Update: they already are deleted, along with many supportive comments I received on this posting. Usually they delete my comments within minutes, so I’ve started posting them at night so they can stay up for a few hours.]


Enter Tom Rosenbaum

Their new revenue-maximization strategy is to tell employers it’s not just older employees they need to worry about. It’s younger employees too.  And it’s not just medical issues that plague the younger workforce. It’s also mental health issues. Their specific language:

Workers under 35 are more likely to struggle with mental health issues, such as stress, depression and anxiety.

Tom decided to fact-check this particular item using actual data. It turned out:

  • 5.39% of older workers had claims for these mental health items, vs. 5.33% of younger workers
  • Older workers spent 32% more on antidepressants than younger workers

This insight got him into Employee Benefit Adviser as likely the youngest person ever to author a column for them. And the second-youngest person ever to get mentioned in They Said What.

Of course, it is possible that Interactive Health’s data is different than everyone else’s, and here’s why. According to their White Paper:

Here’s perhaps the reason why their customers’ employee stress levels are so much higher than average. If someone tells you that you have a “condition” and you “should be directed to a doctor,” you’d be stressed out too.

Something very similar happened to me when I let Interactive Health fiddle with my calves and tell me they were tight and could cause problems — one went into spasm shortly afterwards.

Luckily I didn’t let them anywhere near my tongue.

 

 

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