Provant sent me. I’m hunting for healthy people…
This is the entire saga of my entry into the world of wellness. My wife’s employer has engaged a prominent wellness vendor to run their program, and since last November I have been documenting my experience. The entire series, in segments, is available on my blog.
The first 10 episodes are here, in reverse chronological order. If you want to read from the beginning, you need to scroll down to Episode 1.
Episode 11 will be out soon. I finally got into the “new” wellness portal, and I redid the HRA. Not only am I more at-risk than I was two months ago, I learned all kinds of new things about myself.
Your employee gets an ad from the local hospital to have a “preventive” full-body scan (at your expense). What should she do?
Epsiode 10, and the vendor is….
Provant. Provant is a privately held wellness vendor, based in East Greenwich, Rhode Island. Funny thing, ShapeUp is also from Rhode Island. Must be something in the water. Rhode Island is the Ocean State, you know. Until we got hit with, er, I mean, invited to enroll in the Provant wellness program, the only thing I knew about them was that they were being sued in Florida by former employees, accusing them of unfair labor practices. A wellness company, whose ostensible claim to fame is helping improve the lives of employees, being sued by former employees who say it gave them the business. Go figure.
By the way, a tangential sidelight to mention. Over the past couple of weeks, we have been treated to a surfeit of stories about the re-emergence of measles in the U.S., thanks in large part to the abject stupidity and ignorance of vaccine opponents. Here is something my wife and I NEVER heard: we never got a single message from Provant (or our health plan, for that matter) asking about our vaccination status or the vaccination status of kids in our household, or a reasoned, evidence-based defense of vaccines, especially childhood ones. We never got an email, a glossy postcard (what a waste of money that could go to raises and other benefits they are), or a flier. There is nothing posted in the wellness portal. I was recently booking a kennel stay for our two German Shepherds, and the kennel owner told me in person, then by email, and then over phone to ensure that the dogs’ shots were up to date and that we sent her a copy of their certificates before they showed. Score 1 for the kennel and the dogs; 0 or, better yet, -1 for the “wellness” company.
Episode 9, who designs this stuff?
Ok, I gave in. I relented and, for the THIRD time, I have created an account for my wife in her employer’s wellness program, run a by a vendor to be named VERY soon. Yes, you read that right, this is the THIRD portion of time wasted registering, creating a password, and re-entering or confirming basic data. As I noted in Episode 8, this vendor does not have single log-in. In other words, my information does not appear under my wife’s log-in, even though I am the qualified spouse, and she and I both completed the HRA and biometrics to get our premium discount.
The lack of a single log-in made me wonder about other organizations with whom we do business where we frequently have multiple accounts and diverse transactions in which security is paramount. So, I went through all of them, and here is our list:
- The financial firm we save and invest with: 8 different accounts, including two daily transactional accounts (checking and/or savings) and two OUTSIDE accounts, all accessible by single log-in.
- A local bank: one transactional account, two credit accounts, and a safe deposit box account…single log-in.
- Major credit card company: two accounts, titled differently…single log-in.
- Health plan through my wife’s employer: she is the “account holder” with family members each listed below her name and the entire record of utilization (such as it is) readily accessible by a click.
- Vision plan: she is again the “account holder” with family members each listed below her name. (I have never accessed the dental coverage online, but watching my dentist’s secretary do it, it is clearly one log-in.)
With most other vendors we use (cable company, cell phone vendor, etc.), we have only one account, so only one log-in. But, in the accounts listed above, especially the financial ones, there are differences in titling, tax status, purpose, etc., and yet each company manages to connect all our accounts under one umbrella. Amazing that a wellness vendor can’t figure out how to do that, despite the fact that the health plan and vision plan did.
Speaking of time wasted. Once I created her account, I tooled around the new portal and learned that we could earn $100 per quarter for the first three-quarters of the year by engaging in wellness activities. And, that is where the trouble began.
Fitness: my wife exercise daily, and I frequently do two-a-days. Despite our efforts, we cannot get credit towards the $100 gift card because…we don’t workout at a gym where our comings and goings can be “verified.” So, my 8 to 10 hours of weekly exercise and her 6 to 8 count for nothing. I guess I could write in Vik’s Gym.
Next, there are a bunch of courses we can take, many of them are 6 or 8 sessions; even if only 30 minutes each, they add up to 3 to 4 hours on topics so relevant to working age adults like congestive heart failure. According to Emory University, of the 5 million adults with heart failure in the U.S., only 28% are under age 60. The vendor has a bizarre preoccupation with all things heart: 8 lessons to discern your “risk for having” high cholesterol (that phrase makes no grammatical or scientific sense), and 7 sessions on preventing heartburn. Here’s how to prevent heartburn, which I have occasionally: don’t eat foods that you know provoke it, don’t eat too close to bedtime, minimize alcohol. If it is mild and intermittent (as most cases are), use the lowest dose of the least expensive generic over-the-counter medication you can. See your doctor only if it persists, worsens, or is interfering with sleep or other activities. Done.
Now, wellness vendors are highly prone toward the empty, highly emotional claim that they are going to prevent heart disease and cancer in working populations. Well, all this heart focus better make a big and sustainable impact, because the median age of the American workforce is 42. But, according to the CDC, they of the chronic-disease-causes-7-out-of-10-deaths liturgy, 95% of heart disease deaths occur in people over age 65. In fact, 88% happen after age 75. The people wasting time on these lessons better retain this knowledge for a very long time.
Next, we could earn credit toward the gift card for eating healthy, which we do naturally. But, no, that would make too much sense. Instead, we have to join an inane nutrition game, called 5-on-5, where we join a team and our healthy food choices are scored as in a basketball game. I can’t show the graphic because of all the logos and identifiers I would have to edit out, but I did get a kick out of this little nutrition tracker, encouraging me to drink water and using the mythological 8 glasses per day meme.
Finally, there is this…a biometrics tracker. We had to give up part of our morning to go get biometrics taken. The resulting information is wrong, when it isn’t merely pointless. Unbelievably, they have a biometrics tracker, in which you can adjust the time of the measurement. To what end?
I’d say this couldn’t get any worse, but I am not sure we have reached bottom yet.
Episode 8, welcome to wellness where you can’t log in
On January 7, my wife and I emailed the wellness vendor’s customer service rep with whom we’ve been in contact and asked why we cannot log-in to the new wellness portal. The new portal at least has a valid security certificate. However, all the log-in information from the old portal, which did not have a valid security certificate, did not carry over. Hence, in order to see any of our information, we need to create new accounts.
At the old, insecure portal, we had to create two accounts. I could not figure out why it was not designed as a single log-in, with me shown as a dependent on her account. I have not gone through all the steps necessary to create a new account because, well, of all the steps necessary to create a new account (and possibly two new accounts).
As of today, our 1/7/2015 inquiry to customer service about logging into the new portal remains unanswered.
Episode 7, when risk really isn’t
This whole wellness game started in November 2014, with the first entreaties from my wife’s employer. One of the most important steps was to get biometric screenings, which were supposed to go directly from the lab company to the wellness vendor.
It took six weeks, but the results eventually got posted to our wellness portal. The six-week wait produced a restatement of the obvious: we are both healthy by conventional metabolic markers, which was completely predictable. Our biggest risk factors are age and gender, neither of which are modifiable. So, we do what we should do: we work out diligently and eat smartly. Who needs a wellness vendor for that?
There was no explanation from the vendor about why the long delay.
Curiously the “customized” risk report for my petite, fit wife labeled her at moderate risk for stroke.
My wife’s stroke risk.
It further termed her at-risk based on a “prehypertensive” BP (hers is 110/60, which is 100% normal), and as having a borderline high total cholesterol (around 200). Neither of these makes a highly fit middle-aged woman who exercises daily and eats a diet rich in fruit and vegetables at-risk for stroke. The cholesterol warning is also a massive non-sequitur. The report scolds her for having high triglycerides and then goes on to expound on cholesterol. Well, cholesterol and triglycerides are not the same thing. In fact, the cholesterol warning box admonishes against dietary cholesterol, claiming that it is a prime mover of elevated blood cholesterol. This might come as news to nutrition scientists at Harvard who say that it is a rare person indeed who is a strong responder to dietary cholesterol.
Both her and my report are based on obsolete approaches to characterizing disease risk. There is a heavy reliance on cholesterol as a dispositive risk factor, which it clearly is not in healthy people who have neither diabetes nor hypertension. My theory is that the vendor claims credit for these false positive findings, which the employer probably never audits, and finding risk factors, even non-existent ones, is a demonstration of having done something.
My report says that I, too, have moderate stroke risk, and that my 10-year risk of cardiovascular disease is 12%.
Vik’s risk of CVD
The report claims that the data comes from a Framingham Risk Calculator. So, I went to the NHLBI website and used their Framingham calculator, plugging in the exact data from my biometrics screening. The wellness vendor’s estimate overstates my risk by at least 50%. Even more important, my Reynolds Risk Score puts my 10-year CVD risk at 5%, which means the wellness vendor’s calculator overstates my risk by 140%. If I brought my cholesterol number down to “normal” (160), my risk drops 40%! WOW! A 40% risk reduction! In other words, all that work to reduce my cholesterol (changing my diet, working out more…I’ll be an Olympic athlete if I do more, taking a statin) will reduce my 10-year risk from 5% to 3%. Not even remotely worth the effort. But, the wellness vendor is on a search for disease…some poor sap will get that 12% estimate and panic, and, a patient is born.
My report also accuses me of having a risky BMI of 25, which is 0.1 over the upper end of normal. I have a 40″ chest and can do dips wearing a 20-pound weight vest, with lifting chains around my hips for more resistance. I have muscle, which is inherently healthy. And, my waist to height ratio is below 0.5, which is what it should be. They never calculated one. If they had, they would have deduced that as a muscular individual, a slightly elevated BMI is essentially immaterial to any statement of my risk. The warning box even says that BMI is a VERY accurate indicator for most of the population.
Finally, the website still does not have a valid security certificate. My very pointed and clear questions of the customer service rep I’ve been emailing about this have gone completely unanswered. When I attempt to access our wellness portal, both Chrome and my Internet Security software give me a huge red warning “UNSAFE.”
Episode 6, ignorance is bliss
The customer service rep for my wife’s employer’s wellness vendor simply ignores our question about why the server certificate is not secure.
We remain flummoxed by a wellness vendor using a server that does not have a valid security certificate.
Episode 5, the customer service and the security
My wife and I visited an outpatient lab office on November 17 to have our biometrics done. The wellness vendor and lab company both promised that results would be ready in two weeks. We are now exactly one month past the biometrics date, and there is nothing posted to either of our wellness accounts.
Here is what’s worse: when we log into the wellness portal, both our browser (Chrome) and our PC’s Internet security/antivirus program warns us that the site does not have a valid security certificate, and that we should not go there. We have to manually override the warning. When we finally get to the site, the letter HTTPS in the URL have a bright red line through them, meaning that it is NOT a secure server.
We are flabbergasted that this is how a company managing a treasure trove of personal information goes about its business.
ADDENDUM: customer service emails us back to inform us that the biometrics were received 12/8/2014, but have not yet been recorded to our portal. Is this not simply a file transfer that should be readily uploadable. Further, the customer service rep COMPLETELY ignores our very clear and important query about why the server is not secure.
Episode 4, the HRA
My wife and I have now both completed the wellness vendor’s HRA, also known as a health risk appraisal. The tool used by the vendor is like every other one I have ever seen or used. It is a conventional HRA; here are the major gaps and errors. To wit:
- There is a question about whether I wear a seat belt, which is odd given that seat belt use in the U.S. is at all-time highs. What they don’t ask, which is far more important today, is whether I talk on a cell phone or text or email from my smart phone when driving. Distracted driving is a far more important issue today than is seat belt usage.
- My HRA told me that I was overweight, with a BMI of 25.8, and, thus, that I was a “moderate” risk for a chronic disease. If I had been asked about my waist (32″) and my chest (40″) or my waist-to-height ratio (0.48), it would have been immediately clear that my “overweight” is muscle mass, which is inherently healthy. When you combine my high level of aerobic fitness with my muscle mass and strength, you see that I have the lowest possible risk of chronic disease of any kind and my only two major risk factors are both immutable: age and gender.
- My wife’s HRA classified her as “moderate” risk for chronic disease even though the only reason for doing so is her age. Like me, she is trim and fit, and, thus, at low risk for a chronic disease, such as heart disease, cancer, diabetes, or depression.
Three strikes for the HRA. Not a thing of value learned; the experience is actually negative when you take into account the errors noted above.
To read all the episodes in this sage, go to this page of choose “Belly of the Beast” from either the categories or tags.
Episode 3, the biometrics
My wife and I spend 2-person-hours going to a lab to part with some blood for the biometric sampling. Interestingly, according the lab voucher, they are measuring only blood cholesterol and blood sugar. It will take two weeks to get our report and our “action” plan.
Here’s my question: how do they know that this testing was medically appropriate for either one of us? Blood cholesterol is NOT by itself a major indicator of cardiovascular disease risk, especially not in someone like me. The proportion of 50-something year old men who are more fit and more active than me can be estimated with the digits on one hand. My wife is also fit; together, we fall into that minority of American adults who are very physically active (to the point that we are actually fit) and not overweight or obese. Two strikes against the wellness program: first, for wasting my and my wife’s time and, second, for measuring something that has no clinical relevance to either one of us. Next up for us is the HRA, which must be done within the next two weeks, by which time we will get our customized action plan based on two blood tests.
Episode 2, the threat, the penalty
The employer lets it be known that there is a significant sum of cash in play here. If my wife and I refuse to submit to biometrics and an HRA, we will face a penaltythat is equal to more than two times our monthly premium contributions for family coverage. The sum in play is greater than $500, but less than $1,000. I like cash. And parting with more of it than is necessary seems awfully wasteful to me. The positioning of the money as a penalty, rather than an incentive is very telling. It is exactly what Penn State leaders did to their employees, in a programdesigned by Highmark and defended by Ron Goetzel.
Episode 1, the opening gambit
My wife’s employer starts sending an endless stream of mailers teasing about the upcoming open enrollment period and the — WOW! — wellness program. I am so excited. I can’t wait to have some half-wit “wellness specialist” tell me to eat more fruit and not smoke.