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So much winning! Provant Health goes bankrupt.

Even by wellness industry standards, Provant Health’s business practices earned it our first multi-part series. It required nine parts to do them justice…

And now they are bankrupt too. Their remaining assets are being purchased by Quest Diagnostics, a reference lab company no doubt hoping to run additional lab tests on Provant’s dwindling employee base.

We knew this was coming because they had already started cutting back on spending, by dropping their internet connection, and hence didn’t realize that employees are not supposed to drink 8 glasses of water a day.

 

Or perhaps the kiss of death was being endorsed by Wellsteps,


 

Here is a real-life example of what an employer can expect to achieve by spending a million bucks on these very stable geniuses:

BMI and glucose got worse. Somehow, blood pressure stayed the same — 120 over 75. Yes, despite the average employee being almost prediabetic, and sporting a 40-inch waist for males (and close to that for females), pretty much everyone in this company has ideal blood pressure.  One explanation for this would be that Provant, whatever their shortcomings in weight control, are the world’s leading experts in all things cardio. (And that’s even before they started — when everyone in this company already had ideal blood pressure.)

That expertise might also explain how they were able to keep the cardiac ratio so low.  An alternative explanation might be that there is no such thing as a “cardiac ratio.” (Google it.)  I’ve heard of wellness vendors making up data, but this is a first–making up an entire metric to present its made-up data.  Maybe the reason Quest Diagnostics purchased them was to develop a new lab test for cardiac ratios.


The good news is that, despite these underwhelming results, Provant was able to beat its targets, which is easy enough if you move the goalposts to the 50 yard line:

So much winning! Provant “wins” if the average employee is overweight but not quite obese yet, has glucose only 74 points higher than the threshold to be considered diabetic, and is only borderline hypertensive.  No target is set for the cardiac ratio, of course, because it doesn’t exist.

In that sense the cardiac ratio is not unlike Provant itself.

 

 

 

 

 

 

 

Should your employees get annual checkups?

Note that this blog post is my personal posting and does not necessarily represent the views of any organization with which I am affiliated, other than the one with which I am most closely associated, and of which I am one of the founders.  I am referring, as everybody knows, to the Needham Frisbee Club.  People who play Ultimate 3 times a week don’t need no stinkin’ checkups.


Why Wellness Vendors Hate Information: A New Theory

I have no clue why wellness vendors hate information so much.  Perhaps they are repressing childhood memories of being bitten by a librarian.

A far-fetched theory, perhaps, but there is simply no other explanation for half the things half these very stable geniuses insist upon doing.  In many cases, reams of information demonstrating the futility, fallacies and even harms of what they do is right there — begging to be googled — and yet no one in the wellness industry (or at least the wellness companies “profiled” on this site — there are plenty of exceptions listed at www.ethicalwellness.org) does.

Before we get into the checkups, consider some other information gaps, like the eight-glasses-of-water urban legend. Anyone with an internet connection can easily learn that you do not have to drink eight glasses of water a day, and the whole meme was completely made up. 70 years ago someone estimated that humans require that much water a day — but also that basically everyone with access to water already gets that much without having to force themselves to drink when they aren’t thirsty.

Yet try telling that to a wellness vendor (excluding the ones who have signed the Code of Conduct, of course). One vendor, Provant, even provides an infographic in case the employees they are harassing can’t count to eight:

Wellness Corporate Solutions — no stranger to these pages — has gone one step farther.  Along with their crash-dieting contests, they offer what they call “healthy competitions” to see who can drink the most water:

Water-drinking “healthy competitions” may or may not make employees “more aware of their health status,” but they certainly make employees “more aware that this meeting better end really soon.”

Maybe WCS should combine those two competitions — along with their massive overscreening campaigns — to create a competition to reward employees for doing the most stupid things to themselves.

Failure to understand that thirst is your brain’s signal that you need a drink of water is not an isolated oversight. Wellness vendors take great pride in their ignorance of wellness generally. Consider their propensity to screen the stuffing out of employees. There are clinical guidelines for optimal screening frequencies and lists of biometrics that should be screened for, that most wellness vendors (It Starts with Me, US Preventive Medicine, and Limeade being three huge exceptions) have apparently never laid eyes on. If it helps, here they are:


There are a few subtleties beyond these words. “People at risk for diabetes” (under “Diabetes test”) would include people with high blood pressure or family history (which wellness vendors can’t ask about). It would also include people who are overweight or obese. Additionally, “members of certain ethnic/racial groups may be at increased risk at a lower body mass or a younger age.” Otherwise, it’s quite clear that cardio screenings should begin at 35 for males and 45 for females, and take place “at least once every five years” after that.

Some people should get that frequency, others a higher one. But like most other things in healthcare, the answer is not the same for every employee of every age and every health status, and you do not just screen people because you make money on each screen, so the more you screen, the more you make. Otherwise you end up like Interactive Health, one of the most expensive vendors, positively hyperventilating about all the false positives they’ve found:

Finally, let’s once again review the aforementioned crash-dieting contests, a staple of many wellness programs besides Wellness Corporate Solutions. Schlumberger, for example, pays out thousands of dollars to the team which does the best job packing on the pounds in December and then taking them off in January. “Just plain fun,” is how their ironically named vendor, HealthyWages, describes it.  None of these vendors have apparently seen the CDC’s advisory memo warning that crash-dieting is futile, likely counter-productive, and possibly harmful.


What about annual checkups?

Let’s cut to the chase: there is not one shred of evidence that annual checkups are a good idea for asymptomatic working-age employees.  There are many good reasons to go to the doctor — you notice a change in some aspect of your body, you want to develop a plan to improve your health, you need help managing a chronic disease,  or even that you’re sick — but here’s what’s not among them: the earth completing a revolution of the sun.

New England Journal of Medicine says that while the major benefit is “less patient worry,” checkups “may actually be harmful.”

“Less worry” is not necessarily a good thing. An employee (name on request after an NDA — not a made-up person) had a checkup in order to collect a wellness incentive…and as a result of being told not to worry, ignored heart attack symptoms about a week later.

The Journal of the American Medical Association says offers of health checks did not reduce any kind of mortality, but “may be associated with more diagnoses and drug treatments.”

Choosing Wisely says: “Annual checkups usually don’t make you healthier,” and “tests and screenings can cause problems.”

None of this takes into account the cost of annual checkups — which often lead to more unneeded and expensive tests and prescriptions, as JAMA notes — but we have definitely observed that wellness vendors and even some HR departments don’t really care about costs. It’s not their money. Here is Reuters on the high and unneeded cost of prevention.

Here is The Incidental Economist on the same subject.

Meanwhile, I’ve yet to find a wellness program that does not either pay employees to get checkups or fine them if they don’t — or shunt them into a worse health plan unless they submit to an annual physical.

I would also note that, however useless annual checkups are to begin with, they are likely even more useless if someone is visiting the doctor because their benefits department is forcing them to do so, against their will.

Finally, there isn’t exactly a surplus of primary care doctors. Why are we paying healthy employees to take up clinician time that unhealthy employees might actually need?


What is the argument in favor of checkups?

If checkups don’t actually prevent anything, why make employees undergo them? Two reasons have been proposed. One is that employees can “build a relationship” with their PCP.  This of course assumes that neither the employee nor the PCP ever retires, moves or changes jobs. It also assumes that somehow the things that affect employees can be prevented by having a “relationship” with a PCP. However, if you look at the list of the most frequent reasons for hospitalization among the working-age population, it’s kinda hard to find anything that fits that description.

Can you think of any disease in your own life that would be cured by a relationship with a PCP? I can’t think of only one problem — chronic heartburn — that my PCP could have prevented. But she didn’t. The PCP was perfectly happy to keep me on Prevacid, which, as Quizzify teaches (right on the home page quiz!), is likely harmful in long-term use. Fortunately, I happened to run into a yogurt salesman one day, who told me about active-culture yogurt. Within days my heartburn was gone, never to return.

The second argument in favor of checkups, proposed by the CEO of Bravo Wellness, Jim Pshock, is as follows:

The hope is that the [Bravo] 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.

It isn’t his money, so he is perfectly fine with employees “hopefully” spending more on drugs and office visits.  On the other hand, there is no information supporting his claim that all this spending and all these checkups will prevent all these diseases.  Quite the contrary, 100% of available information reaches the opposite conclusion — especially JAMA, which specifically measured mortality due to heart attacks, cancers and strokes and found no improvement. You’ll fine zero information suggesting the contrary finding, no matter how hard you search.

Perhaps when he was a toddler, Mr. Pshock’s parents threw him into an entire cage of librarians.


What is the best frequency for checkups?

The literature is quite adamant: not at all.  That seems a bit extreme and I would bet the people who write these articles do occasionally get a checkup. For the most reasonable compromise I would turn to Quizzify, the leading health literacy vendor. They recommend a simple mnemonic: get two checkups in your 20s, 3 in your 30s, 4 in your 40s, 5 in your 50s, and annually after that. Quizzify’s advisory colleagues, doctors at Harvard Medical School, approved this recommendation too. As with most other questions, this one carries the HMS “shield.” (Quizzify also reports that this question is the one most likely to be removed by its customers, which is an option for all questions in their database before they get seen by employees.)


So what’s the solution?  

In three parts, it’s:

  1. Screen according to guidelines
  2. Send employees to the doctor at age-appropriate and health-appropriate intervals
  3. Pay the fines on overdue books.

Ever wonder what it’s like to actually participate in a wellness program?

Do you know anyone who is actually in a “pry, poke and prod” wellness program run by one of the 50 vendors “profiled” on this site?  If so, try asking them what they think…and then compare those opinions to what the vendors want them to think. A few tidbits of the latter are listed below:

But none of these vendors ever ask the flesh-and-blood employees how they feel. Turns out there’s an excellent reason for that: employees hate “pry, poke and prod” programs. Here are four sets of vignettes to that effect.

  1. Last month, we collected some comments from an article in Slate about wellness. Just when we thought the news cycle on that article had run, more employees weighed in.  Still, those are just comments, not in-depth experiences.
  2. Getting into the belly of the beast, Vik Khanna posted a ten-part series on the Provant program he and his wife were forced to submit to subject to a major forfeiture. This program sucked up 6 hours of his time and provided tidbits like “drink 8 glasses of water a day,” which of course is a total myth . This myth dates from a misinterpreted finding from 1945. It is now perpetuated only by some wellness vendors (not all of them — incredibly a few have now procured internet connections), as well as presumably Poland Spring, Aquafina, Dasani, Kohler and American Standard.  Obviously if the human race were that dehydrated we would have gone extinct long ago.   Provant water
  3. In addition to Vik’s regular journal entries, every now and then, someone writes in detailing their own experience in being forced to submit to one of these programs. Here is one of our favorites, someone complaining about Optum’s program. No wonder Optum is so opposed to the Employee Health Code of Conduct. I’d be opposed too, if I offered Optum’s program.
  4. Finally, here is the program du jour.  In their alleged attempts to create a culture of health, these vendors are creating cultures of resentment, distrust, and deceit.  We’re copying-and-pasting the opening paragraphs of this rant, but would encourage you to click through to the whole thing.

News Flash, The Dodo Bird is Still Alive

Well another year has rolled around and I was talking to the person who’s experience with their wellness program I had discussed below. Lo and behold, the problems I had originally documented continue unabated. This is a common example, and explains why so many wellness programs should be discontinued.

It was time for next years enrollment period for her insurance and she needed to get a number of points, schedule a coaching visit and get her biometrics and lab work completed to qualify for the premium differential.

The lab work requirement upset her as she had just gotten all the lab work done by her PCP the month earlier, but no, those lab results couldn’t be used. So the vendor repeated all the lab work her PCP had done and more, most of which were absolutely unnecessary based upon USPSTF guidelines. But hey let’s go ahead and waste some money and do a few unnecessary tests.  That’s become the norm for many a wellness program.

The story continues here.

Health Advocate Caught in the Act…

…Of getting it right!

Quizzify 4

Proof that wellness can be both useful & fun.

People think this site is all about “outing” scoundrels, but we’re just presenting facts, usually in the form of screen shots, that can’t be denied.  That’s why none of the organizations or people “profiled” have ever sued us, despite our entreaties.  However, sometimes the facts are actually good, and we want to recognize that too.

For this posting let’s set aside policy/economics issues and just focus on on-site execution of screenings.  I attended a Health Advocate biometric screening which was being held in my neighborhood, to attract potential customers, meaning the attendees were comped but had been invited on the hopes that they would set up a screening event.  The first thing they got right was the list of tests.  The manager on site, Rich Prall, listed the usual tests.  I then asked what other tests they had available.  As you know, many vendors “profiled” on this site push completely inappropriate tests, that even if they were free would cause more harm than good.  We have three more vendors in the queue too, each worse than the previous one in pushing tests that the US Preventive Services Task Force specifically says not to do.

Mr. Prall listed the same bunch of tests that the USPSTF recommends not doing, but then volunteered without being prompted that the right answer was indeed for an employer not to do them.  (“If you do them at all, it should be at the doctor’s office.  What’s an employer going to do about your potassium level, anyway?”)  So Mr. Prall was willing to sacrifice revenues for integrity.  Literally, this is the first time we’ve seen that happen.  What Mr. Prall was appropriately shying away from, other vendors call their “Gold” or “Platinum” packages.

Next, I did some height/weight stuff.  They had a device that measures body fat (and BMI, which of course is a bit squirrelly as a measure, but leave that aside for now).  The body fat measurement was almost 20%.  I am usually 2-3 points lower.  It could have been the inaccuracy of the machine or perhaps because this winter’s weather has crimped my workout routine, but I expressed a little concern.  The screener said: “Actually as you get older (I’m 59), you want to have a little body fat.”  That is, once again, the right answer,an answer which shockingly few vendors are aware of.

Finally, I did the fingerstick.  The screener explained it all very thoroughly, understood the distinction between fasting and non-fasting, and did everything quite well.  Unlike Vik’s experience with Provant’s six-week delay, he ran the numbers right on the spot.

Even though a finger-stick is not particularly accurate, my values were what they usually are, except cholesterol.  My cholesterol, at 127, was 30 points lower than usual.  I expressed concern that a cholesterol value could be too low, and the screener said he didn’t know what too low was, but didn’t think it was an issue at 127.

So I googled it, and indeed there is a “too low,” but it is south of 127.  Apparently people with too-low cholesterol tend to do impulsively self-destructive things, like attempt suicide or drive recklessly.  I’ve never done anything particularly impulsive/self-destructive, unless one counts running this blog.   So, once again, the Health Advocate person was right.  That was 3 in a row, which might be a record for wellness vendors.

I could have talked to a counselor about the numbers but there was a bit of a line to get into these private areas, and in any event, I was so pleased with these guys that I didn’t want to risk bursting my balloon with one more conversation.  (Nor have I visited their website to see if they make wacky ROI claims.  Let me just live the moment, please…)

So I idenitifed myself (I hadn’t misrepresented myself earlier–remember, Vik and I are in the “integrity segment” of the market — but I just hadn’t given the full story) and congratulated them on best-in-class job of screening.

Literally every other vendor on this site could learn a lot from Health Advocate.  I know I did.

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