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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 excepts in all things cardio.

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 opposite end zone:

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 and Limeade being two 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.

The Beast Revealed: The Vendor is…Provant

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.

Enjoy!

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.

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%.

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 “wellness specialist” tell me to eat more fruit and not smoke.

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