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Healthcare Heroes of 2022
Yes, I know. You read TheySaidWhat for the same reason you rubberneck. You simply can’t look away. You were hoping this week we would be publishing the annual Deplorables Awards.
In 2022, we are not bestowing any Deplorables Awards because at this point most of the vendors who would otherwise qualify have crawled back into their holes. Nonetheless, anxious readers need not be walk away empty-handed. There are enough Deplorables Award winners from 2021 and previous years (separate links) that I think we’re gonna need a bigger basket. Yes, there are that many vendors striving to outstupid their competitors to win the Race to the Bottom in the quest to give cluelessness a bad name.
Healthcare Heroes of 2022
Last year, albeit with a less catchy moniker (“Healthcare Heroes”), we also started recognizing people and organizations that were doing the opposite, and helping to reduce healthcare waste, corruption and misinformation. Last year’s Healthcare Heroes can be accessed here, and would all requalify this year.
One addition to the vendors list would be Virta. I originally thought that all diabetes vendors were like Livongo, with their sleight-of-hand savings claims, and Better Business Bureau and Amazon ratings and reviews (“Obviously developed by people who are clueless about diabetes”) that could make Dr. Duntsch blush.
Consequently, I started out being totally skeptical of Virta’s claims…but now am quite literally putting my money where my mouth is supporting those very same claims.
This year, we are going to highlight winners in two categories we overlooked last year – government and unions – that have done the most to reduce healthcare waste and corruption.
From the government sector
We often say that we can’t rely on the government to tackle healthcare waste…until, apparently, we can. But that’s only because of the concerted efforts of a few committed people on both sides of the aisle, people who not just believe that the role of government is to curb corruption, but also do it.
First on that list would be Virginia McMillin, a longtime Senate HELP Committee staffer, when Sen. Alexander (R-TN) ran it. I first met Virginia in 2015. The circumstance was that Rep. Foxx (R-NC) was doing the bidding of the American Benefits Council to railroad the Preserving Employee Wellness Programs Act through her House committee. This bill would have given employers the right to, among other things, collect employee and family DNA in the name of wellness and fine people who didn’t measure up. I asked Tennessee resident and uber-concerned citizen Sally Pace to invite her to the World Healthcare Congress, where we were jointly able to convince her to make sure that bill – corrupt even by the standards of healthcare – died in the HELP Committee.
Ms. McMullin is recognized today because she was clearly the lead dog in the Consolidated Appropriations Act too. The full backstory is here, courtesy of Dave Chase. The highlights:
It wouldn’t have happened if Virginia Heppner McMillin and her Senate staff colleagues hadn’t done the hard work to understand the deep conflicts-of-interest and dereliction of fiduciary duty in employer #healthplans.
Upon reading the explosive Marshall Allen ProPublica expose about how benefits brokers had up to 17 undisclosed revenue streams, Virginia dug in to understand how this was possible and the devastating ramifications. In short, the perverse incentives are a key enabler of why healthcare became the #1 driver of inflation, debt, poverty and bankruptcy for over two decades.
It’s not only difficult to understand the #healthbenefits industry, they had to craft legislative language that would get a hearing, be durable against attacks during Senate hearings and survive legal challenges.
Through their success, every non-government employer in the U.S. is now legally required to report on direct and indirect forms of compensation. Failing fiduciary duties is a personal legal liability for CFOs, CEOs and board members not covered by Directors & Officers liability policies which gets their attention.
On the local politics side, kudos to Julie Menin, the New York City Councilperson (from the Yorkville district where, as coincidence would have it, I cast my first vote at Julia Richmond High School), who recently introduced legislation to find as much as $2 billion in savings by auditing exactly how much city workers are paying for their health care at various hospitals, and making recommendations on ways to lower the prices. All told, roughly 10% of New York City’s entire budget goes to employee healthcare costs.
Extra kudos for this Profile in Courage because the largest employer in her district is also the most rapacious hospital, New York-Presbyterian’s Weill-Cornell Medical Center. This is what elected representatives are supposed to do – stand up to the monied interests on behalf of their constituents. And yet very few do.
Rep. Foxx’s wellness scam was just the opposite: probably not one single person in her district was asking for a bill to let their employer collect their DNA. But her financiers were, and that’s what counts.
The Union Runner-Up…
As they generally enjoy much more generous benefits than others, union members have traditionally not considered wages plus benefits to be a zero-sum game. Especially in the private sector, the connection between the two has been so attenuated that the unions would be 100% correct in that conclusion. (There is also the tax issue. Wages are taxed. Health benefits aren’t.)
The corollary would be that unions would naturally distrust the idea that if they make concessions in benefits that are generally painless but save money, they could get much more back in wages. Management is largely to blame, because most proposals they put forward require that the union give up a significant benefit, as opposed to one such as the aforementioned Livongo, to get higher wages.
But when was the last time you saw management propose a reduction healthcare costs by adding a free benefit that demonstrably saves money?
One easy example: why not cover silver diamine fluoride for cavities at 100%, or even just cover it at all? Quizzify has posted at length about this. Everyone wins except the dentist. My wife’s plan doesn’t cover it at all…and yet the $39.92 I paid for my own cavity was half my 50% responsibiltiy for a drill-and-fill.
Or, as we covered last year, why not give pregnant employees free access to PreTRM, which (assuming the results are followed with a high-risk maternity program) achieves almost Nobel Prizeworthy increases in gestational age.
No, it’s always about us vs. them in healthcare negotiations.
Fortunately, there are two cases where unions and management are often on the same side of the table in health benefit strategies, and hence earn the awards for 2022.
The runner-up is New Jersey. The state runs and finances the health plan, with a commission comprised partially of representatives of several unions. The unions have put their most knowledgeable representatives on this Commission, representatives who are generally much better versed in healthcare financing than most benefits consultants, with none of the latter’s conflicts of interest. (The fact that certain vendors even exist is testament to the benefits consulting industry’s conflict of interest. Some choose instead to “partner” with vendors, so that they can collect money from both parties to a transaction.)
The magnitude of New Jersey’s spend is visible enough that the unions and management are generally aligned in demanding that the carrier and the hospital cartel (ER costs in New Jersey are #1 in the nation!) come to heel. I expect that 2023 will see them in the Winner’s Circle in this column.
…And the Envelope Please
But for 2022, the winner is the 32BJ Health Fund. By federal law, this Welfare Plan is run by Trustees with equal representation from management and labor. Along with the trustees, the directors who run this fund are very knowledgeable and conscientious. Most importantly, they realize that a dollar saved is a dollar earned, meaning every dollar they save gets back to the members.
There are two reasons for this realization.
First, savings specifically go back to the rank-and-file. They don’t line the pockets of management. And not just on a small scale. The 32BJ Health Fund was able to (among other things) return a $3000 bonus to all eligible members by (also among other things) removing the aforementioned New York-Presbyterian Hospital system from their network. (Groups that remove hospitals can avoiding overcharging with Quizzify’s ER Sticker Shock Prevent Consent, to pay a very reasonable 200%-of-Medicare price for all non-electives, even out of network.)
Second, because 32BJ consists largely of people at the lower end of the pay scale, benefits are an outsized portion of total compensation and hence get far more attention than, for example, at the United Auto Workers, which has shown no particular interest in looking for win-win opportunities to reduce cost. Nor have the auto companies proposed any.
Whether you are union or management looking for solutions that perhaps your consultants have overlooked, or if you want to nominate a vendor for a Deplorables Award, you can contact me directly through this blog.
Please put comments on Linkedin instead of here. I don’t moderate these posts for comments.
Healthcare Heroes of 2021
Yes, I know. You read TheySaidWhat for the same reason you rubberneck. You simply can’t look away. You were hoping this week we would be publishing the annual Deplorables Awards. They are coming next week, when we will reveal which very stable genius is Vendor Zero in the wellness industry’s epidemic of cluelessness.
Today we are doing the opposite: giving credit to the people and corporations (they are people too, you know) who stood out in 2021 for advancing the causes of cost-effectiveness, quality, innovation, and health equity.
These are in alphabetical order and if you think I left someone out send me a linkedin note and I will add them if I agree they are worthy.
I would like to separately recognize my uncle, Dr. J. Michael Lane, who passed away fairly recently. He did more than anyone else to wipe out smallpox. First, he wrote the paper which provided the economic justification for investing in the eradication of smallpox, in lieu of vaccinating everyone in sight.
He observed that the vanishingly low smallpox incidence rate outside Africa was maintained by millions of vaccinations that created thousands of complications. And that the cost of going to Africa to eradicate the disease from its last strongholds was far less than the cost of said vaccines and complications. He then procured the budget from CDC and WHO, and led the team which went to Africa to teach the locals how to inoculate up to 10,000 people a day. The logistics of convincing local and tribal leaders, some of whom were Russian allies carrying AK-47s, to stick their friends and families with needles, were challenging, to put it mildly.
It turns out he didn’t win a Nobel Prize in Medicine because prizewinners are required to invent or discover something. Whereas all he did was wipe out the biggest viral scourge in the history of mankind, albeit using a technology that had been around for centuries.
And now, the winners…
Marshall Allen’s Never Pay the First Bill almost hit the New York Times bestseller list. it is the first how-to book empowering patients/consumers to pay a fair price for services rendered. You shouldn’t need a book for that. I mean, no one has written a book to teach people how not to get snookered by, for example, laundromats. And yet we do. And yet he did.
His expose of broker compensation helped lead to the Comprehensive Appropriations Act, which requires full disclosure of all streams of payment between vendors/carrier/PBMs and middlepeople. This could change the industry, favoring honest vendors like Quizzify that don’t make under-the-table payments.
Jerry Ashton’s nonprofit, RIP Medical Debt, has paid off a total of $5 Billion of old medical debt, and as part of that, restored credit to the debtors, most of whom were otherwise essentially barred from procuring credit on favorable terms (if they can get credit at all), not to mentioned totally stressed. There is still tons more to go. Mind-blowing numbers of insured Americans carry mind-blowing amounts of medical debt. They accumulate this debt even as they’ve paid down their credit card debt in record amounts.
Dr. Bill Bestermann has developed an enormous national following among PCPs and cardiometablic clinicians by studiously mastering and integrating the genomic and metabolic evidence behind Optimal Medical Therapy and a unified theory of chronic disease. The health outcomes he achieved working with BCBS Louisiana, Ochsner, andea other groups are consistently far beyond conventional care, and he has been open and mission driven about sharing his model for the betterment of all humankind.
Katherine Baicker and Zirui Song, for publishing the definitive cluster randomization study on wellness, which naturally showed no impact at all. Special kudos for allowing themselves to be guided by the evidence. Yes, you shouldn’t get an award for that, but in this industry you do. Likewise, we reversed our opinion on these two. As Prof. Baicker demonstrated with her study on Oregon Medicaid’s natural experiment using a lottery control, she is the #1 researcher in this field. (The 2010 Health Affairs thing was well-intentioned, but wrong. I would add that I can’t talk — I didn’t figure out these vendors were scamming people until 2013. If you look hard at my 2012 textbook on outcomes measurement in disease management and patient-centered medical homes, you will see a brief but positive mention of wellness.)
Leah Binder dramatically expanded the Leapfrog Group’s scope, forging ahead with ethical billing ratings (inspired in part by Marty Makary and one other guy…hmmm…wonder who that was?). Combined with Dr. Makary’s efforts, shining a light on these practices has without question had an impact on billing practices.
Dr. Eric Bricker consistently produces the best short video exposes of anyone in the industry and nothing seems to escape his smackdowns. I learned from him, for example, why hospitals charge so much more for emergency care than for electives. I had always just assumed it was because you don’t really have a choice in an emergency. That would explain out-of-network price-gouging (which is ending a couple weeks after you read this), but Dr. Bricker explained the specific reason in-network rates are so high, summarized here.
Dave Chase, and other next-generation benefits advisors, showed it really is possible to reduce the overall cost of healthcare while increasing benefits. Maybe you could attribute the first few cases to good luck but after hundreds of similar outcomes, you have to think Health Rosetta’s special sauce works.
Christin Deacon became the highest-visibility benefits manager in the country, running the 4th largest health benefit in the country. The state of New Jersey had the good sense to combine all public-sector employees into one group, to increase purchasing power. Overcoming many hurdles from politicians and others, she made major changes that saved billions, to be shared with employees and taxpayers. Hear Chris tell her story in our January 6th webinar Presenting Chris Deacon…Unplugged.
Bryce Heinbaugh, who has been working tirelessly and successfully to make Direct Primary Care available for participants in the plans that he serves in rural areas of Ohio and West Virginia. He has put in a couple of years of effort to find and recruit DPC practices in underserved areas, and then drove a couple of thousand miles in a week to tell the participants about this great feature of their health plans. And yet you’ve never heard of him. That’s what we’re here for.
Brian Klepper devotes an absurd amount of time to curating a googlegroup in which like-minded (well, in the broadest sense of the word) disruptors can find common ground, share ideas and make connections. It is important for those of us on the “bleeding edge” to realize we are not alone in the universe, so this Healthcare Hackers Group performs an invaluable function. Curating it is way harder than it looks. Or as I sometimes say, it takes a lot of effort to make something look easy.
The advisors on the Hackers Group – Alera, Connect Health Collaboration, EPoweredBenefits, Higgenbotham, Mitigate Partners, Provinsure, and more – are all “next generation” advisors who have achieved excellent results and who welcome next month’s Consolidated Appropriations Act (CAA) instead of dreading its bright lights behind shined on their business practices. Indeed, asking two questions of your advisor or vendor will determine their ethics:
- What do you think of the CAA?
- What do you think of Al Lewis?
Dr. Marty Makary’s The Price We Pay also hit the bestseller list (in paperback). His quest to reduce or eliminate the number of lawsuits filed by hospitals against patients who unwittingly sign financial consents has shown clear results, as the number of such suits has plummeted. Only a small minority of hospitals were doing this, but they compensated for those small numbers with lots of lawsuits. (And some are still at it, of course.) Dr. Makary was also the inspiration for the “Prevent Consent,” which Quizzify literally guarantees will keep ER bills in the 3 figures, in the continental US.
Rosen Hotels is arguably the best employer health benefit in the country, per dollar spent. They get plenty of plaudits already, but we can pile on.
Gillian Pieper, Ashley Johnson, Amy Gilbert and colleagues at VEHI PATH have achieved a relationship with their constituents, the 19,000 Vermont teachers, that would be the envy of any organization anywhere. Quizzify is very engaging in most places, and yet somehow they are twice as engaging as the Quizzify average. It isn’t just Quizzify. Their combination of mutual trust, “champions” in every building, and an easily accessible and interesting set of offerings doesn’t just result in mind-blowing engagement levels, but does so with among the most modest incentives we’ve ever seen.
We should also give shout-outs to some of the leading Business Coalitions. It’s a tough thing to do because you have to rely on funding (at least partially) from exactly the organizations you are trying to negotiate with. But Jessica Brooks of PBGH, Chris Skisak of HBGH, and Bob Smith of CBGH deserve a special shout-out. (This is not to say some others don’t, but these three are willing to take bullets.)
The Vendors of 2021
Among vendors, we’d like to draw special attention to three which solve specific problems. This is no knock against some other vendors, but it’s very unusual for a vendor to make a bright-line change. Usually, with more or less success, the idea of vendors is to change employee behavior.
Quizzify also changes behavior, by teaching employees how to recognize and avoid useless and potentially harmful tests and procedures. Quizzify also tries to change eating behavior. For example, you probably think cranberries are a “superfruit,” if for no other reason than the package tells us so.
Yet they are completely devoid of vitamins. That’s not even the bad part. The bad part is that in the form we usually eat them, “Craisins,” are literally 50% sugar, a proportion that could make Captain Horatio Crunch himself blush. You have to do the math on the label below, which needless to say Ocean Spray is not exactly forthcoming about. 1/4 Cup is 2 ounces. There are 29 grams in an ounce. Ergo…
See? We just changed your eating behavior.
But the reason Quizzify is on the list of bright-line change is the Prevent Consent. As noted above, this was largely inspired by Dr. Makary. We simply took the next step from “Don’t sign their consent,” to “Sign your own instead.” So far this Consent has been accepted everywhere (treatment in the ER without affirmative objection constitutes acceptance–Contract Law 101), though occasionally the hospital seems to “forget” that they agreed to it and tries to send a conventional bill. Quizzify will take care of that.
It is now available in a mobile app, Quizzify2Go, which includes a “cheat sheet” to remind employees of their rights in the ER, and a support hotline if the ER intake person is being recalcitrant. It also has a full list of questions to ask during doctor visits for 100+ different topics.
The next is Sera Prognostics. They market a test called PreTRM, which dramatically increases an obstetrician’s ability to predict prematurity. If followed by an intensive prenatal health program, accurate prediction can substantially reduce, and has substantially reduced, the number of NICU days in a population. I’m not undertanding why employers who spend large sums to help employees get pregnant seem less interested in saving large sums by helping employees stay pregnant. But maybe that’s just me.
Employers who compare their NICU days/1000 to their primary-coded diabetes days per 1000 will see that with all the fuss about diabetes, reducing NICU days is a vastly more economically worthwhile activity. This is a list of the top 25 inpatient total spends by employers. Do you see a trend? The plurality are birth events. Diabetes doesn’t show up at all.
Not to mention that, unlike diabetes, your employees will love you for it and you won’t get reviews like Livongo’s.
Next is the Validation Institute, which really came into its own this year. Employers have finally figured out that vendors don’t retain actuaries to determine whether money was saved. They retain actuaries to “prove” that money was saved. Here is their master list of vendor sleight-of-hand techniques.
In 2021, the Validation Institute (VI) drew a bright line between its own validations and actuarial number salad with its Credibility Guarantee. If you, as a customer of a validated entity, can show VI overstated a vendor claim, the VI will send you a multiple of the fee that the vendor paid to be validated.
And, finally, it is important to recognize that the wellness industry has some fine, upstanding citizens. As far as we know, this is the all-inclusive list but we are happy to add others if indeed they qualify. US Preventive Medicine leads the list because, uniquely in wellness, it has achieved validation by the Validation Institute for making a clear reduction in risk factors. Aduro, Limeade, Sonic Boom, Wellable, and Wellright also make the cut.
Please put comments on Linkedin instead of here. I don’t moderate these posts for comments.
These three minutes will make you an expert on the new EEOC rules
Rarely can you become an expert in something in 3 minutes but then again rarely is there a wellness vendor as cool as Wellable. Their 3-minute “Whiteboard Wednesday Wellness Minute” will show you how to make lemonade out of this EEOC lemon.
And you’ll see why it is so easy for Quizzify to indemnify the whole ball of EEOC wax