Tag Archives: Wellbeing

The Continuing Errors of the Wellbeing/Wellness Industry: Notes from a recent conference.

At some point the industry needs to come up with some way to police itself. Why?  I recently attended a meeting of the key companies and leaders in the wellbeing industry. Here were some statistics presented by a large corporation during a panel that included one of the Senior Executive’s of the company offering the employer their wellness service:

Incentives Associated with the Company Wellness Program

Annual Physician Visit –  $100

So why are they incenting employees to get an annual visit? Amongst the many screenings recommended by the USPSTF it gives it an A Grade to annual screening for adults aged 40 years or older and for those who are at increased risk for high blood pressure. Adults aged 18 to 39 years with normal blood pressure (<130/85 mm Hg) who do not have other risk factors should be re-screened every 3 to 5 years.

Health Risk Appraisal (HRA) $100

I believe this one is fine.

Annual Biometric Screenings $300

Again this is over-testing and not recommended annually. Per the USPSTF various biometric screens such as abnormal blood glucose a typical screening included in these gets a B Grade. The USPSTF recommends screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese.

Both the annual physician office visit and the annual biometric screening are not recommended for many in the younger age categoris or those with no known risk factors.  So why would the conference, the company and the senior population health executive offer up this information as an example of an excellent program?

Then they presented a slide on outcomes:

82% of all continuously enrolled maintained or improved their health continuum status.

This one is just bogus as presented, but let’s go through it.

  1. Selection bias, by only measuring those who enrolled and then were continuously enrolled (2 out of 3 strikes) selection bias is all over this one. See the Illinois Workplace Wellness Study.
  2. How many didn’t enroll at all?
  3. How many enrolled, but quit?
  4. What was the definition of maintain or improved health?
    1. Might it have been one measure and others got worse?
  5. What was the net overall change in risk a la Dee Edington (Natural Flow) or perhaps the movements for each of the individual health measures?

Again as a Wellbeing expert why would the vendor allow their client to put this slide up?

The weight loss program they ran offered by one of the well-recognized national vendors had 2,600 participants who lost 9,226 lbs during the year.  Wow an average of 3 lbs! Was that at 12 months? How many gained versus lost weight during the period? How many dropped out?

And the next line showed a weight loss challenge at 12 weeks. In which over 1,300 participants had lost about 12,000 lbs or about 10 lbs each.  Again these weight loss challenges have not been shown to create sustainable weight loss.   How did they look at the end of the year?

But to add insult to injury, this presentation was the final one of the day that began with a nationally recognized academic who when asked which is the best weight loss program, gave this answer:

“any weight loss program can show weight loss over 3-6 months, but a year or two later they gain it back and often gain back more.”

So they started the day honestly and finished it a little less so, to put it nicely. But the bigger issue is:

Isn’t part of our job as experts to inform and educate clients to do what works, what is evidence based and report on what’s meaningful and real? ”

Why would you let one of your clients present this at a major national conference. And then while you are on the stage, tout it as success and look the other way. And, if this is a reflection on your program, one allowing excess testing, inappropriate visits and the reporting of meaningless results what does it say about your program?

Come on, we can and must do better.




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The Validation Institute and Certification – Stand out from the Crowd



As many of you know, I am on the advisory board of the Care Innovations Validation Institute.  This is an important organization for the Population Health and Wellness industry. The advisory board is chaired by Dr. David Nash, Dean of the Jefferson College of Population Health.

Our industry is facing some questions; one need only look at the multitude of population health and wellness vendors and their reports of amazing outcomes to know that something is not right.  RAND has published some very good studies (here, here and here)  that showed limited to negative returns from various wellness and employe health improvement programs and Al Lewis has published many examples in his books (here and here)  and on his website.  While on the other side, Ron Goetzel at the Institute for Health and Productivity Studies within Johns Hopkins Bloomberg School of Public Health,  has a whole section devoted to programs that do work.

Last year the Population Health Alliance held a debate between Ron and Al. The event was standing room only and came to the conclusion that many of the programs do not work, while a few very well designed and implemented programs do.

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Update to: The Dodo Bird and Employee Wellness Programs – The Phone Call


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. 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.

As for getting the points, she recorded her exercise by selecting the boxes to document 30 minutes per day. That was the correct answer. Wink…

She was also required to speak with a coach so she had previously set that up, and when asked by the coach if she could take up some new behaviors,

said “oh yes that’s a good idea, I will.”  Wink..

The coach asked if she could follow-up in 3 months

“of course” she said

During the follow-up call, she dutifully reported to her coach that in fact the suggestions were a good idea and yes she had changed her behavior. Wink, wink…

“Congratulations” said the coach as she documented her successful intervention in the wellness vendors system.

Premium differential achieved.

I know exactly what this vendor’s annual report will look like. They’ll be touting all the calls they made, engagement they got, and behavior change achieved.

Don’t you just love self reported data.

Perhaps the vendor involved should call the Validation Institute and get some suggestions on how to measure their program so they can actually understand that their reported results are just plain wrong.

I can hear Al Lewis saying “I told you so”, but perhaps more interesting would be calling this vendor to testify and document why their program should be continued as part of the AARP lawsuit against the EEOC.

For the original story keep reading

Original Post

Given todays news report that the Feds say “Smokers are Lying on Obamacare Enrollment Forms” I thought I would publish this post written well over a year ago.  Seem’s it’s not just those enrolling on the exchanges who may be misrepresenting this important information, probably in ways you’d never think.

We have a crisis in the wellness program industry.

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My New Exercise Routine

So I think I have figured out an exercise routine that works for me using trackers and apps. I have played with the Fitbit Flex, Basis watch, and Google Glass as devices and tried a several health tracker apps, finally settling on Bodbot.

I have used the Fitbit continuously for well over 6 months now to track my steps each day. With the Fitbit I shoot for 10,000 steps a day, usually getting one half or more of my daily goal during a morning workout at the gym. This week Bodbot announced that they had integrated with Fitbit and Jawbone; but for now it just shows the steps taken during the day in the Bodbot app or online and does not assign them to various walking or running activities that Bodbot tracks. When working out at the gym I enter this into Bodbot from my cell phone.

Bodbot, is a relatively new exercise app that I have used for a number of months now. It has been very good for me because:

  • it varies my daily routine,
  • has exercises for both the gym and home,
  • allows me to  remove those exercises that I cannot do that day due to lack of equipment access when traveling or when I switch the recommended exercise for another similar one,
  • times the various stretches and activities
  • Allows me to add/drop sets and weights,
  • explains the exercise and often has videos to show how, and
  •  it is easy to add other exercises via the app in real-time.

I also like that Bodbot has a broad range of fitness activities including free weights, kettle bells, weight machines, stretches, aerobic and other activities which have increased my strength, stamina and flexibility and introduced me to new things. While the social aspects are okay, that has not been of much use for me. Here is a screenshot of one days recommended workout:

Bodbot Screen Shot

Bodbot Screen Shot


Each morning before heading to the gym I check Bodbot to get a sense of what’s coming. I then spend about 15 to 20 minutes doing aerobic activity on the treadmill, except when Bodbot recommends either sprints or a long run, which I then incorporate into my time on the treadmill.  This is followed by the Bodbot recommended exercises and then I finish back on the treadmill to cool down.  During the past month, I have averaged 6 days of exercise a week, and feel that this habit is settling in nicely.  Often in the evenings I go for a walk, and sometimes a hike on the weekends, or a trip to Kona Skate Park where I ride my BMX bike.

I do not track meals via either the Fitbit app or Bodbot, as it is still a hassle. This is one area that is a major stumbling block with all the apps I’ve tried.

My thoughts about the Basis watch have changed and I stopped wearing it.  I found it lost the tracking of my heart rate too often during exercise, and while the sleep tracking was interesting, was not enough to make up for the inability to track my heart rate during workouts.  I tried tightening the band and loosening the band, all to no avail.  It seemed to lose track  when weight lifting or during high intensity activities. I also found that it under-counted steps; I even  manually counted them and then looked at the watch to check.  The Fitbit worn on the other arm at the same time was consistently better.  In the end, for my needs, the Fitbit is just simple, easy and more accurate.

As far as the Fitbit and social, here is an interesting story…

My brother who has a Fitbit and lives on the other coast and I linked our accounts and we get our weekly progress comparisons and can see daily activity.  A few months back I was speaking with my mother who said “your brother is a little worried about how you are doing.”  I asked why, as all was well, and she said “he saw that your walking activity has dropped way off and thought maybe something was wrong or you got hurt and is planning to call you.”  I proceeded to inform her that the band on my Fitbit had broken and I had not worn it for 3 days!   I then called my brother to explain…The power of social!

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What is the Value of Investing in Population Health Management Programs?

Originally many organizations sought to determine the value of their wellness, disease management or population health management programs based upon a reduction in medical claims costs.  It is now recognized that there are other reasons and a broader influence of these programs on organizations and payers that implement them.

To help sort this out and come up with standards, The Population Health Alliance has established a working committee which is also reaching out and asking for your thoughts.  You can learn more about this effort and add to the conversation by clicking this link:


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May 21, 2014 · 12:33 pm