Tag Archives: Wellness

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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Casino Healthcare – An Interview with Dan Munro

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I recently interviewed Dan Munro on PopHealth Week and we discussed his book Casino Healthcare. dan-munro-picWe all know about the high costs and poorer outcomes associated with American Healthcare.  In Casino Healthcare Dan explains his view of how our system, one built with Selective Health Coverage is like a casino; or really three casino’s, the insurer casino, provider casino and pharmaceutical casino.

Dan explores each of these areas and explains how they work to maximize revenue through a system of complex transactions and systems.

As an example, on the Provider side Dan explains a little known group called the AMA/Relative Value Scale Update Committee  or “RUC” as its more affectionately known.   Continue reading

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The Validation Institute and Certification – Stand out from the Crowd

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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

11/6/16

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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Validic, an Interview with Chris Edwards, Chief Marketing Officer

As the world continues its push to mobile health and monitoring, Validic has been getting a lot of attention.   Validic provide’s a digital health platform linking a broad array of mobile devices to companies looking to use this data. Their services’ are being used by  hospitals, doctors, insurers, health and wellness companies, pharmaceutical companies and other health care entities.

The revolution going on in healthcare to truly understand the person, how they live, its impact on their health, the creation of a two-way stream of data and impactable information is being fueled by companies like Validic.

Join Chris Edwards, their Chief Marketing Officer as I learn more about Validic, their services and growth brought to you by Health Innovation Media.

 

 

 

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