Tag Archives: AHA

New Health Metrics in Life Insurance

A new measure of fitness and health, called Personal Activity Intelligence (PAI), has important implications for both life insurers and their policyholders.

It’s now possible to predict, using new technology, the chances that consumers of all ages will develop heart disease. Even better, if the data from the new technology shows improvement, there is also an opportunity to reduce the potential health risk.

Digital technology applications offer life insurers the chance to engage customers with personalized health data that is both easy to provide and simple to understand. And, of course, this is a win for life insurers, too – customers with personalized health data receive more value from the relationship. After all, enabling healthier, longer lives means a longer lifetime value to the benefit of the policyholder and the insurer.

The secret to personalized health data

There is a secret to this personalized health data, and it is based on cardiorespiratory fitness (CRF). CRF is one of the best predictors of health and mortality, with a direct correlation between cardiorespiratory fitness and lifestyle diseases.

Until now, CRF has been the missing link to quantify the level of physical activity required to reduce the risk of lifestyle diseases. In England, healthcare costs related to physical inactivity are five times more than smoking, and in the U.S. $117 billion health care expenditures per year were associated with inadequate levels of physical activity.

Health data analytic companies, such as PAI Health, offer solutions to make CRF data accessible and relevant to insurers and consumers alike. Customers’ activity levels and CRF data are tracked using a personalized baseline risk assessment. Dynamic, real-time risk monitoring improves customer engagement and reduces risk. Insurers are therefore able to determine the level of risk and understand the health profile for individual customers.

Shifting the conversation from payer to partner

Think of how providers currently handle the customer relationship. Once a customer purchases an insurance policy, the communications typically become almost entirely transaction-based, focused on renewals and claims. What if an insurer had access to data insights that assess customers’ health and risk levels dynamically over time? This now opens the door to a personalized health dialogue.

See also: Making Life Insurance Personal  

One of the largest life insurance companies saw this opportunity when it just entered into an agreement to provide its policyholders with wearable digital devices and gain their customers’ health and fitness data. The insurer will offer rate discounts and other incentives to its policyholders, creating a conversation between the company and its customers about fitness and health.

By using CRF metrics and personalized health data, software tools present complicated data in a comprehensible format for the first time. Here is exactly why tracking this valuable CRF data is not only the best approach for insurers, but also is extremely important in the future of health:

  1. It takes the guesswork out of health: Innovations in biometric algorithms help make big data simple enough for anyone to understand. The data that comes from these algorithms is also personalized for anyone of any health level. It offers the chance to meet people where they are, in a more open and understanding environment, to get them started on the path to a longer, healthier life.
  2. It’s educational and accessible: For most customers, the idea of changing their lifestyle can be daunting. CRF metrics can be a conversation starter opening the door to educational content that naturally supports the transition to a healthier lifestyle, making the entire process less intimidating for customers. What’s more – it’s extremely accessible and convenient, because all a customer needs to do is take a minute out of the day and get started via smartphone.
  3. It’s universal and trusted: Health isn’t one size fits all, but the beauty in CRF metrics such as the Personalized Activity Intelligence (PAI) is that they work for customers at any health level and with whatever type of exercise they prefer. And what many customers don’t realize is that they are becoming healthier through daily habits, such as mowing the lawn, washing the car or doing housework. By using an activity metric underpinned by CRF, you are providing customers with data that is trusted by the AHA, NHS and sports science experts as a proven measure of health.
  4. It fits real life: CRF activity metrics take a holistic look at improving activity, rather than looking day by day. This means if a customer misses a day or needs a break, it isn’t the end of the world. The activity prescription provided to the person readjusts and the risk models update, so the person can stay motivated on the journey to his or her best self. Improving CRF is a physiological adaptation that requires continual work, which is exactly what the data molds to.
  5. It doubles as a measure of health: As an insurer, it’s important to know the health levels of individual customers. A simple score tells the insurer and its customers exactly where they are, to achieve optimal health. The information might be incorporated into rates and underwriting.

The time is now to start engaging customers in a dialogue using personalized health metrics that can lower risk and costs, while adding more to the relationship.

See also: This Is Not Your Father’s Life Insurance  

Through this data, insurers and policyholders alike have a new opportunity to advance the way we monitor and act on health, to help customers enjoy happier, longer lives.

Wellness Industry’s Terrible, Horrible, No-Good, Very Bad Week

Just as the Bear Stearns implosion presaged the 2008 financial crisis, the events of the last few days, building on earlier events, are presaging the collapse of the “pry, poke, prod and punish” wellness industry.

For those readers still living in Biosphere 2, here is a brief review of how we got here:

First was Honeywell’s self-immolation with the Equal Employment Opportunity Commission (EEOC). We’re not sure how Honeywell’s benefits consultants failed to advise that all the company needed to do was offer a simple wellness program alternative that didn’t require medical exams, and there would be no way Honeywell would get hit with an  EEOC lawsuit. But they didn’t.

Second, the Business Roundtable (BRT) decided to go to the mat with the president over this EEOC-wellness issue. It is possible that there is some conspiracy at work here, where large companies really want to retain the ability to shame and fine overweight employees into quitting (because you can’t fire people for being overweight). But we lean toward a less sensationalistic interpretation: that the BRT is simply getting lousy advice, likely from consultants whose business model depends on more companies doing wellness. Because the BRT’s member CEOs have actual day jobs, they can be excused for taking the BRT’s word for the benefits of wellness and not investigating this industry on their own; if they did, they would find that the wellness industry attracts more than its share of well-intentioned innumerates and outright scoundrels, perhaps because the industry lacks adult supervision.

Third was our popular Health Affairs posting, which spurred see-we-told-you-so pickups by the Incidental Economist and Los Angeles Times, the latter of which helpfully added the word “scam” to the discussion.

Thus, we bore witness to a perfect storm, the first-ever lay media feeding frenzy on wellness, from both the right-leaning Federalist and the, uh, non-right-leaning All Things Considered. Those would be the first times wellness in general (as opposed to specific programs like, for instance, the Truven/Highmark Penn State debacle or Nebraska’s falsified outcomes) has attracted the lay media. Additionally, the comments, even on the typically erudite All Things Considered, were merciless. Skeptics that we are, we still underestimated employee resentment of forced screenings and risk assessments.

The wellness true believers’ rebuttals were quite in character. As we say in Surviving Workplace Wellness, in this field you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself. Because most of the true believers’ “A Team” are ethically compromised, they had to go to their bench to find a rebutter. Against all those eviscerations in the major national media, they countered with: Siyan Baxter, a graduate student at the University of Tasmania, who claimed a positive return on investment (ROI) for wellness. She wrote in a journal that contains the words “health promotion” in its very title and has never once published a negative article about wellness savings. Publication bias, anyone? That isn’t even the punchline. The punchline is that, as our book predicted, Ms. Baxter self-invalidated. She says, right in the article: “Randomized controlled trials show negative ROIs.”

How did she still come up with a positive assessment of wellness? Because she “averaged” those ROIs with studies she herself describes as low quality, to get a positive ROI. (These 5- to 30-year-old studies were conducted in an era when, as the award-winning book The Big Fat Surprise observes, the American Heart Association bestowed a “heart-healthy” endorsement on every box of Kellogg’s Frosted Flakes.)

Her approach is, of course, is like averaging Ptolemy and Copernicus to conclude that the earth revolves halfway around the sun.

The other rebuttal was from Professor Katherine Baicker, who is considered a deity in this field because she basically launched it with a claim, published five years ago in Health Affairs, that wellness achieves a very precise 3.27-to-1 ROI. (As with Baxter, the wellness programs where Baicker found savings were conducted during the era when the AHA apparently conflated Tony the Tiger with Dean Ornish). Having recently stated she no longer had interest in wellness and having more recently blamed readers for relying on the headline “Workplace Wellness Can Generate Savings” and not reading the fine print, she nonetheless decided to defend her legacy.

Her defense on NPR is worth reviewing. Baicker said: “There are very few studies that have reliable data on the costs and benefits.” That, of course, is not the case – the wellness true believers’ own meta-analysis above shows that in well-designed assessments, the programs lose money. Baicker also said: “It could be that when the full set of evidence comes in, it will have huge returns on investment, and the billions we’re spending on it are warranted.”

This all sounds a little different from the three significant digits of: “Wellness achieves a 3.27-to-1 ROI.” And it is invalid because, as any epidemiologist knows – and as Dr. Gilbert Welch elegantly explained in Overdiagnosed — if an impact is truly meaningful, it would show up in a small or medium-sized sample. This means that, if indeed there were “billions” to be saved, we’d know it based on the hundreds of millions of employee-years that have been subjected to wellness in the last 10 years.

The “full set of evidence” is already in….and it’s game, set and match to the skeptics.

The Wellness Industry Pleads the Fifth

The wellness industry’s latest string of stumbles and misdeeds are on the verge of overwhelming the cloud’s capacity to keep track of them.

First, as readers of my column may recall, is the C. Everett Koop Award Committee’s refusal to rescind Health Fitness Corp.’s (HFC’s) award even after HFC admitted having lied about saving the lives of 514 cancer victims. (As luck would have it, the “victims” never had cancer in the first place.) Curiously, HFC’s customers have won an amazing number of these Koop awards, which are given for “population health promotion and improvement programs.” Why so many, you might ask? Is HFC that good? Well, HFC is not just a winner of the Koop Award. HFC is also a major sponsor. Perhaps it was an oversight that HFC omitted this detail from its announcement that both Koop Awards were won by its customers for 2012.

Second, the American Heart Association (AHA) recently announced its guidelines for workplace screenings. They call for much more screening than the U.S. Preventive Services Task Force does. As it happens, the AHA guidelines were co-written by a senior executive from Staywell, a screening vendor. Not just any vendor, but one that had already been caught making up outcomes.

Third, although the American Journal of Health Promotion published a meta-analysis that showed a degree of integrity rare for the wellness industry, it then hedged the conclusion. The analysis showed that high-quality studies on wellness outcomes demonstrated “a negative ROI in randomly controlled trials.” But the journal then added that invalid studies (generally comparing active, motivated participants to non-motivated non-participants) showed a positive return. The journal said that if you averaged the results of the invalid and the valid studies you got an ROI greater than break-even. However, the averaging logic leading to that conclusion is a bit like “averaging” Ptolemy and Copernicus to conclude that the earth revolves halfway around the sun.

How does the wellness industry respond to criticisms like these three? It doesn’t. The industry basically pleads the Fifth.

The industry knows better than to draw attention to itself when it doesn’t control the agenda. The players know a response creates a news cycle, which they will lose — and that absent a news cycle no one other than people like you are going to read my columns and notice these misdeeds.

One co-author of the AHA guidelines wrote to my Surviving Workplace Wellness co-author, Vik Khanna, and said the AHA would respond to our “accusation” but apparently thought better of it when the lay media didn’t pick up the original story.  (As a sidebar, I replied that saying a screening vendor was writing the screening policy was an “observation,” not an “accusation,” and recommended the editors check www.dictionary.com to see the difference.)

Similarly, in the past, I have made accusations and observations about the wellness industry both in this column and on the Health Care Blog…and gotten no response. So to make things extra easy for these folks, I dispensed with statements that needed to be rebutted. Instead, I asked some simple questions. I said I would publish companies’ responses, which would create a great marketing opportunity for them…if, indeed, their responses appealed to readers.

I posted the questions on a new website called www.theysaidwhat.net.  I got only one response, from the Vitality Group. The other wellness companies allowed the questions to stand on their own, on that site.

To ferret out responses, I then did something that has probably never been done before: I offered wellness companies a bribe…to tell the truth. I said I’d pay them $1,000 to simply answer the questions I posted about their public materials, which would take about 15 minutes.( If someone makes me that offer, I ask, “Where do I sign?” but I’m not a wellness vendor.)

Here’s how easy the questions are: Recall from a previous ITL posting that Wellsteps has an ROI model on its website that says it saves $1,358.85 per employee, adjusted for inflation, by 2019 no matter what you input into the model as assumptions for obesity, smoking and spending on healthcare. The company claims this $1,358.85 savings is based on “every ROI study ever published.” Compiling all those citations would require time, so I merely asked the company to name one little ROI study that supports this $1,358.85 figure. Silence.

I asked similar questions (which you can view on the click-throughs) to Aetna, Castlight, Cigna, Healthstat, Keas (which wins style points for the most creative way to misreport survey data), Pharos, Propeller Health, ShapeUp, US Corporate Wellness and Wellnet, as well as their enablers and validators, Mercer and Milliman. Propeller and Healthstat responded — but didn’t actually answer the questions. Healthstat seems to say that rules of real math don’t apply to it because it prefers its own rules of math. Propeller – having released the completely mystifying interim results of a study long before it was completed – said it looks forward to the study’s completion and didn’t even acknowledge that questions were asked.

In all fairness, one medical home vendor sent a response expressing a seemingly genuine desire to understand or clarify issues with its outcomes figures and to possibly improve their validity (if, indeed, they are invalid). As a result, I am not adding the vendor to this site; the idea is not to highlight honest and well-intentioned vendors. (The company would like its name undisclosed for now, but if anyone wants to contact it, just send me an email, and I will pass it along to the company for response.)

Likewise, there are good guys – Towers Watson and Redbrick, despite their high profiles, managed to stay off the list by keeping their hands clean (or at least washing them right before inspection). Allone, owned by Blue Cross of Northeastern Pennsylvania, even had its outcomes validated and indemnified. I will announce more validated and indemnified vendors in a followup posting.

As for the others, well, I am not saying that their historic and continuing strategy of pleading the Fifth when asked to explain themselves means that they know their statements are wrong. Nor am I saying that they are liars, idiots or anything of the sort. Something like that would be an “accusation.” Instead, I am merely making an “observation.”

It isn’t even my observation. It is credited to Confucius:  “A man who makes a mistake and does not correct it, is committing another mistake.”