Tag Archives: arkansas

The Evil Genius of a Wellness Program

Arkansas recently contracted with an out-of-state vendor called Catapult Health to come in to the state’s schools and “play doctor” with the teachers, asking them personal questions, taking their blood and then telling them everything that’s wrong with them. This is a classic example of a “pry, poke and prod” program.

This is followed by admonishments to take more steps and eat more broccoli. The program then refers teachers into lifestyle and disease management programs “at record rates.”

Sounds terrible, but the good news is that this program isn’t going to cost taxpayers anything because, as Catapult Health’s website says:

Phew! At least it’s free to taxpayers because Catapult’s expenses and profits are “already in your budget” and “fees are processed through your health plan.”

Except that the state of Arkansas is its own health plan. There is no “Don’t worry. Insurance will pay for it” here. The state is self-insured, meaning it picks up the tab, not some nameless insurance company.

But, hey, at least this program will save money, right?

The return-on-investment for the state is allegedly 3.27-to-1, as shown by the so-called “Harvard Study,” conducted by Katherine Baicker.

Except that the Harvard study has been proven wrong, not just by the nonprofit, nonpartisan highly respected RAND Corporation (and I myself chimed in, as well), but by an ace researcher named Damon Jones, part of the prestigious National Bureau for Economic Research. His work showed that wellness accomplishes virtually nothing other than the expenditure of money. (Don’t worry—insurance will pay for it.)

See also: Wellness Vendors Keep Dreaming  

But, hey, maybe Professor Jones is wrong. After all, why should he care what Professor Baicker thinks, right?

Um, because he reports to her? Yep, he’s an associate professor at the exact same school of public health where she is now dean. Just guessing here, but it would seem a subordinate would have to be pretty darn sure of his findings (and they are rock solid, and completely in agreement with all the other recent research, summarized here) to publicly humiliate his own dean.

Even Baicker doesn’t defend her findings any more. She says: “It’s too early to tell.” That means she is running away from her very widely cited signature study, upon which essentially the entire wellness industry’s economic justification is based. This would be like Arthur Laffer, whose Laffer curve created supply-side economics, which has been used to justify two tax cuts, saying, “Well, maybe it’s not right. I dunno. Let’s wait and see.”

But, hey, at least forced wellness improves employee health, right?

Apparently not. Forcing people to get annual wellness checkups doesn’t benefit them, according to the New York Times, the New England Journal of Medicine, the Journal of the American Medical Association and Consumer Reports. (Before dismissing the credibility of those sources due to possible political bias, keep in mind that Newsmaxthe Federalist and Laura Ingraham hate “pry, poke and prod” programs, too.)

Forced wellness also takes teachers away from the classrooms to be pried, poked and prodded, stresses them out and hurts morale.

Further, sending “record rates” of employees into lifestyle and disease management is classic hyperdiagnosis – braggadocio-fueled misunderstandings of the arithmetic of lab results, resulting in large numbers of people getting told they need coaching and care they don’t want or, in general, need. Nothing makes a wellness vendor happier than to hyperdiagnose as many employees as possible.

But, hey, maybe teachers are a special case. Maybe the impact of “pry, poke and prod” programs is different for them?

It sure is. The single school district for which the data has been compiled is Boise, Idaho. According to the wellness vendor’s own data, the health of the teachers got somewhat worse as a result of this pry, poke and prod program. (The vendor, an outfit called Wellsteps, also admitted that it flouted clinical guidelines and fabricated its only positive outcome. The company also previously admitted that costs went way up as a result of its program. The company later suppressed that admission. Wellness vendors are not known for their integrity.)

So the health of teachers may deteriorate, creating more medical expense. but don’t worry. Insurance will pay for it.

But, hey, at least the teachers like it, right?

According to Catapult, employees love the program. Ask the employees, and you might get a different impression. Indeed, I was tipped off to this program by an Arkansas teacher who hates it, like most of her colleagues do — and that’s before they learn that they are actually paying for it…keep reading.

Obviously, if teachers wanted to submit to a “pry, poke and prod” program, the state wouldn’t have to threaten them with massive fines – almost $1,000/year, which appears to be close to a record for any “pry, poke and prod” program anywhere — for refusing to let a private, out-of-state corporation play doctor on them at state expense.

But, hey, at least the state taxpayers save money by fining the teachers who don’t want to play doctor, right?

Actually, wellness makes claims costs go up, probably by more than the fines. There are lots of unneeded lab tests and other tests. For instance, the state of Connecticut admitted that, in addition to throwing away all its money on the actual wellness program, the state spent more on health care. The state comptroller who administered the program said the increased spending was “a good thing.” I guess he wasn’t worried because insurance was paying for it.

See also: Ethics of Workplace Wellness Industry  

But, hey, at least the teachers don’t pay for it.

Actually, they do. The state’s human resources department brilliantly figured out that it could launder its wellness spending by hiring this outfit. By paying extra to Catapult (a multiple of what an effective wellness program would cost), the state is able to pick up the tab for wellness using the extra paperwork of a medical claim, as opposed to an outsized administrative expense in a separate line item. The latter would clearly need to be picked up by the taxpayers…and the state would have an incentive to control this highly visible figure.

By contrast, paying for “pry, poke and prod” as a medical claim will never be noticed, like Steve McQueen and David McCallum sprinkling the dirt from the tunnel around the stalag. On the other hand, the program will increase overall medical spending by 2% to 3% (the cost of the screening plus the added hyperdiagnosis expenses).

Here comes the evil genius part: At the next contract negotiation, the state can limit wage increases (or reduce benefits) by pointing out how high the health spending is.

So the teachers get pried, poked and prodded, hyperdiagnosed with hidden illnesses most of them don’t have – all against their will…and then they have to pay for the privilege in reduced wages.

Wow…the teachers are getting screwed. But, hey, at least they can’t sue the state, right, so taxpayers won’t have to pick up that bill, as well?

Starting in January, this program will be in blatant violation of two laws, the Americans with Disabilities Act and the Genetic Information Non-Discrimination Act. Those laws disallow forced wellness checkups but allow so-called “voluntary” ones.

Until recently, “voluntary” meant “do wellness or pay a big fine” like this one. But thanks to a lawsuit by AARP, the rules are changing in January so that “voluntary” must mean voluntary, like a dictionary would define the word.  (This summary has the links to all you need to know about the case.) To get these fines back, teachers will be able to sue the state, possibly even as a class action, and possibly being awarded punitive damages. Exposure to lawsuits could cost the state millions more in addition to its current expenditure on Catapult Health.

And that doesn’t even cover the costs of a possible teacher walkout, like the one in West Virginia that was spurred in part by – you guessed it – the wellness program.

But, don’t worry. Insurance will pay for it.

Marijuana and Workers’ Comp

I read an interesting story recently on the front page of Yahoo.com titled “ESPN’s NFL player poll about marijuana had some surprising results.” I then read the source article on ESPN.com, “Survey: Two-thirds of NFL players say legal pot equals fewer painkillers.” The title is fairly self-explanatory.

First, just to ensure we’re on the same page: This is a workers’ compensation issue. The NFL is an employer. The players are employees. The gridiron is a workplace. Pain and injury are realities for the vast majority if not all players/employees at some point in their careers.

See also: 4 Goals for the NFL’s Medical Officer  

The survey was of 226 players, 11% of the total number of players on active rosters and practice squads. So I would consider it a statistically significant sample, and, depending on how the 226 were selected, likely reflective of the full population.

Following are the highlights as tweeted out by @ESPNNFL:

  • Nearly three-quarters of NFL players surveyed (71%) say marijuana should be legal in all states.
  • About one-in-five (22%) say they’ve known a teammate to use marijuana before a game.
  • Two-thirds (67%) say the NFL’s testing system for recreational drugs is not hard to beat.
  • When asked which was better for recovery and pain control — marijuana or painkillers — 41% say marijuana, compared with 32% for painkillers.
  • More than half (61%) say that, if marijuana were an allowed substance, fewer players would take painkillers.

Do these results scare you? Probably depends on the personal opinion you held before you read them. Do these results surprise you? They shouldn’t. According to the Associated Press-NORC Center for Public Affairs Research survey of 1,042 adults in February 2016:

  • 61% said marijuana should be legal, and of those …
  • 33% with no restrictions
  • 43% with restrictions on purchase amounts
  • 24% only with medical prescription

Add to those figures the five states (Arizona’s Proposition 205, California’s Proposition 64, Maine’s Question 1, Massachusetts’ Question 4, Nevada’s Question 2) that voted last Tuesday whether to legalize recreational marijuana. (Legalization was approved in California, Massachusetts, Nevada and Maine — though by such a close vote in Maine that a recount is being requested. The pro-legalization side appears to have lost in Arizona, but the vote is still being counted.) Add to that four other states (Arkansas, Florida, Montana, North Dakota) that will vote on medical marijuana legalization. (Legalization was approved in all four states.) All of that means the landscape looks very different than it did a week ago.

So if you are a private or public employer, an insurance company, a work comp stakeholder, a clinician, a politician or state regulator … How different do you think your specific constituency is from the numbers listed above? My educated guess is that both surveys are fairly representative of the U.S. (the only other country that I’ve been following is Canada, which appears to be along the same trajectory in public opinion). Which means the numbers above are likely to guide coming public policy.

See also: How Literature and the NFL Shed Light on Innovation

So what does this all mean for the workplace? Of paramount importance is to have a jurisdiction-specific (because all states are different) drug policy (pre-employment, post-accident, return-to-work) that explicitly addresses marijuana (because presence does note equal impairment, a characteristic unique to marijuana among intoxicants).

And … keep your seatbelts handy.

First Lyft Fatality Shows Inadequacies of California Law

A Lyft passenger was killed over the weekend near Sacramento, an incident that underscores inadequacies in California’s insurance laws. As reported in Forbes, the Lyft driver saw a stalled Kia on Interstate 80 and swerved to the right, hitting a tree. One passenger died. The second passenger and the Lyft driver were injured. An incident like this causes one to ponder the arbitrary rules governing life, death and the arbitrary rules governing uninsured and underinsured motorist coverage (UM/UIM) in California.

For example, the news article asserts that “if the death had been caused by a hit-and-run driver, the accident would be covered under Lyft’s $1 million uninsured/underinsured motorist policy.”

Not so.

Lyft does not disclose on its web site the provisions of its UM/UIM coverage, so let’s assume it tracks California Ins. Code sec. 11580.2 governing UM/UIM coverage. Subsection (b)(1) requires “physical contact” with the UM/UIM vehicle. If the Lyft driver hit a tree rather than the car, there is no physical contact with the UM/UIM vehicle. The nimble driver who avoids the pile-up but comes to grief on a tree receives no UM/UIM coverage. Neither do the passengers.  It makes no difference whether a convention of 20 bishops saw the hit-and-run vehicle, or even if the accident were recorded on video.

Many jurisdictions (about half) find this restriction unnecessary, so why should California leave the passengers and driver unprotected?

Assume the hit-and-run driver is discovered and the driver carries $1 million in liability coverage (highly improbable). The pile-up included a number of cars, plus a big rig, and caused numerous injuries. By the time this $1 million is spread around, there may only be leftovers for the occupants of the Lyft car. Because the coverage is inadequate to compensate their injuries, they can, then, call on Lyft’s $1 million UM/UIM coverage, right?.

Not so.

UM/UIM coverage is triggered only when the underinsured party’s limits are “less than the uninsured motorist limits carried on the motor vehicle of the injured person [the Lyft car in this case].” Subsection (p)(2). It makes no difference that the responsible party is grossly underinsured with respect to the damages.

Again, this is a restriction many states (e.g., Arkansas) find unnecessary.

Now assume the responsible driver has a $50,000 limit, and a gravely injured Lyft passenger accepts $49,500 in settlement with the underinsured driver. Now the passenger may look to Lyft’s $1 million UM/UIM policy for compensation, right?.

Not so.

By failing to collect the remaining $500, the passenger has forfeited any claim to the $1 million UM/UIM coverage. Subsection (p)(3) provides that UIM coverage does not apply “until the limits of bodily injury liability  policies applicable to all insured motor vehicles causing the injury have been exhausted by payments of  judgments or settlement . . . .” Thus, the passenger must go to trial against the intransigent party to collect the remaining $500.

Once again, many states (e.g., Nevada, Idaho) do not follow this restriction.

Once a gravely injured Lyft passenger has collected the $50,000 limit from the responsible party, the passenger may recover any remaining damages up to the $1 million limit of Lyft’s UM/UIM policy, right?

Not so.

California allows the UM/UIM carrier to subtract from its limits any recovery from other parties regardless of the extent of the passenger’s injuries, according to Subsection (p)(4)(A).

Yes, once again, many states (e.g., Nevada, Utah) do not endorse this setoff rule.

California’s UM/UIM rules fall well below best practices in other states. If Arkansas can have better UM/UIM coverage, why not California? California should follow the lead of other states and scrap these arbitrary restrictions.

Even if California’s rules were tolerable with respect to private automobile insurance, in commercial settings the public is entitled to more protection (otherwise, why must Lyft carry $1 million bodily injury and $1 million UM/UIM coverage when only $15,000/$30,00 is required for private auto, and UM/UIM is optional?) Changes could be accomplished either by legislation or possibly by the California Public Utilities Commission’s specifying the commercial UM/UIM coverage requirements for charter party carriers. After all, if Uber, Lyft and others are to operate in other states, they must purchase UM/UIM policies that do not have these restrictions.