Tag Archives: bmi

Rapid Diagnostics for Life Policies

For years, insurance companies have taken steps to improve the life insurance underwriting experience in the hope of removing obstacles and decreasing not-taken ratios. To that end, some have forgone the traditional exam altogether in favor of simplified issue. But the truth is, consumers still aren’t flocking to life insurers, and the results of these efforts have been incremental.

Force Diagnostics has taken a different approach. We’ve developed a consumer-centric process featuring rapid testing that delivers results in 25 minutes. Tests are performed outside of the home in retail clinics and pharmacies, and results are immediately transmitted directly to the carrier’s underwriting engine for immediate processing. Because of the speed to results, innovative insurers and reinsurers could offer an accurate quote for life insurance to their consumers within 24 hours. And with the benefit of testing with fluids (HbA1C for diabetes, cotinine for nicotine, lipids for cardiovascular risk and the presence of the HIV virus, as well as body mass index and blood pressure), insurers may offer the majority of their products quickly and with assurance.

See also: Next Generation of Underwriting Is Here  

The potential results of using this new process can be seen in this underwriting performance calculator.

Once the calculator is downloaded, you may select a typical life insurance policy from a dropdown menu and enter assumptions that reflect an existing underwriting process. The calculator then shows a comparison on underwriting costs, internal rate of return (or IRR) increases, issued policy increases and the potential effects on persistency. At the end, total costs per app are calculated, as are total profits.

There is tremendous value in improving the customer experience throughout the underwriting process.

fat tax

Should You Announce How Fat Workers Are?

A shockingly serious proposal has been floated to first persuade (and later possibly compel) publicly traded companies to disclose to shareholders quite literally how fat their employees are.

Also, how much they drink, how well they sleep and how stressed and depressed they are.

This proposal, advocating what is known as a fat tax, shouldn’t even merit a discussion among rational businesspeople, and yet here we are, discussing it. Even Harvard Business Review (HBR) is discussing this.

Why? Because the well-financed, well-organized cabal behind this fat tax proposal include corporate names like Johnson & Johnson, PepsiCo, Humana, Merck, Novo-Nordisk and Unilever. The leader of this group is a South African insurer called Discovery Health.

If you guessed that any critique written by me would also implicate Ron Goetzel, you would be correct. Despite having now himself admitted that most wellness programs fail, he is the one justifying this entire scheme by claiming that wellness programs increase stock prices — even though they don’t. We’ve already offered a completely transparent analysis to the contrary.

He also made a rookie mistake in his own analysis. The stock prices of companies in his study diverged greatly in both directions from the averages, and he didn’t rebalance existing holdings annually. It’s simple compounding arithmetic. Suppose the stock market rises X% a year. If every stock in your portfolio increases at that rate, you’ll match the averages. However, if half your stocks increase 2X% a year while the other half don’t appreciate at all, and you don’t rebalance, you’ll beat the averages. Simply by doing nothing.

Goetzel’s study appeared right before the fat tax proposal was floated at Davos. No coincidence here — Discovery Health (the sponsor of the Vitality Institute) cites the study as a basis for wanting shareholders to “pressure” companies into disclosing the number of fat employees they have. And the more fat employees a company has, the more shareholders will insist on wellness programs, thanks to this study. Johnson & Johnson and Discovery both sell wellness programs, while Merck and Novo-Nordisk sell drugs for various wellness-related conditions.

We urge reading the HBR link in its entirety to see why a fat tax would be even worse than it sounds. Some highlights:

Most importantly, though – and you don’t need Harvard to learn this – it’s just not nice to stigmatize employees for their weight or other shortcomings unrelated to job performance. Basic human decency should have been taught to this cabal a long time ago.

We’ve pointed out many times in ITL that these wellness people were absent the day the fifth-grade teacher covered arithmetic. This proposal suggests that they were also absent the day the kindergarten teacher taught manners.

Triathlete’s View on Workplace Wellness

We frequently get complaints from “average” employees about wellness, and our most popular article on the Huffington Post was about the fat-shaming aspects of wellness programs that obsess with BMIs.  (Weight discrimination under the guise of weight control is one of the hallmarks of wellness, of course.)

But what about triathletes? What about people for whom those wellness incentives are a complete windfall? They can collect money for what they do anyway, sort of like when you buy something at a store and don’t learn it was on sale until you check out.  Obviously, as the beneficiaries of these programs’ largesse (at the expense of other employees indirectly, of course), fitness buffs should embrace wellness, like –to quote wellness apologist Larry Chapman — “a beloved pet.”

Sure, if that pet is the Hound of the Baskervilles.

tasmanian devil

(Note to the literal-minded.  This isn’t actually the Hound of the Baskervilles, who declined to sit for a photo session. This isn’t even a dog, as far as we know.)

I’d encourage you to read this critique of Virgin Pulse’s program in its entirety.  You’ll have to scroll down through the blog post (not too fast – you’ll miss the review of Quizzify) to Comment No. 3, but it’s worth a full read to capture the essence beyond these excerpts.

First, Virgin Pulse — here’s a shocker — can’t do math.  Because of its innumeracy (also one of the hallmarks of wellness), Virgin is accomplishing exactly the opposite of what wellness is supposed to do:

When I ran 5 miles in 50 minutes, at a 10-min/mile pace, I got more points for having >45 min of active minutes, but when I actually ran it faster, say, 8-min/mile pace which gave me a 40 min time, I only got >30 min activity, and fewer points, despite performing a much harder task. Nothing like being punished for being successful.

And Virgin Pulse apparently can’t do wellness either (yet another hallmark of the wellness industry):

Those of us who lift weights and do things that do not have “steps” but require greater physical acumen are greatly disadvantaged. Sadly, most government programs place a higher priority on “aerobic” activity rather than strength training. This “cardio = fitness” mentality is about 30 years behind the times.

The author, of course, is completely correct about this on multiple dimensions. Virgin Pulse’s information is way out of date, outdated information being — you guessed it — yet another hallmark of the wellness industry.  Among other things, giving “points” for cardio but not strength will increase back pain and other musculoskeletal problems, which account for a vastly higher share of employer health spending than the 1-in-800 incidence of heart attacks – in two different ways:

  1. Strength exercises are now shown to be the best way to prevent and control back pain.
  2. Obsessing with “steps” increases the likelihood of falls, sprains and repetitive motion injuries.

At the risk of “burying the lead,” here is another thing Virgin managed to do:

It can also be annoying to be reminded constantly to get my mammogram. I am a breast cancer survivor and have had a double mastectomy. No mammograms for me. How insensitive of you!

After several paragraphs of other observations about the intrusiveness (still another hallmark of the wellness industry, in this case including monitoring employee sleep), she concludes:

The entire program is childish and silly. Another “social media” forum for people to get imaginary medals or stupid stuff while [Virgin] surreptitiously inserts little “healthy” reminders that may or may not be considered current health information. [Editor’s note: The majority of Virgin’s “1,440 habit-building interactions per member per year” are self-evident and cliched, outdated, wrong, unrelated to wellness or controversial.]

I’m sure there are better ways to promote corporate fitness that are not insulting to the intelligence of adults. As a personal trainer and health coach, I’d be happy to give you a few ideas.

Here’s one idea: Require wellness vendors to know the first thing about wellness.

Will Policies Break Down Into Apps?

With the news that Uber is partnering with Metromile to offer Uber drivers “pay-per-mile” insurance, along with AirBnB announcing host protection insurance to supplement existing insurance policies on rooms and houses, we may be seeing the first cracks in the decades-old marketplace for all-encompassing insurance policies.

And really the change should not surprise us. After all, it was just a few years ago when an airline ticket bought you everything: the seat you wanted, free drinks and hot meals even in the economy cabin and transportation for your luggage. These days, your ticket buys you admittance to the inside of the airplane-and basically nothing else. Every other option is now on an a la carte menu-Wi-Fi, beverages, meals, bags, preferred seating, movies. The whole experience is an upsell by the airlines.

Now that the door has been cracked a bit, what might be next? Well, as seen with the awesome app MyFitnessPal being acquired by UnderArmour, in industry after industry the advantage is all about the apps and the data. And if apps in cars can now track how far we drive and how often we’re slamming on the brakes, to save us money on our auto insurance, might we also be able to save some money on our health insurance by providing our health data to our carriers as well?

Fitbit

After all, when I step on my Fitbit Aria scale, it knows my weight and body mass index (BMI). MyFitnessPal knows what I’m eating and drinking, and, if I’m lying, the scale will catch me. If I go paleo and lose 10 pounds or complete an hour of CrossFit every day, shouldn’t I be rewarded with a lower health premium? Previously, you’d have to take a blood test and tell the underwriter if you were a smoker. But what if my rates could vary based on how healthy a lifestyle I’m leading?

And once you drive your health through this gap, you can disaggregate any part of our lives into the proverbial Chinese menu of costs. Might I pay more for life insurance if I drive my family vs. flying, which is inherently less safe? What about feeding my travel itinerary into an app and getting personalized travel insurance based on what I do on vacation? And don’t get me started on the “Internet of Things.” We already provide our thermostat and carbon dioxide levels to Google through their Nest products-shouldn’t we get a rebate from our homeowner’s policy for keeping the house at a cool 68 degrees?
Digital Thermostat

What’s interesting about these scenarios is how easily they flow once you get started. Which is how the whole apps market works-you break down a process into pieces and start to handle the individual parts.

So why wouldn’t we want to do the same with our insurance?

As younger people continue to lead the movement toward the sharing economy, showing less propensity to care about exchanging data for cost savings, it’s an increasingly interesting question. In a recent survey by the National Association of Insurance Commissioners (NAIC), 43% of drivers between the ages of 18 and 29 said they would consider enrolling in a pay-per-mile insurance policy-and that’s with only a few carriers offering such programs. There’s no doubt that the world is moving to this model.

Of course, the $100,000 question is, “when is enough, enough?” Will altruistic motivation among younger people to lower greenhouse gases and pollution triumph? Will $200 a year less in health insurance premiums be worth the cost of sending your Fitbit data to your health insurer? Will I choose to let someone track my movements in my house in exchange for preferential rates on my homeowner’s policy?

While we can’t say for certain right now, it’s not a huge leap to expect that, at some point, we’ll all be asked to “name our price.”

Obesity as Disease: A Profound Change

The obesity rate in the U.S. has doubled in the past 15 years. More than 50% of the population is overweight, with a BMI (body mass index) between 25 and 30, and 30% have a BMI greater than 30 and are considered obese. Less than 20% of the population is at a healthy weight, with a BMI less than 25.

On June 16, 2013, the American Medical Association voted to declare obesity a disease rather than a comorbidity factor, a decision that will affect 78 million adults. The U.S. Department of Health and Human Services said the costs to U.S. businesses related to obesity exceed $13 billion each year. With the pending implementation of ICD (International Classification of Diseases) 10 codes, the reclassification of obesity is is fast becoming a reality and will dramatically affect workers’ compensation and cases related to the American Disability Act and amendments.

Before the AMA’s obesity reclassification, ICD-9 code 278 related to obesity-related medical complications rather than to obesity. The new ICD-10 coding system now identifies obesity as a disease, which needs to be addressed medically. Obesity can now become a secondary claim, and injured workers will be considered obese if they gain weight because of medications, cannot maintain a level of fitness because of a work-related injury or if their BMI exceeds 30. The conditions are all now considered work-related and must be treated as such.

The problem of obesity for employers is not confined to workers’ compensation. The Americans with Disability Act Amendment of 2008 allows for a broader scope of protection for disabilities. The classification of obesity as a disease now places an injured worker in a protected class pursuant to the ADA amendment. In fact, litigation in this area has already started. A federal district court ruled in April 2014 that obesity itself may be a disability and will be allowed to move forward under the ADA (Joseph Whittaker v. America’s Car-Mart, Eastern District of Missouri).

Obesity as an impairment

Severe obesity is a physical impairment. A sales manager of a used car dealership was terminated for requesting accommodation and won $128,000. He was considered disabled, and the essential function of the job was walking, so he was terminated without reasonable accommodation.

The judge ruled that obesity is an accepted disability and allowed him to pursue his claim against his employer. This could have substantial impact for employers as injured workers could more easily argue that their obesity is a permanent condition that impedes their ability to return to work, as opposed to a temporary life choice that can be reversed.

The Equal Employment Opportunities Commission (EEOC) has recently chimed in on obesity. According to the EEOC, severe [or morbid] obesity body weight, of more than 100% over the norm, qualifies as impairment under the ADA without proof of an underlying physiological disorder. In the last year, we have seen an increasing number of EEOC-driven obesity-related lawsuits. Federal district courts support the EEOC’s position that an employee does not have to prove an underlying condition, especially in cases where there is evidence that the employer perceived the employee’s obesity as a disability or otherwise expressed prejudice against the employee for being obese.

Workers’ compensation claims are automatically reported to CMS Medicare with a diagnosis. When the new ICD-10 codes take effect, an obesity diagnosis will be included in the claim and will require co-digital payments, future medical care or continued treatment by Medicare.

There is good news on the horizon. Reporting of a claim only happens if there is a change in condition not primarily for obesity. It is recommended that baseline testing for musculoskeletal conditions be conducted at the time of hiring and on the existing workforce. In the event of a work-related injury, if a second test is conducted that reveals no change in condition, it results in no reportable claim and no obesity issue. In the event of ADA issues, the baseline can serve to determine pre-injury condition or the need for accommodations.

What does this mean to employers?

Obesity is now considered a physical impairment that may affect an employees’ ability to perform their jobs and receive special accommodations pursuant to the ADA.

An increasingly unhealthy workforce will pose many challenges for employers in the next few years. Those that can effectively improve the health and well-being of their employee population will have a significant advantage in reducing work comp claim costs, health and welfare benefits and retaining skilled workers.

Recent studies

In a four-year study conducted by Johns Hopkins with an N value of 7,690, 85% of the injured workers studied were classified as obese. In a Duke University study involving 11,728 participants, researchers revealed that employees with a BMI greater than 40 had 11.65 claims per 100 workers, and the average claim costs were $51,010. Employees with a BMI less than 25 had 5.8 claims per 100 workers, with average claim costs of $7,503. This study found that disability costs associated with obesity are seven times higher than for those with a BMI less than 30.

A National Institute of Health study with 42,000 participants found that work-related injuries for employees with a BMI between 25 and 30 had a 15% increase in injuries, and those with a BMI higher than 30 had an increase in work-related injuries of 48%.

The connection between obesity and on the job injuries is clear and extremely costly for employers. Many employers have struggled with justifying the cost of instituting wellness programs just on the basic ROI calculations. They were limiting the potential return on investment solely to the reduction in health insurance costs rather than including the costs on the workers’ comp side of the equation and the potential for lost business opportunities because of injury rates that do not meet customer performance expectations. Another key point is that many wellness programs do not include a focus on treating chronic disease that may cause workers to be more likely to be injured and prolong the recovery period.

Customer-driven safety expectations

There are many potential customers (governments, military, energy, construction) who require that their service providers, contractors and business partners meet specific safety performance requirements as measured by OSHA statistics (recordable incident rates) and National Council on Compensation Insurance (NCCI) rating (experience modifiers) and, in some cases, a full review by 3rd party organizations such as ISNet World.

Working for the best customers often requires that your company’s safety record be in the top 25th percentile to even qualify to bid. To be a world-class company with a world-class safety record requires an integrated approach to accident and injury prevention.

Challenges of an aging workforce

The Bureau of Labor Statistics projects that the labor force will increase by 12.8 million by 2020. The number of workers between ages 16 and 24 will decline 14%, and the number of workers ages 25 to 54 will increase by only 1.9%. The overall share of the labor force for 25- to 54-year-olds will decline from 68% to 65%. The number of workers 55 and older is projected to grow by 28%, or 5.5 times the rate of growth in the overall labor force.

Employers must recognize the challenge that an aging workforce will bring and begin to prepare their workforce for longer careers. A healthy and physically fit 55-year-old worker is more capable and less likely to be injured than a 35-year-old worker who is considered obese.

Treating chronic disease

Employers who want a healthy work force must recognize and treat chronic disease. Many companies have biometric testing programs (health risk assessments) and track healthcare expenditures through their various providers (brokers and insurance carriers).

The results are quite disappointing. On average, only 39% of employees participate in biometric screenings even when they are provided free of charge. For those employees who do participate and who are identified with high biometric risk (blood pressure, glucose, BMI, cholesterol), fewer than 20% treat or even manage these diseases.

This makes these employees much more susceptible to injury and significantly lengthens the disability period. The resulting financial impact on employers can be devastating.

Conclusion

Best-in-class safety results will require a combined approach to reduce injuries and to accommodate new classes of disability such as obesity. It is important that employers focus on improving the health and well-being of their workforce while creating well-developed job descriptions, identifying the essential functions, assessing physical assessments and designing job demands to fall within the declining capabilities of the American workers. It is important for an employer to only accept claims that arise out of the course and scope of employment. This is especially true with the reclassification of obesity as a disease. Baseline testing will play an essential role in separating work-related injuries from pre-existing conditions in this changing environment.