Tag Archives: DNA

Wellness Promoters Agree: It Doesn’t Work

How many times do wellness promoters have to admit or prove that wellness doesn’t work before everyone finally believes them?

Whether one measures clinical outcomes/effectiveness, savings or productivity, the figures provided by the most vocal wellness promoters and the most “successful” wellness programs yield the same answer: Wellness doesn’t work.

  • Outcomes/Effectiveness

Let’s start with actual program effectiveness. Most recently, Ron Goetzel, head of the committee that bestows the C. Everett Koop Award, told the new healthcare daily STAT News that only about 100 programs work, while “thousands” fail.

In that estimate, which works out to a failure rate well north of 90%, he is joined by Michael O’Donnell, editor of the industry trade journal, the American Journal of Health Promotion (AJHP). O’Donnell says that as many as 95% of programs fail. (For the record, I have no beef with him, because he once willingly admitted that I am “not an idiot.”)

The best example of this Goetzel-O’Donnell consensus? McKesson, the 2015 Koop Award winner. McKesson’s own data –even when scrubbed of those pesky non-participants and dropouts who are too embarrassed to allow themselves to be weighed in – shows an increase in body mass and cholesterol:

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Vitality Group, which contributed to this McKesson award-winning result as a vendor, wants your company to publicly disclose how many fat employees you have. Why? So that you are “pressured” (their word) into hiring a wellness vendor like Vitality. Yet Vitality admits it can’t get its own employees to lose weight.

McKesson and Vitality continue a hallowed tradition among Koop Award-winning programs of employees not losing noticeable weight. For instance, at Pfizer, the 2010 award-winner, employees who opened their weight-loss email lost all of three ounces:

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Maybe it’s unfair to pick programs based on winning awards. Awards or not, those programs could have cut corners. Perhaps to find an exception to the rule that wellness can’t improve outcomes, we should look to the most expensive program, Aetna’s. Unfortunately, even Aetna registered only the slightest improvement in health indicators, throwing away $500/employee in the process. Why that much? Aetna decided to collect employee DNA to predict diabetes, even though reputable scientists have never posited that DNA can predict diabetes.

So even award winners, wellness vendors themselves and gold-plated programs can’t move the outcomes needle in a meaningful way, if at all. Bottom line: It looks like we finally have both consensus on the futility of wellness, and data to support the wellness industry admission that way north of 90% of programs do indeed fail to generate outcomes.

Savings

Because wellness promoters now say most programs fail, it is no surprise they also say most programs lose money. Once again, this isn’t us talking. The industry’s own guidebook – written by Goetzel and O’Donnell and dozens of other industry leaders — shows wellness loses money. We have posted that observation on ITL before, and no one objected.

However, very recently, the sponsors of this guidebook (the Health Enhancement Research Organization, or HERO) did finally take issue with our quoting statistics from their own guidebook. They pointed out — quite accurately — that their money-losing example was hypothetical. It did not involve numbers they would approve of, despite having published them. (At least, we think this is what HERO said. One of their board members has learned that they have sent a letter to members of the lay media, telling them not to publish our postings. We are told HERO’s objection centers on our quoting their report.)

To avoid a lawsuit for quoting figures they prefer us not to quote, we substituted their own real figures for their own hypothetical figures — and using real figures from Goetzel’s company, Truven Health Analytics, multiplied the losses.

This very same downloadable guidebook notes that these losses, as great as they are, actually exclude at least nine other sources of administrative costs–like internal costs, impact on morale, lost work time for screenings, etc. (Page 10). Truven also excludes a large number of medical costs (Page. 22):

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One could only assume that including all these administrative and medical losses in the calculation would increase the total loss.

Lest readers think that this consensus guidebook is an anomaly, HERO is joined in its conclusion that wellness loses money by AJHP. AJHP published a meta-analysis showing a negative ROI from high-quality studies.

Productivity

RAND’s Soeren Mattke said it best:

“The industry went in with promises of 3-to-1 and 6-to-1 ROIs based on healthcare savings alone. Then research came out that said that’s not true. They said, ‘Fine, we are cost-neutral.’ Now research says: ‘Maybe not even cost-neutral.’ So they say: ‘It’s really about productivity, which we can’t really measure, but it’s an enormous return.'”

The AJHP stepped up to make Dr. Mattke appear prescient. After finding no ROI in high-quality studies, proponents decided to dispense with ROI altogether. “Who cares about ROI anyway?” were O’Donnell’s exact words.

Because health dollars couldn’t be saved, O’Donnell tried to estimate productivity impact. But honesty compelled him to admit that workers would need to devote about 4% of their time to working out to be 1% more productive on the job. Using his own time-and-motion figures, and adding in program costs, his math creates a loss exceeding $5,200/employee/year.

I would have to agree with O’Donnell, based on my experience in the 1990s as the CEO of a NASDAQ company. Ours was a call center company, which meant someone had to answer the phones. If I had let employees go to the gym instead of working, I would have had to pay other employees to cover for them. Our productivity would have taken a huge hit, even if the workouts bulked up employees’ biceps to the point where they could pick up the phone 1% faster.

Where Does This Leave Us?

Despite our using their own figures, wellness promoters may object to this analysis, saying they didn’t really intend for these conclusions to be reached. Intended or not, these are the conclusions from their figures, and theirs largely agree with ours, expressed in many previous blog posts on ITL. And, of course, our website, www.theysaidwhat.net, is devoted to exposing vendor lies. The bottom line is, no matter whose “side” you are on, the answer is the same. Assuming you look at promoters’ actual data or statements instead of listening to the spin, the conclusion is the same: Conventional wellness doesn’t work.

It’s time to move on.

Genetic Testing: The New Wellness Frontier

The Wall Street Journal just reported that Genetic Testing May Be Coming to Your Office Soon. This is all well and good, assuming employees want their health insurer’s buddies collecting their DNA for no good reason, handling it, selling it and possibly losing it.

This is not us talking. This is what the genetic testing company itself says on its website. You can read all about it here.

We will focus on the fact that this genetic testing simply doesn’t save money – even according to a study by the main proponents of this dystopian scheme, Aetna and its buddies at the ironically named Newtopia.

If engineers learn more from one bridge that falls down than from 100 that stay up, this new Aetna-Newtopia study is the Tacoma Narrows of wellness industry study design. No article anywhere – including our most recent in Harvard Business Review – has more effectively eviscerated the fiction that wellness saves money than Aetna just did in a self-financed self-immolation published in the Journal of Occupational and Environmental Medicine. We hope the people who give out Koop Awards to their customers and clients will read this article and finally learn that massive reductions in cost associated with trivial improvements in risk are because of self-selection by participants, not because of wellness programs. And certainly not because of wellness programs centered on DNA collection.

Aetna studied Aetna employees who, by Aetna’s own admission, didn’t have anything wrong with them, other than being at risk for developing metabolic syndrome, defined as “a cluster of conditions that increase your risk for heart attack, stroke and diabetes.”

In other words, Aetna took the wellness industry’s obsession with hyperdiagnosis to its extreme: The “diagnosis” of those Aetna studied was that they were at risk for being at risk. Not only did they not have diabetes or heart disease, they didn’t even have a syndrome that put them at risk for developing diabetes or heart disease. You and I should be so healthy.

As this table shows, after one year, the changes in health indicators between the control and study groups were trivial (e.g., a difference in waist measurement of less than 3/10 of an inch), only the change in triglycerides was statistically significant, and just barely (p=0.05). The control group actually outperformed the study group in three of the six measured variables, as would be predicted by chance. Bottom line: Nothing happened.

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Yet Aetna reported savings of $1,464 per participant in the first year. This figure is more than 20 times higher than what Aetna’s own HERO Report says gets spent in total on medical events that could be affected by wellness programs. The figure is also far higher than Katherine Baicker’s claim of a 3.27-to-1 return on wellness spending. (Yes, in keeping with wellness industry tradition, Aetna cited the claim even though it has been thoroughly discredited and basically retracted; only now, because the Baicker study is six years old, Aetna feels compelled to insist that it is “recent.”)

How did Aetna achieve such a high savings figure in a legitimate, randomized controlled trial (RCT)? Simple. That savings was not the result of the legitimate RCT. Having gone through the trouble of setting up an RCT, Aetna largely ignored that study design.

As Aetna’s own table above shows, nothing happened. Spending was a bit lower for the invited group, but obviously there couldn’t have been attribution to the program. A responsible and unbiased researcher might have said: “While there is a slight positive variance between the spending on the control group and the spending on the invitee group that wouldn’t begin to cover the cost of our DNA testing, we can’t attribute that variance to this program anyway. The subjects were healthy to begin with, there was no change in clinical indicators and we didn’t measure wellness-sensitive medical events even though we know from our own HERO report both that those represent only a tiny fraction of total spending, and that those are the only thing that a wellness program can influence.”

Instead, Aetna coaxed about 14% of the invitees to give up their DNA and measured savings on that small sample. (More than coincidentally, that decidedly uninspiring 14% participation rate was about the same as the Aetna-Newtopia debacle at the Jackson Labs reference site-from-hell. Basically, employees don’t want their DNA collected, and DNA turns out to be quite controversial as a tool to predict heart disease down the road, let alone during the next 12 months. Further, Newtopia admits that it stores employee DNA, that lots of people have access to it and that Newtopia could lose it.)

The DNA seems to have had precious little to do with the actual wellness program. This Aetna program seems like a classic wellness intervention of exactly the type that has never been shown to work, with the DNA being only an entertaining sidebar. The subjects themselves exhibited no interest in hearing about their DNA-based predictions.

This is the first time a study has compared the result of an RCT to the result of a participants-only subset of the same population. The result: a mathematically and clinically impossible savings figure on the subset of active participants, and an admission of no separation in actual health status between the control and invitee groups by the end of the program period.

So Aetna accidentally proved what we’ve been saying for years about the fundamental bias in wellness study design that creates the illusion of savings:

Participants in wellness studies will always massively outperform non-participants – even when the program doesn’t change health status and even when there was no program for the “participants” to participate in.

How to Hire for Attitude: 5 Steps

What do companies like Southwest Airlines, Ritz-Carlton and Zappos have in common? They hire for attitude and train for skill.

It’s a simple mantra but one that has a profound impact on how to successfully recruit and select new employees.

Prioritizing Soft Skills

During their hiring process, these companies weigh “attitudinal” characteristics very heavily.

These are personal attributes that it’s difficult to train employees on — such as being a people-person, having an upbeat personality or possessing a keen ability to learn.

While these firms won’t ignore technical skills (Southwest doesn’t put unqualified pilots in the cockpit, no matter how bright and cheery they are) they nonetheless look very carefully at these soft skills — far more than most employers do.

These companies gain a lot from this hiring strategy. By focusing on attitudinal characteristics that align with their company brand, these companies reinforce their distinctive company culture with each new hire.

And because they’re hiring people whose values align with that culture, the result is a workforce that’s happier, more engaged and less likely to turn over.

But the benefits of this hiring process don’t stop there. When a workforce embodies the company brand (think how Southwest employees exude “fun”), it differentiates the customer experience where it counts most — in consumers’ one-on-one interactions with your staff.

If you have any doubt about the power of that dynamic, just consider how Southwest, Ritz-Carlton and Zappos have dominated their respective markets.

Five Steps to Hiring for Attitude

So how should you go about hiring for attitude, seeding your workforce with true brand ambassadors? You could run your applicants through personality tests and behavioral assessments — but that can be pricey, time-consuming and onerous for the candidates.

Fortunately, there are other approaches you can employ to put this strategy in practice. Here are five simple, low-cost ways to hire for attitude:

1. Be clear about expectations.

Take advantage of candidate self-selection by clearly broadcasting what qualities you look for when bringing on staff.

For example, if you tell the world that you’re in the market for extroverts – fewer introverts will apply (and that’s a good outcome for you and them).

By defining what personal qualities you’re searching for up-front, you make it more likely that candidates with those attributes will throw their hats into the ring.

2. Be aggressive.

Don’t just wait for people with the right attitude to apply for a job – spot them in the marketplace and make your pitch!

When you see someone who clearly embodies the qualities you want on your team, give her your card and invite her to apply for employment.

As any great recruiter knows, that extremely attentive waiter, remarkably patient sales associate or well-spoken repairman could be your next great hire.

3. Focus on the person behind the paper.

Gauging attitude from a resume requires insight and vision. Consider how the personal qualities you seek would manifest themselves in a candidate’s resume and background.

For example, individuals who are adept at overcoming adversity may have demonstrated that spirit in how they responded to a layoff. People-oriented extroverts may belong to a variety of business associations and community groups. Skilled communicators will likely design and organize their resume content in exceptional ways.

In addition, your interview questions can also reveal attitudinal characteristics. Looking for someone with customer service in his DNA? Ask about the most over-the-top service he ever delivered (the best service people never forget such stories).

Looking for someone with a sense of humor? Ask about the time she laughed the hardest.

Whatever attitude you seek to hire, the key is to look beyond the words on the resume and search for more subtle clues about a candidate’s character.

4. Observe applicants when they think no one is watching.

Want to see a candidate’s true colors? Then see how he behaves when he thinks no one is watching.

How did the applicant treat your receptionist? Did he strike up a conversation with other applicants in the waiting room? Did he eat alone in the cafeteria or introduce himself to a table of strangers?

What the candidate says and does outside of the hiring manager’s view can give you a glimpse into her true personality (which may differ from how she presents in an interview). Use these clues to help judge if the applicant will really be a good fit in the culture you’re cultivating.

5. Enlist today’s stars to spot tomorrow’s standouts.

Toward the end of the hiring process, see if it’s possible to have your job finalists spend some time shadowing existing employees.

This serves two objectives. First, candidates get an unfiltered look at the job they’d be performing, so there’s less chance of unpleasant surprises and post-hire buyers’ remorse.

Second, by pairing these finalists with the best employees (the ones who embody the desired attitude), your existing staff can help identify those applicants who have the right stuff.

Hiring for attitude is about building a distinctive workplace culture and company brand that, unlike skill sets, can’t easily be copied in the market. It’s what gives Southwest Airlines, Ritz-Carlton and Zappos their unique character — and competitive advantage.

Follow the lead of these legendary firms as you look to recruit great candidates. Don’t just hire for skill; hire for attitude. It makes all the difference.

This article originally appeared on monster.com.

Customer Perception Is Your Reality!

The quote in the headline — “The customer’s perception is your reality” — is from the renowned business trainer Kate Zabriskie, and I hope you agree it is absolutely true. No matter how excellent you think you are, or your company is, at service delivery, your future success as an enterprise depends principally upon how good you are in your customers’ minds when responding to their ever-changing needs. Or, as John Mackey (CEO, Whole Foods) put it, “For us, our most important stakeholder is not our stockholders, it is our customers. We’re in business to serve the needs and desires of our core customer base.”

But what are those needs? Are they those that you may have already identified, based on your experience? Has your considerable operational expenditure, in people and systems, really met what your customers need? Or is our thinking unconsciously restricted by our knowledge of what we can and cannot easily achieve?

There are many publications, a plethora of business processes ideas and of course the Internet itself, all crammed with customer relationship management theories. I don’t suggest that these are wrong, but what I do believe is that most financial services customers want something better than the superficial contact often delivered regularly by mailshots or e-mails. The “relationship” they require is more like that of their general medical practitioner! Namely a service that is accessible, resulting in knowledgeable and courteous attention, one that is effective, on call always but available only when needed.

This article focuses on customer perception and service delivery for existing insurance customers and associated stakeholders. More specifically about how appropriately the enterprise responds to customers’ post-sales questions, claims and changes about personal lines policies.

It might first be helpful to consider, in general terms, the prime means of post-sales service delivery in the UK currently deployed by insurance companies, brokers, claims service companies, etc.

These channels are principally face-to-face in offices; via the Internet; over the telephone, including SMS texting; and, to an under-developed extent, through mobile service platforms.

Branch contact used to be normal, but face-to-face customer contact seems on the decline. No doubt the cost of staff, the use of alternative technologies and the need to drive down costs have all contributed to the demise of the branch office. The challenge then is how to achieve the goal that Sam Walton (founder of Wal-Mart) described as “customer service that is not just the best but legendary.”

Well, I imagine that the words “call center” do not spring immediately to your mind as “legendary.”

At their best, call centers provide a good and necessary service, but I do not believe that the sophisticated telephony statistics and in-house customer surveys yield an entirely accurate picture of customer perception.

In the main, customer perception is that call centers are a dismal fact of life. They often describe their experience as an endless series of numerical options and pre-recorded messages. These are followed by an interminable wait brought to an unsatisfactory climax by what they perceive as a “factory service,” so often a conversation with an underpowered and strictly timed operator, who seems in a hurry to deal with the next call.

Is this the sort of post-sales service your customers deserve? Does it really surprise and delight your customer with “legendary” service?

From an enterprise point of view, call centers are generally sub-optimal. Staff turnover can be high, recruitment and training costs significant, with onerous levels of supervisory oversight. Management often experiences prolonged stress, justifying service delays and fretting how to improve service without incurring more costs. Most call center staff cannot make significant changes to policy records, or handle customers’ resulting needs themselves; instructions have to be prepared for other processing technical staff.

Is there a better or additional way, other than a call center, in which the increasing expectations of existing insurance customers can be met and exceeded? Is it possible to achieve this and at the same time drive a huge chunk of operational costs out of the business?

The answer is emphatically yes! In fact these benefits can be achieved quickly and cheaply compared with traditional legacy and Internet technology. The solution is to deploy the latest and powerful mobile technology directly to customers, to empower them to access their own records and to make self-service changes, raise claims and initiate inquiries directly to a database or a secure copy.

Today’s customer is never far from a smartphone or tablet. The expectation from an enterprise is that of mobile technology being available to post-sales and post-renewal. Customers do not want to be pinned down to call center hours or a static location from which to call to make changes or to deal with claims.

Any company that offers a post-sales insurance service that suits the time and place of their choice must surely have a significant and differentiated product. If that same company, as a result, is able to eliminate a huge percentage of its operational costs, then it also will derive a massive commercial advantage. Let’s see how this can be achieved.

To explain and to avoid confusion with traditional legacy solutions, I will briefly describe the provenance of modern mobile technology platforms.

It was not long ago that mobile phones were used solely for voice calls and texts. Today’s smart phones and tablets are multifunctional devices that can insert themselves into the very DNA of the customer-enterprise relationship.

This is possible by means of developing intelligent mobile processes. Operating systems for smart phones such as Mac iOS, Android, Windows and RIM are now fully mature and open a window of opportunity for the development of third-party software.

But quality matters, too, and development needs to be easy and intuitive to use because mobile users demand more choice, more ways to use their phones more functionally.

The Internet just allowed us to connect with anyone in the whole world. But with mobile technology we will connect anytime and anywhere with everything through “the Internet of Things” (IoT). Manufacturers and retailers are investing immense amounts of money in intelligent appliances, and very soon your home will be as smart as your car. This technology offers a unique chance for insurance enterprises to integrate intelligent mobile devices in their post-sales service delivery.

For example:

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How would this work in practice? Mobile and tablet applications are limited only by vision and imagination, and space in this article permits only a brief summary. There are two principal post-sales areas where advantage can be gained, namely policy changes/inquiries and claims reporting/progress.

Imagine your home and contents policyholder receiving a renewal notice and reviewing the cover. This might show that the sums assured need revision and that a newly acquired item of jewelry should be added; perhaps an optional extra such as legal expenses cover is to be considered. By means of an appropriate mobile phone or tablet, the policyholder “logs in” and views current policy details. No doubt this will include a reminder that renewal is almost due.

Using the form of graphic display the policyholder is used to (sliders and check boxes on smart phones for example) the cost of changes are modeled. More information about the legal expenses cover is requested, received and possibly some questions answered. Mid-term changes are frequent, too, so any relevant date and details of change may subsequently be selected once the policy records are accessed from the mobile. When the customer is satisfied with the modeled changes, the new risk profile is sent to the insurer and a new premium generated. If accepted (or remodeled), payment details are collected, and no doubt certain questions required by the insurer are “check-boxed,” instant confirmation is given and promptly afterward updated documents e-mailed to the policyholder.

All of these events take place at a time, day and location of the customer’s choice. Unless the customer chooses otherwise, no call center conversation is required; no staff are needed to manually process the changes. In this example, all the requested changes were within the insurer’s underwriting and rating rules; had they not been, then an appropriate message would be generated ensuring, that a call center contact is focused upon more specialized and justified issues, requiring a smaller number of trained and empowered people. In effect, the call center becomes a skill center, a quite different entity.

Reporting claims and dealing with claims progress issues can easily be imagined, and again the limit is process appetite and creativity. Mobile technology has the advantage of a camera, GPS and verifiable date and time. So this data can be assured and becomes invaluable within the claims oversight process.

Photographs can be taken, with assured dates/times/locations of loss-related events, damage, articles etc. These can be attached to a mobile claims notification, with appropriate inbuilt guidance, and sent to the claims department to initiate the process. The mobile can be used to receive calls, texts and e-mails. Even voice messages or videos from the customer can be attached. Adjusters can be appointed automatically subject to a “rules engine”; replacement goods can be selected and offered via the mobile connection; estimates and invoices can be generated or photographed for sending on to the claims department.

The effect of these customer processes upon service delivery is abundantly clear. But what of the opportunity to save costs? In my experience, between 25% and 50% of inbound customer calls are of a standard, non-exceptional nature. Conservatively, once fully operational, I would expect mobile technology for post-sales activities to drive out 30% of staff and call center costs of the enterprise. For those who also use call center or technical staff to actually manually process changes, as well, similar levels of savings could be achieved in that part of the operation.

At this stage it is reasonable to ask, if the technology is available now, the advantages so attractive and already being employed by other enterprises, why have insurers, generally, not yet filled this space?

I speculate that there are five reasons:

– The skills required to build mobile technology platforms are not generally available in most insurers’ computer departments.

Mobile process development is new and different, and simply importing legacy or internet systems on mobiles produces ugly, cumbersome customer applications. The solution is the careful selection of a third-party provider, working with staff, to introduce these new skills into the computer department.

– Core processes and enterprise data is jealously guarded by departments. Security is also of paramount importance.

They are right to be careful! These assets must not be put in harm’s way. Until complete confidence is established, the safe solution is to use replicated rules engines and validate changed data outside the core processes. The use of the latest and most secure encryption technology is paramount.

– Most IT departments have a tremendous backlog of legacy system updates. It’s essential but difficult to focus on a new mobile future when you are trapped in the technology of the past developments.

By using a third-party provider to quickly develop applications and train existing staff, an enterprise can begin to move forward and avoid being left behind by newer competitors.

– Development is seen as possibly expensive and probably protracted.

In fact, the opposite is true. It is surprisingly quick and relatively inexpensive to develop the latest generation of applications for mobile platforms compared with legacy systems. Payback can often be achieved within months of launch.

– There may be a lack of imagination or strategic understanding of what mobile applications can achieve.

It is, in my opinion, dismally true that some of the few mobile insurance “apps” available download little more than contact details, or a claim form. Recreating on a mobile what an enterprise already does on the Internet misses the point entirely and wastes a unique opportunity.

In conclusion, mobile technology has rendered the call center, in its current form, obsolete. The only question is how long the process will take. It will be fascinating to see the more agile and visionary insurance enterprises seize the opportunities presented by mobile technology.