Tag Archives: uspstf

A Proposed Code of Conduct on Wellness

So many wellness industry misdeeds to expose, so little room on the internet.

This posting will start out as one of my typical shock-and-awe postings featuring a wellness vendor raising the bar for dishonesty and employee harms. Uniquely, though, we will close with a surprisingly uplifting slam-bang conclusion that could change the wellness industry forever…but only with your help.

The Bad News

It’s that time of year again, when traditionally the C. Everett Koop Award Committee bestows an award upon a fellow committee member or award sponsor, in recognition of doing the best job of fabricating dramatic savings while making only trivial improvements in employee health. That’s par for the course, and isn’t even news any more.

See also: The Yuuuuge Hidden Costs of Wellness

However, this year, the Koop Award Committee apparently decided that actually improving employee health was too high a bar for a wellness program to clear, so the committee gave the award to a committee colleague, Wellsteps, for a program in which the health status of Boise School District employees deteriorated. We’ve done the arithmetic so you don’t have to. The award application below shows that 5,293 employee biomarkers improved, while 6,397 got worse.

Screen Shot 2016-08-14 at 7.46.59 PM

In addition to the objective failure of the program, consider employee self-reported health. The single most important question to ask to gauge the state of someone’s health is: “How is your health?” Wellsteps buried the answer to that question at the end of a long list, but squint hard enough and you can see that Boise employee self-reported health status declined, by a small but statistically significant (p=0.0007) amount:

Screen Shot 2016-08-14 at 7.48.39 PM

There are many other problems with this program, too. Wellsteps is shaming even the lightest drinkers, attributing massive savings to improved health despite the deterioration in health, suppressing data showing increased health spending and flouting clinical guidelines. All that is covered in this Linkedin Pulse.

In all fairness, here is the response from Wellsteps’ Troy Adams (best known in the wellness industry for posting that ”It’s fun to get fat, and it’s fun to be lazy”) to my initial observations that Wellsteps is harming employees and fabricating savings. Surprisingly, I agree with both points:

  1. Yes, the Wellsteps data is “rock solid;” and,
  2. Yes, having just walked into from 92-degree heat, I am at least temporarily full of “hot air.”

The Good News

Fabricating savings is part of the Koop Award DNA, but bestowing an award on a vendor that actually harmed employees crosses a bright red line. Rather than complaining about it (or more accurately, in addition to complaining about it), I thought it might be time to take steps to prevent this type of performance from being considered acceptable, let alone prizeworthy.

So I convened a group, including WELCOA‘s respected and forward-thinking new CEO, Ryan Piccarella, and leading wellness gurus Jon Robison and Rosie Ward of Salveo Partners. Together, we crafted a very simple and minimalist Code of Conduct. (I don’t want to take more than my share of the credit. This was a joint effort. I just happened to be the one who initiated the email chain.) In full, it appears below. It is definitely “minimalist,” a Code of the first-do-no-harm variety. And yet, as low a threshold as it is, many vendors – including Wellsteps and many previous Koop Award winners – would not be able to meet it.

What we would ask of ITL’s readership is:

  1. Circulate this posting/the Code widely;
  2. As brokers or customers, insist that your vendor(s) follow the Code of Conduct…and add it as an actual contractual term;
  3. As brokers or vendors, announce that you will be following the Code. (While this blog is my own effort, I am also affiliated with Quizzify. Quizzify will be announcing this week that it intends to make this Code of Conduct a contractual term, meaning that failing to adhere to it would constitute a breach of our obligations under the contract.)

The Employee Health Program Code of Conduct

Our organization resolves that its program should do no harm to employee health, corporate integrity or employee/employer finances. Instead, we will endeavor to support employee well-being for our customers, their employees and all program constituents.

Employee Benefits and Harm Avoidance

Our organization will recommend doing programs with/for employees rather than to them, and will focus on promoting well-being and avoiding bad health outcomes. Our choices and frequencies of screenings are consistent with U.S. Preventive Services Task Force (USPSTF) and CDC guidelines and Choosing Wisely.

See also: Wellness Promoters Agree: It Doesn’t Work  

Our relevant staff will understand USPSTF guidelines, employee harm avoidance, wellness-sensitive medical event measurement and outcomes analysis.

Employees will not be singled out, fined or embarrassed for their health status.

Respect for Corporate Integrity and Employee Privacy

We will not share employee-identifiable data with employers and will ensure that all protected health information (PHI) adheres to HIPAA regulations and any other applicable laws.

Commitment to Valid Outcomes Measurement

Our contractual language and outcomes reporting will be transparent and plausible. All research limitations (e.g., “participants vs. non-participants” or the “natural flow of risk” or ignoring dropouts) and methodology will be fully disclosed, sourced and readily available.

Wising Up on Prostate Tests (Finally)

The number of tests for prostate cancer has dropped, according to an article in the Wall Street Journal by Melinda Beck, but it’s not for the reason that first jumps to mind.

The article says, “The declines follow the U.S. Preventive Services Task Force’s recommendations against routine testing for prostate cancer, first for men aged 75 and older in 2008, and then for men of all ages in 2012, on the grounds that the benefits likely don’t outweigh the harms.”

I repeat: The benefits of prostate screening likely don’t outweigh the risks.

In short, the diagnosis rate is down because, apparently, more doctors are following new guidelines on prostate screening. At last…at long last.

But there is a joker in the deck. Every wellness program I’ve looked at has not adopted the USPSTF’s prostate screening guidelines. (There may be some that have adopted the new recommendations, but I haven’t seen them.)

It’s worse. I asked a wellness vendor why the company was persisting in promoting prostate over-screening. His reply made my stomach churn. He said that, if his wellness company changed the guidelines, it would have to admit it was wrong in the first place. So it is keeping flawed recommendations to save face. I’d name the vendor, but I agreed to keep what he told me in confidence. Alas.

If you have a wellness program, and the vendor is not following that guideline on prostate screening, you need to give it a big nudge.

P.S. Years ago, I asked my primary care doctor to stop doing PSA tests on me.

Wellness Programs Save Money!

April Fools.

Of course wellness doesn’t save money. Even the industry trade association itself, the Health Enhancement Research Organization, admits wellness loses money.

That doesn’t mean the industry lacks other benefits, such as levity. And in the spirit of the wellness field’s most appropriate holiday, we present “On the (Even) Lighter Side,” a compendium of the funniest moments in recent wellness history.

Unfortunately, the joke is that wellness is not a joke. Besides damaging morale, things are being done to employees that could even harm them — medical interventions that the U.S. Preventive Services Task Force (USPSTF) urges not be done. Even routine screens that are done to employees — only for cholesterol and related blood values — shouldn’t be done annually, and shouldn’t be done on everyone, according to the USPSTF.

Still, we’ll let it go this one day and urge you to do the same and enjoy the one contribution that wellness advocates are bringing to the healthcare policy debate: merriment.

Are Annual Physicals Really Worthless?

Dr. Ezekiel Emanuel wrote a contrarian opinion piece in the Jan. 8, 2015, issue of the New York Times titled, “Skip Your Annual Physical.” Dr. Emanuel is an oncologist at the University of Pennsylvania and was an adviser to the Obama administration regarding the design of health reform. He is also the brother of Rahm Emanuel, a former presidential chief of staff.

As you can guess from the title of the opinion article, Dr. Emanuel believes that annual physicals are not worth having because they do not reduce mortality. He cites a Cochrane Review study to back up his statement. Click here to read a summary of the study by the American Association of Family Practice.

Dr. Emanuel’s comments bring the following question to mind: How is one to have the evidence-based screenings recommended by the U.S. Preventive Services Task Force (USPSTF) without an annual physical?

Here is a list of some of the USPSTF screenings and interventions that studies have shown to be of value by reducing morbidity or mortality that could be accomplished at an annual physical:

  1. Screening for Type II diabetes
  2. Screening for hypertension
  3. Screening for lipid disorders (e.g. high cholesterol)
  4. Screening and counseling for alcohol abuse
  5. Screening for cervical cancer every 3-5 years
  6. Screening for obesity
  7. Potential use of aspirin for the prevention of heart attack
  8. Counseling on folate vitamin supplements for all women capable of pregnancy to prevent neural tube defects
  9. Counseling overweight and obese patients to improve their diet and exercise habits

Source: American Association of Family Practice

Many of these conditions are not rare.  For example:

  • 9.3% of the U.S. population has diabetes-of whom, 9 million are undiagnosed (Click here for ADA source). Assuming a U.S. population of 300 million, 9 million is 3% of the population, so three in 100 screenings would find undiagnosed diabetes. In a company with 1,000 employees, screening for diabetes would result in identifying 30 new cases of diabetes.
  • 29% of the adult U.S. population has hypertension-17% are undiagnosed (Click here for CDC source). 17% of 29% is about (again) 3% of the adult U.S. population, so three in 100 screenings would find undiagnosed hypertension. In a company with 1,000 employees, screening for hypertension would result in identifying 30 new cases of hypertension.

An annual physical is a great way to address these nine proven screening tests and interventions that will lengthen life and reduce suffering. This is only a representative sample from the USPSTF.  There are actually more than nine. You would not “technically” need an annual physical, but you would have to have some other mechanism for having these screenings and interventions performed.  A similar point is made by the American Academy of Family Physicians in its review of the Cochrane study. However, the use of the doctor’s office as the setting for the screening means that if an abnormality is found (i.e. diabetes, hypertension, etc.), then the doctor can prescribe an intervention.

To skip an annual physical and to not have the screening performed some other way-and followed up on-is hazardous to your health