Tag Archives: wellness industry

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.

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.”

Pinch Me! A Healthcare Program That Works

Those of you who are regular readers of this column may have noticed my postings usually observe that most vendors don’t save money — for example, Wellness: An Industry Conceived in Lies, Retractions and Hypocrisy. (Note that this particular article was accompanied by an editorial in which Paul Carroll, ITL’s fearless leader, described how he had asked the perpetrators for rebuttals, but no one had stepped up.)

So it is with great satisfaction that I can finally recommend a company to ITL readers: Quantum Health, which really does save significant money while providing a better employee experience. One might ask: “Wait—you just said the wellness industry is conceived in lies, retractions and hypocrisy. How is Quantum any different?”

Simple: Quantum isn’t a wellness company. It’s sui generis. If categorized at all, it would be called “coordinated care.” Unlike a wellness program, Quantum doesn’t require or even involve health risk assessments, biometric screenings and checkups. Instead, Quantum leaves employees alone unless they’re sick, are high utilizers or ask for help.

Unlike wellness programs, Quantum’s offering is not bolted on to existing administrative programs. Instead, it replaces them, assuming most of the member interface functions from the carrier. Whereas, within a carrier, those functions are siloed — often in different buildings, always with their own budgets, targets and incentives — Quantum is organized by customer, with all the functions for that customer comingled.

The advantage of that arrangement is best described with a story. Once, when I was on a site visit at Quantum, an employee of a new customer called, asking if diabetic shoes were a covered benefit. In most, if not all, carriers, the person answering that query would be evaluated based on accuracy, number of rings, politeness and how many calls they handled that hour. So the person would say “yes” or “no” and then get off the phone. At Quantum, the agent answered the query but was prompted by the supporting software (and by training) to recognize that question as a red flag. Here was an employee whose diabetes was already so advanced he was asking about shoes…and yet he was nowhere in the diabetes registry. A typical carrier wouldn’t find out about this person until after the inpatient claim for his inevitable crash was filed, warehoused, prioritized and queued for telephonic outreach. And then, assuming the carrier had the correct phone number, and this patient answered the call and was receptive, rehabilitation could begin. And yet there he was – right on the phone – asking for help. So the agent probed a little further and then transferred him to a nurse in the same pod, who engaged him right away, almost certainly avoiding or forestalling a future high-cost medical event.

This is just one of many examples of touches that allow Quantum to save your clients more money than any other vendor of any other population health management service. I can guarantee this.

This performance also does not come on the backs of employees. Satisfaction rates are very high, and no one has to be bribed or penalized to participate, as happens with wellness, where the average bribe/penalty has almost tripled in five years, to $594.

Before you get too excited, here are the catches.

First, the carrier has to be willing to give up a chunk of its administrative services…and, more importantly, its administrative fees. It is unlikely that the administrative services contract that your client signed anticipated that, meaning the concession has to be negotiated.

Second, even once that concession is extracted from the carrier, the incremental fee for Quantum will in total generate a higher total administrative cost — Quantum fields several times as many member calls, often lasting several times longer than the calls of the carrier being replaced.

Third, to encourage inbound phone calls at the right times, like when a specialist referral or other high-cost resource is recommended, you need to tweak the benefits design to vary the co-pays according to whether the employee is willing to take the extra step of a phone call. Because of this financial incentive, these phone calls tend to come in at exactly the right times, when an employee is in the midst of an episode of care, and is about to fall into the “treatment trap.” That is the point at which patients are most concerned and most receptive to assistance. All good, except that human resources executives are often reluctant to tweak benefits designs.

Finally, Quantum needs to control its growth, because its performance relies to a large degree on staff training and experience. As the only vendor that has cracked the coordinated care nut, they can’t handle all comers. Consequently, they focus instead on large and jumbo employers. Therefore, you would need a minimum case size of 1,000 employees to engage them.

Still, the outcomes advantages that Quantum confers are compelling.

(Disclosure: There are no disclosures. I am not a shareholder and do not get commissions from Quantum for articles like these.)