Influential RAND researcher Soren Mattke had this to say in support of Al Lewis and Vik Khanna’s latest post on the Wellness story “Would the Real Professor Katherine Baicker Please Stand Up?”
“Gentlemen. Great post. Like you, I am disappointed that researchers of the caliber of Kate Baicker and David Cutler do not respond to the mounting debate about their paper. They should defend or disown their work rather than hope that the debate goes away.
In my mind, their paper is a product typical of high-end academic research. Two brilliant professors spot a gap in the evidence on a hot policy topic and decide to go after it. But the actual work gets done by a graduate student in his cubicle without windows or guidance, and then hastily published.
Then the problem arises that the paper becomes hugely influential and people start having a closer look. For our paper on the PepsiCo program, we reviewed in detail the seven publications that Baicker and colleagues called “high quality evidence”. We found that five of those analyzed programs that operated over 20 years ago and most of them had severe methodologic flaws. (John P. Caloyeras, Hangsheng Liu, Ellen Exum, Megan Broderick and Soeren Mattke. Managing Manifest Diseases, But Not Health Risks, Saved PepsiCo Money Over Seven Years. Health Affairs, 33, no.1 (2014):124-131)
Unfortunately, many defenders of the industry continue to take the Baicker paper at face value, while closely scrutinizing or ignoring more nuanced and scientifically sound findings.
So I herewith support your motion!
Filed Under: OP-ED, THCB
Tagged: Al Lewis, Commentology, David Cutler, Kathleen Baicker, Vik Khanna
Jan 4, 2015
The recent Health Affairs Blog post by Al Lewis, Vik Khanna, and Shana Montrose titled, “Workplace Wellness Produces No Savings” has triggered much interest and media attention. It highlights the controversy surrounding the value of workplace health promotion programs that 22 authors addressed in an article published in the September 2014 issue of the Journal of Occupational and Environmental Medicine titled, “Do Workplace Health Promotion (Wellness) Programs Work?” That article also inspired several follow-up discussions and media reports, including one published by New York Times columnists Frakt and Carroll who answered the above question with: “usually not.”
There are certainly many points of contention and areas for continued discussion on this topic. It turns out that Lewis et al. and I agree on many things, and there are other areas where we see things differently. Continue reading “The Value of Workplace Health Promotion (Wellness) Programs”
Filed Under: OP-ED, THCB
Tagged: Al Lewis, Biometric Screenings, Incentives, Ron Goetzel, Vik Khanna, Wellness, Workplace Wellness
Dec 22, 2014
Al’s son once complained to Al’s Aunt Tillie about an overbearing supervisor. Aunt Tillie suggested that he try to work under a different supervisor. Tillie was one of those people – and we all know them – who could be counted on to inadvertently provide punchlines when needed. Conversely, Al is one of those people – and we all know them – who can’t resist setting up those punchlines. So I lamented that this suggestion may not work because, “Aunt Tillie, it’s a sobering fact that 50% of all supervisors are below average.”
Tillie replied, “I blame our educational system for that.”
Likewise, we may need to blame our educational system for Keas’ new poll on workplace stress. To begin with, the lead paragraph from Keas — which like many other companies is “the market leader” in wellness – “reveals” that “4 in 10 employees experience above-average stress.”
SAN FRANCISCO, CA – (Apr 2, 2014) – Keas (www.keas.com), the market leader in employer health and engagement programs, today released new survey data, revealing four in ten employees experience above average levels of job-related stress. Keas is bringing attention to these findings to kick off Stress Awareness Month, and is also providing additional insight and tips to bring greater awareness to the role of stress in the workplace and its impact on employee health.
Wouldn’t that mean some other employees – mathematically, also 6 in 10 – must be experiencing average or below-average levels of stress? It would seem like mathematically that would have to be the case. However, the Keas poll also “reveals” that while some employees are average in stress, no employee is below-average – a true paradox. Hence Keas’ selfless reasons for publishing this poll: All employees being either average or above average in the stress department means we have a major stress epidemic on our hands. This perhaps explains why Keas is “bringing attention to these findings.”
In a further paradox, Keas also uses the words “average” and “normal” as synonyms, even though they are often antonyms: All of us want our children to be normal but who amongst us wants their children to be average?
Continue reading “Keas Poll on Workplace Stress and Disease Burden Provides an Education”
Filed Under: THCB
Tagged: Al Lewis, Hypertension, Keas, Obesity, productivity, stress, Vik Khanna, Wellness, Workplace, Workplace Wellness
May 2, 2014
Recently, The Health Care Blog published a post by Robert Sutton asking why there were so many jerks in medicine.
That posting made the underlying assumption that being a jerk is a bad thing. In response, we are posting today a defense — really more an explanation of the features and benefits — of jerkdom, at least in our segment of healthcare, wellness and outcomes measurement.
In 1976 an obscure graduate student named Laura Ulrich (now a Pulitzer Prize-winning professor) wrote: “History is seldom made by well-behaved women.” That statement could be applied much more broadly. In any field governed by voluntary consensus – especially where the consensus specifically and financially benefits the people making the consensus – radical change does not happen jerklessly.
The best current example might be the critique of Choosing Wisely in the New England Journal of Medicine in which it was pointed out that only three specialty societies blacklisted controversial procedures still performed in significant enough quantity to affect that specialty’s economics.
(Another example of financially fueled consensus gone awry is the RUC, also frequently and justifiably excoriated in The Health Care Blog and elsewhere.)
Specifically, there are three reasons we act like jerks. (Four reasons if you include selling our book, but we acted like jerks well before our book came out.)
First, as Upton Sinclair said, “You can’t prove something to someone whose salary depends on believing the opposite.” Hence, making nice rarely works and may backfire when you are pointing out a total waste that also happens to be someone else’s income.
After Community Care of North Carolina (CCNC) sponsored an outcomes study by Mercer finding massive savings through their patient-centered medical home (PCMH) in an age cohort (children under one year of age) in which no utilization reduction took place and which, as luck would have it, was not enrolled in the PCMH anyway, we kindly wrote to them and offered to show them the error of their ways, privately.
We didn’t get a response. We repeated the offer when they put out another RFP for even more validation, pointing out that using the HCUP database meant no RFP was needed — we would be able to give them an answer in less time than it would take them to evaluate the RFP responses, and save them close to $500,000 in taxpayer money too.
Continue reading “Why Are Al Lewis and Vik Khanna Such Jerks?”
Filed Under: THCB
Tagged: Al Lewis, Health Risk Assessment (HRA), Outcomes, Vik Khanna, Wellness, workplace wellness programs
Apr 24, 2014
Since 2000, the government and healthcare industry have sold Americans a bill of goods called workplace wellness, which turns out to have been a colossal waste of billions of dollars.
Most of this money was spent bribing employees to do things that they don’t want to do, such as submit to biometrics, answer intrusive health risk appraisals, and get preventive medical care.
The marketing pitch that wellness makes people healthier and lowers medical care costs, and thus, produces a return on investment for the employer, isn’t true. Wellness also allowed companies to position themselves as employee-friendly, even while wages stagnated and employees morphed into fungible widgets, instead of vital assets in whom employers invested for years or decades.
However, it looks to us as though at least one major US company is treating economic reality seriously, and, consequently, asking its employees to act like adults.
Let’s look at wellness by Amazon.com, which has apparently avoided conventional wellness whole cloth. Despite our best research efforts, we find no evidence that the company makes conventional wellness programming a priority for employees.
It’s a bit ironic that they don’t given the recent spate of tough publicity about the company’s employment practices.
Amazon has been lambasted lately for the plight of the warehouse workers who animate its backroom operation, where constant video surveillance, productivity demands, and getting your bag searched before you go home are the norms. Message boards also detail the pressure-cooker atmosphere of the company’s white collar space, which raises, in our minds, the pointed question of why haven’t they done wellness?
We think it’s because Amazon’s philosophy about work is straightforward: if you work here, expectations are high and relentless. Amazon’s approach to employee well-being seems to be to not have one other than we invite you to grow with us. This is counter-cultural, and it has more to recommend it than first appears obvious.
When you are competing against Walmart and Target, remaining lean and low-cost is critical; wellness drives costs up, not down.
Expecting many staff to work 50, 60, or even 70 hours per week leaves little time for discretionary visits to the doctor that are pointless even before they happen because this superfluous care will save neither lives nor money. When you are not pouring money into coercing employees to join a wellness program, you preserve capital needed to optimize the technologies and product mix that help you grab market share and crush competitors like Best Buy.
Continue reading “Amazon Shows the Way on Wellness — Treat People like Adults”
Filed Under: Tech, THCB, The Vault
Tagged: Al Lewis, Amazon, Corporate culture, Drones, Jeff Bezos, Vik Khanna
Apr 16, 2014
A state the size of Vermont claiming savings of $120,000,000 through a patient-centered medical home (PCMH) program should raise eyebrows.
North Carolina made similar claims about its PCMH model, only to have the results so thoroughly debunked that consulting firm, Milliman, was forced to retract its key assertion.
I expect more from Vermont, if only because I’m a Democrat and Vermont has turned so “blue” that in 2008 John McCain received only 10,000 more votes than Calvin Coolidge garnered in 1924. However, it turns out red states don’t have a monopoly on invalid PCMH data.
A brief summary of the Vermont Blueprint for Health, as described in the enabling legislation, would be: “a program for integrating a system of healthcare for patients, improving the health of the overall population…by promotion health maintenance, prevention, and care coordination and management.”
This is to be achieved by emphasizing the usual suspects — patient-centered medical homes and various support mechanisms for them. The idea is to achieve “a reduction in avoidable acute care (emergency visits and inpatient admissions).”
Growth in participation has been phenomenal. In 2009, only a few practices and a dozen employees were involved, so we can call that the baseline year. The report’s findings take us through 2012, by the end of which two-thirds of the state’s primary care practices (104) and population (423,000) were involved, along with 114 full-time employees.
The State’s Analysis
Through the end of 2012, the state — by using the classic fallacy (also embraced by the wellness industry) of comparing participants to non-participants — was able to show savings of $120,000,000 and a double-digit ROI.
Continue reading “More Evidence That Patient Centered Medical Homes Don’t Work”
Filed Under: THCB, The Business of Health Care
Tagged: Al Lewis, patient centered medical homes (PCMH), Vermont, Vermont Blueprint for Health
Apr 1, 2014
T was never a star service tech at the auto dealership where he worked for more than a decade. If you lined up all the techs, he wouldn’t stand out: medium height, late-middle age, pudgy, he was as middle-of-the-pack as a guy could get.
He was exactly the type of employee that his employer’s wellness vendor said was their ideal customer. They could fix him.
A genial sort, T thought nothing of sitting with a “health coach” to have his blood pressure and blood taken, get weighed, and then use the coach’s notebook computer to answer, for the first time in his life, a health risk appraisal.
He found many of the questions oddly personal: how much did he drink, how often did he have (unprotected) sex, did he use sleeping pills or pain relievers, was he depressed, did he have many friends, did he drive faster than the speed limit? But, not wanting to rock the boat, and anxious to the $100/month bonus that came with being in the wellness program, he coughed up this personal information.
The feedback T got, in the form of a letter sent to both his home and his company mailbox, was that he should lose weight, lower his cholesterol and blood pressure, and keep an eye on his blood sugar. Then, came the perfect storm that T never saw developing.
His dealership started cutting employees a month later. In the blink of an eye, a decade of service ended with a “thanks, it’s been nice to know you” letter and a few months of severance.
T found the timing of dismissal to be strangely coincidental with the incentivized disclosure of his health information.
Continue reading “What If Your Employer Gets Access to Your Medical Records?”
Filed Under: THCB, The Vault
Tagged: Al Lewis, data breaches, Employers, personal health records, Privacy, Vik Khanna, Wellness, workplace wellness programs
Mar 25, 2014
We’ve seen shorter abstracts, and we’ve seen abstracts with more curious findings, but we’ve never seen a shorter abstract with more curious findings than this one, done by Dignity Health and Dr. Rajan Merchant, and financed by the California Healthcare Foundation, evaluating a gadget made by Propeller Health.
The study group’s use of inpatient care for asthma declined by a whopping 62% vs. the control group. You might think this result violates Dr. John Ioannidis’ well-known conclusion that large treatment effects are usually wrong, but you’d be mistaken. You see, there was no treatment here.
There was only an effect. Dr. Ioannidis’ result applies only to actual comparisons of effects due to different treatments, not to random changes in effects using the same treatment. In this study, the actual treatment protocol was the same and the inhalers were the same.
The only thing different was frequency of drug use. Whereas the conventional wisdom for disease management states that hospitalizations can be avoided by more adherence and hence more drug use, in this case the study group used less medication than the control group, reaching for their rescue inhalers 25% less– once every 6.3 days vs. every 4.7 days for the control group.
Continue reading “Meet Propeller Health: Digital Health’s Poster Child for Invalid Savings Reporting”
Filed Under: Tech, THCB
Tagged: Al Lewis, Asthma, Asthmaopolis, Control, Propeller Health, Vik Khanna, Wishful Thinking Multiplier
Mar 21, 2014
THCB is excited to announce the first official e-book release from THCB Press, “Surviving Workplace Wellness” by contrarian Wellness industry observers Al Lewis and Vik Khanna.” What exactly is the “Wellness industry” anyway? How scientific is the “science” behind wellness programs? Are stop-smoking programs a good idea? Should your company really be paying to send employees to the gym?
Should you be using technology to help your employees monitor and understand their health? You may not always agree with the authors (we certainly don’t here at THCB world headquarters, where Al and Vik have started more than a few food fights) but we still think you’ll find this title a provocative examination of many of the fundamental assumptions underlying prevention and wellness today.
You can order your digital copy from Amazon.com here at the discounted price of $9.99. If you’re a healthcare insider trying to understand the controversies facing wellness or a conscientious wellness professional trying to get a handle on developing a program that works for your employees, this is the e-book for you.
Be sure to look out for upcoming releases from THCB Press in the months to come. If you’d like to be placed on the THCB Press mailing list to be notified of upcoming new releases, send us an email with “update me” in the subject line. Author inquiries and partnership requests should go to this same address. — John Irvine
Continue reading “Good News! A Workplace Wellness Vendor Saying You’re Sick Means You’re Probably Healthy”
Filed Under: THCB
Tagged: Al Lewis, corporate wellness, eBooks + Downloads, Surviving Workplace Wellness, THCB Press, Vik Khanna, Wellness
Jan 25, 2014
The ever-blurring line between the practice of medicine and the business of profiting from unhealthy lifestyles was crossed again Wednesday, as Aetna announced a collaboration with two pharmaceutical companies to pitch their prescription weight loss drugs to selected Aetna members.
This announcement crosses multiple lines, not just one. First, no insurer has ever announced that it would openly direct a specific class of members to use particular proprietary drugs. Disease management (DM) programs rarely recommend specific drugs, and certainly in the exceptionally rare instances when they do, the recommendations are not specific brand-name drugs (in this case, Arena’s Belviq and Vivus’s Qsymia).
Instead, DM focuses on improving compliance with existing drug regimens, and DM firms encourage members “talk to their doctor” about changing therapies. While DM companies shy away from directing patients to specific products, physicians and pharmacists have discretion to discuss the full range of covered generic and brand products with patients, in order to optimize therapy and close algorithm-identified care gaps.
Second, there are no generally accepted care algorithms (other than those created by the manufacturers of those products) for these two drugs in the treatment of obesity. So there is no “gap” to fill. If there were an accepted protocol, these drugs might be blockbusters but instead Belviq’s recent quarterly sales were an anemic $4.8-million, “well below even reduced Wall Street expectations,” while QSymia sales are “flailing” at $6.4-million for the same period.
Obese people and their physicians seem to be avoiding these drugs in droves. Regardless of what Aetna and the manufacturers believe about their effectiveness, or whatever promotional deal they’ve cut, market reaction is telling a different story, and unfortunately for Aetna, Vivus, and Arena we live in a market economy.
Continue reading “Dr. Aetna Will See You Now”
Filed Under: THCB
Tagged: Aetna, Al Lewis, Belviq, Disease Management, Obesity, Pharma, Qysmia, Vik Khanna, Wellness
Jan 15, 2014