The exponential growth in wellness programs indicates that Corporate America believes that medicalizing the workplace, through paying employees to participate in health risk assessments (“HRAs”) and biometric screens, will reduce healthcare spending.
It won’t. As shown in my book Why Nobody Believes the Numbers and subsequent analyses, the publicly reported outcomes data of these programs are made up—often to a laughable degree, starting with the fictional Safeway wellness success story that inspired the original Affordable Care Act wellness emphasis. None of this should be a surprise: in addition to HRAs and blood draws, wellness programs urge employees to go to the doctor, even though most preventive care costs more than it saves. So workplace medicalization saves no money – indeed, it probably increases direct costs with these extra doctor visits – but all this medicalization at least should make a company’s workforce healthier.
Except when it doesn’t — and harms employees instead, which happens altogether too often.
Yes, you read that right. While some health risk assessments just nag/remind employees to do the obvious — quit smoking, exercise more, avoid junk food and buckle their seat belts — many other HRAs and screens, from well-known vendors, provide blatantly incorrect advice that can potentially cause serious harm if followed.
Continue reading “Caution: Wellness Programs May Be Hazardous to Your Health”
Filed Under: OP-ED, THCB, The Business of Health Care
Tagged: Affordable Care Act, Al Lewis, Cancer, CDC, corporate wellness, Costs, Employers, Health Risk Appraisal (HRA), NCQA, Obesity, overdiagnosis, prevention, Screening, WebMD, workplace medicalization
Apr 26, 2013
The following statistic from the Centers for Disease Control and Prevention (CDC) never fails to shock: the 133-million adults – or “nearly 1 in 2” — with chronic disease account for 75% of spending. Engaging those high utilizers, the story continues, will help bring healthcare spending under control.
This storyline is a classic healthcare urban legend. Essentially nothing in that paragraph makes sense as a matter of policy, or even arithmetic.
Yes, the CDC got their arithmetic wrong. 133-million Americans comprise about 60% of adults, not “nearly 1 in 2.” Second, their definition of “chronic disease” specifically includes stroke, which is a medical event, not a chronic disease, and cancer, many of which would not fit that definition either. (Sloppy editing and arithmetic is a CDC trademark. They also observe that ”almost 1 in 5 youth…has a BMI in or above the 95th percentile” on their growth chart, which of course is mathematically impossible as written.)
Third, speaking of definitions, how are they defining “chronic disease” so broadly that 60% of us have at least one? Are they counting tooth decay? Dandruff? Ring around the collar?
Corrected or Not, The Statistic Itself Makes No Sense
The statistic is intended to demonstrate that a concentration of costs among people with out-of-control chronic disease but actually shows the opposite. It shows a diffusion of costs, not a concentration. 60% of adults accounting for 75% of spending – or even the incorrect 50% of adults accounting for 75% of spending — is about as far from a 20-80 rule as one can get. Basically costs are not concentrated in ongoing day-to-day chronic disease.
Second, that 75% covers all expenses of that 60%, not just being out of control and needing to go to the hospital, which seems to be the underlying assumption behind the flurry of activity designed to engage these people and control their conditions. Quite the contrary: in many conditions (rare diseases, high blood pressure and asthma come to mind) preventive drugs already overwhelm medical events as a expense category. In a typical commercial or even TANF Medicaid population, only about 10% of hospitalizations are for the five “common chronics” of asthma, diabetes (and its complications), CAD, COPD and heart failure. (In Medicare this percentage and absolute number are much higher – that is indeed a population where control of chronic disease matters.)
Continue reading “Is Patient Engagement the Solution…or a Healthcare Urban Legend?”
Filed Under: OP-ED, THCB
Tagged: Al Lewis, CDC, patient engagement
Apr 14, 2013
Infections from contaminated steroid injections, influenza outbreaks, destruction from Sandy, West Nile Virus, measles and pertussis outbreaks. These are just a few of the public health crises we faced down in 2012, thanks to the tireless efforts of local and state health departments. Each outbreak takes tremendous resources on top of day to day surveillance activities, but public health is now facing its own crisis of funding: The sequestration will cripple local and state public health departments. Analysts calculate an effective funding reduction of 9%, with the Centers for Disease Control and Prevention losing $350 million. While every federal agency will have to tighten its belt, for public health there are no more belt holes.
“Sequestration would impact every CDC program and could increase the risk of disease outbreaks,” Centers for Disease Control and Prevention Director Thomas R. Frieden recently told CQ HealthBeat. “More than two-thirds of our budget goes out to boots-on-the-ground work at the state and local level to find and stop outbreaks and other health threats.”
Continue reading “Shoe-Leather Epidemiology Needs More, Not Less Funding”
Filed Under: Uncategorized
Tagged: Affordable Care Act, Andi L. Shane, CDC, Prevention and Public Health Fund, sequestration, shoe-leather epidemiology, state/local health departments
Mar 29, 2013
The CDC has noted an early and nasty start to the flu season. Perhaps their own website has caught it, because as I’m writing this, the whole thing is down. Assuming it recovers, I will insert relevant links per routine. Otherwise, I wish it well, and leave you to find your way there on your own.
It’s a bit soon to say, but the virus and the outbreak pattern at this point seem to resemble those of the 2003-2004 flu season, in which nearly 50,000 Americans died. At least two children have already died of flu complications this fall.
This is not the sort of stuff a public health physician can ignore.
So, I recently noted on LinkedIn andTwitter that I’ve been vaccinated — as I am every year — and recommend this year’s vaccine, which appears to match the prevailing viral strain quite well, to everyone else. I promptly got comments back from naysayers, including at least one self-identified microbiologist, who noted he never got vaccinated, and had “never gotten the flu.”
I believe him. But this is like that proverbial “Uncle Joe” everyone knows, who smoked three packs a day and lived to be 119. It could happen — but I wouldn’t bet the farm on it. Uncle Joe is that rare character who somehow comes away from a train crash with a minor flesh wound. The rest of us are mortal.
But there is something more fundamentally wrong with the “I’ve never gotten the flu, and therefore don’t need to be vaccinated” stance than the Uncle Joe fallacy. Let’s face it — those who were ultimately beneficiaries of smallpox or polio immunization never had smallpox or polio, either. If they ever had, it would have been too late for those vaccines to do them any good.
Continue reading “The Great Influenza of 2013?”
Filed Under: THCB, The Insider's Guide To Health Care
Tagged: CDC, David Katz, Influenza, Pandemic, public health, Uncle Joe Fallacy, Vaccine
Dec 9, 2012
There is a corner of the health care industry where rancor is rare, the chance to banish illness beckons just a few mouse clicks away and talk revolves around venture deals, not voluminous budget deficits.
Welcome to the realm of Internet-enabled health apps. Politicians and profit-seeking entrepreneurs alike enthuse about the benefits of “liberating data” – the catch-phrase of U.S. Chief Technology Officer Todd Park – to enable it to move from government databases to consumer-friendly uses. The potential for better information to promote better care is clear. The question that remains unanswered, however, is what role these consumer applications can play in prompting fundamental health system change.
Michael W. Painter, a physician, attorney and senior program officer at the Robert Wood Johnson Foundation, is optimistic. “We think that by harnessing this data and getting it into the hands of developers, entrepreneurs, established businesses, consumers and academia, we will unleash tremendous creativity,” Painter said. “The result will be improved and more cost efficient care, more engaged patients and discoveries that can help drive the next generation of care.”
The foundation is backing up that belief with an open checkbook. RWJF recently awarded $100,000 to Symcat, a multi-functional symptom checker for web and mobile platforms. Developed by two Johns Hopkins University medical students, the app determines a possible diagnosis far more precisely than is possible by just typing in symptoms as a list of words to be searched by “Dr. Google.” Symcat also links to quality information on different providers and can even direct users to nearby emergency care and provide an estimate of the cost.
Continue reading “App-Happy Health Care Full of Optimism, Money”
Filed Under: Health 2.0
Tagged: Apps, behavior change, CDC, Data, entrepreneurship, HDI, Health 2.0, HHS, Michael Millenson, Mobile health, Startups, Symcat, Todd Park
Aug 2, 2012
At the recent Health Care Quality Summit in Saskatoon, Sarah Patterson, the Virgina Mason Medical Center expert on Lean process improvement, noted, “I’d rather have no board rather than an out-of-date board. They have to be real.” She was referring to the PeopleLink Board that is placed is key locations in her hospital to provide real-time visual cues to front-line staff as to how they are doing in meeting quality, safety, work flow, and other metrics in the hospital.
Now comes the CDC, announcing in April 2012, that 21 states had significant decreases in central line-associated bloodstream infections between 2009 and 2010.
CDC Director Thomas R. Frieden, said “CDC’s National Healthcare Safety Network is a critical tool for states to do prevention work. Once a state knows where problems lie, it can better assist facilities in correcting the issue and protecting patients.”
I am trying to be positive when progress is made, and I am also trying to be respectful of our public officials — whom I know to be dedicated and well-intentioned — but does Dr. Frieden really believe that posting data from 2009 and 2010 has a whit of value in helping hospitals reduce their rate of infections?
Try to imagine how you as a clinical leader, a hospital administrator, a nurse, a doctor, a resident, or a member of the board of trustees would use such data. Answer: You cannot because there is not use whatsoever.
I am also perturbed by the CDC’s insistence on using a “standardized infection ratio” as opposed to a simple count of infections or rate of infections per thousand patient days.
Continue reading “A (Real) Tragedy at the CDC”
Filed Under: The Business of Health Care
Tagged: CDC, Central-Line associated bloodstream infections, Data, HAI, Health Care Quality Summit, Paul Levy, Thomas Frieden, Transparency
Jun 18, 2012
In the fall of 2009, at the height of fears over swine flu, our research group discovered that a majority of clinical trial data for the anti-influenza drug Tamiflu ― data that proved, according to its manufacturer, that the drug reduced the risk of hospitalization, serious complications and transmission ― were missing, unpublished and inaccessible to the research community. From what we could tell from the limited clinical data that had been published in medical journals, the country’s most widely used and heavily stockpiled influenza drug appeared no more effective than aspirin.
After we published this finding in the British Medical Journal at the end of that year, Tamiflu’s manufacturer, Roche, announced that it would release internal reports to back up its claims that the drug was effective in reducing the complications of influenza. Roche promised access to data from 10 clinical trials, 8 of which had not been published a decade after completion, representing more than 4,000 patients from every continent except Antarctica. Independent verification of the data seemed imminent. But more than two years later, and despite repeated requests, we have yet to receive even a single full trial report. Instead, the manufacturer released portions of the reports, most likely a very small percentage of the total pages. (One of us, Tom Jefferson, has been retained as an expert witness in a lawsuit relating to some of these issues.)
Continue reading “Drug Data Shouldn’t Be Secret”
Filed Under: Pharma, THCB
Tagged: Avandia, CDC, Clinical Trials, Data, evidence-based decision, F.D.A., influenza vaccine, peer-review process, Peter Doshi, Roche, Smart Medicine, stockpiling, swine flu, Tamiflu, Tom Jefferson, unpublished research, WHO
May 11, 2012
Yes, I am going to talk about…autism. The last time I did so I was inundated with people trying to convince me of the dangers of immunizations and their causal link to autism. I really, really, really don’t want to go anywhere near that one.
No, I am not going to talk about the cause of autism; I am going to talk about my observation of the rise of the diagnosis of autism, and a plausible explanation for part, if not most of this fact. The thing that spurs me to write this post is a study by the CDC which was quoted in the NY Times:
The new report estimates that in 2008 one child in 88 received one of these diagnoses, known as autism spectrum disorders, by age 8, compared with about one in 110 two years earlier. The estimated rate in 2002 was about one in 155.
The rise in numbers is cited as one of the main evidences for some external source – a new thing in our environment – that is causing this rise. The article, however, gives another clue:
The frequency of autism spectrum diagnoses has been increasing for decades, but researchers cannot agree on whether the trend is a result of heightened awareness, an expanding definition of the spectrum, an actual increase in incidence or some combination of those factors. Diagnosing the condition is not an exact science. Children “on the spectrum” vary widely in their abilities and symptoms, from mute and intellectually limited at one extreme to socially awkward at the other.
Children with such diagnoses often receive extensive state-financed support services — which some experts believe may have contributed to an increase in numbers.
That last sentence holds the golden ticket. What would make me think this? My experience.
Continue reading “Behind the New Autism Numbers”
Filed Under: THCB, The Insider's Guide To Health Care
Tagged: Asperger’s syndrome, Autism, autism spectrum, CDC, Rob Lamberts, The Insider's Guide To Health Care
Mar 30, 2012
On Wednesday the Centers for Disease Control and Prevention (CDC) released the results of its yearly survey on Electronic Health Records (EHR) adoption for office-based physicians. No surprises. Generally speaking, the majority of physicians in ambulatory practice are now using an EHR, and over half of surveyed doctors say that they intend to seek Meaningful Use incentives. The report is also presenting results broken down by state, so you can learn what folks are doing in your immediate vicinity. The more instructive exercise is to compare last year’s survey results [Fig. 1] to this year’s estimated EHR adoption numbers [Fig. 2].
Filed Under: THCB
Tagged: CDC, EHR, EHR adoption, Margalit Gur-Arie, Meaningful Use, Office-based physicians
Dec 2, 2011
This week the Centers for Disease Control and Prevention will kick off its annual campaign aimed at reducing the overuse of antibiotics, drugs that one by one are becoming useless in the war against antibiotic-resistant microbes.
The CDC campaign – “Get Smart: Know When Antibiotics Work” – urges consumers to use these drugs sparingly and many Americans have taken that message to heart. Recent data from the CDC show that antibiotic use is leveling off in the United States. In 1994, 300 out of every 1,000 pediatric office visits resulted in an antibiotic prescription. By 2007, that number had fallen to 229, a 24 percent decrease. However, interactive maps by Extending the Cure, a research project of the Center for Disease Dynamics, Economics & Policy, show regional disparities in the use of antibiotics, including very high consumption in some Southeastern states.
These findings can and should be used by public health officials to understand why certain regions show high patterns of consumption and then put in place solutions, including public education campaigns tailored to stop the overuse of these powerful drugs.
The new research reveals a high rate of antibiotic use in some Southeastern states and much lower rates in the Pacific Northwest, compared to the rest of the country. West Virginia and Kentucky had striking rates of antibiotic use: People living in those states took twice as many antibiotics as people living in states like Oregon and Alaska.
High rates, like those seen in the southeastern United States, might reflect an environment in which consumers are anxious to get an antibiotic prescription for a case of the flu – and doctors are only too willing to comply. But antibiotics do nothing to combat viral illnesses such as common colds or influenza.
Continue reading “Americans Must Stop Overusing Antibiotics”
Filed Under: Pharma, THCB
Tagged: antibiotic use, CDC, Extending the Cure, Flu vaccine, ResistanceMap
Nov 17, 2011