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Wellness Puts CEOs on a Collision Course with Obamacare and Common Sense
By now readers of this and many other outlets know that conventional workplace wellness doesn’t work. Period. It’s not that there is no evidence for it. It’s far more compelling: all the evidence is against it. The so-called “evidence” in favor of it is easily disproven as being the result of gross incompetence and/or dishonesty. And occasionally, as in the American Journal of Health Promotion, investigators in this field manage to disprove their own savings claims without intending to, “face invalidity” as it might be termed. This is not an isolated event: analytic self-immolation happens so often that Surviving Workplace Wellness even has a line about it: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
Just before Thanksgiving, both Health Affairs (with our blog post which, given the events we are about to describe, seems almost prescient) and the often-misquoted author of multiple RAND studies (in a comment to that post) weighed in with the same conclusion, as described in the headline: “Workplace Wellness Produces No Savings.”
The article, Health Affairs most widely read posting of November and one of the most widely read of the year, was described to me as the wellness equivalent of the 1912 Armory Show, as being the seminal event that immediately changed the field forever. No longer could anyone claim with a straight face that “pry, poke, prod and punish” wellness programs saved money, or were even beneficial for employee health.
And yet…
Within one business day of this posting, Reuters’ Sharon Begley reports that on Tuesday, December 2, the Business Roundtable’s (BRT’s) CEO is having a sit-down meeting with President Obama to demand exactly the opposite of what all the evidence shows: more flexibility and less enforcement to do wellness as the ACA empowers them to. In particular, they want the Administration to call off the EEOC watchdogs, who have recently attacked Honeywell and others for forcing its employees into medical exams that appear to violate the Americans with Disabilities Act.
The BRT’s goal is to allow companies to punish unhealthy workers to the limits of the Affordable Care Act’s wellness provision. (Recall from our earlier postings that the ACA wellness provision itself was modeled after the Safeway wellness program, which Safeway later admitted did not even exist during the period for which the company claim it saved money.) In essence, the BRT leadership wants to make their employees love wellness whether they like it or not.
The Case Against Patient Portals
Let’s stop calling them patient portals, for crying out loud.
It’s a relic of the early internet days; when you could go to this cool technology called the world wide web that let you peer into far away places which were new and candidly, otherworldly. Yahoo was a portal – waaaay back in the day. To me, it’s reminiscent of the old TV shows Land of the Lost dimensional portal and Star Trek machinations about the future. It conjures up quantum physics and a tear in the time-space continuum.
For some reason, the healthcare cognoscenti are as creative as a lizard when it comes to using language that is both welcoming and fresh.
Patient Portals sound sterile and distant. Furthermore, a portal is a gateway; both an entrance and an exit. Patients, or better, people want access. They want information like everyone else…and why are they called patients (separate post – coming soon).
We don’t log into an Apple Portal, a Facebook Portal or a Google Portal.Continue reading…
Recalling To Err’s Impact and a Small (But Telling) IOM Mistake
This year marks the 15th anniversary of the Institute of Medicine (IOM)’s To Err is Human report, which famously declared that from 44,000 to 98,000 Americans died each year from preventable mistakes in hospitals and another one million were injured. That blunt conclusion from a prestigious medical organization shocked the public and marked the arrival of patient safety as a durable and important public policy issue.
Alas, when it comes to providing the exact date of this medical mistakes milestone, the IOM itself is confused and, in a painful piece of irony, sometimes just plain wrong. That’s unfortunate, because the date of the report’s release is an important part of the story of its continued influence.
There’s no question among those of us who’d long been involved in patient safety that the report’s immediate and powerful impact took health policy insiders by surprise.
The data the IOM relied upon, after all, came from studies that appeared years before and then vanished into the background noise of the Hundred Year War over universal health insurance. This time, however, old evidence was carefully rebottled in bright, compelling new soundbites.Continue reading…
RIP Meaningful Use Born 2009 – Died 2014???
The policy known as Meaningful Use was designed to ensure that clinicians and hospitals actually used the computers they bought with the help of government subsidies. In the last few months, though, it has become clear that the policy is failing. Moreover, the federal office that administers it is losing leaders faster than American Idol is losing viewers.
Because I believe that Meaningful Use is now doing more harm than good, I see these events as positive developments. To understand why, we need to review the history of federal health IT policy, including the historical accident that gave birth to Meaningful Use.
I date the start of the modern era of health IT to January 20, 2004 when, in his State of the Union address, President George W. Bush made it a national goal to wire the U.S. healthcare system. A few months later, he created the Office of the National Coordinator for Health Information Technology (ONC), and gave it a budget of $42 million to get the ball rolling.
Health Care for Dummies (and Innovators): In search of a practical definition of health
For a while now, I’ve been working on an ebook about making digital health more useful and usable for older adults.
(Don’t hold your breath, I really have no idea when it will be done. I can only work on it for about an hour every weekday.)
In reflecting on the health innovation conferences and conversations in which I’ve participated these past few years, I found myself musing over the following two questions:
1. What is health?
2. What does it mean to help someone with their health?
After all, whether you are a clinician, a health care expert, or a digital health entrepreneur, helping people with their health is the core mission. So one would think we’d be clear on what we’re talking about, when we use terms like health and health care.
But in fact, it’s not at all obvious. In practical parlance, we bandy around the terms health and health care as we refer to a wide array of things.
Actually defining health has, of course, been addressed by experts and committees. The World Health Organization’s definition is succinct, but hasn’t been updated since 1948:
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
A more recent attempt to define health, described in this 2011 BMJ editorial, proposed health as “’the ability to adapt and self manage’ in the face of social, physical, and emotional challenges.”
This left me scratching my head a bit, since it sounded more like a definition of one’s resilience, or self-efficacy. Which intuitively seem much related to health (however we define it), but not quite the same thing.
I found myself itching for a definition of health that would help me frame what I perceive as the health – and life – challenges of my older patients.
MyFitnessPal Works If You Use It
You may have seen some news regarding a study MyFitnessPal recently did with UCLA.
I wanted to take a minute to address this study, since we participated in it directly. We are excited that we got to work with some very smart people to answer a question we also wanted to know the answer to. We jumped at the opportunity to find out—is having your physician introduce you to the app and help you sign up enough to kickstart a health journey?
What we learned is that just introducing people to MyFitnessPal wasn’t enough. People have to be ready and willing to do the hard work.
The app itself does work—if you use it. Our own data and the data from the study show that the more you log on, the more you use the app, the more success you will see. Users that logged in the most lost the most weight. In fact, we already know that 88% of users who log for 7 days lose weight.
We make tools designed to make it as clear and simple as possible for you to see the path to achieving your fitness goals. We are not, however, making a magic bullet—because there is no magic bullet. Ultimately, you’re the one who has to do the work.
HIT Newser: The CommonWell Alliance Gets More Common
The CommonWell Alliance Gets More Common
Aprima and CareCloud join Allscripts, Cerner, McKesson, athenahealth, Greenway, and RelayHealth in the CommonWell Alliance, a nonprofit consortium of HIT vendors focused on fostering interoperability.
Coalition Says Stick to ICD-10 Schedule
CHIME, AHIMA, HFMA, and a dozen more industry organizations send a letter to Congressional leaders urging no further delays to the implementation of ICD-10.
CVS Health Ramps Up Digital Health Efforts
CVS Health will expand its efforts in digital healthcare with the opening of a 15,000 square foot innovation lab in Boston that will house up to 100 employees.
KLAS: NextGen Tops for RCM Services
KLAS names NextGen Healthcare the top provider of ambulatory 2014 RCM services in a report that ranks the best-performing HIT vendors for outsourced billing and RCM.
Is Deborah Peel up to her old tricks?
Long time (well very long time) readers of THCB will remember my extreme frustration with Patients Privacy Rights founder Deborah Peel who as far as I can tell spent the entire 2000s opposing electronic health data in general and commercial EMR vendors in particular. I even wrote a very critical piece about her and the people from the World Privacy Forum who I felt were fellow travelers back in 2008. And perhaps nothing annoyed me more than her consistently claiming that data exchange was illegal and that vendors were selling personally identified health data for marketing and related purposes to non-covered entities (which is illegal under HIPAA).
However, in recent years Deborah has teamed up with Adrian Gropper, whom I respect and seemed to change her tune from “all electronic data violates privacy and is therefore bad”, to “we can do health data in a way that safeguards privacy but achieves the efficiencies of care improvement via electronic data exchange”. But she never really came clean on all those claims about vendors selling personally identified health data, and in a semi-related thread on THCB last week, it all came back. Including some outrageous statements on the extent of, value of, and implications of selling personally identified health data. So I’ve decided to move all the relevant comments to this blog post and let the disagreement continue.
What started the conversation was a throwaway paragraph at the end of a comment I left in which I basically told Adrian to rewrite what he was saying in such a way that normal people could understand it. Here’s my last paragraph
As it is, this is not a helpful open letter, and it makes a bunch of aggressive claims against mostly teeny vendors who have historically been on the patients’ side in terms of accessing data. So Adrian, Deborah & PPR need to do a lot better. Or else they risk being excluded back to the fringes like they were in the days when Deborah & her allies at the World Privacy Forum were making ridiculous statements about the concept of data exchange.
Here’s Deborah’s first commentContinue reading…
Unlucky In Coverage
Unlucky in Coverage writes from the Southwest:
I am self-insured. I was quite pleased last year when I had a chance to purchase health insurance through the Federal Marketplace because my new plan was significantly less expensive and more comprehensive than the coverage I had previously. However, I just learned that my (Gold Plan) insurance is jumping from $399 to $508 a month – that’s 29%! I’ve been reading reports that the average rate increases are only a few percentage points but all of those studies are based on the lowest-priced Silver Plans.
