11/6/16

News Flash, The Dodo Bird is Still Alive:

Well another year has rolled around and I was talking to the person who’s experience with their wellness program I had discussed below. Lo and behold, the problems I had originally documented continue. This is a common example and explains why so many wellness programs should be discontinued.
It was time for next years enrollment period for her insurance and she needed to get a number of points, schedule a coaching visit and get her biometrics and lab work completed to qualify for the premium differential.
The lab work requirement upset her as she had just gotten all the lab work done by her PCP the month earlier, but no, those lab results couldn’t be used. So the vendor repeated all the lab work her PCP had done and more, most of which were absolutely unnecessary based upon USPSTF guidelines. But hey let’s go ahead and waste some money and do a few unnecessary tests.  That’s become the norm for many a wellness program.
As for getting the points, she recorded her exercise by selecting the boxes to document 30 minutes per day. That was the correct answer. Wink…
She was also required to speak with a coach so she had previously set that up, and when asked by the coach if she could take up some new behaviors,
said “oh yes that’s a good idea, I will.”  Wink..
The coach asked if she could follow-up in 3 months
“of course” she said
During the follow-up call, she dutifully reported to her coach that in fact the suggestions were a good idea and yes she had changed her behavior. Wink, wink…
“Congratulations” said the coach as she documented her successful intervention in the wellness vendors system.
Premium differential achieved.
I know exactly what this vendor’s annual report will look like. They’ll be touting all the calls they made, engagement they got, and behavior change achieved.
Don’t you just love self reported data.
Perhaps the vendor involved should call the Validation Institute and get some suggestions on how to measure their program so they can actually understand that their reported results are just plain wrong.
I can hear Al Lewis saying “I told you so”, but perhaps more interesting would be calling this vendor to testify and document why their program should be continued as part of the AARP lawsuit against the EEOC.
For the original story keep reading

Original Post

Given todays news report that the Feds say “Smokers are Lying on Obamacare Enrollment Forms” I thought I would publish this post written well over a year ago.  Seem’s it’s not just those enrolling on the exchanges who may be misrepresenting this important information, probably in ways you’d never think.
We have a crisis in the wellness program industry.

Last year I called a clinician friend in the healthcare business, and during the call they said:
“boy this wellness stuff is crap.”
I asked her what she meant and she proceeded to explain that she was working on her HRA for her wellness program; that she didn’t have much time and needed to get her points to qualify for an insurance discount. I asked if she would mind telling me what was going on as she did the process/program. Below are some of the key things she said, issues she raised, and problems she had. I was typing as fast as I could to get the quotes correct.
The fist series was a zinger………
She started by saying “I’m thinking of listing that I’m a smoker so I can get 20 points.”
“What do you mean?”, I said, “you’re not a smoker! Why would you do that?”
“Others told me about it. They’ve done it, they list it, they say they quit and get 20 points”  she said
“Really” I said
You think I’d come up with that myself?” She responded forcefully.
“Wow, are you kidding?” I asked,
“No, its an easy way to get 20 points.” She replied
I then asked if they validate smoking status “Do they do any lab work, a cotinine test?”
“Nope” She said stating that it was all self report. “Others are doing it. They all lie.”
I could stop here but it gets better or worse…
She then began to complain that she had completed a section but it would not allow her to continue, the system kept saying she had some open questions, when she went back and reviewed the questions, she had completed them all, she was very frustrated, so she left this section and went to another.
The next section was a series of questions about her emotional state. She was surprised to find that a few of the questions already had answers selected, even though she had not answered them herself. when she changed the answer to reflect the correct one, the previous answer also remained highlighted.
“All I get is fricking locked up. I’m sick of this and can’t even change an answer that’s wrong, its showing both answers now.”
She then proceeded to complain that they ask the same question slightly differently and blurted out “It’s just stupid.”
The screen apparently had some educational note pop up which she read to me mockingly
“Did you know 54% of users need help boosting their self esteem. Emotion regulation and impulse control will impact self confidence” Wow she said “they diagnosed me with a self esteem issue?”
After reading a few more questions, she said
“I’m going back to change my answers and just lie.”
So she went back, but again her original answer remained highlighted as well as the new one and that concerned her greatly.
“Do you think they’re looking at this, are they reporting this to my employer?”
I tried to alleviate her concerns by responding “Only in the aggregate” but I don’t think she believed me,
“This is the stupidest thing I’ve ever seen, if they’re stupid enough to pay for it, they’re stupid enough to get the wrong answers” she said as she continued rapidly completing questions.
“I just have to earn my points, I just want my points.”
She went back to look at how many points she now had and none were shown, she began to complain again that the system did not update the points instantly.
She had taken 5 assessments and it was still not completed so she went back to the one that had locked up.
Then at another section and this question
“Have you ever used prescription medication to relax?” She started to laugh, and said
“The answer is no, but I’ve used over the counter medication to relax.”
“Okay this is where I get the 20 points as a smoker.” Would she do it, she waited and then said “let me go to another section.”
At the next section she got really ticked off when she hit continue, the system crashed and cleared all her answers.
A few minutes later she had gotten back in and completed the wellbeing assessment.
“Oh it says I have a bad blood sugar, I must have entered the wrong number on my A1c.”
An obvious problem with self reported data.
“yes I did” she said “I don’t know the exact number but its always good, I keyed in a bad one.”
She then found that the program reported she had back problems when she had none and had answered the related questions appropriately.
Her comment “I’m just laughing my A__ off. I need some more points, how can I earn them.”
The system told her she could earn points by visiting an onsite fitness center. The only problem, her location did not have one.
She then burst out sarcastically and somewhat ticked
“If you go to your fricking doctor it’s only worth 5 points but I get 20 for this?”
And a few seconds later
“I only get 1 point for 120 minutes of exercise per week, isn’t that stupid?”
She found she could get 5 points for volunteer work, but could find no place to enter her volunteer efforts.
The system offered her the opportunity to take a class that would cost $225 and she could get 20 points for it,
“Oh I can buy my way in.” She said, and we discussed that it was not clear if the company reimbursed her for the class, so she moved on.
“Oh this has got to be the place that everyone talks about where you get an easy 20 points, oh it locked up again.”
Then she got in to that section
“I’m doing a program, now, answering the way it wants me to so I can boost my numbers. Great it gave me 5 points.”
And then she went for the kill:
“Based on what I’m learning, you may need to find a new line of work because this is going to go the way of the Dodo bird.”
The number of issues raised by this one poor example of an employee wellness program are astounding, but I know there are more of these than we are willing to admit.
As she finished the assessment she said “nope I didn’t list I was a smoker.” Well I guess she won’t earn those 20 points.