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Why do staff reductions lead to declining trend in a company?

May 17, 2013 / Tom Emerick / No comments

In a previous post I made the following comment: “Trend always abates during periods of layoffs and downsizing. Why? Because such things impact older workers especially.” That comment generated some questions so I thought I’d explain this phenomenon. Why do layoffs lead to lower trend for a company? Three

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Low Sodium Diets Prevent Heart Disease? Not So Fast

May 16, 2013 / Tom Emerick / One comment

U.S. dietary guidelines have historically suggested a low sodium diet as a way to help prevent heart disease. A new article in the WSJ calls that notion into question. Jennifer Corbett Dooren is the author. She writes, “The Institute of Medicine, in a report released

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Declining Trend? Look a little closer

May 14, 2013 / Tom Emerick / 5 comments

An Op/Ed in the WSJ describes how “American health-care spending appears to be slowing down.” Of course much or most of the decline in trend is caused by the weak economic conditions today. Some writers are saying this may be part of an underlying slowdown

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Questions to ask yourself about your wellness program

May 13, 2013 / Tom Emerick / 2 comments

A huge amount of health spending is simply not preventable in the usual ways. In order to evaluate the effectiveness of your wellness program, i.e., its potential to save real dollars, here are a list of questions you should ask yourself: Much of the money we spend

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A Terrific Article on Cost and Quality by Leah Binder

May 10, 2013 / Tom Emerick / One comment

Leah Binder has written a great article in Forbes and recent revelations on hospital charges and the lack of correlation with quality. Click here to read the full article. Writes Leah, “A Rational Person might wonder if the variation in hospital pricing is somehow related

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Why do staff reductions lead to declining trend in a company?

May 17, 2013 / Tom Emerick / No comments

In a previous post I made the following comment: “Trend always abates during periods of layoffs and downsizing. Why? Because such things impact older workers especially.”

That comment generated some questions so I thought I’d explain this phenomenon.

Why do layoffs lead to lower trend for a company? Three reasons. First, layoffs almost always hit older workers hardest. Since a 60 year old worker on the average spends about 4X more on health care than a 22 year old worker, a small reduction in older workers leads to a big drop in trend.

Second, during periods of job insecurity in a company, many times people will defer elective surgery out of fear, a very normal reaction. If a small number of people defer expensive surgery it can make a company’s trend look lower. (Remember most surgery is “elective”, meaning non-emergent.)

Third, layoffs tend to impact the less productive workers, who are often very heavy spenders on health care.

If a company has done “right sizing”, layoffs, down sizing, staff reductions, etc, then for the next several years such companies will very probably experience a period of low increases in cost of their health plans.

Inasmuch as many HR and benefit executives do not understand this well, they can sometimes attribute the lower trend to whatever other cost control mechanisms they have coincidentally implemented, such as a new wellness vendor. When a company tells me they have experienced very unusually low trend, the first thing I ask is if they have had staff reductions in the past few years.

Of course the reverse can be true too. If a company has low turnover and is not growing and hiring, it can have higher than average trend.

_____________________________________________________________________________

Tom Emerick

Coming soon: Cracking Health Costs, the book, is now available for pre-order on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

If you pre-order now you’ll receive your copy first.

Tom Emerick is the President of Emerick Consulting, LLC, and Partner and Chief Strategy Officer with Laurus Strategies, a Chicago-based consulting firm, and co-founder of Edison Health. Prior to starting his consulting career, Tom was with Walmart Stores, where his last position was Vice President, Global Benefit Design, which involved designing and managing benefits for over 1.3 million employees in the U.S., and 300,000 plus in international. For about six years, Tom also headed up Walmart’s Six Sigma and process improvement initiatives. Prior to Walmart, Tom had positions with Burger King Corporation, British Petroleum, and American Fidelity Assurance Company. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever.

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Low Sodium Diets Prevent Heart Disease? Not So Fast

May 16, 2013 / Tom Emerick / One comment

U.S. dietary guidelines have historically suggested a low sodium diet as a way to help prevent heart disease. A new article in the WSJ calls that notion into question. Jennifer Corbett Dooren is the author.

She writes, “The Institute of Medicine, in a report released Tuesday, said there isn’t sufficient evidence that cutting sodium intake below 2,300 milligrams per day cuts the risk of heart disease.”

Further, “The group of medical experts also said there is no evidence that people who already have heart disease or diabetes should cut their sodium intake even lower.”

Click here to read the full article.

My question is how do these things become national dietary guidelines and corporate wellness/prevention constructs without scientific studies to back them up? Something is fishy.

No wonder typical wellness programs have great difficulty finding an legitimate ROI when they are promoting flawed notions.

_____________________________________________________________________________

Tom Emerick

Coming soon: Cracking Health Costs, the book, is now available for pre-order on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

If you pre-order now you’ll receive your copy first.

Tom Emerick is the President of Emerick Consulting, LLC, and Partner and Chief Strategy Officer with Laurus Strategies, a Chicago-based consulting firm, and co-founder of Edison Health. Prior to starting his consulting career, Tom was with Walmart Stores, where his last position was Vice President, Global Benefit Design, which involved designing and managing benefits for over 1.3 million employees in the U.S., and 300,000 plus in international. For about six years, Tom also headed up Walmart’s Six Sigma and process improvement initiatives. Prior to Walmart, Tom had positions with Burger King Corporation, British Petroleum, and American Fidelity Assurance Company. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever.

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Declining Trend? Look a little closer

May 14, 2013 / Tom Emerick / 5 comments

An Op/Ed in the WSJ describes how “American health-care spending appears to be slowing down.” Of course much or most of the decline in trend is caused by the weak economic conditions today.

Some writers are saying this may be part of an underlying slowdown in health care spending in general. We need to be a bit skeptical of that point of view for several reasons:

Trend always abates during periods of layoffs and downsizing. Why? Because such things impact older workers especially. A slight decline in the number of workers over 55 will cause a big but temporary decline in trend. (Whenever I’ve heard a company report a sharp drop in trend caused by their new wellness program, an employee education initiative, or whatever, the first thing i ask is if they have had any ten percent staff reductions recently. Usually they either have or their numbers are too low to be credible.)
Such reports are usually measuring net trend not gross trend. Gross trend is trend before increases in deductibles, etc. True trend can be camouflaged if you’re raising deductibles and out of pocket maximums.
When ACA hits trend will surge in a way we have never seen before.

Beware of those who say the rate of growth in health care prices and spending may be permanently rebased.

Click here to read the full article.

_____________________________________________________________________________

Tom Emerick

Coming soon: Cracking Health Costs, the book, is now available for pre-order on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

If you pre-order now you’ll receive your copy first.

Tom Emerick is the President of Emerick Consulting, LLC, and Partner and Chief Strategy Officer with Laurus Strategies, a Chicago-based consulting firm, and co-founder of Edison Health. Prior to starting his consulting career, Tom was with Walmart Stores, where his last position was Vice President, Global Benefit Design, which involved designing and managing benefits for over 1.3 million employees in the U.S., and 300,000 plus in international. For about six years, Tom also headed up Walmart’s Six Sigma and process improvement initiatives. Prior to Walmart, Tom had positions with Burger King Corporation, British Petroleum, and American Fidelity Assurance Company. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever.

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Questions to ask yourself about your wellness program

May 13, 2013 / Tom Emerick / 2 comments

A huge amount of health spending is simply not preventable in the usual ways. In order to evaluate the effectiveness of your wellness program, i.e., its potential to save real dollars, here are a list of questions you should ask yourself:

Much of the money we spend on health care is for older workers. Does your wellness program prevent aging?
A huge share of your plan dollars go for employees who are simply misdiagnosed, as much as 8-16%. Does your wellness program prevent misdiagnoses?
A huge amount of money is wasted on overdiagnosis and over treatment. Does your HRA and screening program stop those practices; or by recommending more tests and exams, does it contribute to those practices?
In America people commonly get surgery that they do not need. Will wellness prevent doctors from giving surgery to people who don’t need it?
Much metabolic syndrome…high blood pressure, diabetes, high cholesterol…is caused by stress in peoples lives. Stress is often caused by bad marriages, tyrannical bosses, poor personal budgeting, etc. Does wellness help you have a better marriage? Handle money better? Make your boss a better person?
Much of spending is simply related to genetics. Will wellness change your genome in some way?
Around 30-40% of dollars spent on health care in the US is wasted filling excess capacity by providers. Does your wellness plan prevent such irrational spending?
Huge dollars are wasted on poor coordination by specialists. Will wellness make specialists coordinate care of patients better?
A big category of spending is birth events. How will wellness reduce that category?
How many heart attacks did your cardiometabolic screen avoid last year?
Read your own HRA results. How many tests and exams did it tell you to get? How much would these have cost if you had gotten them?
If your wellness program is so popular, how come you have to pay people more and more each year to get them to participate? If an offering is truly popular, people would pay you. Apple doesn’t pay people to buy iPhones.

Again, a huge amount of health plan spending is not preventable by run-of-the-mill wellness programs.

_____________________________________________________________________________

Tom Emerick

Coming soon: Cracking Health Costs, the book, is now available for pre-order on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

If you pre-order now you’ll receive your copy first.

Tom Emerick is the President of Emerick Consulting, LLC, and Partner and Chief Strategy Officer with Laurus Strategies, a Chicago-based consulting firm, and co-founder of Edison Health. Prior to starting his consulting career, Tom was with Walmart Stores, where his last position was Vice President, Global Benefit Design, which involved designing and managing benefits for over 1.3 million employees in the U.S., and 300,000 plus in international. For about six years, Tom also headed up Walmart’s Six Sigma and process improvement initiatives. Prior to Walmart, Tom had positions with Burger King Corporation, British Petroleum, and American Fidelity Assurance Company. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever.

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A Terrific Article on Cost and Quality by Leah Binder

May 10, 2013 / Tom Emerick / One comment

Leah Binder has written a great article in Forbes and recent revelations on hospital charges and the lack of correlation with quality. Click here to read the full article.

Writes Leah, “A Rational Person might wonder if the variation in hospital pricing is somehow related to variations in quality…There is simply no relationship between price and quality in healthcare.”

Further, “The findings are bizarre. The average cost of a pacemaker implant at one hospital is $127,038, while at another hospital it’s just $66,030. Joint replacements range from $5,304 in Ada, Oklahoma, to $223,373 in Monterey, California.”

Often it seem the best rated hospitals may have among the lowest charges. Unfortunately the opposite is true too. In short price has nothing to do with quality.

“…employers and other purchasers in the private sector need to be more aggressive in the healthcare marketplace.”

_____________________________________________________________________________

Tom Emerick

Coming soon: Cracking Health Costs, the book, is now available for pre-order on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

If you pre-order now you’ll receive your copy first.

Tom Emerick is the President of Emerick Consulting, LLC, and Partner and Chief Strategy Officer with Laurus Strategies, a Chicago-based consulting firm, and co-founder of Edison Health. Prior to starting his consulting career, Tom was with Walmart Stores, where his last position was Vice President, Global Benefit Design, which involved designing and managing benefits for over 1.3 million employees in the U.S., and 300,000 plus in international. For about six years, Tom also headed up Walmart’s Six Sigma and process improvement initiatives. Prior to Walmart, Tom had positions with Burger King Corporation, British Petroleum, and American Fidelity Assurance Company. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever.

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Yet Another Prevention Failure-A Guest Post by Vik Khanna

May 9, 2013 / Tom Emerick / No comments

BMC Cardiovascular Disorders: Cost-effectiveness of a coronary heart disease secondary prevention program in patients with myocardial infarction: results from a randomised controlled trial ProActive Heart

Posted on May 8, 2013 by vikramkhanna

This randomized trial can only disappoint prevention proponents whose dream is a health coach for every person who could conceivably use one. Personalized health coaching for patients with coronary heart disease led to higher costs, more hospital admissions, and no meaningful change in health-related quality of life (HRQOL), using a real QOL instrument, the SF36. (Hey, there’s an idea…measure QOL with a real instrument, instead of a health risk appraisal [HRA].)

If this approach does not help people who should be ideally suited for it, how is it possible that your typical corporate wellness program, targeting younger, employed people with far less wellness-sensitive disease, could lower costs and improve QOL? Answer: easy…cook the books.

Notice also the differences between this study and Michael P. O’Donnell’s piece of dreck from the American Journal of Health Promotion. You know, the really complex stuff, like randomization, a control group, and valid measurement tools.

Secondary prevention program fails to help people with coronary heart disease AND produces higher costs.

In a related vein, look at the randomized, controlled clinical trial proposal below from a team of European researchers, as well as the editorial and study abstract for work done by Canadian researchers. Both the proposal and the reported results pertain to the impact of exercise on patients with cardiac disease. The proposed study will aim to learn whether exercise can prevent readmissions (my bold prediction is that YES, it will), which is a major clinical and financial endpoint. The Mayo paper (a retrospective analysis of people with an average age of 60) reports that cardiovascular fitness is a major determinant of survival after cardiac rehabilitation, and, importantly, increasing physical capacity dramatically lowers mortality (and, although they did not report it, it would not surprise if it also lowered utilization). Because the study is behind a pay wall, it is especially important to read the editorial, which is not. The editorial describes the study well and includes two particularly powerful graphics: one of risk factor accretion and another of how cardiorespiratory fitness plays an irreplaceable role in cardiac health.

Proposed clinical trial discussion paper: https://www.google.com/calendar/render?tab=mc

Cardia rehab abstract: http://www.mayoclinicproceedings.org/article/S0025-6196(13)00191-2/abstract

Cardiac rehab editorial: http://www.mayoclinicproceedings.org/article/S0025-6196(13)00225-5/fulltext

So, let’s conclude today’s lesson with a summary of what we’ve learned:

Actual improvement in physical capacity improves health and lowers mortality

Having someone talk on the phone to a “health coach” not only doesn’t improve health, it worsens it and it raises costs, but, yet, this is what corporate wellness automatons tell us is essential

Using objective, measurable data (cardiorespiratory fitness, mortality, QOL, hospital readmissions, etc.) matters

_____________________________________________________________________________

Tom Emerick

Coming soon: Cracking Health Costs, the book, is now available for pre-order on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

If you pre-order now you’ll receive your copy first.

Tom Emerick is the President of Emerick Consulting, LLC, and Partner and Chief Strategy Officer with Laurus Strategies, a Chicago-based consulting firm, and co-founder of Edison Health. Prior to starting his consulting career, Tom was with Walmart Stores, where his last position was Vice President, Global Benefit Design, which involved designing and managing benefits for over 1.3 million employees in the U.S., and 300,000 plus in international. For about six years, Tom also headed up Walmart’s Six Sigma and process improvement initiatives. Prior to Walmart, Tom had positions with Burger King Corporation, British Petroleum, and American Fidelity Assurance Company. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever.

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Health Care’s ‘Dirty Little Secret’: No One May Be Coordinating Care

May 8, 2013 / Tom Emerick / One comment

Kaiser Health News posted an article with this title written by Roni Caryn Rabin. The article describes something regular readers of Cracking Health Costs already know: doctors and specialists are failing to coordinate care in a wholesale way. That in turn leads to misdiagnoses, deeply flawed treatment plans, runaway costs, and patient misery.

” ‘Nobody is responsible for coordinating care,’ said Dr. Lucian Leape, a Harvard health policy analyst and a nationally recognized patient safety leader. ‘That’s the dirty little secret about health care.’ ” Click here to read the full story.

Again this is nothing new, but I’m encouraged to see more and more publicity around this problem. BTW, many companies’ efforts to control costs—wellness, high deductibles, patient education, etc—do not touch in any way this massive problem of misdiagnoses and incompetent treatment plans.

_____________________________________________________________________________

Tom Emerick

Coming soon: Cracking Health Costs, the book, is now available for pre-order on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

If you pre-order now you’ll receive your copy first.

Tom Emerick is the President of Emerick Consulting, LLC, and Partner and Chief Strategy Officer with Laurus Strategies, a Chicago-based consulting firm, and co-founder of Edison Health. Prior to starting his consulting career, Tom was with Walmart Stores, where his last position was Vice President, Global Benefit Design, which involved designing and managing benefits for over 1.3 million employees in the U.S., and 300,000 plus in international. For about six years, Tom also headed up Walmart’s Six Sigma and process improvement initiatives. Prior to Walmart, Tom had positions with Burger King Corporation, British Petroleum, and American Fidelity Assurance Company. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever.

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Is There Hope for Real Market-Driven Reform? Yes

May 7, 2013 / Tom Emerick / One comment

According to a news story on Kaiser Health News, Boston Children’s is taking on, “Overuse of some medical treatments – and underuse of others, when patients fail to get recommended care — are two factors linked to high medical spending in the United States.”

Is there hope? Time will tell but at least another hospital is talking about putting the lid on over treatment. Click here to read the full article.

On the other hand success at Boston Children’s will depend on what they mean by “underuse” of treatments. Let’s hope that doesn’t mean coming up with even more reasons to give children MRIs, CT scans, etc.

If employers will continue to move patents to medical destinations and company-sponsored centers of excellence expressly to avoid unnecessary surgery and poor diagnosing, the bad hospitals will have to listen…hopefully.

_____________________________________________________________________________

Tom Emerick

Coming soon: Cracking Health Costs, the book, is now available for pre-order on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

If you pre-order now you’ll receive your copy first.

Tom Emerick is the President of Emerick Consulting, LLC, and Partner and Chief Strategy Officer with Laurus Strategies, a Chicago-based consulting firm, and co-founder of Edison Health. Prior to starting his consulting career, Tom was with Walmart Stores, where his last position was Vice President, Global Benefit Design, which involved designing and managing benefits for over 1.3 million employees in the U.S., and 300,000 plus in international. For about six years, Tom also headed up Walmart’s Six Sigma and process improvement initiatives. Prior to Walmart, Tom had positions with Burger King Corporation, British Petroleum, and American Fidelity Assurance Company. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever.

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Diagnostic Errors Leading Cause of Death

May 6, 2013 / Tom Emerick / One comment

An article in the Washington Post describes something readers of CHC already know. Missed diagnoses are a huge cause of preventable deaths in America. “By one estimate, 40,000 to 80,000 Americans die from missed diagnoses each year.”

Medicine is both an art and a science. Doctors, even diligent doctors, will make errors.

My beef is with health systems that are willfully not using proven methods of preventing misdiagnoses, and therefore patient deaths, such as:

Coordination among specialists
Team evaluations
Team decision making
Eliminating hasty diagnoses by doctor with surgery biases

The best places do these things. One name for such systems is medical destinations. Another is company sponsored centers of excellence.

Click here to read the full article.

_____________________________________________________________________________

Tom Emerick

Coming soon: Cracking Health Costs, the book, is now available for pre-order on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

If you pre-order now you’ll receive your copy first.

Tom Emerick is the President of Emerick Consulting, LLC, and Partner and Chief Strategy Officer with Laurus Strategies, a Chicago-based consulting firm, and co-founder of Edison Health. Prior to starting his consulting career, Tom was with Walmart Stores, where his last position was Vice President, Global Benefit Design, which involved designing and managing benefits for over 1.3 million employees in the U.S., and 300,000 plus in international. For about six years, Tom also headed up Walmart’s Six Sigma and process improvement initiatives. Prior to Walmart, Tom had positions with Burger King Corporation, British Petroleum, and American Fidelity Assurance Company. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever.

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Nebraska State Employee Wellness Program Motto: “First, Do Harm” by Al Lewis

May 2, 2013 / Tom Emerick / No comments

Nebraska State Employee Wellness Program Motto: “First, Do Harm”

APRIL 28, 2013

Author, Why Nobody Believes the Numbers

If Nebraska’s public relations blitz about the success of its wellness program is to be believed, state employees have sixty times the cancer incidence of former residents of Love Canal. The only other interpretation is that, in the name of wellness, state employees were subject to the most overdiagnosis and overtreatment ever documented — at taxpayer expense, no less.

Here is the one fact known to the public. Prompted by a mass mailing and copay waivers encouraing them to go get cancer screens, 514 of the participating state employees who underwent biometric screens were identified as having undiagnosed “early stage cancer,..resulting in early treatment.” (There were also 26 with later-stage cancer, for a total of 540.)

The question is, 514 out of how many? Both the state’s vendor, Health Fitness Corporation, and point person for the program Roger Wilson are refusing to say absent a Freedom of Information Act request – the marketing equivalent of “pleading the Fifth” for a program they previously couldn’t shut up about — so we can only guess. Start with the roughly 7000 employees who took part in a basic blood test. Let’s call that the pool (out of a total of 20,000 program-eligible employees and spouses) of potential screening participants, on the theory that almost no one would submit to a complex screen without also submitting to a simple one.

Then, take out maybe 30% who were too young to be screened for cancer, and assume another 20% were already getting appropriate screens, you’d be screening 3500 people anew. That yields a cancer rate of 15% in a two-year period. As mentioned in the first paragraph, to put this massive overdiagnosis in perspective, Love Canal residents had a 5% cancer rate in a 20-year period – one sixtieth of the alleged Nebraska rate.

Nebraska’s massive overdiagnosis is not a belt-and-suspenders approach that saves lives even if some people don’t benefit. Quite the opposite is true – cancer treatments themselves have health consequences, but no doubt most of those 15% identified with early-stage cancer elected to undergo expensive, debilitating, futile and potentially harmful “early treatments” that the state could have avoided by taking the recommendations ofmedical societies not to screen and/or simply doing a little arithmetic and not sending out mass mailings recommending cancer screens, and/or realizing that 15% of people do not have undiagnosed clinically significant cancer and that state employees should stop overutilizating screens. (Ironically, “overutilization of healthcare services” was one of the justifications for Nebraska’s program cited in their report.)

The state also opened its checkbook to reduce or eliminate co-pays on many chronic disease medications, which proved a windfall for state employees, because fully 2400 new annual prescriptions (among those 7000 participants — once again, a very high diagnosis rate) are now being written for hypertension or high blood pressure, as a result of further screening.

Yet somehow, despite the cancer expenses, waived copays, and large proportion of the population being newly medicated, the state “cut employee health claim costs by millions.” Such are the magic beans of wellness. It doesn’t matter how much you spend—in order to continue to receive funding, you simply claim impossible savings and hope no one notices you’re lying. Or if the program administrators aren’t intentionally lying and genuinely believe they saved $4.7-millon by having risk factors decline at least temporarily for roughly 160 participants (saving a mathematically impossible $30,000 per participant who lost a little weight or recently stopped smoking), they would certainly lack the sophistication needed to recognize massive cancer overdiagnosis. One more reason they shouldn’t be “playing doctor” with their employees’ health.

Considering all that overdiagnosis, overtreatment and the obviously fictional savings figures, you might be thinking, “This program must be an outlier. The whole industry can’t be like this.” And you’d be right. The Nebraska program is an outlier — but in the other direction. The combination of fictitious savings and cancer overdiagnosis/overtreatment won Nebraska the 2012 C. Everett Koop Award as one of the country’s best wellness programs, as well as awards from the Wellness Council of America and others. (In case you haven’t heard of WELCOA, here is an overview.) Both the fictitious savings and the 500+ cancer cases received plaudits from America’s Health Insurance Plans as well.

The major question raised by this debacle and the cover-up that has followed is, why isn’t there any adult supervision of these programs? Oh, wait a second, there is adult supervision: Nebraska’s wellness vendor is accredited by the National Committee for Quality Assurance.

So a better question would be, who is supervising the adults? Someone better start doing it soon, because statistically speaking it won’t be long before a state employee actually dies from complications of one of these cancer overtreatments, in the name of wellness.

Al Lewis is the author of Why Nobody Believes the Numbers, co-author of Cracking Health Costs, co-author of forthcoming How to Cut Your Company’s Health Costs and Provide Employees Better Care, and president of the Disease Management Purchasing Consortium.

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