New Mass. Challenge: How To Spend $43 Million On Getting Healthier

Ladies and gentlemen of the Massachusetts health sphere, start your mental engines.

As decreed in the state’s latest health reform law, Massachusetts will spend a total of $60 million dollars over the next several years on trying to stop health spending before it happens — by keeping people healthier. Of that $60 mllion total, $43 million goes to competitive grants, and if you’ve got a brilliant idea, you can now apply for one.

I must say, prevention money so often gets short shrift when it comes to health budgets that I’m pleasantly surprised to see that the state’s “Prevention and Wellness Trust Fund” did not fall victim to any sort of fiscal knifery. And I can’t wait to see what people come up with.

The folks at the Massachusetts Public Health Association, which led the effort to create the trust fund, kindly sent over the state document below laying out the basics on the grants. And if you want to actually apply, you must navigate the terrifying jungles of the state procurement system; you can try going to this page and typing “Prevention and Wellness Trust” into the search box. I just tried it and it worked for me (just as a test — we’re not competitors; so if you think your idea is so cool it deserves CommonHealth coverage, give us a yell…)

Massachusetts Prevention and Wellness Trust Fund

· Funding available: $42,750,000 over 4 years

· Goal: to reduce healthcare costs in the Commonwealth by supporting evidence-based community and clinical prevention strategies and providing activities that will simultaneously decrease preventable risk factors and illness and improve the management of existing chronic disease.

· Priority conditions: funded programs must address at least two of the program’s priority positions:
o tobacco use
o pediatric asthma
o hypertension
o falls among older adults Continue reading

Could Your Company’s Wellness Program Actually Harm You?

Author Al Lewis (Courtesy)

Author Al Lewis (Courtesy)


Wellness is good. Wellness programs that possibly hurt people by leading to overdiagnosis and overtreatment are not so good.

Author and disease management expert Al Lewis, a prominent skeptic of some wellness industry claims, offers this cautionary tale in his latest blog post here. It begins with a grabber:

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 encouraging 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 New York Times Magazine featured a major piece on breast cancer, including a focus on overdiagnosis, just yesterday. Readers?

Charging The Obese For Their Extra Pounds

A tiny Samoan airline has apparently begun charging fares based on a passenger’s weight, reports Patrick Smith in a provocative post on his “Ask The Pilot” blog today.

Smith explains why the practice makes sense for the Samoans (and why it’s extremely unlikely that any major airlines will follow suit). But his piece also underscores an inexorable trend: forcing the overweight and obese pay for their extra pounds.

He writes:

obese kid

…Americans are quite a bit larger than they used to be, and doesn’t that extra weight affect an airplane’s performance? Is it just a matter of time before passengers on United, Delta or American are asked to stand on a scale, like their suitcases, when checking in?

Well, no. It makes sense if, like Samoa Air, you’re a company operating light, ten-seat aircraft in a region with extremely high rates of obesity, but not if you’re a major carrier with a fleet of Boeings or Airbuses. There are some touchy social and civil liberty aspects that probably make the idea controversial, if not untenable, but let’s take a look at the practical side:

To begin with, passengers account for surprisingly small percentage of a plane’s overall weight. As a general rule, the larger the plane, the less of a factor it is. That sounds counterintuitive, but consider the example of a Boeing 747″>Boeing 747. A 747 typically seats around 420 people, and its maximum allowable takeoff weight is 875,000 pounds. Four hundred and twenty people * and * their carry-on luggage weigh in at just under 80,000 pounds. That’s less than ten percent — ten percent! — of the plane’s maximum heft. Most of what it weighs comes from the mass of the jet itself, plus the fuel load, which runs into the hundreds of thousands of pounds.

So while it appears that obese people are, for now, paying the same fares as everyone else, they are paying more in other realms.

It’s not just obscure airlines.

WBUR’s On Point ran a segment today on the growing practice of big employers charging overweight and obese workers more to pay for their health insurance. “As health care and insurance costs rise, employers increasingly want to know your weight, your blood pressure, your glucose and cholesterol levels. Six in ten, according to one survey, Continue reading

Debunking The Bad Math Of Workplace ‘Get Well Quick’ Schemes

doctor exam

(Wikimedia Commons)

“Workplace wellness” is a big and burgeoning movement. But is it a bubble?

If you work in a company of any size, chances are you know the “wellness” drill. Your employer is getting killed by health care costs, and tries to bring them down by motivating workers to get healthier. The wellness program offers you incentives — as much as several hundred dollars a year — to fill out a questionnaire on your health risks, get medical tests, lose weight, quit smoking, lower your cholesterol.

What could be bad, right? You win, your company wins. The idea is so appealing that it’s enshrined in the national health overhaul best known as Obamacare, and in the latest groundbreaking health reform moves in Massachusetts. And it has fast become the norm: Most companies that offer health insurance benefits now also offer some sort of wellness plan as well.

Author Al Lewis (Courtesy)

Author Al Lewis (Courtesy)

So when Al Lewis takes on the $6-billion wellness industry in his recent book, “Why Nobody Believes The Numbers,” he’d better be packing some good ammo. And he is: Fifth-grade math. Well, sometimes fourth-grade.

Lewis — an expert in “care management” across populations and measuring efforts to improve it — argues that yes, wellness is a bubble, because much of the movement carries a fatal flaw: Its potential economic benefits have been outrageously oversold.

Many wellness program vendors promise companies that they can quickly and cheaply cut their workers’ health costs — and back their claims with numbers that could not survive the most elementary scrutiny, he says. (Lewis titles Chapter 3, “Case Studies That Flunk Every Plausibility Test Known To Mankind.”)

‘The entire economic justification for wellness is made up.’

One example of many, his helpful analogy from the housing world: “If you insulate your house, you should save money overall, but you won’t save money on insulation.”

The health care equivalent is that you need to spend money to save money overall. If you get your workers to go to the doctor more and take more of the drugs they need, you may save money by avoiding hospital stays and ER visits. But — contrary to what some wellness experts claim — you’re not going to see your spending on drugs and doctors go down, too, Lewis says. That would be like saving money on insulation.

“What are these people thinking?” he asks. (On his Website here, he bestows “Intelligent Design Awards” to some of the more egregious overpromisers for “setting back the evolution of the wellness field.”) In essence, he argues, virtually all the data on the wellness Return on Investment — “The entire economic justification for wellness, is made up.” Continue reading

Can My Company’s Wellness Program Really Ask Me To Do That?

doctor exam

(Wikimedia Commons)

“Wellness” is like apple pie, isn’t it? What could possibly be bad about companies helping their workers be healthier?

I wouldn’t dream of finding fault with many typical wellness offerings: Quit-smoking programs, on-site gyms, more appealing cafeteria salads. Good for worker, good for employer, everybody’s happy. But consider this email I received from an employee at a major national retailer:

I see you’ve written several articles about the new health insurance laws, etc. The company I work for has [a major national insurer]. Last year we received a $25 discount bi-weekly if we filled out a health questionnaire, which of course everyone felt compelled to do as that would be a savings of $650 per year. Most people I spoke to felt uneasy doing it, as they felt it would lead to other invasive practices. Well, sure enough, this year, if you DON’T smoke cigarettes you get $10 off bi-weekly, but to get the additional $25 not only do you have to fill out a questionnaire, but everyone employed [here] (and taking the health insurance) has to have a screening which involves:
1. Waistline measurement
2. Blood pressure measurement
3. Blood draw to test for glucose, HDL and triglyceride levels.
If you do not pass these tests, you will lose your $25 if these are not brought down to an acceptable level by August (when we will be tested again).
Needless to say, this really shook a lot of people up, as it is so invasive, and is this even legal?
Would love to hear your thoughts on this.

Let’s cut to the chase. Yes, it’s legal. And it’s a huge trend that began with only “carrots” — discounts on gym memberships, fun health fairs — and is now progressing to sticks. Or at least, to carrots that can feel a whole lot like sticks.

There are some important limits on what your company’s wellness program can do. More on that soon. But here’s the bottom line: Under federal law, your employer can vary your health insurance premium by up to 20 percent based on a “health factor;” that goes up to 30% as of 2014 and the government could eventually raise it as high as 50%.

Why should you foot the bill for all your Marlboro-packing, Miller-cracking, Big-Mac-chomping co-workers?

Readers, what do you think? On the one hand, if you’re a fit, non-smoking, careful eater, why should you have to help foot the bill for all your Marlboro-packing, Miller-cracking, Big-Mac-chomping co-workers? An unhealthy lifestyle is known to be a major contributor to health care bills. and health costs have skyrocketed for years, sending premiums through the roof, hurting businesses and costing jobs. Any levers to bring them down must surely be tried.

On the other hand, there is clearly a potential yuck factor here. Having my employer measure my waist, or draw my blood??? Getting weighed and monitored in the workplace setting, or in the personnel filing cabinet, may not always be comfortable. What if my boss starts a “fun” pedometer contest among our company’s departments and I’m the morbidly obese one? What about my medical privacy? Continue reading

Dreyfus On Health Cost-Cutting Marathon: ‘We’re Barely To Framingham’

If you missed Andrew Dreyfus’ speech last week to the Greater Boston Chamber of Commerce you are forgiven: it wasn’t exactly Fifty Shades of Grey. To be fair though, the president and CEO of the state’s largest health insurer, Blue Cross Blue Shield of Massachusetts, did make some good points about how hard it is to cut health care costs and the historic divisions that make it even harder, among other topics.

To put the problem in perspective for a Boston crowd, Dreyfus (who reportedly is very attached to his pedometer and competes with his daughter to see who can accumulate the most steps daily) offered this health-related metaphor:

“…If health care reform is a marathon, I believe then we are already at about mile 22 – past Boston College – on coverage, and at mile 15 on quality – crossing Wellesley at Route 16, but with those steep Newton hills still ahead. But when it comes to cost, we’re barely to Framingham, with a long, challenging race ahead of us.”

Here, excerpted, are snapshots of his speech:

On The Path To Value

“First, we must hasten the redesign of our system for delivering care and paying for it. Second, we need to promote better health so we spend less time and money treating illness. Third, we must empower patients to play a central role in their care. And finally, we need to bridge some historic divides that subvert our affordability efforts again and again.

On Wellness Vs. Illness

“You’ve heard it before but it’s worth repeating: 50 percent of health care costs are associated with just five percent of patients, and 25% of costs with just 1% of patients. While these expensive patients include a small number of organ transplants, major traumas, and premature infants, the vast majority of spending is for people with multiple chronic illnesses, such as diabetes and coronary artery disease, or renal disease and depression. For these patients, staying healthy requires constant vigilance; they typically have multiple clinicians, multiple prescriptions, and are frequently hospitalized. By putting our focus on the health of the 5% of patients with multiple chronic conditions, we can help them lead healthier lives and reduce costs for all of us.

Some solutions are breathtakingly simple and low-tech, like ensuring patients have a PCP or nurse practitioner who coordinates their team of caregivers, deploying home health aides, social workers, and medical specialists as needed. Other solutions exploit new technology: telemedicine to monitor patients at home, medical records that connect hospitals and physicians offices, and social networks for patients to support one another. Continue reading

Subsidizing The Salad Bar

I spent $8.10 on a skimpy “make your own” salad at my employer’s cafe today.

If I had made the same salad in the Tufts Health Plan cafeteria it would have been at least 25% cheaper. Tufts “subsidizes” the fruit and salad bar prices for employees. Hello, are other employers listening?

Tufts isn’t out to compete with other employers. It’s trying to encourage employees to buy salad instead of pizza. In short, to eat healthy. (Warning: Bacon bits don’t count as healthy.)

Tufts says the subsidies are working. The cafeteria sold 661 pounds of salad each week in May 2010. Last week, those Tufts employees ate 915 pounds of salad. But pizza consumption is not down. Hmmm…Are more Tufts employees eating out or are Tufts employees just eating more?

I’ve been thinking about these salad subsidies as I read about renewing the farm bill. Yes, Congress is talking about moving from subsidies to insurance against losses for corn, wheat and other crops that critics say contribute to obesity, but price supports for sugar are still in. And subsidizing salad? Nope – not there – not yet.

Downward-Facing Docs: Med Students Study Yoga To Help Patients, Selves

BU med students attend yoga class as part of their professional and personal training.

Ben Tannenbaum, a wiry first-year medical student, is under pressure.

His typical day involves about five hours of lectures and test prep — physiology, genetics and histology on a recent weekday; a mad dash off to a clinic to practice as a doctor learning physical exams and basic medical history-taking; and then, after getting home around 8:30 pm, a few more hours of work reviewing the day’s material before it all starts again the next morning.

“And that isn’t including elective courses, student organizations, research, volunteer work, or extracurricular activities that almost everyone is trying to find time for as well,” says Tannenbaum, a-24-year-old student at Boston University School of Medicine.

But on Tuesday night, the perpetual motion of Tannenbaum’s life stopped. He entered a packed classroom, rolled out his blue yoga mat and plopped down on the floor. Alongside 25 other barefoot medical students, Tannenbaum listened to a half-hour talk on “the relaxation response” and how the technique — a simple type of meditation that reduces the activity of the autonomic nervous system — can alleviate stress-related maladies, from migraines to depression.

Then everyone took a deep breath and stretched into downward-facing dog. The yoga part of the medical school’s weekly yoga course had begun.

As everyone knows, medical students are a singularly stressed-out lot. “More than 20 percent end up with depression, more than half suffer from burnout, and in any given year, as many as 11 percent contemplate suicide,” Dr. Pauline Chen writes in a New York Times report on the “toxic” nature of the medical education process.

So it makes sense to offer these overwhelmed kids de-stressors like yoga and meditation. But here, at the BU medical school’s first-ever yoga elective the aim is even broader: The faculty and instructors who launched the class hope these future doctors will be able to exploit their knowledge of yoga and its research-based benefits to someday help patients and to feel as comfortable prescribing yoga as they do Prozac. Continue reading

FreshStart Check-In, And Slipping In The Exercise

Dear FreshStarters — How goes it? Please report in the comments below. (What is FreshStart? Click here and read from oldest to newest.)

Our theme of the week: Pedometers, and the whole notion that you can do yourself a lot of good by just slipping exercise into the interstices of your life — the 10-minute desk exercise (see a how-to video in the upper right corner here), taking the stairs, parking farther away. I have to confess to skepticism that verges on prejudice against this notion. In my experience, it’s the good long workouts that carry magic, not the bits and pieces along the way. But I’d love to be corrected. Please set me straight if your experience or reading of the research contradicts my instincts.

Meanwhile, here’s proponent #1 for the pedometer this week: Blue Cross Blue Shield chief Andrew Dreyfus, whose pedometer-use is featured in the Globe this week and in the Blue Cross video below. It’s kind of an ad for Blue Cross, but he does make this cogent point: “It’s amazing how having a quantifiable goal is motivating.”

The Globe story emphasizes that competing against others for higher numbers of steps — as Andrew does with his 12-year-old daughter — helps push people. To me, though, the whole pedometer idea raises a basic question: Do I want to mesh fitness into every aspect of my life, always trying to do the right — that is, more active — thing? Or do I want to keep it more segregated in discrete workout periods? I know I could do both, but right now, I relish the feeling after a workout of being “done” with my fitness quotient for the day.

For the counter-argument, here’s Dr. Eddie Phillips, director of the Institute of LIfestyle Medicine, in an email:

“The recommendations for daily physical activity can be achieved anywhere, throughout your day by adding up your steps. You need not break a sweat, get out of breath or need to change your clothes in order to meet the daily physical activity goals, as Andrew Dreyfus has shown.”

“Additionally, you can multi-task by walking slowly (1 MPH) while typing on your laptop or talking on the phone… The trick is to keep walking and do it throughout the day.”


Boston Business Journal Highlights Healthiest Employers, But Which Are Unhealthiest?

The Boston Business Journal has just introduced a cool new feature: a special section on the area’s healthiest employers. IBM, the insurance company MiddleOak, EMD Serono and the Massachusetts Hospital Association are among winners featured. (Hat-tip to the MHA for pointing it out.) From an MHA release:

“As the leading voice for Massachusetts hospitals, MHA walks this talk with our own initiative known as HEALING, which promotes healthy eating, active living and a greener work environment,” said MHA President & CEO Lynn Nicholas. “MHA’s achievements in this area are made possible because leadership and support for our HEALING initiative came from every level of the organization.”

MHA’s HEALING initiative sponsors health-related lectures, screenings and cooking demonstrations, and supports a wide variety of healthy options such as a healthy snacks honor bar, off-site walks and activities such as canoe trips after work hours. The HEALING Committee also worked with MHA’s senior management to create a “Chill Zone” where employees can go during the day to take a few minutes to meditate, stretch, lift small weights, or listen to soothing music.

Wow, sounds virtuous. But don’t you wish the Boston Business Journal also included a Hall of Shame for the least healthy employers? The tech companies that still ply their employees with candy and soda? The high-prestige academic posts where workplace bullies are allowed to torment subordinates? The labs that expect graduate students to work day and night until they’re so exhausted they get sick? The hospitals that give paltry maternity leaves? The offices that don’t give workers long enough lunch breaks for exercise? Readers, do you have a nominee?