Preventive Health Science Gets Expelled from Wossamotta U

Wossamotta U logo“If these programs saved even one life because a medical condition is uncovered as a result of this program it will have been worthwhile from Penn State’s perspective.”

Imagine a university determined to turn its employees into patients by coercing them into an array of unfounded health screenings, with disregard for all scientific evidence and with a rationale that changes from “we want to save money” to the old standby, “If it saves one life, it’s worth it.” Such a university, seemingly determined to find something medically wrong with you, might aptly be nicknamed Wossamotta U. And, for now, that’s what we’ll call it. Its real name is Penn State.

The quote, above, was blurted by Wossamotta U’s Senior Vice President for Finance and Business at a telephone-based press conference, after Highmark Health Service’s Chief Medical Officer faltered to try to explain how, in defiance not only of scientific evidence but all common sense, a screening-palooza like WU’s might lead to health care savings. It was as if, when pressed, he was saying, Continue reading

Karoshi: Death by Overwork in Japan

Karoshi -- Japanese "salary men" work late into the night before clocking out

As American managers puzzle over how to help employees “thrive” at work, Japan struggles at the other end of the spectrum — how to keep employees from working themselves to death. Karoshi, literally translated as “death from overwork,” is an officially recognized cause-of-death in Japan. In the United States, one of the few countries where employees work more paid hours than Japanese employees, we commonly think of karoshi as someone else’s problem. But is it? Continue reading

Health Risk Assessments: The Baby and the Bath Water

When considering your health risk appraisal, be cautious before throwing out the baby with the bath water.The ShapeUp employer survey found that employers are increasingly skeptical about health risk assessments. An evocative infographic summarizing the survey results shows that, if employers’ wellness budgets were cut in half, HRAs would be programs they’d be most likely to cut. Three times as many respondents would eliminate their HRAs, for example, compared to those that would eliminate health coaching. Approximately 50% of respondents “do not believe in HRA.”

But some of the survey respondents’ comments — as well as much of the employee wellness literature — reveals that employers Continue reading

Are Health Risk Assessments Effective?

Are health risk assessments effective? Three systematic reviews have sought to answer this question.

Technology Assessment: HRA

Technology Assessment: HRA (click to access the pdf)

One of the most rigorous and most recent analyses, Health Risk Assessment: Technology Report, conducted by McMaster University Evidence-based Practice Center for Agency for the Healthcare Research and Quality, examined 118 studies of health outcomes associated with HRAs. The report concluded:

Many HRA programs demonstrated improvements on intermediate health outcomes such as blood pressure, cholesterol, physical activity, or fat intake. However, only one article considered Continue reading

How Useful Is Health Risk Assessment for Predicting Health Care Costs?

Health risk assessment and medical claims predict high health care cost employeesHealth risk appraisals are used to serve several purposes, with varying levels of success. In addition to identifying employees with health risk factors, HRAs also are commonly used to predict health care costs based on the health risks and chronic conditions they measure. And, as a logical next step, they also are used to predict potential for health care cost savings. For example, an HRA vendor’s analysis of aggregate data may state something like, “Based on your group’s profile, you will pay an estimated 4 million dollars based on excess health risk next year.” (This is a mild oversimplification of what a report might really include.) They’ll go on to say, “You can save x millions of dollars by reducing health risk.” They may say you can save money by Continue reading

How Valid Is A Cholesterol Measurement?

Worksite biometric screening results for cholesterol, triglycerides, and HDLAs the saying goes: Garbage in, garbage out. The validity of a health risk appraisal inevitably is limited by the validity of the data entered into it — which includes mostly self-reported data but also, sometimes, biometric data uploaded via the back-end. A lot of people malign self-reported data and revere biometric lab values. But self-reported data may be more valid than we think. And, using one example of a biometric, we’ve seen that blood pressure screening results may not Continue reading

How Valid Is A Worksite Blood Pressure Measurement?

Employee having blood pressure measured through sweater at onsite biometric screening

This employee is having the pressure of her giant sweater measured so that she can add it to her health risk appraisal.

Self-reported data on health risk appraisals has its pros and cons, despite the failure of many wellness and benefits professionals to acknowledge the pros. What about data obtained at worksite biometric health screenings? How valid is it?

[For this post, "biometric" refers to the measurement of biological test results, as opposed to its increasingly popular usage describing the identification of individuals based on their biology. "Valid" is used in a more casual, rather than statistical, context.]

No health test is perfect. For an example, Continue reading

How Valid is Self-Reported Health Risk Appraisal Data?

One of the most common knocks on health risk appraisals is that, by definition, they rely on self-reported data. Critics assume self-reported data biased and inaccurate. In fact, one of the respondents in the Shape Up employer wellness survey was quoted as saying, “Biometric screening is a prerequisite for any program. …Self-reported is pointless.” So the real question is not just whether self-reported data is valid, but how it compares to other sources of data, such as biometric screenings (and medical claims data, too), generally perceived to be the gold standard.

The true validity of self reported data is murky. Most of the research on self-reported data validity is Continue reading

What Is an HRA (Supposed to Be)?

At some point in every health educator’s life, someone, frustrated by the fact that none of the seemingly endless choices of health risk appraisals on the market are the perfect fit for your organization, will suggest, ”Why don’t we develop our own HRA?” When you hear this, run the other way.

Unless your organization has expertise in epidemiology, has a readily available source of frequently updated mortality databases that include diverse populations, and has a high level of expertise in questionnaire design, preventive health, chronic disease, health communications, medical cost prediction, productivity measurement, and health behavior theory, it has little chance of being able to Continue reading

The (Theoretical?) Framework of Employee Wellness

How is employee wellness supposed to work?

We still haven’t wrapped up our commentary on the Shape Up employer wellness survey. Things got stuck when it came to understanding the opinions employers expressed about health risk appraisals. In order to understand their opinions of HRA’s we need to know their expectations of HRA’s. And, to do that, it’s important to appreciate how health risk fits Continue reading