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
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.
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
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.