walkitout (walkitout) wrote,
walkitout
walkitout

The intersection of FitBit, smoking and privacy and other random crap

Over on my FB feed, a friend asks about the intersection of employer wellness programs that include FitBits, ToS on fitbit, breaks for exercising and other healthy habits and comes up with this question: "could the employers contracting with wellness service use this to determine who gets cheaper premiums?"

And all kinds of questions occur to me.

Expect lots of updates.

http://www.desmoinesregister.com/article/20131201/NEWS/312010065/Insurance-smoking-fee-could-spur-another-vice-Lying-about-doing-it

Insurers aren't necessarily being horrible about the 50% extra they are allowed to charge.

"CoOportunity Health, a new Iowa insurance carrier, is charging 49 percent extra. Cliff Gold, the company’s chief operating officer, said the premiums are justified because of the increased medical costs many tobacco users incur.

Gold noted that tobacco users can avoid the extra premiums by agreeing to participate in tobacco-cessation efforts. For CoOportunity policyholders, that would entail participating online in three 20-minute educational sessions over two months. Participants also would be offered free stop-smoking aids, such as nicotine replacement patches or gum.

“We certainly hope that people will go through with that process,” Gold said.

Tobacco users who participate in the education sessions but fail to kick the habit would qualify for the lower premiums until the beginning of the next year, Gold said. Then, they could either retake the tobacco-cessation classes or pay the higher premium."

A friend had her oxygen saturation checked with a finger clip pulse oximeter on a recent doctor's visit. She misunderstood what was going on and found out what it was for (obvs, as someone who has had two c-sections, I'm way familiar with these things): a cheap and easy way to find out whether someone is a smoker (or chronic, heavy drinker, conceivably):

http://www.masimo.com/pdf/clinical/carboxyhemoglobin/reddy-noninvasive-pulse-co-oximetry-as-a-tool-to-dectect-smoking-oct-2007.pdf

For all of that, however, there are people who think using a pulse oximeter on a smoker who _just_ smoked could be misleadingly high.

http://respiratory-care-sleep-medicine.advanceweb.com/Article/Pulse-Oximetry-User-Beware.aspx

Looks like doctors can _definitely_ tell your insurer that you are a smoker -- so insurers who catch you at this and terminate/raise your rates are already happening presumably.

What about the employer/FitBit question?

https://www.linkedin.com/pulse/20130123054057-258347-fitbit-to-give-employers-your-fitness-report

This guy claims to be pretty blase about privacy stuff and new tech, but he's freaking out about "Fitbit is working with an insurance company to "determine whether individuals who use the mobile devices visit their physicians less than those who do not use the devices."". I don't think he's as blase as he claims. Wouldn't we kind of all want to know this or some similar health proxies (lower blood pressure, better controlled blood sugar, better triglycerides, lower whatever the hell that proxy for inflammation is, etc.)? I mean, isn't that what we _believe_ FitBit does? Wouldn't contrary evidence be kind of important?

Here's a funny one:

http://www.forbes.com/sites/parmyolson/2014/06/19/wearable-tech-health-insurance/

Especially this paragraph, which is about as loony as I have ever read.

"The founders of stickK, a NYC based startup that sells white-label software for corporate-wellness programs, have been trying to talk large U.S. companies into plugging both wearable devices and punitive measure in their wellness plans. These punishments include taking away wellness points if employees don’t reach certain activity targets. It’s a controversial approach, but stickK argues it’s far more effective than offering rewards. (More self-insured employers are already looking at adding $50 surcharges onto the premiums of employees who smoke.)"

This suggests that I am right to believe employers will be wary of this approach. And I find it risible that punitive measures work at all (other than to chase away everyone who can get a job somewhere else -- and believe me, that's not likely to help your company). We've got decades of research on aversives, incentives and environmental change and the most effective stuff is environmental (remove the cigarette vending machines from the lobby and ban smoking in the office), next is incentives and somewhere way, way, way later is aversives. Otherwise moral and ethical people are highly likely to strap their FitBit to a vibrator or the washing machine or the kid -- whatever is necessary to juice their numbers -- if they are subjected to a program as disrespectful as what stickK is proposing.

Wow, this is even better. Derek Newell of Jiff, a "health platform", "Devices that can passively monitor what we eat are also on way, he says."

Seriously? How would that even work? I feel like some of these people played a lot of D&D and don't really understand that when Arthur Clarke said that thing about technology and magic, he meant technology seemed like magic NOT that magic could all shortly be implemented by technology.

Wow. stickK is actually way sillier than I thought.

https://www.stickk.com/faq

So they don't seem to even have a psychologist around to explain to them where they are making their errors. *sigh* Their current focus is on helping people attain goals they have set for themselves (think: volunteer). You can't take the techniques that may work in this context and then apply them to goals Other People Have Set For Them and expect it to work (think: draftee). You aren't actually motivated to cheat (much) if you set the goal. But if someone else set the goal . . .

"And it makes sense. We all start off wanting to achieve our goal, but most of the time there's simply nothing out there to make us stickK to our word. By entering into a Commitment Contract, backing out on that promise just got a whole lot harder. If drinking a can of soda meant you'd have to fork over $10 to your friend, just about anyone would look for something else to drink."

Yah, actually, especially if it wasn't actually our goal, a whole lot of people would sneak the soda and then lie about it. I get that this is a law professor and an econ guy, but do they not remember childhood? Do they not have kids? Who _are_ these people?

Dean Karlan got his MPP and MBA from U Chic, so I think we all know what is going on there. Sure, he got his PhD from MIT in Social Capital and Microfinance so he's not a _horrible_ human, but there are some real blind spots involved here.

Ian Ayres has a picture on his faculty profile page with a classic Ekman half-smile!

http://www.law.yale.edu/faculty/ianayres.htm

Who _does_ that? Somebody who can't be expected to show much respect for anyone else, presumably. (On a _profile_ page? Who puts a contempt smile on their _profile page_?)

That part of me that found really great tricks in NLP wants to like this guy, but that half-smile makes me run in fear. Altho I think this trick actually is pretty awesome:

http://perinealpressure.yale.edu/

I finally found someone who took a look at efficacy that isn't part of this amazingly blinkered little mini-group!

http://www-psych.stanford.edu/~knutson/bad/karlan09.pdf

They aren't very impressed. It mentions this:

Bosch-Capblanch X, Abba K, Prictor M, Garner
2
P. Contracts between patients and healthcare
practitioners for improving patients’ adherence to
treatment, prevention and health promotion activities.
Cochrane Database Syst Rev
2007;(2):CD004804.

So that's a Cochrane review of from 2007. Let's go look for it!

http://www.ncbi.nlm.nih.gov/pubmed/17443556

That's not real enthusiastic. But this one is even more negative:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232314/

Read that one -- it's good.
Tags: economy, politics
Subscribe
  • Post a new comment

    Error

    default userpic

    Your reply will be screened

    Your IP address will be recorded 

    When you submit the form an invisible reCAPTCHA check will be performed.
    You must follow the Privacy Policy and Google Terms of use.
  • 0 comments