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Yearly Archives: 2015
Our year-end jubilee has so far featured lists of the worst vendors and the funniest vendors. To close out the year on a more serious note — if for no other reason than to show we are indeed capable of treating the extremely serious topic of wellness with the Extreme Seriosity it deserves — we’ll list the most influential posts of the year.
In terms of views, the top spot is shared by our two smackdowns of worthless employee weight control programs. Our peer-reviewed smackdown, in the American Journal of Managed Care, should end the year at #1 on their list too, of the most-viewed articles. I say “should” because a lot will depend on people clicking through on it today or tomorrow (hint) and at least pretending to be enthralled by it, even though it is a bit dry.
The Reader’s Digest version got picked up on Huffpost. Absent the constraints of peer review, we took the gloves off. Our reward is that we are the most-widely read Huffpost of the year on wellness.
If “most shocking” is the criterion, the winner is our recent evisceration of Aetna’s employee DNA collection program. This one is best viewed here, at Insurance Thought Leadership, but was also picked up by The Health Care Blog. You know the old Woody Allen joke about the two ladies in the Catskills? One of them says: “You know the food here is terrible.” The other replies: “Yeah, and the portions are so small.”
Collecting employee DNA is a shockingly stupid idea on many levels — the kind of program that someone would make up in order to make wellness look bad, but we didn’t have to. As if that weren’t enough, Aetna also decided to fabricate outcomes. And because the program was so expensive, to show a 2-to-1 ROI they had to concoct $1464/person in savings in the first year alone–on employees who, by Aetna’s own admission, weren’t even sick. One of the editorial board members of the journal that published it wrote that it should never have passed peer review.
The biggest category — and the one where it would be hardest to pick a winner from among the many worthy entries — would be: “Most likely to show Ron Goetzel making things up.”
You might vote for yesterday’s post on how Ron said wellness programs increased stock price valuations when in reality they reduce stock prices. (Ron also misused the word “valuation”. It is not a synonym for “stock price.” In all fairness, the only people who would be expected to know the distinction would be people who write articles about stock valuations that are actually intelligent and insightful.) However, he probably didn’t make up that conclusion. I reviewed 5 years and compared each company to its relevant sector index. By contrast, he reviewed a longer period and has probably never heard of a sector index. We reached opposite conclusions about the correlation of wellness programs and stock prices. The real answer, though, is that wellness programs have absolutely no meaningful effect on either stock prices or stock valuations. If they did, one securities analyst somewhere, writing a report on one company anywhere, would have noted it. Not to mention that a hedge fund would have made a business out of buying shares in companies with the best wellness programs.
Another candidate would be our expose of the HERO report, in which we observed that HERO and their cronies accidentally admitted — a la Robert Durst — that wellness loses money. Despite co-signing this document — a document that required “two years and countless hours” of collaboration, and in which the word “consensus” appears 39 times, Ron insisted during our debate that he had nothing to do with anything in this document that he himself didn’t write. (Of course, in the debate he also insisted that he had nothing to do with Penn State — meaning he just wandered into their press conference by mistake, or maybe I am confusing him with another Ron Z. Goetzel.)
Nonetheless our vote goes to the Unified Theory of the C. Everett Koop Award, in which we reverse-engineered the mathematically impossible formula (the “Goetzel Factor”) that Ron and his integrity-challenged cronies use to anoint award winners, whose programs are almost invariably hilarious and show a complete lack of understanding of the way healthcare and healthcare math work. To paraphrase the immortal words of the great philosopher Samuel Goldwyn, “If Dr. Koop were still alive, he’d be rolling in his grave.”
A good rule of thumb is that when Ron Goetzel publishes something, you should reach the opposite conclusion. TEASER: In this case, had you done the opposite 5 years ago of what he (retrospectively) recommends now, you’d be sitting on a pile of cash.
Yesterday, the Journal of Occupational and Environmental Medicine, fresh off its Aetna wellness DNA collection debacle (which, in all fairness, one of their board members did candidly admit should never have passed peer review — see the comments), published Ron Goetzel’s article claiming that Koop Award-winning companies outperform the averages, thus showing that outstanding wellness programs “favorably affect a company’s stock valuation.”
Try telling that to Gary Loveman. He was the head of the Business Roundtable’s Health and Wellness Committee. As such, he was the biggest supporter of wellness among all corporate CEOs. He even leveraged the Business Roundtable’s formidable financial resources to convince a bunch of senators to take time off from their real jobs in order to host a fact-finding committee hearing with the title: “Employer Wellness Programs: Better Health Outcomes and Lower Costs.”
Ask Mr. Loveman how his company, Caesar’s Entertainment, is enjoying their bankruptcy proceedings. (He might not know because he is no longer allowed to run the company.)
But we digress…
Let’s look at what happens if you had invested in other companies with “outstanding” wellness programs five years ago. Below is the entirety of companies that have won Koop Awards since 2010 — all of which made up their outcomes, as we’ve noted — that are also publicly traded. (There might be 1 or 2 more. The Koop website is down this morning, so I am going off the list I have.) In each case we tracked 5 years of stock prices ending yesterday, and compared to industry indexes. We’ve linked to the indexes.
2010 — Pfizer.
Pfizer stock has risen about 85% — but simply investing in a drug company index would have made you a 156% return.
Highlight of their wellness program: participating employees lost 3 ounces over a year while non-participants gained 2 ounces. Or maybe it was the other way around.
2011 — Eastman Chemical
Eastman Chemical has outperformed the chemical industry index by 33% over this period.
Highlight of their wellness program: Ron Goetzel doctored the original application recently and then covered it up, because this was the company that “showed savings” 2 years before the program even started. Removing the embarrassingly accurate x-axis labels of the original while claiming “the original is still online and available for review” would have been a very effective cover-up had we not kept a screenshot of the original original.
2013 — Dell (the 2012 winners are not publicly traded)
Dell underperformed the tech stock index by 31% before it stopped trading in October of 2013. (We don’t comment on their wellness program so as not to embarrass them, so there aren’t highlights.)
2014 — British Petroleum
Long after underperforming due to the oil spill before this most recent 5-year period, they continued to underperform the oil stock index by 13%.
Highlight of their wellness program: Mercer “validating” outcomes that were not only mathematically impossible, but were also 100 times greater than what the vendor itself, Staywell, had said was possible. Staywell never explained this discrepancy, shockingly.
2015 — McKesson
There is no good drug distribution stock price index, but McKesson did outperform the drug stock price index by 12%. The closest thing to an “index” might be its close competitor, Cardinal Health. McKesson outperformed them over the 5-year period, but over the most recent 3-year period, Cardinal did somewhat better.
Highlight of their program: They boast one of the highest tobacco use rates in the country, but that didn’t stop them from winning an award because employees who attended a bevy of Weight Watchers meetings lost a few ounces.
Put it all together, and you would have been much better off shorting these companies and hedging with the industry index than actually buying stock in them. As noted at the beginning of this article, had you done this hedge, you’d be sitting on a pile of money right now. As they say in the stock market, the only person as valuable as the person who is always right is the person who is always wrong. Perhaps Mr. Goetzel has a future in securities analysis.
In the spirit of Festivus, we reprise four of the funniest vendors we’ve highlighted in 2015 that you might have overlooked. In more ways than one, these vendors didn’t get as many hits as they deserved:
- Vivify Brings Incompetence to Life.
- Keas Meets Lake Wobegone: All Employees Are Above Average (in Stress)
- Star Wellness Illuminates the Health Hazards of Wellness
and just to be fair and balanced…
Seasons Greetings from all (both) of us here at They Said What?
Whoever concluded that more is learned from one bridge that falls down than 100 that stay up did not included Aetna’s data in their calculations: 2 major bridge collapses, nothing learned.
Aetna first gained notoriety in these pages — and in our book, Surviving Workplace Wellness, and on The Health Care Blog — for being the first health plan to pitch expensive name-brand drugs to its members. Not just any members, but members who weren’t sick — and that someone else was insuring, since there wouldn’t be any savings.
And not members who requested them, but members who Aetna pitched them to, members who mostly didn’t want them. And not just any drugs, but drugs that were/are so controversial that they became the subject of an essay in the Journal of the American Medical Association concluding they never should have been approved. (As a sidebar, while all of wellness is claimed, mostly falsely, to increase productivity, one of these drugs says right on its label that it reduces productivity, specifically impacting memory, attention and language. And yet Aetna insisted productivity would increase. Using a drug that reduces productivity to increase productivity truly puts the “off” in “off-label” use.)
So what did they learn from a failed wellness program that was expensive, intrusive, ineffective, and incredibly unpopular using a third-party that doesn’t seem to know what it’s doing? Their takeaway was: “Let’s come up with a program that’s even more expensive, intrusive, ineffective, and incredibly unpopular using another third-party that doesn’t seem to know what it’s doing…and, for added measure, let’s lie about the outcomes.”
And thus they hatched their scheme to bring DNA surveillance into the workplace. Not to identify possibly useful mutations, but to estimate the risk of diabetes and heart attacks. And not: “We’ll cover this testing if you go to the doctor and together decide whether to order it.” Rather: “You’ll forfeit money if you don’t agree to this, and our partner gets to keep your DNA and re-sell it.”
We’ve already covered the intrusiveness, and fact that their partner, Newtopia, seems unable to understand basic arithmetic and science. We’ve also covered their reference-site-from-hell, which didn’t exactly embrace this program.
Most recently, we’ve covered the lying-about-outcomes angle. Because the program is going to sell for up to $700, Aetna had no choice but lying– they needed to “show” $1400 in savings to achieve a 2-to-1 ROI. Scroll down to the comments — the most respected member of the editorial board of the journal that published their outcomes now says they never should have published the study. (He himself hadn’t reviewed it.)
But all of our exposes are trumped by David Shaywitz. Writing in Forbes, he points out that the entire idea of using genetics to predict and manage obesity-related illness is, to use a technical genomics term, stupid.
We’d urge reading the whole posting (though he doesn’t get into Aetna/Newtopia until page 2), but here are the takeaways:
(1) “The three variants examined by Aetna/Newtopia explain a very very small fraction of genetic risk;”
(2) “Even if you carry the harmful genes, there is no obvious course of action” different from standard diet-and-exercise.
Shaywitz — who may have done more research before writing this column than Aetna did before starting this program — also clearly distinguishes this type of genetic information from identifying (for example) the BCRA1 mutation, which might actually be useful. “Useful” is not a term found often in wellness programs so you won’t be surprised to hear that Aetna doesn’t include BCRA1 mutations in theirs.
What are the takeaways?
First, Aetna’s wellness programs need some adult supervision. Programs like these should never be allowed out the door. Of course, not offering wellness is not an option. It is way too profitable, and if they don’t, someone else will. However, there are plenty of other ways to rip off employers and humiliate employees that are less expensive and less intrusive than the two Aetna has come up with.
Second, Quizzify is making a bet that — especially because Aetna is not hiring any of them — there are a lot of smart people still out there, people who would prefer to pay a low price for an employee health program that is non-intrusive, fun, guaranteed to save money, Intel-GE Validation Institute-validated, and carries a Harvard Medical School imprimatur than pay a high price for programs that don’t work and employees don’t like.
Yes, we know it’s not always about us, but we appreciate Aetna’s efforts to make us look good by comparison.
Seems like the only people who hate wellness more than the reviled right-wing media are the reviled left-wing media, specifically the New York Times.
For the third time in the last 16 months, their economics blog has slammed wellness. This posting is about how “voluntary” wellness programs are anything but voluntary. If the incentive is high enough, a program is forced, even if the Business Roundtable pressures the EEOC into redefining “forced” as “voluntary.” Like if I park in a towaway zone here in Boston, I am forced to move my car or face a $200 fine. Moving the car in no way would be considered a voluntary act on my part. And yet fines for refusing to participate in wellness programs can be ten times that figure and still be considered “voluntary.” The column goes into great detail about how forced programs are not voluntary.
This column comes roughly a year after their last smackdown, the first line of which was:
We’re unsure how much clearer they can get, but even so, Ron Goetzel, who never steps out of character, misrepresented their conclusion.
- NYT: “We’ve said it before, many times and in many ways — workplace wellness programs don’t save money.”
- Goetzel interpretation: “The New York Times columnists…answered the question ‘Do Wellness Programs Work?’ with ‘usually not.’ “
If “voluntary” can mean “forced,” then I guess “no, never” can mean “usually not.” You know wellness is in trouble when even Ron Goetzel’s misrepresentation of their position says wellness doesn’t work.
Did we call this one or what? Finally a real news outlet — the Wall Street Journal — reports on the same shock-and-awe that we experienced when we heard that Aetna was collecting employee DNA…and then making up savings figures. George Orwell never would have guessed that Big Brother would be in the private sector, but then again George Orwell wasn’t insured by Aetna.
And if that isn’t enough, here is the prequel.
UPDATE: December 18
Scroll through to the Comments section on The Health Care Blog. Dr. Norton Hadler, the most influential board member of the journal that published Aetna’s article, isn’t exactly thrilled with his editors’ decision, to put it mildly. This is why Norton Hadler is Norton Hadler — his combination of intelligence and integrity is a beacon in an industry notoriously deficient in both.
Yes, I know it’s not always about me — my various ex-wives have all been very clear about that –but this particular time, it actually is. (It’s also about some colleagues as well, so technically the ex-wives are still right. I hate it when that happens.)
Uniquely in the wellness industry, Quizzify is announcing a relationship with the most widely respected medical school in the country. In a nutshell, Harvard Health Publications — that is the consumer publishing arm of Harvard Medical School — is reviewing and approving Quizzify’s content. Further, they have already reviewed the content now in use. Each approved question in the Quizzify quizzes — as well as the in-depth “Speedbump” education modules — will carry the Harvard Medical School logo.
For immediate release
Contact: Kristen Rapoza
Harvard Health Publications Announces Collaboration with Quizzify
Division of Harvard Medical School announces new client relationship to create interactive quizzes that support health literacy in the workplace.
Boston, MA — (December 15, 2015)—Harvard Health Publications (HHP), the consumer publishing division of Harvard Medical School, announced today that it will collaborate with Quizzify, a New York-based start-up that provides employers with educational health information for their employees. HHP will review Quizzify’s content for medical appropriateness as well as advise Quizzify on developments in peer-reviewed medical literature and medical practice. HHP has already reviewed and approved the Quizzify “Launch Quiz,” which Quizzify uses to introduce employees to health literacy.
The need for unbiased, trustworthy health information has never been greater. According to the Centers for Medicare and Medicaid Services, the United States’ National Healthcare Expenditure (NHE) is projected to be $3.207 trillion in 2015, or roughly $10,000 per person. The percentage of employers offering only high-deductible healthcare plans as a way to combat rising premium costs has nearly doubled since 2012, putting increased pressure on consumers to make informed purchase decisions.
“Harvard Health Publications is focused on helping consumers understand an increasingly complex health system and optimize their healthcare purchases,” said Gregory Curfman, MD, Editor-In-Chief of Harvard Health Publications. “Our content taps the expertise and insights of the Harvard medical community on thousands of health conditions as well as issues ranging from cost-effectiveness of care, patient and consumer engagement, and health policy. We are pleased to help Quizzify put this information into consumers’ hands, using an interactive educational format.”
Quizzify was founded by Al Lewis and Vik Khanna, co-authors of Surviving Workplace Wellness. Quizzify aims to help employees avoid inappropriate care and improve self-efficacy by improving their health literacy.
“Americans are over-diagnosed, over-treated, and over-medicated,” said Al Lewis, Quizzify CEO. “Through this relationship with HMS we are helping employees engage more effectively — and hopefully less — with the healthcare system by using novel methods such as interactive quizzes rather than more traditional means. This approach promises to spark interest and engagement.”
Added co-founder Vik Khanna, “Medical care inflation is now at 5.3% per year, far greater than inflation in the general economy. Crucial to controlling the healthcare spend and improving health is increasing the self-efficacy of employees. Amongst American adults, only 12% have a sufficient level of health literacy that empowers them to make smart choices in the medical marketplace and in self-care decisions. Quizzify’s goal is to help increase that figure.”
About Harvard Health Publications
Harvard Health Publications (HHP) is the media and publishing division of Harvard Medical School. HHP draws on the expertise of Harvard Medical School’s 12,000 faculty physicians and researchers at affiliated hospitals to deliver authoritative and trustworthy health information to a global audience through its website, health.harvard.edu. HHP also provides interactive health information content and services to health portals, payers, and providers as well as population health and digital health companies. Representative clients include Anthem, MSN Health and Fitness, Healthgrades and AccentHealth. For more information about content licensing, please visit www.content.health.harvard.edu/.
Here is our Huffpost on fat-shaming. We of course encourage click-throughs (and “likes” and shares!) but the Reader’s Digest version (if you are under 30 ask your parents what that expression means) is:
- Many wellness programs embarrass overweight employees due to a simplistic notion that their inability to keep weight off is due to a lack of willpower. Of course, that facile hypothesis got disproven decades ago, about the time real researchers concluded that homosexuality is not a “lifestyle choice.” The wellness industry does tend to be a few decades behind the curve, though.
- This is especially the case for older employees, for whom weight loss is more difficult. It is also quite possible that some extra weight is protective in older adults.
- There is no rationale corporate objective that gets served by jawboning employees into weight loss (unless you’re a ballclub, specifically the Red Sox, and your two 2015 high-priced free agent signings weigh as much as three regular-priced free agent signings).
- Typical corporate weigh-loss programs are more likely to encourage unhealthy eating behaviors than help your employees become healthier.
One of Albert Einstein’s great regrets was never having developed a “unified theory,” a consistent set of calculations that could explain the universe. That’s the bad news. The good news is that he did give us the word “Einstein” as in: “Ron Goetzel’s Koop Committee members are the biggest bunch of Einsteins in all of wellness, no easy feat considering the competition from WELCOA, HERO and others.”
Past postings have easily invalidated all the Koop awards since 2010. This did not require breaking a sweat. Rather, as Surviving Workplace Wellness observes: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
Previously, we’ve had to content ourselves with pointing out the plethora of individual rookie mistakes in each award. Now, however, we have a Unified Theory of Koop Award Ludicrous Impossibility. It reveals a remarkably consistent set of ludicrously mathematically impossible outcomes across all this decade’s award-winners. Not just any old ludicrously mathematically impossible outcomes but — and this is what excites my Inner Nerd — the same ludicrous mathematical impossibility pervades every award-winning outcome.
In each case the award winner has documented a small risk reduction among active participants. (They have also shown that willingness to participate, rather than the actual program, is what generates the savings, of course, but choose to ignore their own findings.) And in each case that small risk reduction generates what we thought were fairly random claims of savings. But it turns out that in 5 of the last 6 awards, the claims savings weren’t random at all but rather were essentially the same, using the same simple formula comparing risk reduction to claims savings. (The missing year is 2013. We can’t do Dell because we don’t want to embarrass them due to our relationships.)
The Unified Theory of Koop Award Ludicrous Impossibility Revealed
In the real world, trivial reductions in risk among participants — excluding non-participants because they increase in risk — have no impact on spending discernible in the white noise of random claims variation. And if we could discern an impact, it would be even more trivial than the risk reduction, because risk-sensitive medical events are a small percentage of total events. For instance, if risk-sensitive medical events comprise the typical 5% of total spending, and risk declines by 1%, the reduction in total spending would be 1% of 5%, or 0.05%. And that’s before subtracting fees.
However, on Ron Goetzel’s planet — also inhabited by fellow Einsteins like Optum’s Seth Serxner, Wellsteps’ Steve Aldana, and Staywell’s David Anderson, and obviously Mercer and Milliman — the opposite is true: a trivial reduction in risk generates massive cost savings. For example, McKesson saved $13 million via a 1% overall risk reduction. At that rate of savings and their rate of spending, their entire health spend could be wiped out if risk factors fell 14%. Not just their spending on wellness(risk)-sensitive medical events, but their total spending spending on healthcare. Wiped out. Gone. Obliterated.
A simple example can demonstrate how the Unified Theory works. Suppose the Koop Award goes to an outfit that claims to have achieved a 10% cost savings by reducing risks 2%. Then it follows that a 100% cost savings (10 times the claimed amount) could be achieved if risks fell 10 times the claimed 2%, or 20% in total.
To give credit where credit is due, we shall call this resulting figure — 20% in this hypothetical — the Goetzel Factor. The Goetzel Factor is specifically defined as: “The percentage decline in risk factors projected to wipe out spending according to the Koop Award Committee validations of risk and cost savings.”
Let’s review the last five awards (leaving out 2013) using this formula to estimate a Goetzel Factor. Note that the risk reduction is cross-sectional, meaning it is averaged across the entire population, not just participants. So if the stated or calculated risk reduction is 2%, as with McKesson, and half the employees participate (ditto), the figure in the table below for McKesson would be 1% (half of 2%).
Conclusion: the range of Goetzel Factors is remarkably tight–13% to 16%. Given the ludicrous impossibility of wiping out spending by reducing a small minority of risk factors, the consistency of the result is amazing: the Goetzel Factor reveals almost exactly the same ludicrous impossibility every time!
There are a few asterisks in this Unified Theory. In some cases, the award application itself wasn’t specific on some things, like total spending. So we made assumptions and “showed our work” as they say in fifth-grade math. Or, in the case of British Petroleum, we defaulted to their article in JOEM, which had much more detail. In any case, the spreadsheet calculations and sources are available to all legitimately qualified researchers, meaning those excluded from the Koop Award Committee because they aren’t Einsteins.
Now is the time to beat the mad rush to the remainder bin and order Surviving Workplace Wellness…with Your Dignity, Finances, and (major) Organs Intact
- “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
- “Wellness vendors aim to make your employees happy whether they like it or not.”
Here are the chapter headings:
- Why Friends Don’t Let Friends Do Wellness
- Why Your Employer Is Playing Doctor
- The Health Risk Assessment Will See You Now
- First, Do Harm: How Wellness Screens Can Be Hazardous to
- Penn State’s Pound of Prevention
- It’s Time for the Wellness Industry to Admit to Doping
- So Many Lies, So Few Trees: Nebraska’s State Employee
- Really Good Wellness Programs at Companies You Don’t Work For
- Dr. Aetna Is In
- Bibliography, Acknowledgments, About the Authors, and Other Stuff No One Reads
And if you hate this blog, we guarantee you’ll despise the book.