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Paucity of evidence causes wellness to whiplash into well-being

Whiplash_logoThe most amusing quote in this article by Healthcare Payer News writer Anthony Brino is the one from a representative of the National Business Group on Health. The NBGH may finally be awakening from its long wellness stupor to realize that the wellness model it promotes — with an annual awards orgy — isn’t worth a hill of beans. Welcome to reality, NBGH.

The funniest assertion comes from Ron “The Pretzel” Goetzel. Ron is backing away from the delusional claims of wellness ROI to one that is merely inconceivable. Well, it’s progress. Slide1 (1)

It’s time to end workplace wellness programs

stop-32577_1280Physician Richard Young, keeper of the flame at American Health Scare, joins us in calling for an end to workplace wellness. Here are two terrific paragraphs from his essay:

The horrible result of the Baicker article was that it was used in the Obamacare fine print to justify the growth of workplace wellness programs, including penalizing employees who did not participate. This is a travesty of the highest order, as these employers continue to support overtesting, overtreatment, inappropriate utilization scarce resources, and a continued lack of support for primary care, as they continue to do nothing to disrupt the status quo of the U.S. health care system.

Unfortunately, I don’t hold out a lot of hope that the wellness programs will quickly die their necessary death. I have figured out that their primary benefit is to provide emotional cover for employee benefit managers. The CEOs and CFOs complain about the cost of health insurance inflation. They expect the benefits managers to do something. And so the benefits people hire consultants to recommend wellness programs. At least they can say to their bosses that they took action.

The Business Roundtable Runs In Circles

Phodopus_sungorus_-_Hamsterkraftwerk

By Vik

Every now and then I come across wellness news that makes even me — jaded, cynical, sarcastic me — howl with delight. I don’t mean that the people supporting wellness do something worthy of praise. I mean they do or say things to support my oft-stated observation that wellness proponents are their own worst enemies.

Just do an inventory on this page from the Business Roundtable, and you will see what I mean. These are their wellness highlights. The mind reels at the prospect of what the lowlights might look like.

Caesar’s Entertainment, which actually has two entries (here and here). Unfortunately for Caesar’s employees, their program is as bankrupt as their company.  Their major accomplishment after several years of tilting at wellness isn’t a dramatic reduction in wellness-sensitive medical events, which either they don’t know enough to measure or else the results are so disappointing they decided not to announce them.

Here’s the most they can say:  “Early stage clinical results indicate that employee participants are healthier, controlling BMI, improving glucose values and lowering cholesterol and blood pressure.” Unfortunately, in healthcare, early stage results often go up in smoke, sort of like the second-hand smoke that Caesar’s casino employees breathe while their managers, when they not at bankruptcy court hearings, try to financially coerce them to be healthier.

Memo to the Business Roundtable:  You might want to put someone jointly in charge of your wellness committee whose company doesn’t poison their employees.  I’m just sayin’…

CVS Caremark. CVS is the company whose shot at wellness was heard ‘round the world when they became the first high-profile company to get sued by one of their own employees. CVS also has two entries on this page; the second one is here. Their major claim to fame is that they increased wellness program participation from 60% to 90% of employees. Of course they did; they went from a $180 “incentive” in 2010 to a $600 penalty in higher health insurance premiums in 2013 if you don’t take your wellness medicine. Heck, even I joined my wife’s employer’s wellness program after they threatened to hit us with an even larger wellness avoidance penalty. Later this week, I’ll be writing up a new episode in my traipse over the wellness landscape.

Memo to Business Roundtable:  You might wanna put someone jointly in charge of your wellness committee whose company isn’t being sued by its own employees.  I’m just sayin’…

AT&T. AT&T’s claim to wellness fame is that they have a disease management program. Hello? Hello? Can you hear me now? Disease management isn’t wellness. It’s managed care.

Honeywell. Honeywell will be the first inductee into the Wellness Hall of Fame. It is one of three companies to be sued by the Equal Opportunity Employment Commission (EEOC) for violating federal law by implementing a program promoted by federal law. (The other two are Orion Energy and Flambeau, Inc.). Honeywell’s wellness news is that they have programs to help people make better decisions about surgery (more managed care) and something called “Know Before You Go,” which sounds more like bathroom guidance for preschoolers than health education for adults. You just cannot make this stuff up.

Doing well through wellness. You have to read what’s at this link. It’s a report from 2006-07, meaning that it is the wellness equivalent of a first generation iPhone. In other words, nobody uses one any more. And if you did use one, people would look at you funny.SONY DSC

What does it say about a business leadership group whose pantheon of wellness highlights includes two entries from a failed enterprise, two from active defendants, and one from a company that can’t tell the difference between wellness and managed care, along with a report on wellness that predates not just the ACA law regulating wellness, but even the administration that proposed the law?

I am so glad that I don’t gamble, use Verizon Wireless, and fill my scrips at Walgreens.

 

Does screening asymptomatic adults for major disease save lives? It seems not — ScienceDaily

Does screening asymptomatic adults for major disease save lives? It seems not -- ScienceDaily

Screening doesn’t save lives in adults with no symptoms.

Yet even more (and better) evidence that screening healthy adults for disease is a complete non-starter. You cannot save lives with screening tests even in conditions for which mortality is a common outcome. That would include, you know, life itself.

via Does screening asymptomatic adults for major disease save lives? It seems not — ScienceDaily.

Congratulations to RAND’s Soeren Mattke on PepsiCo study award

8758572616_64ec78d961_bWe are proud (but also insanely jealous) of our friend Soeren Mattke, whose PepsiCo article  was named the #2 most-read for the year 2014 in Health Affairs.  We, as our avid albeit narrow fan base may recall, ranked only #12–and even then that was just for blog posts, not articles in print.

Yes, we know it’s not always about Ron “The Pretzel” Goetzel and his twisted interpretations, but he seems to have come up with what appears to be exactly the opposite interpretation of what the PepsiCo study said.  Don’t take our word for it — we’ve cut-and-pasted both what the study says about PepsiCo’s results and what he says about the study.

Here is what the article says about the financial impact of health promotion at Pepsico:  ROIs well below 1-to-1, meaning a net financial loser, for health promotion. (DM, though, was a winner.)

mattke ROI graph pepsico

As low as these ROIs are, several major elements of cost were not available for the calculation — probably enough extra cost to literally make the financial returns so meager that even if the program had been free, PepsiCo would have lost money.

mattke ROI omitting consultant fees etc Pepsico

Clear enough?  Negative returns from health promotion at PepsiCo, even without tallying many elements of cost.  Nonetheless, Mr. Goetzel pretzelized that finding in his recent wellness apologia.  Listed under “examples of health promotion programs that work” as a program that is a “best practice” is:  PepsiCo.  It stands proudly beside the transcendant programs at Eastman Chemical/Health Fitness and the State of Nebraska.

quote from goetzel article on pepsico

We look forward to a clarification from Mr. Goetzel about how a program that lost a great deal of money on health promotion can be an “example of a health promotion program that work(s),” which we will duly print…but don’t be sitting by your computer screens awaiting it.

Medicaid Expansion Post Leads Health Affairs Blog 2014 Top-Fifteen List – Health Affairs Blog

The article that Al, Shana Montrose, and I wrote for Health Affairs, “Workplace wellness produces no savings,” was one of their Top 15 posts of the year, and it didn’t go up until the end of November.

via Medicaid Expansion Post Leads Health Affairs Blog 2014 Top-Fifteen List – Health Affairs Blog.

Ron Goetzel’s “Dumb and Dumber” Defense Deflects Latest Koop Award Ethical Scandal

By Al and Vik

Oh, the twists and turns as Ron “The Pretzel” Goetzel tries to wriggle out of all his ethical stumbles.

This time around, we thought we had nailed both him and his cabal handing out the ironically named C. Everett Koop Award to themselves and their friends based on made-up outcomes.  Specifically, this time they gave their sponsor (Health Fitness Corporation, or HFC) an award based on data that was obviously made up, that no non-sponsor could have gotten away with submitting.  This was the third such instance we’ve uncovered of a pattern of giving awards to sponsors for submitting invalid data while making sure that the award announcement contains no reference to the sponsorship.  (There are probably others; we’ve only examined 3, which might explain why we’ve only found 3.)

How obviously was the data made up?  Well, take a looksee at this slide, comparing participants to non-participants.  This is the classic wellness ignorati ruse:  pretending that non-motivated inactive non-participants can be used as a valid control for comparison to active, motivated participants.  The wellness ignorati would have us believe that any healthcare spending “separation” between the two groups can be attributed to wellness programs, not to inherent differences in motivation between the two groups.   Unfortunately for the ignorati, their own slide invalidates their own argument:  in 2005, the label “Baseline Year” shows there was no program to participate in, and yet – as their own slide shows – participants (in blue) significantly underspent non-participants (in red) nonetheless.  In Surviving Workplace Wellness, we call this “Wellness Meets Superman,” because the only way this could happen is for the earth to spin backwards.

total savings chart

Given that the 2005 baseline label was in plain view, we just assumed that HFC did not indeed have a program in place for this customer (Eastman Chemical) in 2005, which is why they called 2005 a “Baseline Year” instead of a “Treatment Year.”  Not actually having a program would logically explain why they said that didn’t have a program, and why they used that display or variations of it like the one below for 4 years with the exact same label.  Presumably if they had had a program in 2005, someone at HFC would have noticed during those 4 years and relabeled it accordingly.

Originally we thought the Koop Award Committee let this invalidating mistake slide because HFC — and for that matter, Eastman Chemical — sponsor the awards they somehow usually win.  But while trying to throw a bone to HFC, the Koop Award luminaries overlooked the profound implication that the year 2005 separation of would-be participants and non-participants self-invalidated essentially the entire wellness industry, meaning that is is an admission of guilt that the industry-standard methodology is made up.

Slide1 (1)Goetzel the Pretzel to the rescue.  He painstakingly explains away this prima facie invalidation.   Apparently the year 2005 was “unfortunately mislabeled.”  Note the pretzelesque use of the passive voice, like “the ballgame was rained out,” seemingly attributing this mislabeling to an act of either God or Kim-Jung-Un.  He is claiming that instead of noticing this invalidator and letting this analysis slide by with a wink-and-a-nod to their sponsor, none of the alleged analytical luminaries on the Koop Committee noticed that the most important slide in the winning application was mislabeled — even though this slide is in plain view.  We didn’t need Edward Snowden to hack into their system to blow up their scam.  They once again proved our mantra that “in wellness you don’t need to challenge the data to invalidate it. You merely need to read the data.  It will invalidate itself.”

We call this the “Dumb and Dumber” defense.  Given two choices, Goetzel the Pretzel would much prefer claiming sheer stupidity on the part of himself, his fellow Koop Award committee members like Staywell’s David Anderson and Wellsteps’ Steve Aldana, and his sponsor HFC, rather than admit the industry’s methodology is a scam and that they’ve been lying to us all these years to protect their incomes.

Still, the Dumb-and-Dumber defense is a tough sell.  You don’t need Sherlock Holmes, Hercule Poirot or even Inspector Clouseau to detect a few holes in the Pretzel’s twisted logic:

  • How could no one – no member of the Koop Award Committee or employee of Health Fitness Corporation (which used this as its “money slide” for years) – have noticed this until we pointed it out for the third time (the first two times not being as visible to the public)?
  • In early 2012, this slide was reproduced–with the permission of Health Fitness Corporation–right on p. 85 of Why Nobody Believes the Numbers, with the entire explanation of its hilarious impossibility. We know Mr. Goetzel read this book, because he copied material out of it before the publisher, John Wiley & Sons, made him stop.  So we are curious as to why it has taken until now for him to notice this “unfortunate mislabeling.”  Hmm…would the fact that it was just exposed to the world in Health Affairs have anything to do with this sudden epiphany?  We’re just sayin’…
  • If indeed it was just an “unfortunate mislabeling,” how come HFC has now expunged all references to this previously highlighted slide from their website, rather than simply change the label?

As regards the third point, we would recommend that next time Mr. Goetzel invokes the Dumb-and-Dumber defense, he coordinate his spin with his sponsor.

But let’s not overlook the biggest point:  the entire Koop Committee – including “numbers guys” like Milliman’s Bruce Pyenson and Mercer’s Dan Gold — is apparently incapable of reading a simple outcomes slide, as they’ve proven over and over.

So, as a goodwill gesture, we will offer a 50% discount to all Koop Committee members for the Critical Outcomes Report Analysis course and certification. This course will help these committee members learn how to avoid the embarrassing mistakes they consistently otherwise make and (assuming they institute conflict-of-interest rules as well to require disclosure of sponsorships in award announcements) perhaps increase the odds that worthy candidates win their awards for a change.

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