Total Wellness is very concerned about “fostering a positive culture in your office.”
And what better way to “foster a positive culture,” and “recruit talented employees to your workforce” so that they can “improve relationships with one another” than by screening the stuffing out of them?
To start with, don’t just ask your “talented employees” that you just “recruited” if they smoke. That would be too easy and obviously they would all lie, right? Isn’t lying exactly what talented employees do the day after you hire them? Of course! And isn’t deceit what a positive culture is all about? Of course! That’s why you have to test their nicotine 7 ways to Sunday.
And if those tests are too easily gamed, here’s another one — just in case a few of those lying, cheating employees manage to pass the first set of tests, a la Lance Armstrong. And we wouldn’t put it past them to game the test. After all, they are “talented.”
When you’re done with nicotine, screen them for body fat. Nothing spells “talented employee” like an absence of body fat.
But wait…there’s more. Total Wellness offers a package of seven additional tests that aren’t recommended by the US Preventive Services Task Force. Now how much would you pay?
A lot, as it turns out (not even including follow-up from false positives). The more inappropriate tests you authorize, the more money they make.
Total Wellness is able to do this through their “partnership with Clinical Reference Laboratory.” Translation: they charge you, send some of the money to this other outfit, and keep the rest.
Let’s go test by test down their list.
First are two sets of tests that the USPSTF doesn’t even bother to evaluate because it would never occur to them that anyone, even a doctor, would use them as a screen.
Chem-20s aren’t even recommended as screens by the doctors who get paid to do them.
No one bothers to recommend against CBC screens…because CBC tests aren’t screens. A CBC is a test that actual doctors, not wellness vendors, order for patients who are not feeling well. Get it? As has been well-established for two decades, it’s not a screen. it’s a test. It’s useful for finding the sources of symptoms in a patient who presents in an actual doctor’s office, not for telling healthy people they’re sick. By analogy, if you think you broke your arm, the doctor might x-ray it. That’s a test. But even the dumbest wellness vendor wouldn’t propose X-raying all your employees as a screen to see if their arms are secretly broken.
Assuming a CBC were used as a screen, it would be much more potentially hazardous than if a doctor were to do the test. Since apparently Total Wellness doesn’t understand the concept of false positives anyway (a prerequisite for being in the screening business is not understanding false positives), they would likely misinterpret the results.
How did Total Wellness manage to get a license as a wellness vendor without knowing the difference between a screen and a test? Simple — you don’t need a license to be a wellness vendor. That means wellness vendors are allowed to charge employers to perform screens on employees that would get doctors in a lot of trouble if they tried to bill insurers for them.
We’d encourage you to visit their site to see a few more proposed screens that the USPSTF doesn’t recommend doing, like TSH, homocysteine, CRP. But let’s end with the mother lode of the screening industry: screens that the USPSTF specifically recommends not doing, but are very profitable for vendors.
The good news is, Total Wellness isn’t overselling this test. They say it is “possibly an indicator of ovarian cancer cells,” which makes the test literally less than useless, due to the overwhelming number of false positives and false negatives from such a test. That’s why no grownup doctors use it as a screen and that’s why the USPSTF says:
You may say: “Yes, but this ‘D’ recommendation doesn’t apply to women with the BRCA mutation.” Alas, by law, wellness vendors aren’t allowed to ask an employee whether she has a BRCA mutation or any other family history question, dramatically the reducing the already abysmal odds that a screening vendor might do something useful.
Let us close with my favorite test:
Ask vendors why they do it and they’ll say exactly what this one says: this test is “non-invasive and painless.” Sure. In that respect it’s not unlike palm-reading. The more relevant adjective that applies to both: useless.
If you want to get technical, “D” means less-than-useless.
We do like to close on a high note. Total Wellness is right in that this screening program would indeed help your employees “improve relationships with one another.” Forcing your employees to participate in this costly and misanthropic jihad might lead them to use their “talents” to all get together and revolt–just like at Penn State.
Wellness programs that actually help people improve their health are a good thing. But privacy and protecting workers from job-based discrimination are good things too. Corporations and politicians should take care not to invoke ‘wellness’ in ways that weaken important civil rights protections and give employers license to snoop around in our medical records and our private lives. That would most definitely be bad for our health.
The United States Preventive Services Task Force — the only believable resource for guidance on screenings — says screening for thyroid disease lacks a scientific basis. Specifically, they said: “The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for thyroid dysfunction in nonpregnant, asymptomatic adults. (I statement)” In other words, no one has studied this sufficiently to know whether it’s a good idea or not. The lack of evidence is not carte blanche to go ahead and do it anyway, but that’s never stopped wellness vendors before. The lack of evidence means to pause and take a deep breath before telling people to do “just in case.” You buckle your seatbelt “just in case,” you don’t submit to metabolic testing for the same reason.
How long do you suppose it will take the wellness industry to get this message? We’re betting three years or more.
The HERO Report concludes that wellness loses money. We agree. We also think it loses much more money than they will admit to, but the news here is not about us. The news is that more than 3 dozen self-described experts and industry leaders representing more than 2 dozen companies have reached consensus that their industry loses money.
Together, the HERO findings — and our broad consensus with those findings — have serious Affordable Care Act policy implications. The entire basis for the ACA “Safeway Amendment” allowing large fines for (among other things) failure to lose weight is that the cost savings from skinnier employees merits invading their privacy, dignity and automony through medicalizing the workplace (“companies playing doctor” as some have called it). Senate committee hearings, proposed new legislation, and EEOC lawsuits around this provision have all been based on the assumption that wellness saves money. The Senate committee never even lobbed a softball question about that assumption, and even the more hostile witnesses didn’t challenge it.
Recently there was even an eyeball-to-eyeball encounter between the Business Roundtable’s (BRT) Gary Loveman and President Obama. Even though his company (Caesar’s) went bankrupt while embracing wellness as essential to their profitability, Mr. Loveman argued that corporations should be allowed to fine workers who don’t lose weight because the benefit to corporate bottom lines would trump both privacy concerns and the substantial health hazards of these programs.
Apparently, though, Mr. Loveman’s company went bankrupt slightly faster because of wellness. Yes, along with employees, employers would be better off without forced (highly penalized or incentivized) workplace medicalization. If you fire your wellness vendor, everyone benefits.
Everyone, that is, except the wellness industry denizens who make their money off this. That’s why we think HERO spoke the truth unintentionally. Very few people (I was one of them, having switched sides in 2007 when I saw that data failed to support wellness/disease management) willingly undermine their own incomes for integrity’s sake. So this posting will proceed on the basis that is was a gaffe on their part.
Curiously, this is the second time in recent months wellness industry leaders have accidentally admitted wellness loses money, and the third time they’ve accidentally told the truth and had to walk it back.
Equally curiously, wellness economics information disseminates very slowly if at all — testament in large part to the absolutely brilliant and flawlessly executed strategy by the Wellness Ignorati of ensuring that facts get ignored (hence their name). So even as the vendors are admitting that wellness loses money, benefits consultants and HR executives have once again pushed participation incentives/penalties to new highs, a whopping $693/employee/year, according to a new report.
As for the figures themselves, we are also attaching a spreadsheet so that you—as an employer—can figure this out on your own in your own population, rather than just take HERO’s word for it that wellness loses money.
The costs, according to the HERO report’s own screenshots
First, review the screenshot from the first installment, showing the costs of wellness. The list of cost elements is fairly exhaustive –down to the level of a space allocation for a health fair — though the Committee conveniently left out consulting fees. No surprise there, given that Mercer consultants sit on the committee.
Then, compare the list of costs in that screenshot to costs in this second screenshot, from Page 15 of the HERO Report. That comparison won’t take long because only one program cost is listed: “$1.50 — Cost of EHM [Employee Health Management] PMPM fees.”
The two lists of costs are totally inconsistent. Suddenly, when it comes time to measure ROI on page 15, most of the costs on Page 10 have disappeared…
The reason for that? The savings from wellness – in the HERO committee’s own words below – are so trivial that in order for wellness to produce savings, the second screenshot has to ignore most of the costs listed on the first one. Whereas the first screenshot listed three categories of costs covering 12 different line items (13 if you count the AWOL consulting expenses), the second screenshot says you should only count one item: vendor fees.
And by the way, the vendor fees themselves self-invalidate. At about $40 per employee per year, biometric screening fees alone cost more than the stated $1.50 per person per month, or $18/year. Yet $18/year is the total they list for all fees combined, including the $40 screenings.
Rather than point out the many cost elements on the first screenshot missing from the second, we’ll invite you to use our spreadsheet and enter your own data instead of theirs. Simply fill in your own direct costs of wellness.
Whatever number you get will dramatically understate your true costs because there are three elements of cost that we aren’t counting on this spreadsheet:
- What their spreadsheet call the “indirect” costs, which we have listed as “$0”,
- What their spreadsheet calls the “tangential” costs of damaged reputations and employee morale—ask Honeywell whether they brag about their wellness fines and lawsuit in their recruiting (and, ironically, I just returned from a consult for Penn State itself, where the adverse morale impact still overhangs employee relations);
- The massive costs of overscreening, overdiagnosis, and overtreatment generated by biometric screens – all of which are conducted far more often than the USPSTF recommends and most of which (as in the examples we occasionally post on this site) include screens that no one other than a wellness vendor or consultant would ever propose.
The financial benefits
Against those costs are the benefits. Page 15 lists some alleged benefits of wellness that leave us scratching our heads.
Generic substitution? How does that have anything to do with wellness? Quite the contrary, obsessing with wellness might take your eye off the generic substitution ball, and cause you to miss some tiering opportunities. (The company that is best at tiering its pharmacy benefit, Procter & Gamble, is also known for its current employee-friendly wellness program, sort of the anti-Honeywell.) And has anyone ever seen one health risk assessment (HRA) or participated in one health screen that even mentioned generic substitution?
Outpatient procedures? Try to find one person in your organization whose outpatient procedure could have been prevented by eating more broccoli.
ER visits? Maybe they decline. But maybe they increase, due to sports injuries sustained by newly activated employees. And someone who really is eating more broccoli might slice their finger chopping the crowns off the stalks. (Anybody who voluntarily eats the crowns with the stalks still attached doesn’t need a wellness program.)
And then the catch-all: savings through “overall wiser use of healthcare.” Come again? This is an industry that — as well documented by their own words captured on this website — makes its living telling employees to do exactly the opposite: go get checkups you don’t need and won’t benefit from, submit to screens far in excess of USPSTF guidelines so that vendors can brag about how many sick people they find, yo-yo diet for “biggest loser contests” and weigh-ins, like ShapeUp’s get-thin-quick 8-week crash-diet programs, and avoid eating fat and cholesterol and load up on carbs instead.
Perhaps what the HERO committee intends is that since employees largely don’t trust their employers, they will do the opposite of the recommendations.
The savings from wellness
We are going to leave out respiratory savings. To capture those, charge a smoking differential and make smoking cessation available. Done. You don’t need an intrusive and expensive wellness program for that. (We are big believers in a “smoking differential” for employee-paid premiums. It makes sense for all the reasons weight loss and other wellness programs don’t.)
Instead let’s focus on people who have cardiometabolic issues. In order to lose weight and reduce their risk, they need to switch to a low-fat, low-cholesterol diet.
Oh, my bad! That is sooo 2014! While most of us not in the wellness business already knew the dangers of eating too many simple carbohydrates long before now, even the most ardent card-carrying member of the Wellness Ignorati learned in March that all their dietary advice has been wrong — to go along with their incorrect screening and checkup advice. Yet recommending exactly the wrong things hasn’t stopped most vendors from claiming massive savings. See “On the (Even) Lighter Side” and The Smoking Guns for examples.
Now let’s look at all the hospitalizations that can be avoided through wellness – heart attacks, angina, hypertension, and…um, hmm…did we mention heart attacks? You’re thinking: “What about diabetes events?” OK, we’ll add diabetes, only because the HERO report lists it and we want to be true to the report. But diabetes complications admissions (like CHF, which they also list) are a disease management issue, not a wellness issue — you can’t prevent or manage diabetic neuropathy or left-ventricular heart failure by eating more broccoli. The $1.50 PMPM price would not be high enough to also include disease management, and in any event what one does in disease management for complex cases is much different from a typical “pry, poke, prod and punish” wellness program.
And “straight” diabetes admissions are usually the result of diabetic employees pushing their blood sugar too low by over-medicating themselves—often in a good-faith effort to hit Hba1c “targets” that your wellness program set, no doubt on the advice of your consultants. Low blood sugar won’t do much for productivity either. Without the advice of a company specializing in diabetes, you’re likely to get this result. (And if this is the first you are hearing about the likely causes of “straight” diabetes ER visits and admissions, you should consider such an option.)
So we are now adding all ischemic and hypertensive heart events and diabetes as what they call “potentially preventable hospitalizations.” How many of your hospitalizations are for those items? Simply run the primary codes for those events, being careful not to double-count professional fees, to see how many you had. Here’s what happens when you do it for the United States as a whole.
Next, divide the relevant figure (Private insurance, 432,065) by the total number of privately insured discharges in the US (7,360,684)
So—using the HERO Committee’s own acknowledgment of the undeniable fact that wellness can only impact wellness-sensitive medical events (WSMEs) and using the diseases that the report says to use — less than 6% of admissions are WSMEs. If your non-birth-event admit rate is, as the report says, 45 per 1000, then you have 2.6 admissions per 1000 in non-smoking-related WSMEs. Once again, don’t take our word for this. Run this analysis on your own admissions. You won’t be surprised by how few there are. Do you even know anyone admitted to the hospital for these things, especially where the admissions could have been prevented with a few more screens, HRA and servings of broccoli?
Shameless plug: We are happy to do this WSME analysis for you. We do these all the time. It’s $4000. We can also tell you your savings, ROI, trend, comparison to others over time, and more. We also adjust for the major secular decline in cardiac events that has been taking place anyway for decades that the Committee seems to be unaware of, sort of surprising given their alleged expertise in cardiac risk reduction.
Let’s say you run this analysis with or without our help, and a rate/1000 similar to the US average pops up. The HERO report says you need to reduce this rate by “only 1 or 1.25 admissions.” But that’s almost half of your total 2.6/1000 WSMEs! And in any event, you’ve probably seen by now – if you downloaded the spreadsheet – that Page 15 seriously underestimates your wellness program expenses, meaning your breakeven reduction needs to be much higher than “only 1 or 1.25.” It’s probably higher than the number of admissions you have available to be reduced.
You can enter both your admissions per 1000 and the reduction in that figure you achieved directly into the spreadsheet.
But for now let’s very generously assume their expenses are right, and you only need to reduce admissions by 1 to succeed. How hard would it be to go from 2.6 to 1.6 WSMEs per 1000, a reduction of 39%? Here are five things to keep in mind:
- Your true engagement rate itself is probably much lower than that aforementioned 39%, not including people who simply participate for the money, and the people who are engaged generally aren’t the ones who would crash anyway;
- A big chunk of all heart attacks can’t be predicted at all, and certainly not now that law prohibits asking about family history;
- Even events that can be generally predicted can’t necessarily be prevented (we all know people who are “walking heart attacks” and have been ignoring advice for years);
- “Straight” diabetes admissions are more likely to be for over-control than under-control;
- In 7 years of measuring this, we have never seen a reduction in WSMEs remotely approaching 39% after adjusting for secular declines in cardiac events that take place even without a wellness program (which the report overlooks)
See The Million Dollar Workplace Wellness Heart Attack Screen in Health Affairs for a more in-depth view of the math. But the entire committee writing this HERO report insists wellness saves money, right? So, it’s us against them, right? A he said-she said? Wrong. Here’s the denouement. On Page 23, the report’s own example shows that wellness only saves $0.99 PMPM! That figure, by the way, is grossly overstated for reasons we will get to when we deconstruct Page 23. But for the time being, here it is.
So even their own comparison of their own overstated savings estimates to their own understated cost estimates reveal: wellness is a loser financially. They have already admitted it is a loser for employee relations. Funny — if we had made these two arguments, they would attack us. But they are making these two arguments themselves.
Once again, the Surviving Workplace Wellness mantra applies: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
Where does this leave us?
To summarize, pages 10, 15 and 23 combined tell us:
- Even before adding page 10’s cost categories back to page 15, costs are $1.50 PMPM;
- Savings are only $0.99 PMPM, meaning wellness loses $0.51 PMPM;
- The first two points are not our estimates — they’re their estimates and are far more optimistic than ours;
- Adding back the cost elements on page 10 to page 15, and then on Page 23 removing the respiratory savings, adjusting for secular decline in WSMEs, and adding in all the extra doctor visits would create a much larger loss from wellness;
- And they have already admitted that “pry, poke, prod and punish” programs are bad for morale.
Now you see why RAND’s PepsiCo study showed a negative ROI from wellness: It’s because there is a negative ROI from wellness, which no one disputes any more.
And you see the reason we asked the question in the last installment: Why would any company “do wellness” if the biggest proponents of wellness – people who make their living off it – admit that it’s a waste of money that adversely impacts morale?
Likewise, now you see why wellness vendors and consultants get “outed” all the time on this site, advocate savings methodologies designed to obfuscate rather than enlighten, and try to prevent you from learning that we exist. We are not saying they are sociopaths. Sociopaths lie for no reason. Conversely, wellness vendors and consultants are just trying to keep their jobs. Bleeding customers or clients dry is only a good job security plan if indeed the customers or clients never find out about it.
But now customers know how their own vendors and consultants really feel. And we can all work together to dismantle these programs and start doing wellness for employees instead of to them.
Poll: Cue the Wellness Industry Response…
We have a little dispute with RAND’s Soeren Mattke. He says the wellness industry modus operandi is, whenever one claim is disproven, to switch to another claim.
We say the reason they are known as the Wellness Ignorati is, their strategy is to ignore facts, including ones they admit, and they will simply just ignore this posting so as not to create a news cycle, rather than switch claims.
There is also the chance that they admit that their own financial model is accurate. This would demonstrate integrity, a quality historically in short supply in this field.
So vote early (but not often)…
While we aren’t deconstructing this as a sales tool for Quizzify. But as it happens, Quizzify is literally the only wellness program that does pay for itself. Don’t take our word for it. Quizzify is 100% guaranteed to save money and improve morale/engagement–exactly the opposite of what the HERO report says usually happens. No other wellness program is either, let alone both.
“The best evidence suggests that workplace wellness programs based on financial incentives probably don’t work as intended,”
…Of getting it right!
People think this site is all about “outing” scoundrels, but we’re just presenting facts, usually in the form of screen shots, that can’t be denied. That’s why none of the organizations or people “profiled” have ever sued us, despite our entreaties. However, sometimes the facts are actually good, and we want to recognize that too.
For this posting let’s set aside policy/economics issues and just focus on on-site execution of screenings. I attended a Health Advocate biometric screening which was being held in my neighborhood, to attract potential customers, meaning the attendees were comped but had been invited on the hopes that they would set up a screening event. The first thing they got right was the list of tests. The manager on site, Rich Prall, listed the usual tests. I then asked what other tests they had available. As you know, many vendors “profiled” on this site push completely inappropriate tests, that even if they were free would cause more harm than good. We have three more vendors in the queue too, each worse than the previous one in pushing tests that the US Preventive Services Task Force specifically says not to do.
Mr. Prall listed the same bunch of tests that the USPSTF recommends not doing, but then volunteered without being prompted that the right answer was indeed for an employer not to do them. (“If you do them at all, it should be at the doctor’s office. What’s an employer going to do about your potassium level, anyway?”) So Mr. Prall was willing to sacrifice revenues for integrity. Literally, this is the first time we’ve seen that happen. What Mr. Prall was appropriately shying away from, other vendors call their “Gold” or “Platinum” packages.
Next, I did some height/weight stuff. They had a device that measures body fat (and BMI, which of course is a bit squirrelly as a measure, but leave that aside for now). The body fat measurement was almost 20%. I am usually 2-3 points lower. It could have been the inaccuracy of the machine or perhaps because this winter’s weather has crimped my workout routine, but I expressed a little concern. The screener said: “Actually as you get older (I’m 59), you want to have a little body fat.” That is, once again, the right answer,an answer which shockingly few vendors are aware of.
Finally, I did the fingerstick. The screener explained it all very thoroughly, understood the distinction between fasting and non-fasting, and did everything quite well. Unlike Vik’s experience with Provant’s six-week delay, he ran the numbers right on the spot.
Even though a finger-stick is not particularly accurate, my values were what they usually are, except cholesterol. My cholesterol, at 127, was 30 points lower than usual. I expressed concern that a cholesterol value could be too low, and the screener said he didn’t know what too low was, but didn’t think it was an issue at 127.
So I googled it, and indeed there is a “too low,” but it is south of 127. Apparently people with too-low cholesterol tend to do impulsively self-destructive things, like attempt suicide or drive recklessly. I’ve never done anything particularly impulsive/self-destructive, unless one counts running this blog. So, once again, the Health Advocate person was right. That was 3 in a row, which might be a record for wellness vendors.
I could have talked to a counselor about the numbers but there was a bit of a line to get into these private areas, and in any event, I was so pleased with these guys that I didn’t want to risk bursting my balloon with one more conversation. (Nor have I visited their website to see if they make wacky ROI claims. Let me just live the moment, please…)
So I idenitifed myself (I hadn’t misrepresented myself earlier–remember, Vik and I are in the “integrity segment” of the market — but I just hadn’t given the full story) and congratulated them on best-in-class job of screening.
Literally every other vendor on this site could learn a lot from Health Advocate. I know I did.
(March 18) Due to vacation schedules, we are taking a brief time-out from both our “profiles” of vendors and our serial analysis of the HERO report (Part 1 was our most popular posting ever — don’t forget to “Follow” us so as not to miss a single installment.).
This posting is to apologize to the HERO Wellness Ignorati. A comment our posting on the HERO report said we shouldn’t call the Wellness Ignorati “ignorant.” We aren’t calling them ignorant and we apologize if we were misunderstood. Since it has sold almost 6000 copies despite Wiley’s decision to price it to finance their retirement accounts, we thought by now most people had read Cracking Health Costs. That was the book in which the term was coined. It emphatically does NOT mean “ignorant.” We would never call them “ignorant” and the Ignorati are anything but. Quite the contrary, they are smart enough to realize that facts are their worst nightmare.
Or as Tom Friedman said in today’s New York Times, “We wouldn’t be human if we didn’t outright ignore facts that make a laughingstock of our hopes.” (I actually did the opposite. See the blog post: Founding Father of Disease Management Astonishingly Declares: “My Kid Is Ugly.” Dee Edington did something very similar. Both of us were simply not willing to sacrifice our integrity for filthy lucre.)
The Wellness Ignorati are more than smart. They are brilliant. They have elevated fact-ignoring to an art form.
They realize that enough people seeing this site will derail their HR-financed gravy train, so they keep to a strict strategy of not even acknowledging that facts exist. Example: us. Not a mention of our existence in their entire report. A brilliant strategy for them, and one that flatters us immensely. Obviously, in the massive tome they just published, if they thought we were wrong, they could have said: “They Said What and its authors offer a competing view, but it’s wrong because…”
Fact suppression is of course the opposite of what we do — we want facts to be front-and-center. We welcome transparency and debate, though the latter is tough because people either repeatedly decline (Ron Goetzel) or, after the debate, wouldn’t agree to release the recording (Michael O’Donnell).
Instead they simply disappear us. This is despite the fact that the two of us (plus our colleagues like Jon Robison and Tom Emerick) have sold more books, been interviewed in more major publications, authored more articles in high-impact journals than all the Ignorati combined.
I’ll close with a f’rinstance. We copied a screenshot from that report showing that the Ignorati finally admitted that “pry, poke, prod and punish” programs damage morale. This guy looked at that screenshot, and put a comment on our post that this screenshot didn’t exist, but rather it was our propaganda. Someone else said the screenshot was out of context, so we invite everyone to read the context.
The bottom line is, of course the HERO Report is correct about the cost of morale damage. Coincidentally, I am writing this from State College, Pennsylvania. I am here as an honored guest of the Penn State Faculty Benefits Committee, feted for my role in helping to free them from the Goetzel/Highmark forced wellness program (featuring those immortal testicle checks). Try telling Penn State there’s no morale impact. (For those of you thinking of sending your kids here, do it! I’ve never been to a university where the professors were more passionate about teaching their students than PSU–despite what happened to them in 2013.)
“Everyone is entitled to their own opinions, but not to their own facts.”
–Daniel Patrick Moynihan