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Monthly Archives: March 2015

Total Wellness’s Total Package of Totally Inappropriate Tests


Total Wellness is very concerned about “fostering a positive culture in your office.”

total wellness culture

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.

total wellness nicotine

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.”

total wellness cotinine

When you’re done with nicotine, screen them for body fat.  Nothing spells “talented employee” like an absence of body fat.

total wellness 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.

total wellness cbc

total wellness chem 20

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.


Helping employees achieve health shouldn’t include lying to them. Quizzify them instead.

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.

total wellness ovarian

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:

total wellness ovarian

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:

total wellness carotid

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.

uspstf stenosis

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.

We Concede the HERO Report is right–wellness does lose money

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 moneySlide1

Count us more shocked now than we were by the report’s admission that wellness adversely impacts morale, (This is covered in Installment 1.)

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.

gary loveman

Gary Loveman, Business Roundtable


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.

HERO list of costs

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.”

HERO list of costs

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.

cerner cholesterol

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

Quizzify 4

When wellness doesn’t add up, Quizzify does

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.

HCUP WSMEs non-respiratory

Next, divide the relevant figure (Private insurance, 432,065) by the total number of privately insured discharges in the US (7,360,684)

HCUP US as a whole

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.

hero page 23 99 cents  

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:

  1. Even before adding page 10’s cost categories back to page 15, costs are $1.50 PMPM;
  2. Savings are only $0.99 PMPM, meaning wellness loses $0.51 PMPM;
  3. The first two points are not our estimates — they’re their estimates and are far more optimistic than ours;
  4. 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;
  5. 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.

Quizzify 3

Quizzify: the antidote to poke-prod-pry-punish wellness

Health Advocate Caught in the Act…

…Of getting it right!

Quizzify 4

Proof that wellness can be both useful & fun.

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.

Apologies to HERO and the Wellness Ignorati!

(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.).

Quizzify 3

Knowledge + fun + respect = happiness + health

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.

Quizzify 2

Do you employees know when to just say “no” when it comes to medical care?

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

A Short Painless Primer on the Value of Screening

At the risk of knocking our second-most-widely viewed posting (the first of several analyses of the HERO report) off our front page, this is a brief and amusing lesson on the value of screening

If you like this, you’ll love this–it will also tickle your funny bone.

HERO Report: Wellness Industry Leaders Shockingly Admit that Wellness Is Bad for Morale


The question is: how do you help employees spend less and get healthier at the same time?

(March 14) This is the first in a series looking at the strengths and weaknesses of the HERO Outcomes Guidelines report, recently released by the Wellness Ignorati.  One explanatory note:  A comment accused us of insulting the Wellness Ignorati by calling them that.  It is not an insult.  It describes their brilliant strategy of ignoring facts and encouraging their supporters to do the same.  We are very impressed by the disclipline with which they have executed this strategy, and will be providing many examples.  However, if they prefer a different moniker to describe their strategy, they should just let us know.

We encourage everyone to pick up a copy of this report, the magnum opus of the Wellness Ignorati.  Unlike the Ignorati, we are huge advocates of transparency and debate (which they call “bullying”).  We want employers to see both sides and decide for themselves what makes sense, rather than spoon-feed them selected misinformation and pretend facts don’t exist.

The latter is the strategy of the Wellness Ignorati.  Indeed, they earned their moniker by making the decision to consistently ignore inconvenient facts.  (This is actually a smart move on their part, given that basically every fact about wellness is inconvenient for them.)  For example, they just wrote 87 pages on wellness outcomes measurement without admitting our existence, even though we wrote the only book — an award-winning trade best-seller — on wellness outcomes measurement.  Observing the blatant suppression of facts and the loss of credibility that comes with blatantly suppressing facts is just one of the many reasons to read this report.  In total, their report provides a far more compelling argument against pry, poke, prod and punish programs than we ourselves have ever made, simply by bungling the (admittedly impossible) argument in favor of them.

There is too much fodder for us to deconstruct in one posting, so over the next several weeks we will highlight aspects of this report that we think are especially revealing about the sorry state of the wellness industry.

In terms of getting off to a good start, the Ignorati are right up there with Hillary Clinton, with their first self-immolation appearing on Page 10.  Remember our mantra from Surviving Workplace Wellness:  In wellness, you don’t have to challenge the data to invalidate it.  You merely have to read the data.  It will invalidate itself.

And sure enough…

Ironically, the first self-immolation is the direct result of that rarest of qualities among the Ignorati:  integrity.   We were shocked by the revelation that the Ignorati actually realize that employee morale and a company’s reputation both suffer when companies institute wellness programs – but here is the screenshot.  Both morale and reputation are listed, as “tangential costs.”

Try telling a CEO that the morale of his workforce and his corporate reputation are “tangential” to his business.   We ourselves run a company, and we would not list low morale as a “tangential cost.”  Quite the opposite — our entire business depends on our employees’ intrinsic motivation to do the best job they can.   If their morale suffers, our profit suffers.   That’s why we would never institute a wellness program.  The last thing we want to do is impact our morale in order to measure our employees’ body fat.  Obviously, it is harder to hire and retain people if you value body fat measurement over job performance, and we are pleased to see the ignorati finally admit this.

HERO list of costs


Why, having now read this revelation in the ignoratis’ own words, that wellness is bad for morale, would any company still want to “do wellness”?  Or as we say in Cracking Health Costs, “If you’re a general, would you rather have troops with high morale or troops with low cholesterol?”

The fact that employees hate wellness isn’t exactly a news flash.  Anytime there is an article in the lay press, the public rails against wellness — or “bullies” the wellness industry, to use the term that the Ignorati use for people who disagree with them publicly.  You don’t have to look far—just back to HuffPost on Wednesday.  Or All Things Considered.

Obviously, if you have to bribe employees to do something (or fine them if they don’t), it’s because they don’t like it.  If employees would rather sacrifice considerable sums of money than be pried, poked and prodded, they are sending you a message:  “This is a stupid idea we want nothing to do with.”

The news flash is that this whole business of “making employees happy whether they like it or not,” as we say in Surviving Workplace Wellness is now acknowledged – by the Ignorati as a group — to be a charade.

HERO seems to have exhausted their integrity quota pretty quickly, because after that welcome and long-overdue and delightfully shocking admission, they slip back into character.

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To get good answers, you must ask good questions. We do.

Specifically, in their listing of costs, they conveniently forgot a bunch of direct, indirect and “tangential” costs.  Like consulting fees.  Generally, the less competent and/or honest the consultants, the more they charge.  (For instance, we can run an RFP for $40,000 or less, and measure outcomes for $15,000 or less — and do both to the standards of the esteemed and independent GE-Intel Validation Institute. Most other consultants can’t match either the price or the outcome.)    We’re not calling any consulting firm incompetent or dishonest other than pointing to a few examples that speak for themselves, but it does seem more than coincidental that the consultants involved in this report have conveniently forgotten to include their own fees as a cost.

And what about the costs of overdiagnosis caused by overscreening far in excess of US Preventive Services Task Force guidelines?  The cost of going to the doctor when you aren’t sick, against the overwhelming advice of the research community?

Still, we need to give credit where credit is due, so we must thank the Ignorati for acknowledging that wellness harms morale.  It took even less time for this acknowledgement than for the tobacco companies to admit that smoking causes cancer.

Stop the Presses: We Goofed!

When you are in the “countererrorism” business like we are, it’s important to have a zero tolerance for errors.  Occasionally one slips through.  In that case the important thing to do is to admit it, rather than fire the Attorney General and the Special Prosecutor and have your secretary erase the tape.

Vik and I wrote a posting for The Health Care Blog, the upshot of which was that the Affordable Care Act should no longer require insurers to cover adult checkups.   Free checkups are ubiquitous in self-administered plans.  On balance, our posting shows what grownups in health services research already know:  they are worthless.  Not completely satisfied with their innate worthlessness with a full subsidy, many employers — guided by benefits consultants — attach additional money to them:  you are either fined for not getting one or else receive a bonus for getting one.  Our proposed solution was/is quite simple:  employers that attach bonuses or fines to physicial exams need to disclose that checkups are a waste of time and money.  That simple disclosure requirement would end forced checkups.

It turns out, however, that adult checkups are not required by ACA.   It was a complete benefits consulting urban legend and we fell for it.  So we were wrong.

Here are the lessons from this.

First, if someone proves us wrong, we admit it.  See?  Admitting error is a concept that is lost on the wellness and benefits consulting industries.  For example, after we pointed out that Mercer’s client British Petroleum got completely snookered by Mercer Staywell, the response of Mercer to BP wasn’t: “We apologize to for letting your vendor snooker you.”  It was: “Let’s nominate this program for a Koop Award,” which naturally they won because both Mercer and Staywell are represented on the board of the group that gives out the award.

Second, the particular someone who proved us wrong, Chris Glason, did not “bully” us.  He merely asked a tough question that invalidated a (minor) premise of our argument.   However, when we do something quite similar, the people who are wrong (or lying) say we are “bullying” them.  But all we did was ask 11 questions to clarify what someone already said — and offer him $1000 to answer the questions.  Trust us:  if Chris Glason had offered us $1000 to look it up and get back to him, we would have.  (Instead we were rather dismissive, to put it mildly, for which we also publicly apologize.)

Third, our mistake was to assume that benefits consultants actually know something about, well, benefits consulting.  We know they know nothing about wellness—Mercer and Milliman have both basically self-immolated by participating in the aforementioned Koop Award Committee and getting snookered four times by dishonest vendors.  On two occasions the Committee was forced to backtrack as a result of our exposes, though they never admitted they got snookered.  We kind of assumed that since benefits consultants don’t know anything about wellness, the only way they could stay in business was to actually know the first thing about benefits….and we listened to them.

Sidebar:  a few benefits consultants are highly competent.  We recommend the ones whom the Validation Institute (which is not connected with us but which we have a lot of respect for) has certified.  (Don’t strain your eyes–no one from Mercer or Milliman appears on their listing.)

Fourth and most importantly, the answer doesn’t change:  End “pry, poke, prod and punish” programs — especially the “prodding” part, now that even benefits consultants can see that prodding someone to go to the doctor when they aren’t sick is a complete waste of time and money.

“I made a mistake.  I listened to the experts.”

 — John F. Kennedy

WELCOA: In the Belly of the Belly of the Beast

First, a little background.  For those of you unfamiliar with the Wellness Council of America, or WELCOA, this organization, based in Omaha, Nebraska, was founded by the inventor of the all-you-can-eat self-serve restaurant.

Warren Buffet?

Hey, it’s an honest mistake!  Anyone could misspell their founder’s name on their home page, especially when it’s one of those long foreign-sounding unpronounceable names of somebody no one’s heard of.   Besides, WELCOA in particular can’t be expected to know how to spell “Warren Buffett.”  I mean, it’s not like they’re both based in the same city or anything.

WELCOA is wellness’s perfect storm, exemplifying the standards for literacy, numeracy and integrity that have endeared the wellness industry to us humor writers.  Along with Ron Goetzel’s Koop Award Committee (chronicled at length in these pages and never shy about coming back for more), WELCOA truly does put the “Ig” in “Wellness Ignorati.”

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Fun + facts = smarter, happier employees

In general, the modus operandi of the Ignorati — and especially WELCOA — is to suppress facts, because facts are their worst nightmare.  If facts are their worst nightmare, we’re their Night of the Living Dead.  We are tickled pink that we are considered so threatening that nowhere on their site is there the slightest hint that we — or any wellness skeptics — even exist.  For instance, the first time ever that the entire wellness industry (as opposed to individual debacles, like Penn State) was newsworthy enough to be covered by Health Affairs, LA Times, Incidental Economist, Chicago Sun-Times, All Things Considered, Huffpost, the Federalist etc.,  WELCOA’s lead “news” story was:  “How to Jump-Start Your Wellness Program with Big Data.”   (This editorial choice echoed the New York Post, which, on the day the hostages were freed and Reagan was inaugurated, led with “Joan and Ted to Split.”)

By contrast, we embrace transparency, and urge you to read the entire WELCOA site, especially the “premier providers,” who are kind enough to pay WELCOA for the privilege of having their creative approaches to grammar and math become TSW? fodder.  (We have a source inside WELCOA who brought our attention to the comedic potential of this material.)

One of our favorite WELCOA premier providers is Trotter Wellness, which gets its own entry in “On the (Even) Lighter Side.“.

trotterlogo.png (359×61)

Remember that scene in Catcher in the Rye when Stradlater gets Holden to write his English composition but tells him not to put all the commas in the right places so the teacher won’t suspect he wrote it?  The good news is, WELCOA could never be confused with JD Salinger.  In their ad for Trotter Wellness, WELCOA didn’t put any of the commas in the right places.


Frankly, we’re not sure WELCOA has ever put a comma in the right place…

At the risk of ruining a joke by explaining it, it’s not just that all the punctuation is missing from the descriptor.  It’s that the exact spot WELCOA’s crack grammarians decided to place a comma is also the exact spot they shouldn’t have placed a comma, according to Trotter’s own website screenshot right above this screenshot.  That gives WELCOA both a false-positive and a false-negative rate of 100%, which even in wellness is a bit on the high side.

Along with Ron Goetzel’s Koop Committee and Health Fitness Corporation, they were a co-conspirator in the Nebraska workplace wellness fraud, thus proving that great minds aren’t the only ones that think alike.  It was actually their website that claimed the famously fictitious “life-saving catches” of the 514 victims of “early stage cancer.”

nebraska life saving catches

koop001.png (394×241)

What boggles the mind, even by the uniquely gauzy ethical standards of the wellness industry is that they still make that claim, albeit on someone else’s website.  We’ll readily admit they posted the claim originally because they didn’t realize that HFC was lying (again), and that screening about 5000 people wouldn’t yield 514 cases of cancer.  (While Ron Goetzel’s Koop Committee was also snookered, It took us about 2 minutes to figure out that the alleged rate of cancers would have been roughly 50-100 times that of Love Canal.  You could come up with this insight too, using ingredients you already have in your kitchen: an internet connection, a calculator, and a triple-digit IQ.)

But two years later – after (1) we told them this was wrong; (2) we “outed” them in the Wall Street Journal; and (3) HFC admitted right in the Omaha World Herald they made up the claim – this statement is still being made.   We must now reluctantly conclude WELCOA is deliberately lying, because nobody, not even WELCOA, could be this stupid accidentally.*

Even Ron Goetzel briefly stopped defending WELCOA and HFC.  He claimed at the Datapalooza conference in June 2014 that the reason they won his award was due to a technicality. Apparently,  because they had only disclosed this particular lie on their website and not in their award application itself, it didn’t count against them.   Even so, a few months later, the Datapalooza conference being a distant memory, Ron once again declared that WELCOA/HFC/Nebraska was a “best practice”:

list-of-best-practices.png (408×108)

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Just because it’s healthcare doesn’t mean it’s good for you

There is too much to say about WELCOA for a single posting, so we would direct you to two places.  First, in This Is Your Brain on Wellness, WELCOA merits its own entry, of course.  But WELCOA, truly a target-rich environment, also proffered screenshots for Midland Health, Bravo, Balance, Well Nation, the Healthy Company Alliance, Trotter, and Star Wellness.

Second, you can find Chapter 7 of Surviving Workplace Wellness right here.  Even in the target-rich environment of the wellness industry, getting one’s own chapter is quite a feat.  Just to get you in the mood, here is the first paragraph of that chapter:

sww nebraska chapter

Now that we have your attention, you can click on this link and download Chapter 7, with our compliments.

*Our bad!  It turns out WELCOA may very well be this stupid accidentally.  You see, when we pointed out in Surviving Workplace Wellness that they had misspelled the name of their founder, they fixed it on their home page.  (Apparently, while many people can spell and many people have visited their home page, the intersection set consists only of us.)   But it never occurred to them to do a find-and-replace.  You’d think that someone there would have thought: “You know, since we didn’t spell Buffett correctly on our home page, perhaps there are other places we didn’t spell it correctly either.  If only there were some way of testing that hypothesis…”

And that one of WELCOA’s other luminaries maybe couldn’t spell “Buffett” either but had studied the intricacies of Word’s find-and-replace function.  And that maybe — just maybe — these two folks would have bumped into each other, like in those old Reese Cup commercials, and collectively come up with the insight that the “answer” was: run the find-and-replace function on “Buffet.”

But no such luck.  Hence to this very day, the original spelling still appears on their website, in that very same Nebraska case study.

welcoa warren buffet

We’ve just spent 1350 words observing WELCOA’s foibles, but we do like to be balanced in our reporting, so we’ll close with some good news.  The good news is, there is indeed one place where WELCOA is undeniably right:  WELCOA truly has “helped influence the face of workplace wellness in the US”…

…By putting a great big smile on it.



Pittsburgh Post-Gazette Bullies Shape-Up

In wellness, “bullying” is apparently defined as “asking hard questions, particularly to people who make claims they refuse to defend.”  This time it’s not us bullying anyone.  It’s the Pittsburgh Post-Gazette bullying Shape-Up, in a reprise of the last time Shape-Up challenged our numbers.

Guess who won, again?   (Hint:  you won’t see this link on Shape-Up’s website.)

And kudos to the Pittsburgh Business Group on Health for its forward-thinking quotes on the value of wellness programs.

Mrs. Brooks, whose business group members represent some of the region’s largest employers, said workplace wellness “has become a commoditized multibillion-dollar industry versus a value-based solution that addresses the whole.

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What happens when Jeopardy collides with Comedy Central and healthcare?

“We need to figure out how to motivate employees. Many programs today aren’t strategic or focused and, more importantly, culturally integrated into how companies do business.”

Lewis and Goetzel: A Brief Prequel

Note: This is not as clever as our usual stuff.  The sequel (in this case, prequel) is never as good as the original.  Nonetheless, it’s important to know how we got to where we are and how the now-viral “Open Apology to Ron Goetzel” came to be.

u_can__t_handle_the_truth_cat_by_vmanga-d3d1rjbI was just called “mean-spirited” by Michael O’Donnell regarding Ron Goetzel, so I thought a little background might be in order.  Some people no doubt think Vik and I just popped up out of the blue and started insulting people.  Michael O’Donnell’s editorial says we haven’t been willing to engage in “respectful debates” and all sorts of other stuff.  So let’s climb into the Wayback Machine and set the dial for 2011.  I submitted the final manuscript of Why Nobody Believes the Numbers to the publisher, John Wiley & Sons, for June 2012 publication.  For those of you whose consultants and vendors haven’t told you about it (for obvious reasons), this was an award-winning trade-bestselling book on outcomes measurement, that is used in at least 5 graduate-level classrooms.

Despite being almost 3 years old, it is quite relevant today, as a new “official” welness outcomes measurement guide compiled by many of the people profiled on this site recommends 7 approaches to measurement, 5 of which my book had already completely invalidated.

Page 82-83 contain the following lines.  I am using screen shots because, as is usual, no one would believe me if I just quoted text.



I genuinely believed that he was seeking the truth and that his analysis was “much better than mine.”  I was the Boxer to his Snowball.

But then, over the following years, a funny thing happened.  I reluctantly realized that the entire Wellness Ignorati cabal — the Koop Committee, WELCOA etc. — had no interest in facts.  They simply wanted to perpetuate their existence at the expense of their customers.  I had originally been very polite.  for instance, when I displayed the infamous Health Fitness Corporation slide (now disowned) on p 85 of Why Nobody Believes, I didn’t name names:

hfc unnamed

And I know Ron read p. 85, because he copied pages 82-83 and used it in his own presentations until Wiley made him stop.

But you know what happened after Ron read that HFC’s award-winning slide had self-invalidated?  No “respectful debates.”  Nothing.  (We’re still not sure how he didn’t notice in the first place.)  HFC didn’t apologize and didn’t stop using the slide.  Ron didn’t retract their Koop Award.  (It wasn’t until our Health Affairs  expose almost three years later, that Ron was shocked, shocked to discover that that infamous and highly visible slide was, to use his choice of the passive voice, “unfortunately mislabeled.”  It is still a mystery who did the mislabeling.  No one has stepped forward.  We think it might have been the North Koreans.)

The same thing kept happening — Nebraska, Staywell, Mercer, Milliman, Wellsteps etc.   Basically most of the Koop Committee and plenty of others  All of them had mistakes quietly pointed out…and none of them did anything to correct them. Politeness failed.  When a “mistake” is pointed out and not fixed, it becomes a lie.  In retrospect, what we did was as naive as if Rachel Carson had brought her findings to Monsanto and asked them to please stop selling DDT.

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Jeopardy meets Comedy Central meets healthcare.

That’s why and when we started blowing the whistle, which has been interpreted as bullying.  Leave a comment:  what you would have done?  The health of employees all over the country is being jeopardized by overscreening, overdiagnosis and overdoctoring, the evidence is being ignored by the perpetrators…what choice did we have?

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