Wellness is about pushing employees into the healthcare system, almost always both against their will and their better judgment. This story is a perfect example of the consequences of how too much healthcare can be hazardous to your health, and why your best defense against overdoctoring is knowledge.
Once you start asking questions, doctors have to start answering them. While many doctors welcome that, others start fidgeting. If your doctor is one of the latter, it’s probably time to switch.
I myself get occasional bladder tumors. Ironically — and once again, showing the unintended consequences of wellness — I got bladder cancer from eating more broccoli, which of course is exactly what wellness programs would have us do. (And which, in all fairness, is generally a good idea.) The problem was that the broccoli was grown in a garden that was way too close to railroad ties, which leach creosote into the soil. Creosote causes bladder tumors.
So every few years, one grows back and has to be scooped out “non-invasively” (that’s easy for the doctor to say). And every year I go in and get checked, also “non-invasively”. After my last check, the urologist — a new one, whom I had never seen before — suggested a CT scan of the kidneys and ureters.
I asked her why, and she said, because I had had bladder cancer for 15 years and never had this scan.
I replied: “Well, I founded a company, Quizzify, that educates on overutilization. CT scans have 500 times the radiation of x-rays, and that particular set of views is likely to spot tumors on my adrenal glands that are completely clinically insignificant, and yet once spotted will be tracked and possibly removed, for no good reason other than that they are there.”
She said: “OK, why don’t we just start with a urinanalysis.”
From a hazardous and likely counterproductive $1000 scan to a $10 urinalysis in 30 seconds. That’s what knowledge is worth.
To our new readers, while 2016 was the first time a Koop Award ever went to a company that harmed employees, 2016 wasn’t the first Koop Award ever to go to a company whose own data showed they fabricated results. Below is a history of one of the Koop Award’s Greatest Hits.
For those of you who haven’t been following the saga of the Nebraska state employee wellness program, here is a crash course, aka “Lies, Damn Lies, and the Nebraska State Wellness Program.” If you have been following it, you can skip to the end for the latest installment, Mr. Goetzel’s cover-up of his cover-up.
By way of background, this program is called “wellnessoptions” (imagine e.e. cummings-meets-poking employees with needles-meets-a sticky spacebar). They used to say the Holy Roman Empire was neither Holy nor Roman nor an Empire. Likewise, wellnessoptions is neither optional, if you want a decent deal on healthcare, nor wellness. Instead of wellness, it features a hyperdiagnostic anti-employee jihad in which Health Fitness Corporation (HFC) diagnoses employees but does nothing about the diagnosis except take credit for it.
TIMELINE — PART ONE: HFC’S TROUSERS COMBUSTED
September 24, 2012, 2:00 PM
I read Health Fitness Corporation announcement that its customer, the state of Nebraska, won Ron Goetzel’s C. Everett Koop Award for program excellence.
September 24, 2012, 2:01 PM
I recognize that the cancer outcomes were obviously made up. Until then, I hadn’t been following the Koop award closely enough to realize that making up outcomes was apparently one of the award criteria, as I later came to learn.
I read the full write-up on the program and realize that not only were most of the other outcomes made up, but they had actually lied about saving the lives of cancer victims. If you screen a few thousand people for colon cancer, you don’t find 514 cases of cancer, and you certainly don’t save their lives, as HFC was claiming. And you absolutely don’t save money, as they were also claiming. All this is even more true when you waive age-related guidelines and let anyone get screened, and encourage overscreening by sending out 140,000 letters to state employees graced with the picture of a beautiful young model way too young to be getting a colonoscopy.
How this invalid nonsense ever got by all the eagle-eyed Koop Committee members would be a mystery, except that HFC is a sponsor of the Koop Committee.
I review the entire application and all the marketing materials. It becomes obvious that the entire thing was made up, not just the cancer part. They claimed to save $4.2 million because 161 of their roughly 6000 participants reduced a risk factor.
The math is quite self-evident. Suppose you doubled the number of participants who reduced risks to 312. It stands to reason that you could save $8.4-million. Double it again to 624 and you save $16.8.
Now double it one more time. If 1,248 people out of those 6000 reduced one single risk factor, you’d save $31.6-million, which is about equal to the entire spending for all 6000 participants. And of course most medical spending has nothing to do with identifying previously unrecognized risk factors, so this would be quite a feat. (Do you even know anyone under 65 who had a heart attack that could have been avoided by one more workplace screening?)
I later learn that all the Koop Award-winning program outcomes are made up, using exactly the same math.
November 2012 to June 2013
I try to contact the authorities, like Roger Wilson, who allegedly runs this program for the state, but no one seems to care. The rule of thumb in the wellness industry is that what you say counts. What you do is pretty irrelevant.
June 20, 2013
Breakthrough: The Wall Street Journal editors decide that I am correct, and that the outcomes were made up. Vik and I are allowed to publish this on their op-ed page.
July 14, 2013
Breakthrough again: Another very well-read blogger professes shock-and-awe that any vendor could lie so blatantly and apparently get away with it.
July 15, 2013
Breakthrough yet again: Ace reporter Martha Stoddard of the Omaha World Herald gets Dennis Richling of Health Fitness Corporation to admit that the outcomes — at least the “life-saving catches” of “early stage cancer” outcomes — were indeed made up. Richling tries to spin his gaffe by calling the difference between “life-saving catches of early-stage cancer” and saying someone might possibly get cancer in the future “semantics.” So, according to Richling, having cancer and not having cancer are the same thing.
February 1, 2014
The hilarious wellness industry smackdown Surviving Workplace Wellness is published. Since the HFC Nebraska program had too many lies to fit on a page or two, it gets its own chapter. Here’s the opening paragraph, which in all modesty I must admit is one of my favorite in the book.
February 23, 2014
Nebraska political blogger ReadMoreJoe picks up the scent. He points out that this wellness program is an obvious fraud. The problem is that the same posting is also exposing several other equally obvious frauds, so this one gets overlooked.
TIMELINE–PART TWO: GOETZEL STRIKES BACK
Ron Goetzel isn’t about to sit back and let his friends/sponsors/clients be pilloried for a little white lie about saving the lives of cancer victims who didn’t have cancer.
June 2, 2014
At the Health Datapalooza conference, Ron Goetzel, while admitting the Nebraska cancer outcomes data was made up, claims they/HFC still deserve the Koop Award because he somehow didn’t realize the data was made up at the time the award was granted. And it is true that HFC didn’t actually announce they had made up the outcomes. Ron would have had to actually read the materials to figure it out, same as I did.
Ron Goetzel calls the Nebraska program a “best practice” in the Journal of Occupational and Environmental Medicine but refuses to answer any questions about the obvious mistakes and inconsistencies in the article.
After knowing for 16 months that they had lied, Ron Goetzel, writing in Employee Benefit News, finally drops Nebraska from his list of best-practice programs:
Being a fair-minded person, I take it upon myself to congratulate him on his newfound sense of ethics. I don’t specifically agree that what he did was ethical, because the ethical thing would have been to admit complicity, apologize, and revoke their Koop Award. But I do say that Nebraska being dropped from the list of best practices means ethical “progress is definitely being made,” albeit from a low base.
Only 29 minutes elapses before Ron erases all my illusions about his honesty and re-adds Nebraska to the list of “best practice organizations.”
He also adds PepsiCo to the list. I guess losing only $2 for every $1 you spend qualifies as such in wellness, where most organizations lose much more.
In a rally-the-base invitation-only webinar, we are told that Ron has promoted the Nebraska program from “best practice” to “exemplar.” It seems like the more obvious it becomes that the whole thing was fabricated, the more Mr. Goetzel worships its outcomes.
TIMELINE–PART THREE: RON STANDS ALONE
WELCOA finally takes the fabricated case study of Nebraska’s outcomes off their website, 26 months after the fraud was admitted. Perhaps some pressure is being put on them to come clean, given that this is Nebraska’s program and they themselves are based in Omaha.
Just for the record, I’m not saying that an organization founded by all-you-can-eat cafeteria magnate “Warren Buffet” knowingly kept a false document on their site for those 26 months. History suggests they might just be slow learners. [2016 update: WELCOA is under new management, and they appear to be doing a great job, as exemplified by their development of the Employee Health Program Code of Conduct.]
This means Ron Goetzel is literally the only person left who thinks it’s perfectly OK — indeed, a “best practice/exemplar” — to lie about saving the lives of cancer victims. Good luck with that in the upcoming debate. It’s him against the world.
Or, as he sees it, everybody’s out of step but Ronnie.
Nebraska tentatively re-awards the wellness contract to Health Fitness Corporation. I am looking over the precipice towards utter humiliation.
TIMELINE–PART FOUR: THE ORIGINAL DATA DISAPPEARS
November 2, 2015–the original cover-up, on the morning of the Great Debate
At our urging (and we must confess to delighting in creating this “Sting” operation), a third party alerted Mr. Goetzel to the fact that, his protestations to the contrary, the Koop Award Committee did know (even if they had somehow not seen the marketing materials quoted above) that Health Fitness Corporation was making fictitious claims about saving the lives of cancer victims. It was right in the award application. The original award application from Nebraska had originally stated (underlining is ours):
But then, a hour following the call from this third party the morning of the debate, the original award application suddenly read:
In the original application, this excerpt appears in a letter from the Governor of Nebraska. Only now the Governor’s letter says the opposite what he actually wrote. In the real world, this would be considered forgery. In wellness, a forged cover-up of a blatant and admitted lie about saving the lives of cancer victims who didn’t have cancer is considered business as usual. Johns Hopkins and Truven (Ron’s employers) don’t seem to mind either.
The state is rescinding its award to Health Fitness and terminating its wellness program. In the immortal words of the great philosopher Stewey Griffin, victory is mine.
September 2016: The cover-up of the cover-up
Mr. Goetzel finally acknowledges that Health Fitness Corporation told a whopper, and the Koop Committee accidentally overlooked it. He now calls this an “erratum.” The technical term for it is a “lie-um.” You can’t forge official state documents and then call the whole thing an “erratum.” Is a robber allowed to give the money back after he gets caught and just uncommit the crime?
So now, having admitted that the award-winning vendor told the biggest lie in wellness history (once again, quite a feat), and knowing that all the obviously fabricated outcomes were mathematically impossible, and that waiving age restrictions for screening is akin to waiving age restrictions for buying beer, the Koop Committee finally, after 4 years, rescinded the Nebraska award.
Haha. No one falls for that line any more. Quite the opposite, they are doubling down. They say that whopping lies like this one don’t matter, if you are an award sponsor. You get to keep your award.
Ditto, if your entire claim of “separation” between participants and non-participants is shown to be false but you are sponsor, Ron merely doctors the data and you get to keep your award.
Also, if it turns out you lied about your savings because there was no change in the biometrics to attribute the savings to, but Ron was a consultant on your project, you get to keep your award.
Likewise and as was confirmed in 2016, if you are a committee member, as Wellsteps’ CEO was until recently, despite your own data showing that you actually harmed employees, you get to keep your award.
Bottom line: as a friend-of-Ron, you might get to keep your award even if you shoot someone on Fifth Avenue.
I recently attended the annual meeting of the Pittsburgh Business Group on Health. it was a great session, and I am not just saying this because (future exhibitors and sponsors take note!) Quizzify got about 25 inquiries in the subsequent week, and the Pittsburgh Post-Gazette did a great follow-up article. It was very favorable coverage because, as we had predicted to the reporter, WELCOA refused to challenge/rebut/comment. WELCOA doesn’t engage in intellectual or analytical debate for reasons that would become apparent if you read this write-up, which might cause a cynic to conclude that a beam of light leaving intelligence might not reach WELCOA headquarters for several seconds.
However, to WELCOA’s credit, they have finally learned how to spell their founder’s name. Hey, it’s a start. Those who would like to see the original spelling (as well as many other greatest hits of WELCOA and their brethren) might want to visit This Is Your Brain on Wellness.
With uncharacteristic humility, I’ll admit I learned a lot at this conference. In particular, I was very impressed by the wellness program at First Commonwealth Bank. It was the best example I’ve ever seen of a CEO embracing a culture of wellness…and walking the walk by doing wellness for his employees instead of to them, for the most part. One of the tests I recommend to see if a wellness program is valuable is to ask if you can brag about it in recruiting. First Commonwealth Bank clearly can.
The Integrated Benefits Institute’s Tom Parry also gave a very insightful presentation on wellness economics, though I am not sure the opinions he intended to convey aligned 100% with the data on the slides, to put it gently. Kudos to Nicole Ausmus for finding a head-scratcher in this presentation that I hadn’t even noticed — read her comment on this post.
In addition, the PBGH event was very well-produced in every respect…and the place was packed.
And I’d like to take a minute to — once again, with uncharacteristic humility — thank other organizations that did not buy into the wellness industry’s blacklisting of me following publication of the emperor-is-buck-naked best-seller Why Nobody Believes the Numbers. The blacklisting made it possible for wellness to keep snookering customers, who (unless they attended conferences hosted by the folks listed below) had no way of knowing their vendors were making stuff up.
Two groups that never bought into the blacklisting, and for that I am disproportionately grateful, were the Population Health Alliance (which is hosting the Great Debate) and David Nash’s/Peter Grant’s Population Health Colloquium.
Next is the Silicon Valley Employers Foundation, whose Lauren Vela stepped up early. Our presentation wasn’t popular, but we have gotten a lot of follow-up inquiries since then from attendees, including one apology for publicly disbelieving our conclusion. Lauren took a lot of flak for the crime of being ahead of her time, but, Lauren, if you’re out there, thank you.
The National Business Coalition on Health (NBCH) was right out in front too, as were their affiliated organizations in the Northeast, Philadelphia, South Carolina and now Pittsburgh. Note: I know this is confusing (so don’t try to explain it to WELCOA), but the regional business groups/coalitions are loosely affiliated with NBCH, even if their name includes the phrase “Business Group on Health.” They are NOT affiliated with the National Business Group on Health.
Still, even the moribund National Business Group on Health is making progress in understanding the need to present facts about wellness. Example: the previous voicemail I left for them has gone unreturned for two years whereas the most recent has only been ignored for two weeks. (So much for my uncharacteristic humility.)
Next to facts, integrity is the wellness industry’s worst nightmare. Like if one of their brethren were to actually say something honest. Tom Parry of the Integrated Benefits Institute just did exactly that. And unlike the HERO Report, where the self-immolating honesty was accidental (and at odds with the propaganda in the text itself), this slide might actually have been honest on purpose.
***Please read this post all the way through including the new postscript***
I also checked with him, and he is quite clear that you can’t get an ROI on health savings from spending money on “pry, poke, and prod” wellness programs. His exact words are: “It is difficult to spend medical dollars to save medical dollars, particularly in the short term.” (This is at odds with Ron Goetzel’s giving out awards to Eastman Chemical and Health Fitness Corporation, for a program that “saved medical dollars” two years before it started. Mr. Goetzel, unlike Mr. Parry, does not appear to be constrained by self-evident facts.)
And Tom Parry is indeed right. But — as we’ll see — his valid insights don’t stop with healthcare ROI. His slide makes excellent points about absenteeism, “presenteeism” and wellness — even if perhaps they weren’t the points he intended to make.
First, let’s look at the actual slide, the top ten health-related drivers of expense.
Only two “wellness-sensitive” items make it into the top-ten drivers of ill health: obesity and hypertension. Estimating off the y-axis (and dividing by 1000 to come up with costs per employee), it appears that the cost of each of those two is about $10 per employee per year. We already know that employers can’t reduce obesity–that’s in our peer-reviewed article. And let’s say you could reduce hypertension by 10%. That’s a $1 savings per employee per year–before adding back the (much higher) cost of the hypertension drugs. (Presumably extending this top-ten list would eventually reach the other diseases that wellness vendors love to hyperdiagnose, so add a couple of dollars of potential savings there, for a total of maybe $3 per employee per year in savings before adding back costs.)
This being the wellness industry, even the “honest” slides are full of head-scratchers. For instance, how can there be so much absenteeism due to hypertension, which has no symptoms in 99.9% of cases? Do you even know anyone who doesn’t go into work because their hypertension is acting up? And how can HR even track absences due to hypertension, assuming there are any? Absences aren’t coded by ICD-9s (and are rarely even coded by sickness vs. vacation).
Back to the top of the slide, if your biggest problem is depression, why would you institute a wellness program which — according to the HERO report which Tom Parry co-authored — is bad for morale? We don’t mean to make trouble here. We’re just askin’…
And this slide is actually the best argument against “pry, poke, prod and punish” wellness I have ever seen: the nine most expensive items either have nothing to do with screening or HRAs, or in the case of obesity, aren’t fixable by wellness.
We look forward to many more presentations in “support” of wellness. In the immortal words of the great philosopher George W. Bush, bring ’em on.
POSTSCRIPT: Explanation from Tom Parry. We, as you know, are unlike wellness vendors in that we are in the “integrity segment” of the market, which means we print all responses. (We used to seek responses prior to publication but never got any, so we gave that up.) Tom explains below. Albeit not as funny as the “insights” we gleaned, it is the right answer, so here it is. (It doesn’t change the overall narrative or conclusions about the money — and it doesn’t address Nicole’s comment — but it does describe how the findings on the slide can be accurate and can logically have come out of IBI’s research.)
Al – one clarifying point on the research graph (and I’d be happy to send you a copy of the research paper if you like). It is a person-centric analysis rather than an analysis of the marginal impact of individual diseases (parsing out the marginal impact in this kind of data is extraordinarily difficult). We wanted to look at the experience of PEOPLE with different conditions (and because of the prevalence of co-morbidities tend to have other conditions as well). So as you point out, you don’t miss work because of high-cholesterol but those with high cholesterol often have other conditions that together cause them to miss work. Tom
Rants by actual employees subjected to wellness programs are pretty easy to come by. In that respect, the Change.org petition against the Goetzel-Penn State program is basically the Greatest Hits compilation.
Here is one of our newest favorites, that just came in over the transom last week, reprinted word-for-word with identifiers removed and a little punctuation added–and, as you can see a few lines down, a soupcon of bowdlerization.
Since we now know wellness has no ROI, perhaps this is what the Wellness Ignorati mean by “value on investment” — if employees quit as a result of wellness programs, you can save the severance pay from firing them.
My husband and I have had the joy of recently completing our wellness assessments. Here is my rant.
First, it’s a giant pain in the [gluteus maximus]. Second, the questionnaire could not have been more ridiculous and third, my doctor didn’t really do anything with it. She just gets to bill an unnecessary office visit [to my employer] in order to sign a form.
On the first topic, the questionnaire took 45 min for each of us, plus the inconvenience of having to schedule and go to an appointment we didn’t need. And in my case, having just gone through 9 months of prenatal care, labor and delivery care and postpartum care on top of all the newborn appointments, the last thing I needed was another doctor’s appointment.
On the second point, the questions they asked were terrible for assessing my actual health. There was an obvious right answer in every case, and it seemed to want to judge my mental health/level of happiness more than actual health. “Think of yourself on a ladder in terms of xxx (happiness, social status, personal accomplishments). What rung on the ladder would you place yourself, 1 being the lowest and 10 the highest?” How does that assess my health? It’s a personal fulfillment questionnaire that also asks if you exercise. At the end they ask for all these lab values which I don’t have and my doctor didn’t think she was supposed to request so they aren’t filled out at all.
And on the last point, my doctor never looked at the 30 page final assessment that I had to print and she just asked me if I think I’m healthy and I said yes. She was fine with that. The only thing she told me was that I could lose a few pounds to get my BMI in the right place – well OF COURSE! I just had a baby, which on a side note is not a part of the wellness assessment at all. There are all these questions about how much sleep I’m getting, am I stressed, etc… but no accounting for the natural things that happen in life like a newborn.
We are going to make a prediction. We might be wrong, though, because in the immortal words of the great philosopher Yogi Berra, “It’s tough to make predictions, especially about the future.” We predict that the Boise School District, a Wellsteps customer, is going to win the 2015 Koop Award. At a minimum, they will get an honorable mention.
We base this prediction on three insights. First, as our previous posting shows, the award tends to go to the program that spews the most nonsense. Specifically, to the one that ignores both biostatistics and fifth-grade math most creatively. Obviously, Wellsteps misunderstands the statistical concept of regression to the mean. Misunderstanding biostatistics is a requirement for being a wellness vendor. What’s more surprising is that they were absent that day in third grade when the teacher explained the law of math that numbers can’t increase and decrease at the same time. Laws of math tend to be strictly enforced.
In all fairness, it is possible that both Wellsteps’ claims are true: total costs may very well have declined even as cost/person increased. The Boise School District might simply employ or insure fewer people in 2014 than in 2011. Or maybe the Wellsteps program was so unpopular and worthless that employees opted to get insurance through their spouses. But even the most dishonest wellness vendor with the most clueless customer wouldn’t claim credit for a reduction in costs due to fewer people being insured. And even the ethically challenged Koop Committee isn’t dishonest enough to endorse a claim that blatantly specious.
Second, the award almost always goes to a client or customer of a Koop Award Committee member, or to a client or customer of a sponsor of the Committee. Wellsteps’ Steve Aldana sits on the Committee. All the other vendors and sponsors on this Committee have already been graced with an award for one of their customers. So now it’s Wellsteps’ turn, as they have yet to win one for a customer of any size. (This partly reflects their lack of customers of any size.)
After all, why even bother being on this C.Everett Koop Award committee if you can’t give a C. Everett Koop Award to yourself? Isn’t that what Dr. C. Everett Koop was all about — self-dealing, cronyism and corruption? (not)
Third, the timing of the “White Paper” Wellsteps just published is quite fortuitous. Sort of like in World War I, when one side knew an infantry attack was coming because it was preceded by an artillery bombardment by the other side, Wellsteps is preparing us for more “over the top” claims of success in a program that — by their own admission — was a total failure at controlling costs through 2013, and only did OK in 2014 because the cost of non-participants declined precipitously.
Fourth, if the Committee was at all on the fence, our posting last month would have helped them decide in favor of Wellsteps. One thing this Committee enjoys doing is showing us that facts and math doesn’t matter because their customers don’t read our material. The more outrageous their claims, the more they like to rub our faces in the reality that very few people in human resources care what we have to say.
This isn’t because they have, to use Mr. Aldana’s hilariously misinformed term, I-don’t-care-itis. Instead it’s because most HR executives don’t hear what we have to say, as we are blocked from most linked-in groups run by members of the wellness ignorati.
We are actually quite proud of the enemies we’ve made…but even so would appreciate if you could re-post this.
Update: it is also possible that Wellsteps didn’t get their act together in time to apply for this award–applications were due in May and their White Paper just came out last month. In that case, we’ll look forward to revisiting this post next year.
A company wanting to replace the advice given on health risk assessments with actual good advice need look no further than An Illustrated Guide to Personal Health, by Tom Emerick and Robert Woods.
It’s very entertaining, laced with clever illustrations and apropos quotes, but most importantly contains some of the best common-sense health advice you’ll ever read. Not coincidentally, virtually none of this advice shows up in wellness programs. The true determinants of health aren’t how much broccoli you consume or those other tired cliches spouted by wellness vendors, but rather things like your social network, your ability to avoid medical care except when needed, whether you like your job, enjoy your hobbies etc. Forced wellness programs, designed to make employees happy whether they like it or not, just get in the way of true well-being.
In addition to reinforcing good common sense, the book provides a few good tidbits that I myself didn’t know…and that are immediately going into the Quizzify quiz database. Like not using antibacterial soaps. (Who knew? I mean, I don’t use them, but I had no idea of the hazards of those antibacterial chemicals.) Indeed, one of the messages of the Illustrated Guide is that most bacteria are our friends. Or, as our parents used to say, they are much more scared of us than we are of them. One chapter is called: “Let Kids Play in the Dirt.” Really, if dirt were bad for kids none of them would reach adulthood. Common sense, and yet we all know of kids with all sorts of allergies, many of whom were raised almost aseptically.
A great deal of the advice mirrors that of Quizzify closely enough that one idea for a wellness program would be to let employees take the quiz (giving them $1 for every correct answer) after they read the book. Example of the separated-at-birth advice common to both: regardless of what Keas says, don’t routinely swallow multivitamins or vitamin pills of any type. With the possible exception in certain circumstances of Vitamin D and Niacin (and folic acid for pregnant women), they are more likely to harm you than benefit you. And do you even know anyone who has a vitamin deficiency?
Most importantly, An Illustrated Guide is easily digestible, fun to read and in terms of health, the perfect antidote for the stress caused by pry-poke-and-prod wellness programs.