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Wellsteps Apologizes, Returns Koop Award, and Endorses Code of Conduct

Wellsteps has profusely apologized for harming Boise’s employees, according to objective and subjective health indicators, for overscreening the employees, for demonizing even the slightest consumption of alcohol, for suppressing their earlier acknowledgement that costs increased, and for mis-attributing the allegedly massive savings figures.

Not!

They’ve recognized that these smoking guns exist, of course — that much we’ve learned from other sources.  But obviously they haven’t apologized.  In case you haven’t noticed, these days refusing to apologizing is a thing. Indeed it’s more than a thing. It’s a Major Lifestyle Trend, potentially even bigger than quinoa, bidet toilets, and the Kardashians combined.

They (Wellsteps, not the Kardashians) aren’t going to give up their Koop Award voluntarily.  To paraphrase the immortal words of the great philosopher S.I. Hayakawa, they stole it fair and square. (Helps that Wellsteps’ CEO is on the award committee, of course, though you wouldn’t guess it from their announcement.)

And they (Wellsteps again, but probably also the Kardashians) certainly aren’t going to endorse the Code of Conduct.  They can’t, because they and their whole Koop Award cabal would be in immediate violation of its call for no harms to employees and no lying about outcomes.


However, the Code of Conduct is getting great reviews everywhere else, which is actually what this column is all about.

First, honest, well-intentioned, and competent vendors, brokers and consultants — none of which are connected with the Koop Committee or the Health Enhancement Research Organization — have shown their support in large numbers. The Code has garnered tons of “likes” and very supportive comments.  If you see your consultant or vendor on this list of “likers” and commenters, give them the kudos they deserve. And add your own too.

Quizzify

Second, Quizzify on Friday became the first vendor to endorse the Code, and will be incorporating it in every contract going forward.  Read the Quizzify statement, and urge other vendors to follow suit. Embracing the code should be easy for others like it was for Quizzify. Any honest, competent vendor should find the principles self-evident.

ConscienHealth

Third is a pleasant surprise twist, the one referred to in the Linkedin “tease” for this column.  On Sunday, I was delighted to see http://www.ConscienHealth.org pick it up.  By way of background, ConscienHealth is an advocacy group for the evidence-based treatment and prevention of obesity. In their own words:

We develop strategies that are based on sound science [and] public policy, and a deep understanding of consumer needs.”

Here is a summary of what they said, but we’d urge you to read the whole shebang, because they stated it better than we did. Alone among websites with an interest in wellness, ConscienHealth speaks specifically for the overweight employees who are victimized by crash-dieting schemes and other corporate fat-shaming activities:

We now have enough regulations on the subject of employer wellness programs to make your head spin…but the most encouraging development is a code of conduct based on a simple premise: act purely to improve health and do no harm.

The folks who developed this code – Ryan Picarella, Al Lewis, Rosie Ward, and Jon Robison – applied deep knowledge of the good and the harm that employer wellness programs can do. While others fight over the fine points, this code brings us back to the big picture with a few key principles:

  1. Wellness programs should work for the benefit of employees.
  2. Programs should not single out, fine, or embarrass employees for their health status.
  3. Employers should respect and protect employee privacy.
  4. Employers should measure and report program outcomes honestly.

If those considerations seem obvious, it’s because they are. And yet we have examples of “wellness” that have disrespected, humiliated, and financially exploited employees. Sometimes it’s been done out of ignorance. Sometimes it’s a subterfuge for cost shifting to people with chronic diseases – health problems that nobody wants to have.

We here at They Said What would urge Wellsteps and other “pry, poke and prod” vendors to develop programs that satisfy those same four criteria. Unfortunately, they aren’t quite there yet. Indeed a beam of light leaving criteria #1, and #4 wouldn’t reach them for several seconds.


Disclosure: Al Lewis, who co-maintains this site, is also a principal in Quizzify, which endorsed the Code.  Attention to Wellsteps: See how conflict-of-interest disclosures work?  It’s not that hard. Next time you win a Koop Award — and based on the number of consultants and vendors on the award committee (plus sponsors) who need to be win one too, it should be your turn again in about 6 years — try disclosing your presence on the award committee in your breathless announcement of how brilliant you are.

Or, as Mark Twain said: “Always tell the truth. This will delight some people and astonish others.” We will be both, if it ever happens.

The Employee Health Program Code of Conduct: A Game-Changer for Wellness

Even war has a code of conduct.  Why shouldn’t wellness?

Why should vendors like Wellsteps be allowed to harm employees…and win awards for it?  The answer, of course, is that they shouldn’t.  Conversely, vendors that benefit employees, respect their dignity, and measure outcomes validly should be recognized and applauded.

We invite everyone to read the Employee Health Program Code of Conduct, just posted by Rosie Ward, and a joint offering of WELCOA, They Said What, and Salveo Partners.   This is Version 1.0, of the “First, do no harm” variety.

While They Said What and Quizzify are separate entities and normally this blog doesn’t speak for Quizzify, I can assure everyone that Quizzify will be incorporating the Code of Conduct directly into our contracts, as a key contractual term, meaning that if we don’t adhere to it, we are in breach.  We urge other vendors to follow suit, and purchasers to insist on its inclusion in contracts.

While everyone should read Rosie’s full posting for the “back story,” the actual verbiage is as follows:

The Employee Health Program Code of Conduct:  Programs Should Do No Harm

Our organization resolves that its program should do no harm to employee health, corporate integrity or employee/employer finances. Instead we will endeavor to support employee well-being for our customers, their employees and all program constituents.

Employee Benefits and Harm Avoidance

Our organization will recommend doing programs with/for employees rather than to them, and will focus on promoting well-being and avoiding bad health outcomes. Our choices and frequencies of screenings are consistent with United States Preventive Services Task Force (USPSTF), CDC guidelines, and Choosing Wisely.

Our relevant staff will understand USPSTF guidelines, employee harm avoidance, wellness-sensitive medical event measurement, and outcomes analysis.

Employees will not be singled out, fined, or embarrassed for their health status.

Respect for Corporate Integrity and Employee Privacy

We will not share employee-identifiable data with employers and will ensure that all protected health information (PHI) adheres to HIPPA regulations and any other applicable laws.

Commitment to Valid Outcomes Measurement

Our contractual language and outcomes reporting will be transparent and plausible. All research limitations (e.g., “participants vs. non-participants” or the “natural flow of risk” or ignoring dropouts) and methodology will be fully disclosed, sourced, and readily available.

How to read an outcomes report: the Wellsteps example

We’ve summarized the four analyses of Wellsteps’ Koop Award-winning program for the Boise School District, and put it all in one Linkedin Pulse.  The bad news is that they harmed employees, fabricated savings figures, and apparently snookered the Koop Award Committee.

However, there is offsetting good news.  Reading this Pulse — and comparing it to the original Wellsteps submission — should help you become a more discerning reader of outcomes reports generally.  That’s the good news for you. (The good news for me is that, after reading this, members of the Koop Award committee might finally buy Why Nobody Believes the Numbers.)

The other good news for all of us is that this should be a wake-up call for the industry that a code of ethics is needed.  To put it mildly, harming employees and falsifying outcomes should not be allowed, and should certainly not win awards. Yes, I realize that is an understatement, like when Lyndon Johnson said: “Killing, rioting and looking are contrary to the best traditions of this country.”

Still, we have to start somewhere, and a good place to start would be: “First, do no harm.”

A brief intermission from the ongoing Wellsteps-Koop Award debacle

Here are a few items that might be of interest, while I give people a chance to digest last week’s three Wellsteps smackdowns.  And it’s even worse than I thought. In the immortal words of the great philosophers Bachmann Turner Overdrive, you ain’t seen nothing yet.

If you are just tuning in now, here are the links:


At this point, you may be wondering: “Hey, is there any way to get actual helpful information on wellness, since I’m obviously not going to get it from Wellsteps?”   As luck would have it, there are several. First, Jon Robison and Rosie Ward run a CEU-creditable program leading to the Thriving Workplace Culture certificate.  Culture-of-wellness is gradually replacing “pry, poke and prod” as the preferred way to “do wellness.”  I’ve done a guest-lecture to the community of folks that Jon and Rosie have assembled and can tell you this: we are not alone in the universe. If you are reading this blog and feeling deluged by pry-poke-and-prod vendors, you will feel right at home here…and you’ll learn a lot too.

Oh, yes, and claim your Friend-of-Al discount of $100 for the course. Enter FALL16FRIEND in the promo code line.


If that is not within your price range even with the discount, there is a webinar on incentives this Thursday, in which I’m participating along with a few colleagues. It’s a production of Sarah Hunt of the Corporate Health and Wellness Association, and James Kelley, so you know it will be good.


And if you would to save wear-and-tear on your eyeballs, you can listen to a recent podcast I did on wellness. It can be found three different ways:

The website: http://bit.ly/Al_Lewis

iTunes link: http://bit.ly/iTunesRWpodcast

Stitcher link: http://bit.ly/StitcherRWpodcast

Wellsteps Raises the Koop Award Standard for Outcomes Invalidity to a New Low

Wellsteps claims to have dramatically reduced the total cost of the Boise School District’s health spending. Their Koop Committee colleagues gave them an award for it, as they typically do for their fellow board members and sponsors.  (Yes, Wellsteps’ CEO, Steve Aldana is on the committee that grants the award, but, in accordance with Koop Committee tradition and Wellsteps ethical standards, there is no mention of this possible conflict of interest in the announcement from Wellsteps. This is not a violation of the Wellness Industry Code of Ethics, because there is none.)

Unfortunately for Wellsteps, three completely distinct observations from Wellsteps’ own data invalidate their analysis separately. In combination, these observations create a level of impossibility demonstrating that whoever invented the English language was unfamiliar with the wellness industry, or they would have come up with a word meaning: “Impossible doesn’t begin to describe it.”


First, as we saw in the last posting, employee health deteriorated over the course of the program, measured both subjectively and objectively.

There is a concept, covered in Health Services Research 101, called “causation.” Wellness vendors love taking credit for everything that happens during their program. Hence we can conclude that Wellsteps’ program caused employee health to decline.

Therefore, no reduction in costs due to a healthier employee population can be attributed to Wellsteps’ program.


Second, also covered in Health Services Research 101, is the concept of “fifth-grade arithmetic.” Potentially Preventable Hospitalizations (PPH), as described in the official Health Enhancement Research Organization (HERO) outcomes measurement guidelines (a report on which Wellsteps’ CEO claims to have collaborated), account for a very small percentage of all spending. Specifically, as described in the HERO report  and reproduced below, these events account for 2.62 hospitalizations per 1000.  Boise’s 3284 employees would therefore suffer about 9 PPH’s. If each PPH cost Boise the HERO-assumed cost/admission of $22,500, that’s about $202,000. Not enough to cover even the out-of-pocket fees for the Wellsteps program, assuming the Wellsteps did a perfect job. And as we’ve learned in the past, a beam of light leaving “perfect” wouldn’t reach Wellsteps for several seconds.

Still, we’ll never know because despite their endorsement of the HERO report, Wellsteps decided not to disclose the rates of Boise’s PPH’s, likely to obscure the fact that they didn’t reduce it.

hero total page 23 with red bar

And as the HERO guidebook says, any reduction in PPH’s is offset by more spending elsewhere. In Wellsteps’ case, “more spending elsewhere” is annual biometric screenings.  Curiously, Wellsteps admitted annual screenings are a stupid idea four whole days before they announced their Koop Award for doing exactly the opposite.

July 11 blog

wellsteps july 11 blog

July 15 announcement:

wellsteps july 20 blog biometrics

Yet Wellsteps reported annual savings ultimately exceeding $5-million, or about a third of Boise’s total spending.  This would be equivalent to wiping out every hospitalization unconnected with childbirth plus every ER visit.  Adding yet another layer of impossibility to this narrative, at the end of this, we show the rank order of the top 25 reasons people visited the ER or went to the hospital, which basically have nothing to do with corporate wellness programs. Hence the cost of these visits and admissions couldn’t be dented, let along wiped out, by massive overscreening or even by appropriate screening.

Compounding this impossible outcome (and wellness is one of the few industries in which there are degrees of impossibility, since a typical wellness vendor makes at least a dozen impossible claims before breakfast) is the surprising health of the Boise population to begin with. People rated their health as 7.98 out of 10, and only 2.5% reporting smoking (vs. 20% for Idaho as a whole) and only 20% reported drinking (vs. 70% for the US as a whole). These ridiculously low levels did not strike Wellsteps as suspicious, so we will assume they are accurate.

Further, most Boise employees had fairly normal blood pressure, glucose and cholesterol — at least before they got sucked into the program.

So, with impossibly smoking and drinking, excellent reported health status, and largely normal biometrics, how is there room to improve health enough to save money, especially when health status is declining and the population is being overdiagnosed?


Speaking of misunderstanding the concept of arithmetic, third and most important is the data Wellsteps suppressed between their initial report and their Koop Award application. Normally Koop Award Committee Chairman Ron Goetzel suppresses the invalidating data after the award is announced, as with Health Fitness Corp/Eastman Chemical, and then the state of Nebraska (technically actually incriminating, not just invalidating). That’s because in the past I haven’t predicted who would win the award. Rather I just pointed out all the obviously incorrect data after the fact. By predicting Wellsteps would win a Koop Award and pointing out exactly why their data was sufficiently fictitious to merit it, I gave Wellsteps itself the opportunity to suppress their own data, so Ron wouldn’t have to do it for them.

Contrast below the trend they reported for total spending for Boise against the claims cost per person for Boise. The former goes up. The latter goes down even though the number of employees stays the same.  Obviously, this is an impossible coexistence, as mentioned both in the first installment of this series and in every elementary school in the world. This time, we are going to transpose the bar graph, which separated participants from non-participants, onto the line graph, which included both cohorts, for the baseline and the first two years of the program. The assumption, as Wellsteps states, is that their participation rate is 80%, largely because of the massive $870/year incentive, which in classic wellness fashion is not included in the savings calculation. The number of employees seems to bounce around a bit between reports, but we’ll go with 3284 for this valuation.

By way of review from the first installment, here is total spending:

wellsteps overall trend

Also by way of review, here it total spending, participants vs. non-participants, going exactly the other way:

wellsteps cost per person

Now let’s overlay the second set of figures onto the first. In addition to trending in opposite directions during the wellness program years, the total spending on these dueling slides doesn’t even coincide in the baseline year.  Since the whole point of the exercise is to look at the trend subsequent to the baseline, we will add about $3-million to each year for the bar graph figures, so that the 2011 starting points coincide. That let’s us focus on the difference-of-differences in the program years. Starting at the baseline, costs increased about $1.7-million by 2013, putting the 2013 red endpoint almost exactly in line with their prediction.

wellsteps overlaid slides

In all fairness, let’s continue the analysis, by looking at the Wellsteps performance in 2014:

wellsteps overlaid through 2014

As you can see, costs did fall below the “prediction” in 2014, though still way above “Wellsteps Begins” and “Actual.”  The only problem?  More than 100% of the entire decline from the previous year was due to non-participants’ costs plummeting, while participant costs increased.

wellsteps 4 year view

So where do we stand? Wellsteps, by their own admission, overscreened and overdiagnosed this population. And their own admission, the population was quite healthy to begin with. By their own admission, the health of the Boise employees deteriorated. And, by their own admission, the only successful annual performance is attributable to a large improvement in non-participants.

To paraphrase the immortal words of the great philosopher Samuel Goldwyn, the title of this post, Wellsteps has raised the Koop Award standard for outcomes invalidity to a new low.



Top hospital discharge codes:

 

hcup rank order top 25 costs

Top ER visit codes:

er visits using ccs

 

 

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