They Said What?

Home » 2016 » November

Monthly Archives: November 2016

Wellsteps: We don’t need your stinkin’ Code of Conduct.

Wellsteps has joined Michael O’Donnell, HERO and Optum in attempting to stonewall the Employee Health Code of Conduct, which started as a joint project among WELCOA, myself, and Salveo Partners and has attracted many hundreds of favorable responses.  Quizzify and It Starts with Me have both received validation from the Validation Institute for (among other things) our embrace of this simple minimum standard. In both cases, we think the bar should be set much higher, but apparently “do no harm” is already too high a hurdle for HERO, Wellsteps and Optum.  Hence their opposition.  And Kudos to WELCOA, a very fine organization that Quizzify intends to support for 2017, for standing up to Mr. Aldana’s bullying.

There is some irony in that it was Wellsteps’ harms to Boise employees that inspired my participation in the code-writing. Vendors should not be given awards for harming employees. That doesn’t seem like too much to ask.


Here is the Code, in its entirety.

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 HIPAA 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.


What’s there not to like?  Plenty, if you negatively impact employee health, as Wellsteps does, according to STATNews. Here is Wellsteps’ response to the code, complete with their signature name-calling.

The Wellness Bully Code of Conduct

Even though the wellness bullies claim that the wellness industry is a sham, they have announced a new code of wellness conduct.  I’m very interested in improving the quality and effectiveness of wellness programs. I don’t know any wellness professional who would say otherwise. But I think I speak for all of us when I say that I have no interest in a code of conduct written by a gang of bullies. The wellness industry does not need a code of conduct, we have HIPAA and other laws to do that. 

Wellsteps’ Steve Aldana gives bullies a good name

There he goes again.

By way of background, Wellsteps was caught harming Boise’s employees and lying about outcomes. His Boise School District friends no longer talk to the media now that they realize they got snookered — and after he blamed them for the failure of the program.  Wellsteps got some major unfavorable press in STATNews, in which Steve Aldana admitted that his program wasn’t responsible for seeming improvements in the “worst health behaviors.” Rather it was the regression to the mean.

For a full write-up, see “Protecting Employees from Harmful Vendored Wellness Programs,” American Journal of Managed Care, October 10, 2016.

Yes, Wellsteps’ Steve Aldana is acting out.  He is frustrated because we find such a ridiculous number of “mistakes” (actually lies, since mistakes get corrected when they are pointed out) in his work.  Since all our findings are correct, there’s nothing he can do except whine.

He is even attacking us — WELCOA, Salveo Partners, myself and hundreds of others — for supporting the Employee Health Program Code of Conduct.  (For the uninitiated, the Code is designed to prevent wellness vendors like Wellsteps from harming employees, which I guess is why they are attacking it.)

And so, he calls me a bully. He also calls esteemed health/science reporter Sharon Begley a “lier,” so I am in great company, sort of like being on Nixon’s enemies list.

I’m not going to go line by line through his posting (which I can’t see anyway, because he knows better than to get into a public debate, so he blocks me from seeing it — I am finding out second-hand), except to ask a couple of questions.  If I am a bully:

He could get rich off my bullying, and make a sizable charitable donation. If what I do fits his definition of bullying, then, Mr. Aldana, please bully me. Offer to send me money and give me rewards for finding mistakes in your work.  Don’t make me beg!

How to cheat in a corporate weight loss contest (SPOILER ALERT: This gets gross)

If we were real journalists here, we’d have killed a lot of trees in the cause of exposing the massive amount of lying and cheating by wellness vendors.  However, as mere bloggers, all we do is kill millions of defenseless atoms.*

And yet we’ve sacrificed nary a single electron to the cause of exposing the massive amount of lying and cheating by the employees themselves.  And massive it is. My very own extended family members are swapping fitbits around to increase their steps.  Less for the money than for bragging rights about who can game the contest the best.

Indeed, these corporate “challenges” are really mental challenges, not physical ones, to see who can do the best job outsmarting the wellness vendor.  Outsmarting wellness vendors, as past columns have shown, isn’t exactly a heavy lift: we have often observed that the good news about wellness is that NASA employees don’t have to worry about their job security because wellness vendors aren’t exactly rocket scientists.

To that end, the Wall Street Journal wrote an entire article about employees cheating in wellness programs. Apparently, employees are enlisting puppies, hamsters, even power tools and a ceiling fan in their quest to undermine their company’s wellness program. One enterprising employee posted a youtube showing how to cheat on these programs.  A Midwestern cadre of truly dedicated employees took cheating a bit farther than most, and got themselves indicted for defrauding Kansas City out of $300,000 by lying on wellness programs.


30-second shameless plug time

Of course, there is one surefire way to avoid the downside of cheating: design cheating into the program. And that’s exactly what Quizzify does.  The way to cheat on Quizzify is to look up the answers and learn about health literacy — which is exactly what we want employees to do!


How to cheat in a crash-dieting contest

Employees especially like to cheat in crash-dieting contests, enough so that countermeasures are needed. For instance, a vendor named Healthywages is bragging about how it ferrets out “fraudulent participants.”  I figured I’d see what the internet has to offer on corporate biggest loser program cheating, because, after all, these days almost every search generates tons of hits.  I say “almost” because if you search on “honest wellness vendors” and “Wellsteps,” there is only one hit: my observation that the latter could never be confused with the former.

In particular, the search found a group called www.healthstatus.com, which has given this topic altogether too much thought, thankfully. In all fairness to the HealthStatus folks (who do seem very well-intentioned and on the level), before they list their recommendations, they provide a cigarette-type warning label, as these programs richly deserve:

It’s getting to be New Year’s resolution time and many companies will try and “encourage” weight loss with a “Biggest Loser” type contest.  Frankly, this is really a bad idea, as it can create all kinds of bad habits and damaging activities by the participants, as they starve, dehydrate and supplement themselves in an effort to win.

Having gotten the grownup stuff out of the way, here are their “recommendations” for employees whose employers, like Schlumberger, somehow got the impression these contests are a good idea, perhaps because their mothers didn’t listen to enough Mozart when they were in the womb. A few recommendations are fairly harmless, like drink a lot of water starting 3 days early and don’t pee (or do number twosies) before your weigh-in. And, of course, wear heavy clothes, carry lots of change in your pockets etc.  You know, your typical garden-variety dishonesty that is probably woven into the culture of any employer that sponsors these contests.  (These employers think they are “creating a culture of wellness” when in reality they are creating a culture of deceit.)

By contrast, some of these other recommendations boggle our minds, and, having written exposes on the wellness industry for two years now, our minds are not easily boggled:

The day before the weigh-in, ideally about 17 hours or less before your weigh-in time, you want to get yourself a good salty snack.  A bag of chips, you know the ones that if you eat too many your lips hurt from all the salt and a nice tray of cheese and crackers.

For your dinner meal you want to load up on the  proteins and a big glass of whole milk, also, this is a day you want to skip the fiber.  This is one day of eating like this, we don’t encourage it, but a binge day also sets up your metabolism to know that is not starving, and can help in when we start burning fat after the weigh-in.

The day of the weigh-in, minimize your activity, another big glass of  whole milk with your breakfast that contains some salty options will help you retain more water.

“At this point,” they observe, “you should be a big bloated sloshing mess that needs to go to the bathroom really bad. This is the perfect time to get weighed and measured.” They also remind you to accentuate poor posture, since the long-since discredited Body Mass Index measure still preferred by most of these vendors is a height/weight ratio. (HealthStatus also offers hints for contests that use waist circumference.)

In other words, do all the wrong things — eat badly, slouch, and don’t exercise.  Be as unhealthy as possible.  So you’re already obsessing with your weight and abusing your body horrendously in the name of wellness…and the contest hasn’t even started yet!

I hate to leave everyone hanging but HealthStatus hasn’t published the rest of its recommendations yet, meaning advice on how to cheat during the contests themselves.

And a good thing because I don’t know how much more wellness a fellow can take.


Since self-abuse is actually a very serious topic, I would like to step out of character here and offer a few serious notes.  First, no wonder Optum and HERO and other Wellness Ignorati are stonewalling the Employee Health Program Code of Conduct. Nothing violates it more than their cherished corporate crash-dieting contests.  And a particular call-out of the biggest-loser worst offenders: Virgin Pulse (nee ShapeUp), Wellness Corporate Solutions and HealthyWages.  You ought to be ashamed of yourselves, even relative to other wellness vendors like Wellsteps, which had just recently established a new plateau for harming employees, that you people are blasting right through.



*Just for the record, we know that writing blogs does not kill or even injure atoms. And while Keas might find that being used in blog posts stresses them out, we would disagree.  Quite the opposite: if they enroll in wellness programs, they can live to be 100.

Quizzify, The Employee Health Code of Conduct, and Fabricated Savings

The three hottest topics in all of wellness. Or if not, they should be.

And they are all covered in Dr. James Kelley’s new podcast.  You’ll have to download the iTunes app to hear it, but if I can do it, how hard can it be?

 

The Great Debate, Part 8: Optum’s Seth Serxner Jumps In, Throws Himself under the Bus

This is the eighth and final installment of the November 2015 “Great Debate” between Ron Goetzel and myself, at the Population Health Alliance Annual Leadership Forum. If you’d like to follow the entire thread, here is Part 1.

If you want to download the audio, be my guest.  For some reason the progress bar on the audio doesn’t sync with the end of the debate, so if you want to jump to this section, drag the progress indicator to the far end of the bar, like this:

debate-progress-bar

Hence unlike the previous sections, there are no timestamps on these liner notes.  Still, it is the most dramatic part, as Optum’s Seth Serxner does that thing which gets wellness promoters in the most trouble (open their mouths) and Ron Goetzel tries to explain why, when wellness promoters accidentally tell the truth, they don’t really mean it.


Optum’s Seth Serxner, a wellness promoter who sits on the Koop award committee, stands up and makes a couple of comments defending wellness that advance my case more than any of the previous questions attacking wellness.

His first comment — that wellness-sensitive medical events (WSMEs) for employers would have gone way up without wellness — was one that I had hoped Ron would make, but Ron wasn’t stupid enough to take the bait.  Ron knew full well that his company’s database showed exactly the same trend in WSME for the non-employed population (Medicare, Medicaid) as for the employed population, as the graph below indicates. This means, of course, that wellness is worthless. Here is a graphic representation of what I originally said–that wellness had not reduced WSMEs, according to the data produced for the government by Ron’s own company:

WSMEs

I of course pointed out that the data said exactly the opposite of Mr. Serxner’s fantasy, as shown below. I noted: “We didn’t post this data until this morning on the hopes that someone from the wellness industry would ask us that question so we could give that response.”

Here is the revised graph, proving definitively the worthless of “pry, poke and prod,” and making my $1-million reward (now $2-million) for showing wellness works a safe bet on my end.

wsmecombined

Mr. Serxner, despite claiming to be an expert in wellness, apparently didn’t know this. Here is a guy who goes around telling clients that maybe their costs went up, but they would have gone up faster if Optum hadn’t saved the day with wellness.  Of course, now that Mr. Serxner knows that he’s been dead wrong lo these many years, I’m sure he will go back to his clients and tell them he just learned that Optum never saved them anything. Not.

He figured out years ago that some human resources directors will actually fall for this sleight-of-hand. His specific mantra:  “We can conclude that choice [emphasis TSW’s] of trend has a large impact on estimates of financial savings.” (Abstract is here. You’ll have to pay for the article to read his exact quote.)

In other words, in wellness you can make up savings by choosing a higher trendline for the comparison of actual costs.  Is this a great industry or what?


In his second comment, Seth blames the victim. “Our clients won’t let us [screen]” appropriately.  He says that many clients ignore guidelines deliberately. That would lead to the conclusion that clients want to spend more money on Optum’s services in order to screen inappropriately, but that Optum’s salespeople push back, insisting that they should send Optum less money…and the clients refuse.

In followup conversations with Optum, they were unable to name a single program in which Optum tried to insist on infrequent, clinically appropriate, inexpensive screening schedule, but where the account itself demanded the opposite. I can send the email thread to anyone who wants it.  (The back story is that Optum’s mouthpiece contacted me to ask if I would stop embarrassing them by referencing Mr. Serxner’s comments.  I said: “Sure, if you can name one account where Optum pushed back against the customer demanding higher-priced, inappropriate screening programs.” Never heard from them again.)


Another questioner points out that doing wellness for employees — serving carrots instead of donuts — hasn’t reduced costs. Ron says she’s reading the literature wrong. “A lot of programs reduce the rate of increase in costs, and that’s how savings are determined.”  Um, Ron, were you listening a minute ago?

For someone who has proclaimed himself a “scientist” at multiple points, there is some irony (there’s that word again — being oblivious to irony is a prerequisite for being in the wellness industry) in not understanding how science works.  An intervention is targeted at specific variables. Pain medications target pain, chemotherapy targets cancer, heartburn medications target stomach acid etc.  Wellness targets WSMEs.  So if WSMEs decline, that’s called a success. If, however, trauma or c-sections or joint replacements happen to decline while you’re running a wellness program, that’s called a coincidence. Those results are not at all attributable to a wellness vendor browbeating employees into eating more broccoli.


In response to a question, I say that as a former NASDAQ company CEO (and current Quizzify CEO) the greatest advantage I see in wellness is to convince my competitors to do as much of it as possible, so that they waste their time, lose their best people and increase their healthcare costs.


Ron says it’s silly to obsess with spending $100 or $200 on wellness when companies are spending $10,000/employee on “cancer, diabetes, heart disease and hypertension.”

This is nonsense. I’d invite Ron — remember, he says he’s a scientist, so he’s driven by data — to actually look at some data. Employers do not spend most of their money on preventable events in those categories.

Quite the contrary, birth events and musculoskeletal are their two biggest spending categories. Then there are some catastrophic events. The rest is comprised mainly of lots of drugs, tests, doctor visits etc. The actual preventable hospital events in the four categories Ron is referencing account for only a small percentage of all spending. (See the graphs above — about 6% of hospitalizations, meaning about 3% of all costs, or about $150 per covered person are preventable through wellness.)

Don’t take my word for that.  Here are the top ten DRGs for commercially insured populations, according to Ron’s own company, Truven:

hcup rank order us discharges by drg


It took an hour and a half but finally, the infamous Kate Baicker study comes up.  She’s walked it back multiple times, all in print, all cataloged here. But apparently neither she or David Cutler (her co-author) are giving up on it. Apparently there were a series of alleged private conversations I wasn’t privy to in which, notwithstanding their public comments, they are still not willing to retract it.  It doesn’t matter because, in addition to RAND’s smackdowns, I pointed out that the studies comprising her meta-analysis were laughable, including one claiming that wellness caused a reduction in cat-scratch fever.

ted-nugent


Add one more entry to the list of things Ron walking back:  his claim that wellness gets an “expected” 3-to-1 ROI.

goetzel claim of 3 to 1 ROI

He is now perfectly fine with a 1-to-1 ROI. Having just said that Kate Baicker is standing by her 3.27-to-1 ROI, he refers to claims of a 3-to-1 ROI as “ridiculous.”

Which is it, Ron? Is the Kate Baicker 3.27-to-1 ROI correct as you said 60 seconds ago, or is a 3-to-1 ROI “ridiculous,” as you said just now?


I bring up Michael O’Donnell’s infamous statement that “randomized control trials” in wellness “show a negative ROI.”  Yet another example of these wellness Einsteins accidentally admitting that wellness loses money and having to walk it back.  Ron gets a point for being totally prepared for this exchange. He explains that, of course, like everything else I point out where they accidentally tell the truth in print (like the HERO guide earlier in the debate), it doesn’t really mean what it says in print. It means something completely different.

Ron excels at twisting and turning statements into their opposites. We have so much respect for his ability to do this, we call him Goetzel the Pretzel.


Like Mr. Goetzel was prepared to pretzel this gaffe, I am also prepared for Mr. Goetzel’s pretzel.  This researcher, a graduate student at the University of Tasmania (that’s an island south of Australia), “averaged” low-quality studies showing positive ROIs with high-quality studies showing negative ROIs to find an overall slightly positive ROI.  My reply: “That’s like averaging Ptolemy and Copernicus to conclude that the earth revolves halfway around the sun.”

Ron had said no one would do RCTs, but Aetna just did one and found no impact.


Ron, who spent about half the debate talking about how great peer review is, now admits the process is broken.   Then he says “the peer review process works quite well.”

Which is it, Ron? Is peer review great or is it broken?

Then he says the editors of these journals are “not my friends” and then he says they are “close friends” of his.

Once again, which is it, Ron? Are they your close friends or not your friends?


The final question was emblematic of the entire debate, in which Ron makes statements that are obviously the opposite of the evidence.  He alleges that 2/3 of employees want more wellness programs.  I point out that if employees liked wellness you wouldn’t have to fine them to get them to participate. Indeed, they would pay for wellness, just like people are willing to pay for other things they like.

You only have to go to Slate or any other article to see that employees in this country don’t like wellness, any more than the employees in this audience do.



There you have it. Who won? You make the call. None of my work was challenged (except Quizzify –but with a 100% guarantee of savings that’s our problem if we’re wrong — and the reviews and case studies are very positive).  Ron conceded the following:

  • I am right a lot of the time (for anyone is keeping score at home, that would be 100%);
  • I am the best peer reviewer in the field;
  • most wellness programs don’t work;
  • he can’t win my million-dollar reward; and
  • he’s doctored a lot of material.  

Here is a list of what he has said and done, that he just ran away from: 

  • his HERO Report;
  • wellness industry “cheaters” like his colleague, Wellsteps’ Steve Aldana;
  • his Penn State program;
  • his 3-1 ROI claim.

The only program he defended was the indefensible Nebraska program.  


I on the other hand lost on no exchange, and conceded nothing except that maybe Johnson & Johnson saved money on their wellness program.  While blogging on this debate, I was finally moved to read the J&J outcomes report. Surprise! The whole thing is obviously fabricated and never should have passed peer review. I’ll blog on it another day. 

Ever wonder what it’s like to actually participate in a wellness program?

Do you know anyone who is actually in a “pry, poke and prod” wellness program run by one of the 50 vendors “profiled” on this site?  If so, try asking them what they think…and then compare those opinions to what the vendors want them to think. A few tidbits of the latter are listed below:

But none of these vendors ever ask the flesh-and-blood employees how they feel. Turns out there’s an excellent reason for that: employees hate “pry, poke and prod” programs. Here are four sets of vignettes to that effect.

  1. Last month, we collected some comments from an article in Slate about wellness. Just when we thought the news cycle on that article had run, more employees weighed in.  Still, those are just comments, not in-depth experiences.
  2. Getting into the belly of the beast, Vik Khanna posted a ten-part series on the Provant program he and his wife were forced to submit to subject to a major forfeiture. This program sucked up 6 hours of his time and provided tidbits like “drink 8 glasses of water a day,” which of course is a total myth . This myth dates from a misinterpreted finding from 1945. It is now perpetuated only by some wellness vendors (not all of them — incredibly a few have now procured internet connections), as well as presumably Poland Spring, Aquafina, Dasani, Kohler and American Standard.  Obviously if the human race were that dehydrated we would have gone extinct long ago.   Provant water
  3. In addition to Vik’s regular journal entries, every now and then, someone writes in detailing their own experience in being forced to submit to one of these programs. Here is one of our favorites, someone complaining about Optum’s program. No wonder Optum is so opposed to the Employee Health Code of Conduct. I’d be opposed too, if I offered Optum’s program.
  4. Finally, here is the program du jour.  In their alleged attempts to create a culture of health, these vendors are creating cultures of resentment, distrust, and deceit.  We’re copying-and-pasting the opening paragraphs of this rant, but would encourage you to click through to the whole thing.

News Flash, The Dodo Bird is Still Alive

Well another year has rolled around and I was talking to the person who’s experience with their wellness program I had discussed below. Lo and behold, the problems I had originally documented continue unabated. This is a common example, and explains why so many wellness programs should be discontinued.

It was time for next years enrollment period for her insurance and she needed to get a number of points, schedule a coaching visit and get her biometrics and lab work completed to qualify for the premium differential.

The lab work requirement upset her as she had just gotten all the lab work done by her PCP the month earlier, but no, those lab results couldn’t be used. So the vendor repeated all the lab work her PCP had done and more, most of which were absolutely unnecessary based upon USPSTF guidelines. But hey let’s go ahead and waste some money and do a few unnecessary tests.  That’s become the norm for many a wellness program.

The story continues here.

$2-million reward to show wellness works

In 2015 I offered a million-dollar reward to show wellness works. Or, more accurately, to show that it isn’t a complete failure. I got no takers.  I guess when you snooker employers as successfully as they do, a million dollars is pocket change. Not worth their attention, like a penny on the sidewalk.

So now it’s a $2-million reward.  The rules are posted at Insurance Thought Leadership.  And, yes, the rules are legally binding. All you have to do is prove wellness isn’t an epic fail. Not Kate Baicker’s THC-infused 3.27-to-1 ROI.  Not even a standard 2-to-1 ROI. Just that it breaks even. How hard is that?  Name any other industry that doesn’t break even.  And that it doesn’t harm employees. How how is it to show that an industry devoted to employee health doesn’t harm them?

Oh, yeah, one rule is that you have to pass a lie detector test (as do I). This is a risk on my end: few people can lie well enough to beat a polygraph, but then again few people have as much lying experience as these self-anointed wellness industry leaders do.

When I was in high school a teacher had a vat of concentrated hydrochloric acid with a pH of 4, and a silver dollar. (Smaller coins were mostly copper, of course.) He asked if the acid would dissolve the silver dollar when he dropped it in, or if not, why not?  Other kids were peeling through their notes.

I raised my hand and said: “It won’t dissolve, because if it would, you wouldn’t drop it in,” which of course was the correct answer. (A pH of 4 is not much different from acid rain.)

So don’t expect to see me living under a bridge eating squirrel anytime soon. (They say it tastes like chicken.)

 

%d bloggers like this: