Usually when I post an “apology” it is phony, like: “I apologize for calling Wellsteps’ arithmetic fabricated. I should have called Wellsteps’ arithmetic completely fabricated.”
Here’s a similar apology, for Professor Baicker’s infamous “Workplace Wellness Can Generate Savings” meta-analysis claiming the 3.27-to-1 ROI from wellness that RAND also eviscerated:
I had been quite adamant in the previous post that this meta-analysis was likely just a gold-plated package of garbage case studies. I compared it to packaging subprime home loans into AAA-rated collateralized mortgage obligations (CMO).
That was before I looked at the individual studies comprising this meta-analysis. I realize now that comparing the Harvard Study to the CMO scam was unfair. So I owe an apology to Bear Stearns, Lehman Brothers, and Countrywide.
Next, I apologize for pointing out that Ron Goetzel, as recently as last week, is still quoting this very same thoroughly discredited 7-year-old study, as well as many other outdated analyses. For example, he insists on continuing to quote the New York Times economists’ September 2014 analysis that wellness programs “generally” don’t work, even though they subsequently made their conclusion much clearer: “We’ve said it before, many times and in many ways: workplace wellness programs don’t save money.” They then specifically criticized Mr. Goetzel’s own methodology (“industry studies based on study designs that cannot produce valid causal estimates”).
I apologize for thinking that this deliberately selective misinterpretation of these economists’ previous conclusions makes him sound deceitful. And I apologize for being sure that the people who forwarded me this slide would agree with that assessment. And I apologize for once again making phony apologies.
The real apology
Now that I’ve checked off the usual Wellsteps-and-Goetzel-integrity boxes, it’s time to step out of character and seriously apologize. Here’s what I did that I really do need to apologize for: not cutting wellness professionals enough slack on giving them enough time to learn what took me several years to learn about wellness losing money.
I was once guilty myself of believing this 3-to-1 ROI nonsense, specifically about disease management (DM). Why DM in particular? I had some ego wrapped up in it because I am actually credited with inventing DM. Really. Just google on “invented disease management.” Whether or not I did (and plenty of others could share the credit), I was not just drinking the DM Kool-Aid. I was mixing it up and selling it to others.
Then, 10-12 years ago, a few people told me none of the DM savings numbers added up. I didn’t believe them. I thought it was sour grapes because they missed the boat.
True, I had enrolled a few of my own extended family members and friends into DM programs. Vendors were more than happy to offer me their best nurses, VIP treatment, you name it. Yet no one I referred thought these free programs were even worth a second free phone call.
Nonetheless, I was sure that somewhere there existed a whole lot of employees who did benefit from DM. Yes, in my fantasy world tons of people really appreciated these unsolicited calls from their health plan offering to help. After all, who among us doesn’t trust an unsolicited caller from their health plan offering to help?
In my worldview, the lucky recipients of these calls would respond: “You’re right. I should be taking my pills. Hey, thanks. I never would have thought of that on my own. And I was just about to have a heart attack, so you saved a ton of money.”
Yes, I realize this made no sense. Yet I never questioned my own findings. Basically, I ignored the warning signs about DM’s sketchy economics for years. When I finally had the epiphany, it got quite the headline:
A Founding Father of Disease Management Astonishingly Declares: “My Kid Is Ugly.”
Once I questioned my own figures, the rest because immediately obvious to me — one after another after another, sets of numbers in this field simply did not add up. Wellness was a far worse offender than DM, which does appear to roughly break even or better. No surprise about wellness. Screening costs about 10 times as much as DM and whereas people who qualify for DM are already well down the slope to infirmity, screens are performed mostly on healthy employees, who can’t generate any savings. (We of course support screenings according to guidelines, for the health of employees rather than an ROI. But most vendors ignore guidelines and screen the stuffing out of employees.)
Still, it had taken me years to have the initial epiphany…and yet now I was quite curt and dismissive with other people who didn’t immediately get it, and were defensive in support of their lifelong assumption. I was basically saying to others in the field: “You know all those savings claims? Total malarkey. Prying, poking and prodding doesn’t save any money.” I’d expect everyone else to get this right away. When they didn’t, I was not gracious with them in many cases.
Over time, a large number of folks have come around. They did it at their own speed, same as I did. Take WELCOA, for example. They were among the worst (and God bless ’em, funniest) offenders…and yet now you won’t find an organization more committed to getting wellness right, helping employees, and being honest than WELCOA. (In their case, a night-and-day change of leadership helped.) I’m not just saying this–I’m walking the walk. Quizzify is joining WELCOA’s Premier Provider Network for 2017, joining vendors I have a lot of respect for, like It Starts with Me, Populytics, and SelfHelpWorks. The first two, also like Quizzify, are validated by the Validation Institute.
Making good on the apology
A good apology comes with an offer to make it up. So if you feel like I dissed you prematurely, while you were learning wellness economics on your own, you can have one of:
- a free pdf of any of my books — Surviving Workplace Wellness, Cracking Health Costs, or Why Nobody Believes the Numbers
- half-price on a hardcopy of those books (order direct, not through Amazon, of course)
- a free analysis of any outcomes report
- a free month of Quizzify with no commitment (there is a minor asterisk on this one, please inquire)
Thanks Al! – As someone who has been critiquing these things for more than 2 decades and been repeatedly bullied by the establishment, I accept your gracious apology and await similar ones from the folks you mention who are still struggling with these realities! – Dr. Jon
Nothing would make me happier (well, nothing that I can put in a family publication like They Said What) than to apologize to certain other people, once they accept reality. Alternatively, I would be very happy to apologize for any mistakes, in the 450,000 words I’ve written, that they point out, and fix them.
Thanks Al. We’ve all probably been guilt of goetzeling data at one time or another. I goetzeled data once on savings from high deductibles. When I was shown the error by a talented Milliman actuary, I recanted.
And I look forward to doing the same thing if anyone says I am guilty of the same errors that I identify by others.
Good stuff Al and if I was going to read any of those three books; which one would you start with.
Well, the biggest belly laughs are from Surviving Workplace Wellness. Just look at the cover art. Why Nobody Believes the Numbers is specifically about outcomes measurement, and is used as a textbook in several public health programs. (It’s not really a textbook — Apparently some professors have a sense of humor.) Cracking Health Costs covers more of the gamut of health care — PBMs, medical tourism etc.
Why Nobody Believes and CHC don’t name names. (I figured if I didn’t name names I wouldn’t be blacklisted. Silly me.) SWW does. That’s part of the fun.
Since I work for a PE company that was going to bid on one of these outfits, I know math and “got it” right away as soon as someone turned me on to this site. We long since passed on the purchase (thank you for that!), but I stayed with the site for its entertainment value. So it’s thank you time from me, not apology time from you.
At this point, a PE (private equity) company that bought one of the companies “profiled” on this site could easily be sued by its limiteds, since buying one of them would be a total failure of due diligence.