There is a saying: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.” Indeed, if there is one thing you can take to the bank in this field, it’s that articles intending to prove that wellness works inevitably prove the opposite. Another saying is that the biggest enemies of Ron Goetzel and his friends are facts, data, arithmetic, and their own words.
And Mr. Goetzel, writing in this month’s Health Affairs, [behind a paywall] is Exhibit A in support of the paragraph above. The “overscreening today, overscreening tomorrow, overscreening forever” gravy train of the wellness industry is officially dead. He killed it, not me. In one article he managed to do what I’ve been trying to do for five years. (It can now be replaced with a health literacy tool such as, to use one random example, Quizzify. No one will ever invalidate health literacy. And we still support screening according to US Preventive Services Task Force guidelines, even though it won’t save money.)
No, not because of his conclusion that companies with lower risk factors spend more than companies with higher risk factors. That by itself would be worthy of a headline, of course, since it’s quite at variance with the massive savings shown in the Koop Awards he gives to his friends. But there is much, much bigger news, though in this case he “buried the lead,” in a sleight-of-hand that he knew Health Affairs‘ peer reviewers wouldn’t notice.
The Death of the Wellness Industry is Not Exaggerated At All
Here’s what he did — very clever, but not clever enough not to get caught. He and his co-authors pegged average spending on cardiac at a perfectly plausible $329 per employee per year. However, they decided not to split that average of $329 out into “bad” spending (specifically, spending on events, like heart attacks), vs. “good” spending (prevention expense — things being done to avoid heart attacks).
How big a rookie mistake is combining these two opposites, prevention expense with event expense and calling it “average payment for all CVD claims”? It would be like saying the average human is a hermaphrodite.
If they had split that average out into its two opposite components, they would have been forced to reveal that spending on actual avoidable events is less than spending on wellness programs to avoid those events. That, of course, is exactly right, and was what we showed about 14 months ago.
Let’s do the math
How much do employers spend on heart attacks? Well, here is the number of heart attacks. I’m spelling it out so that people can replicate this using the HCUP database for 2014, for all the heart attack DRGs:
- DRG 280 — 12,825
- DRG 281 — 15,404
- DRG 282 — 18,365
- DRG 283 — 1,800
- DRG 284 — 275
- DRG 285 — 160
This totals to 48,829. There are about 100,000,000 adults 18-64 insured through their employers, meaning that about 1 in 2000 will have a heart attack in any given year. I had thought it was 1 in 1000, and my own data — from roughly 30 commercial health plans and large employers for which I measure event rates — backs that up, so let’s totally give Ron the benefit of the doubt (the wellness industry’s business model is based on being given the benefit of the doubt) and double the HCUP figure, to 1 in 1000.
Now assume $50,000 per heart attack all-in. That is high, but once again, benefit of the doubt. So of the $329 PEPY that Ron calculated for prevention and events combined, only $50 is events. The rest is prevention and management expense, like putting people on statins, diuretics etc., doctor visits, lab tests etc. Not avoidable, and not even reducible through wellness. Just the opposite– these wellness people are always wanting to close “gaps in care” by doing more of this stuff.
How this invalidates screening
According to Mr. Goetzel’s own data, a wellness program — health risk assessments, screening, portals etc. — costs about $150 per employee per year. An industry that spends $150 PEPY to get what Ron estimates to be a 1% to 2% reduction in a $50 PEPY expense can’t survive on merit, which explains all the lying about savings, not to mention lying about me.
Anyone care to claim the $2-million reward I’m offering for showing wellness saves money? I didn’t think so…
Nice catch — very impressive piece of arithmetic sleuthing.
Thanks but this isn’t as “impressive” as my usual standard for outing his lies. This one took a full 10 minutes to find. Usually they only take 5.
Possible it isn’t even a “lie.” It’s possible he just has absolutely no idea how to do analysis. If that’s the case, this was just a rookie mistake.
I like the point you are making about good spending vs. bad spending; a good and valuable perspective.
I’m just wondering and I could be off base here, but wouldn’t you need to break down the $150 HRA expense into various disease detection buckets to determine how much of that amount s/be allocated to detection/prevention of a heart attack and then compare that to the $50?
That is an excellent question. If indeed the $150 figure includes flu shots or something like that, we would look at the flu. It also includes diabetes (since cardio and metabolic tend to go together). However, diabetes is a much more slowly progressive thing that rarely generates an inpatient expense worthy of mention in its early stages. If we did throw in diabetes admits (and closely related complications), it would add to the preventable $50 figure. But nowhere near enough to offset the $150. And in any event, we did pump up the initial figure to reach $50, just in case we left something out like you are describing.
[…] that their peer review for that article is as sloppy as it is for wellness articles. Ron Goetzel published a nonsensical article there, which, among other things, concluded that only about 5.5% of the cohort smoked because only 5.5% […]