Announcing the Winner of the Wellness Industry’s 2017 Deplorables Award: Interactive Health
Winning a Deplorables Award is no easy feat for a wellness vendor. You have to out-lie, out-harm and generally out-stupid many worthy competitors. Yet this year’s competition wasn’t even close. Fitbit might have won on lies and stupidity alone, but no one was ever harmed by wearing an activity tracker. Interactive Health clobbered them in harming employees. Like Wellsteps (the 2016 Deplorables Award Winner) they managed to do that multiple ways. This award covers the harms, the lies, and the stupidity. Truly the perfect storm of workplace wellness.
The Harms
Interactive Health’s signature move is conducting mass screens so inappropriate that doctors doing essentially the same thing — paying people to take this panoply of tests and then billing insurance — would lose their licenses.
Needless to say, when you do all sorts of inappropriate tests, you find all sorts of non-existent problems, and send all sorts of employees to all sorts of doctors. This isn’t simple overdiagnosis. This is classic hyperdiagnosis as described in our 2015 posting.
This is what we wrote in that posting, and it appears Interactive Health is the poster child for it. As compared to overdiagnosis, which is the unfortunate byproduct of well-intentioned efforts to help patients who present with symptoms, hyperdiagnosis is:
- pre-emptive — employees aren’t asking to be diagnosed, don’t have symptoms, want to be left alone, and often aren’t even old enough to have the stuffing screened out of them yet;
- either negligently inaccurate or purposefully deceptive (and IH has been requested many times to stop doing inappropriate screenings but they continue unabated);
- powered by pay-or-play employee forfeitures for non-participation, of the type about to become illegal in 2019;
- all about the braggadocio – wellness companies love to announce how many sick people they find in their screens…
…And here is Interactive Health doing exactly that:
What do you do after you round up all sorts of unsuspecting employees with inappropriate screens? Obviously, you bombard them with inappropriate advice, of course. Specifically, the huge percentage of employees at risk for diabetes — thanks to those “a1c tests for everyone” (which of course are specifically not recommended by the USPSTF) are supposed to drink full-fat dairy, not skim. And absent hypertension, they are also not supposed to avoid salt. Quite the contrary, maintaining US-average salt consumption appears to be protective against diabetes. (Not to mention that salty snacks often substitute for sweet ones.) We had no trouble finding these studies online. Hopefully Interactive Health will use some of their award money to purchase an internet connection.
Fortunately, most employees pay no attention to Interactive Health’s 1500-word single-spaced tomes, so it’s unlikely their antediluvian advice harmed anybody.
Third, speaking of harms, they also harmed me when I went in to be screened. Not just by announcing my PSA score when I specifically asked not to be tested for PSA, but by stretching my calf far enough to send it into spasm.
The Lies
The English language already has 450,000 words, the most of any language. And yet none of those words adequately describe the amount of lying done by Interactive Health, even after they’ve been caught.
They are claiming “amazing results” based on one study by an unknown, now-defunct consulting firm that couldn’t even pay its internet provider. (The consulting firm had also made up a set of qualifications in which, other than articles and prepositions and conjunctions, every word was a lie.)
Once the lies were initially exposed, they paid me to stop writing about them for a while. I agreed, provided that they stop lying — meaning that I can write about them ad nauseam.
The smoking gun for the initial lie was that they accidentally admitted that they didn’t really reduce any risk factors. You can’t save a gazillion dollars by reducing employees’ wellness-sensitive medical events if you can’t improve employees’ wellness. According to their own figures (and of course excluding dropouts and non-participants, whose risks likely climb), their risk reduction was quite trivial. How trivial? The Wishful Thinking Multiplier — savings divided by the number of risk factors temporarily reduced — exceeded $50,000.
After that expose, they sealed their front-runner status for a Deplorables Award by simply trying to suppress the evidence. They took the trivial risk reduction displays out of that study, and now only make available the bowdlerized version, which they call a “research summary.” The only way you can get the raw risk reduction data is by scrolling down this post. Rule one in wellness whistle-blowing: always take screenshots.
And most recently, they’ve become strong proponents of Wellsteps’ strategy, bragging about how many high-risk employees became low-risk without mentioning that roughly as many low-risk employees became high-risk. Suppose you flip 100 coins. It’s not enough to say that of 50 heads, 25 became tails. You also have to admit that 25 of the tails flipped to heads. At the end of the day, nothing changed. Here are the heads-to-tails, from their website. (By the way, this is also not true, even on its face.)
The Stupidity
Ask any employer what is the “new smoking” in terms of employee hazards and mortality. Most will say opioids, of course. Not Interactive Health. For them the “new smoking” is…
Hey, Interactive Health, maybe you can find a smart person to explain this particular statistic to you:
- According to the CDC, the number of annual deaths caused by smoking: 480,000
- According to the CDC, the number of annual deaths caused by sitting: 0
Here are some other differences between the two activities: Chairs don’t carry excise taxes or warning labels. If you’re under 18, you can buy a chair without a fake ID. Workers are allowed to sit inside the building. Chairs don’t make you clothes smell, cause lung cancer or dangle from the lips of gunslingers in old John Ford westerns. Sitters aren’t assessed health insurance penalties. Your Match date will not feel misled if he or she catches you taking a seat, even if your profile didn’t disclose that you sit.
And finally…
Take The Interactive Health IQ Test
Which of these images is most unlike the others?
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NY Times’ economists and Pulitzer Prizewinning LA Times columnist skewer “voluntary” wellness incentives
In the immortal words of the great philosopher Dizzy Dean, don’t fail to miss it.
Ever since Ron Goetzel’s Penn State debacle, the news cycle has been the Health Enhancement Research Organization’s (HERO) kryptonite.
To be sure, they have other enemies too — transparency, integrity, math, data, facts, employees, smart people — but those bullets just bounce off them. How do we know this? We think we’re making an impact with our exposes and whistleblowing — and yet forced, incompetent and sometimes harmful prying, poking and prodding continues unabated. When we prove that none of the wellness numbers add up and back that proof with a monster reward for disproving us, they retreat rather than fight — but then they pop up again, whack-a-mole style with yet another claim: “Oh, well, numbers don’t have to add up. It’s all about the value.” Yada yada yada.
That’s why they never respond to anything we ever write, or for that matter anything anyone else ever writes. STATNews, for example, wanted to host a point-counterpoint, but couldn’t find anybody to oppose me. Health News Review posted a podcast with no opposing views.
The one wellness executive who failed to understand the news-cycle-as-kryptonite dynamic was Wellsteps’ Steve Aldana, not exactly a rocket scientist even by the standards of the wellness industry. In an attempt to get his name in the paper, he accidentally admitted that all of Boise’s Koop Award-winning numbers were fabricated. Yes, he humiliated himself, yes, he admitted he lied, yes, he could easily have been charged with defrauding the city…and yet Boise is still Wellsteps’ account.
If they had any lingering doubt, that lesson taught the rest of these people to stay out of the media even if it means taking a few punches.
That brings us to today. I’ve been scouring Google to find someone — anyone — to take the side of the EEOC in what is likely to become an extended news cycle over the definition of “voluntary” for wellness programs. So far, no one has stepped forward to support the EEOC’s and HERO’s argument that “voluntary” can mean “we’ll fine you up to $2000 if you don’t.” Instead, both The Incidental Economist (the NY Times‘ economics bloggers) and the LA Times‘ Pulitzer Prize-winning business columnist, Michael Hiltzik, come down strongly on the side of AARP, Merriam-Webster, Funk & Wagnalls and Dictionary.com.
Los Angeles Times, Michael Hiltzik
Highlights:
- In 2015, the EEOC proposed a rule treating wellness programs as “voluntary” if they involved premium differences of no more than 30% of the full cost of a health plan. Worker advocates were aghast — 30% of a full-price premium could amount to thousands of dollars, and since the workers’ share of their health plan premiums often was only 30% or so, the penalty could double their annual costs. For many families, that made voluntary programs effectively mandatory.
- [The judge] observed that the 30% incentive “is the equivalent of several months’ food for the average family, two months of child care in most states, and roughly two months’ rent.” He recognized that a fee of that magnitude could be especially coercive to lower-income employees
- The biggest problem with wellness programs is there’s no evidence that they work. The most frequently cited statistic in their favor came from Safeway, whose claim to have saved on per capita healthcare costs after implementing a wellness program prompted drafters of the Affordable Care Act to liberalize the incentive rules. But Safeway’s story was soon debunked. Other supposed success stories came from wellness program promoters themselves, who were engaged in selling their wares to big employers.
Highlights:
- The rule allowed employers to impose huge penalties on employees who refused to participate in wellness programs, even though the Americans with Disabilities Act says those programs must be “voluntary.”
- In the court’s view, the EEOC had basically ignored the problem in its rulemaking, asserting without explanation that wellness programs backed by enormous penalties were somehow voluntary. I applauded the decision: I’ve been railing against the EEOC for two years now for blessing mandatory wellness programs over the ADA’s express prohibition.
Once again, I’d urge everyone to sign up for the January 18 webinar. There will be more clarity, you can ask questions, and you’ll hear questions from others too. What you won’t hear is a peep out of HERO. Not because we censor or blacklist adversaries (that’s their signature move, not ours — one person reports that HERO took him off the program because he admitted to respecting my work) but because they know better than to, in the immortal words of the great philosopher John Cusack, say anything.
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Q&A about landmark AARP v. EEOC court decision on wellness
UPDATE: Here is the link to a January 18th webinar on this topic.
This is a follow-up to the announcement and “back story” of the December 21 wellness decision in AARP vs. EEOC, a decision which could severely curtail incentives and penalties…and which could, to paraphrase the most memorable G-rated words ever spoken by Bill Clinton, end wellness as we know it.
That’s the bad news. The good news is that as you’ll see later, this decision may actually be a windfall for employers with heavily incentivized wellness programs.
Q: What just happened?
AARP just won a very favorable district court ruling against the Equal Employment Opportunity Commission (EEOC), the agency charged with enforcing the Americans with Disabilities Act (ADA) and the Genetic Information Non-Discrimination Act (GINA). The full decision is here.
Q: How is this different from the previous ruling in AARP v. EEOC?
The original ruling, though in favor of AARP, gave EEOC more than three years to amend its rules to redefine “voluntary” to match the dictionary definition. The new ruling gives one year both for the EEOC to write the rules and for employers to implement the rules, and makes clear what is expected of them. Here is the key to why this decision should stick:
The government can’t define “voluntary” to include fines of $2000 or more for non-compliance if it also requires a “mandate” — the opposite of a voluntary option — that carries only a $695 penalty for non-compliance. A voluntary option can’t include remotely as high a penalty for non-compliance as a mandatory requirement, especially in the very same law.
Q: What will remain as of January 2019 that employers can require subject to forfeitures?
It is still OK to offer medical screenings and HRAs (collectively, “medical exams”) OR dangle incentives or fines (collectively “forfeitures”), just as it is today. The difference is that the programs involving required forfeitures can’t also require medical exams, which both the ADA and GINA say can only be “voluntary.” The court ruled that you can’t force employees to undergo “voluntary” exams by dangling or threatening to withhold large sums of money.
So you can still require employee forfeitures up to 30% (50% for smokers), and you can still offer medical exams. You just can’t combine the two. That’s because in order for a wellness program to fall under ADA and GINA in the first place, medical exams must be involved. So, for example, requiring employees to either do screening or do Quizzify is still allowed.
Q: Isn’t this already the “reasonable alternative” language for employees to avoid screening?
No, for two totally distinct reasons. First, those “reasonable alternatives” nonetheless involved medical exams. Second, an employee had to petition. An employee couldn’t just say: “I don’t want to be screened. Give me something else.”
Q: Does this cover screenings only, or are programs combining annual physicals and forfeitures also affected?
A: If the results of the latter are not shared with the employer, it appears that they may still be require-able. A better question is why an employer would want to require them. First, they lose money. Second, they don’t appear to benefit employees either. The New England Journal of Medicine, The Journal of the American Medical Association, Choosing Wisely and Consumer Reports (and also Slate) have all looked at the data and concluded that for most people annual physicals confer no net health benefit, meaning even if they were free they would be worthless. (People who have ongoing health issues should of course see their doctor regularly. Those would not be considered checkups under this definition.)
Logically and intuitively, this conclusion would appear to be especially true when employees submit to those physicals under duress. Quizzify — and this question, like most Quizzify questions, carries the Harvard Medical School (HMS) shield — recommends two checkups in one’s twenties, three in one’s thirties, four in one’s forties, five in one’s fifties and for most people annually after that. However, this is also Quizzify’s most edited-out Q&A, as some employers nonetheless want even healthy employees to get physicals every year, and Quizzify respects that choice (though a customized question advocating it could not carry the HMS shield).
Q: These Q&A’s seem very Quizzify-centric.
A: That’s not a question but I’ll answer it anyway. There are two reasons for that:
- We know of no other vendor that solves the problem and guarantees the solution, with EEOC indemnification. Quizzify was both conceived and architected in anticipation that this court decision would happen someday. (I just didn’t expect it to happen four days before Christmas, which meant a lot of my cousins got gift cards instead of ugly sweaters.) All my exposes on the wellness industry led me to conclude that conventional “wellness or else” (as Jon Robison calls it) could never survive a court challenge…and I designed a product specifically to allow employers to address that challenge immediately and completely.
- Those of you familiar with my work know I have only three talents in life: wellness outcomes measurement, employee health literacy/consumerism education, and self-promotion.
Your vendor, Quizzify or not, should offer something like this right on their website. If they do, you’re safe:
Q: What other analyses should we be looking at?
The best is The Incidental Economist. AARP hasn’t released a formal statement but their informal back story can be found at the bottom of this posting.
Q: So what should we do about it?
Simply add the option of taking Quizzify quizzes to the option of HRAs/screenings. That one-step fix is guaranteed and indemnified to solve your legal issues. It will also save money both up front (a year of Quizzify costs much less than a single screening) and down the road, because wiser employees make healthier decisions…and healthier decisions save money. Employees also like playing trivia more than they like being browbeaten into promising to eat more broccoli.
If your vendor refuses to add Quizzify via a “single sign on” and you don’t want to add it separately, you can fire the vendor (we can help you do that — if they show a positive ROI it means their outcomes are fabricated, which we can easily demonstrate) and replace them with one that will, of which there are quite literally more to choose from every week.
Q: What happens next?
A: The EEOC needs to rewrite the rules to comply with this decision by making new rules — and needs to do it in 2018 so that they can be adopted and implemented by employers by January 2019. The definition of “voluntary” will be a line-drawing exercise. Likely gift cards and small incentives will be considered “voluntary.” If your incentive falls within whatever cap they decide upon already, you’re fine, with or without Quizzify.
Q: Is this is last word?
A: No. First, the final rules have yet to be written, as noted above. The rules then have to be approved by the district court.
Along with that uncertainty are two others. The EEOC could appeal, since these days it tends to oppose employee rights, rather than support them. However, the DC Appellate Circuit, led by Merrick Garland, would likely not be favorably disposed towards arguments that require, for example, defining “involuntary” as “voluntary,” especially when the Court will know that even award-winning vendors harm employees, vendors flout guidelines and screen the stuffing out of employees and give incorrect advice, creating further harms, and that the industry itself is rife with corruption, starting at the top. (I published my last paper in a medical-legal journal rather than a clinical journal specifically in anticipation that it might be the basis for an amicus curiae brief specifically in a situation like this.)
In an unregulated, employee emptor, environment like this, voluntary fines collected by shareholders from employees wanting to protect themselves from the harms above should not exceed fines set as penalties for a mandate, and paid into a pool to create an insurance product. (That the mandate is going away is not relevant — it’s the fact the government has two words with opposite meanings that have inverse fines.)
Alternatively, an Act of Congress could gut GINA. The American Benefits Council could try to convince the legislators their colleagues contribute heavily to, like Virginia Foxx (R-NC5), to push HR1313, for example. HR1313 is arguably the worst bill of any type ever to clear a Congressional Committee, in that nobody benefits from it (other than DNA collection vendors, for whom it would be a windfall), but the ABC has already demonstrated their disregard for the best interest of its own members by browbeating Rep. Foxx into proposing that bill in the first place. The ABC is down, but not out…and as this video shows, being down but not out can cloud one’s judgment.
However, since quite literally none of her constituents are helped by this bill and most of them in both parties detest it, Foxx may decide to disappoint her corporate overlords on this one, especially because it’s an election year.
Q: How is HR1313 (or a bill like it) that ABC might propose on behalf of its members (large employers) not in “the best interest of its own members” as noted above?
A: Many employers have finally figured out that even their own vendors know wellness loses money, and that incentives generally don’t change behavior because employees revert to their old behaviors once the incentive ends. (Incentives do work for Quizzify-type programs, because as you’ll see for yourself if you take the quiz, once you pay an employee to know things, they can’t un-know them. Pay an employee to learn that CT scans are full of radiation once, and they will stop demanding unnecessary CT scans forever.)
However, employers are stuck with these huge incentives now, which some employees expect annually. This rewrite of the “voluntary” rules, likely capping incentives in the low three figures, will allow employers to spend much less on incentives…and blame the government. (Obviously we hope they maintain the incentives and instead just offer the Quizzify alternative. This will also save money due to Quizzify’s low price and a much-reduced number of employees having to follow up on false positives.)
If ABC were to be successful in gutting GINA and allowing financially coercive wellness programs to continue unabated, employers would still have to fork over large incentives.
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Forced “voluntary” wellness programs to be gone as of 1/1/19
UPDATE: Here is the link to a January 18 webinar on this topic.
Looks like Festivus came early for Quizzify this year…
Thanks to the AARP (which won “best organization” in Monday’ Wellness Stars posting), as of January 2019, it will no longer be allowable to offer the conventional “forced “voluntary wellness” programs that wellness vendors are so enamored of…
…unless they include a program like Quizzify. Uniquely in the wellness industry, Quizzify was actually designed with this contingency in mind, and offers a guarantee that an organization using Quizzify will not lose an EEOC challenge. Because Quizzify doesn’t involve a medical exam or the disclosure of medical information, it is not covered by GINA or ADA…and is not subject to EEOC regulations or jurisdiction.
Several vendors — It Starts With Me, Sterling Wellness, Sustainable Health Index and Switchbridge — already offer Quizzify in conjunction with screening. They, and their customers, will have the safe harbor automatically.
Otherwise, if you are an employer, you should look into Quizzify or a company like Quizzify that is not subject to EEOC. As long as it is an option, an employee is not forced to do wellness…and therefore you are not subject to EEOC. (Your vendor should guarantee that.)
If you are a vendor, you should partner with a company that is not subject to EEOC and is willing to provide the same guarantee/indemnification that its use doesn’t break any rules.
PS It is also possible that Congress will override this decision, and reconsider HR1313, the Required Employee DNA Disclosure Act. To which I say, good luck with that.
Update 12/22:
It’s not just us writing in an eggnog-induced haze who think this is huge. Here is The Incidental Economist weighing in.
The back story from AARP
Late yesterday (12/20), we received the great news that the federal district court granted AARP’s motion to vacate the EEOC’s wellness regs!
As you will recall, last August, the District Court for DC ruled for AARP in our challenge to the EEOC’s 2016 regulations, finding that the agency failed to provide a reasoned explanation of how the allowance of large financial penalties (usually in the form of much higher health insurance premiums) squared with the requirement under the Americans with Disabilities Act and the Genetic Information Nondiscrimination Act that inquiries and exams as part of workplace wellness programs must be voluntary. The court required the EEOC to go back to the drawing board and re-do its regulations in accordance with the court’s opinion. However, the judge left the faulty rules in effect, citing a concern about the risk of disruption to the employers’ already-planned benefits offerings, and told the EEOC to submit a schedule for redoing the rulemaking. The EEOC’s proposed schedule would have left the EEOC’s coercive rules in effect for at least another 3 years (2018 through 2020, see e.g., ADA schedule here).
AARP objected to the “manifest injustice” of permitting workers to continue to have their civil rights and medical privacy violated while the EEOC re-regulates, and we filed a motion asking the judge to reconsider and to vacate the rules as of January 2018 or as soon as possible thereafter. Yesterday, the court granted AARP’s motion to alter and amend its prior order to invalidate the rules. Although the order is coming too late to address coercive penalties for the 2018 enrollment year, the vacatur will take effect as of Jan. 1, 2019. This means that workers may no longer be financially coerced into providing medical information or undergoing medical exams, and instead this type of participation in a wellness program must be genuinely voluntary, beginning in 2019 (instead of 2021)!
What could happen next? The EEOC could appeal. Or it could decide not to appeal and go forward with the new rulemaking as order and planned – though in the opinion, the Court “strongly encouraged” the EEOC to speed up its schedule for the new rulemaking. Another risk to watch out for is that the business lobby could push to move HR 1313, the Foxx-Byrne bill that would straightforwardly gut the ADA’s and GINA’s protections against coercive wellness programs.
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The Health Value Awards — nominations due
At the risk of diluting my previous posting and creating a new news cycle, no doubt much to the relief of the runners-up for the wellness industry’s 2017 Deplorables Awards, Brian Klepper asked me to “rebroadcast” this, and it is important, so here goes:
The Health Value Awards competition – a joint project of The World Congress, The Health Rosetta Institute and The Validation Institute – seeks nominations in 6 non-validated categories.
Benefits Professionals
- Outstanding Benefits Professional in 2018
- Lifetime Achievement Benefits Professional
- Outstanding Benefits Broker or Consultant Leadership – Firm and/or Individual
Organizational Health Care Purchasers (Employers/Unions)
- Small Groups (<250 employees)
- Mid-Sized Groups (250-5,000 employees)
- Large Groups (>5,000 employees)
If you’re aware of a benefits manager, benefits consultant or organization that deserves to be recognized for driving innovative, high value programming, by all means, let us know. We want to shine a bright light on actions that accrue to the benefit of patients and purchasers throughout the system.
You can submit a nomination here. Or get in touch directly with bklepper@worksitehealthadvisors.com.
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The 2017 Deplorables Awards — Runners Up
It’s time for the 2017 Deplorables Awards, lovingly bestowed on those vendors who do the best job making other vendors look good.
The good news is that you don’t have to actually win the Deplorables Award to sue me. Runners-up are eligible too. Here is my address for hand-service delivery most of the year:
890 Winter Street #208, Waltham MA 02451
In case you decide to sue me between June 22 and August 8, use:
8 Paddock Circle, Chilmark, MA 02535
And don’t leave out my attorney:
Josh Gardner, GARDNER & ROSENBERG P.C., 33 Mount Vernon Street, Boston, Massachusetts 02108
I don’t know how much more I can do for you, other than lick the envelope. So go for it. Don’t make me beg.
But, remember, unlike your usual business model, in court you are required to actually tell the truth (I would be happy to explain to you how that works), meaning there is no chance of your winning — or likely even avoiding summary judgment, since none of the evidence is in dispute. It’s all your own writings. Oh, and I do my own cross, which means you won’t be able to find an expert witness. Anyone who knows enough about wellness to be an expert witness also knows enough about wellness to know that attempting to defend you would be a humiliating, on-the-record experience.
And there is always the chance that some annoying jerk might blog about it…
The 2017 Runners-Up
Imagine a four-square matrix with competence on one axis and integrity on the other. The people and organizations we’ll be highlighting today would intersect with the companies mentioned in Monday’s posting at only one single point.
Springbuk and Fitbit
As many of you recall, earlier in the year we analyzed the study done by Springbuk that secretly financed by Fitbit. Or maybe I need new glasses, because I just couldn’t find the disclosure in the Springbuk report that this paean to Fitbit was financed by Fitbit, the way Nero used to have the judges award him Olympic medals.
Coincidentally, the study showed Fitbit saving gobs of money because employees taking more than 100 steps a day spend less money than those taking fewer. However, a simple tally of one’s own footsteps shows that it is impossible not to take 100 steps a day unless you are both:
- in a hospital bed; and also
- on dialysis.
This 100 steps-a-day threshold was repeated many times in the study, with no explanation of how that number came to be. However, it turns out we owe these two outfits an apology. Fitbit and Springbuk have told a number of people privately (not publicly, in order to avoid an embarrassing news cycle) that they didn’t really mean to say that 100 steps a day constituted activity. They meant to say that taking 100 steps a day implied you had your Fitbit on. My apologies for failing to read their minds that their conclusions were based on reading people’s minds to determine whether they wore the Fitbit deliberately, or simply forgot/remembered/cared to put their Fitbit on.
They never did explain — privately or publicly or to anyone — how employees who took an average number steps during the baseline year could show huge savings by taking an average number of steps in the study year too.
They also never explained how these two statements didn’t completely contradict each other, even though I specifically asked them to in a personal letter, excerpted here:
Third, can you reconcile this statement…:
“The materials in this document represent the opinion of the authors and not representative of the views of Springbuk, Inc. Springbuk does not certify the information, nor does it guarantee the accuracy and completeness of such information.”
“This demonstration of impact achieved by integrating Fitbit technology into an employee wellness program reinforces our belief in the power of health data and measurement in demonstrating ROI,” said Rod Reasen, co-founder and CEO of Springbuk.
National Business Group on Health
Next up is the National Business Group on Health. Last year they made the list for criticizing the US Preventive Services Task Force for not demanding enough screenings, in a country that is drowning in them. Not content to rest on those laurels, this year they earned an Honorable Mention for inviting Dr. Oz to keynote on the role of quackery in corporate wellness, and perhaps tell us about his latest lose-weight-by-eating-chocolate miracle diet.
Health Enhancement Research Organization
HERO of course also earns a runner-up award. 2017 will be remembered as the year they finally came to grips with the realization that a business model based on fabricating outcomes requires that perpetrators possess that critical third IQ digit. Without that extra “1”, an organization trafficking in math that can at best be considered fuzzy is going to be outed.
This year’s set of lies? By way of background, their 2016 poison-pen letter insisted they had fabricated that data set showing that wellness loses money without disclosing that it was fabricated — and also never reviewed their fabricated data before publication. Early in the year, I had the insight that, wow, this “fabricated” Chapter in their guidebook is so much better than the other chapters that something is amiss. No one at HERO can analyze data competently…and yet, here it was, a competent data analysis.
I did something I had never thought to do before, which was look up the actual author of that chapter. It was Iver Juster MD. He was a great analyst even before he read all my books, took all my courses, and achieved all my certifications in Critical Outcomes Report Analysis.
So I called Iver. Here’s what I learned:
- Whereas Paul Terry and Ron Goetzel had insisted that Iver fabricated the data, Iver said, of course he didn’t — whatever made me think that? (“If it wasn’t real, I would have disclosed that,” he observed. Of course he would have. Iver has tremendous integrity.)
- The Board discussed and reviewed his chapter at length, and made helpful suggestions, for which he was quite grateful. This review process required “countless hours,” just as the HERO document says:
The number of transparent lies HERO tells could make a president blush. In the immortal words of the great philosopher LL Cool J, they lied about the lies they lied about.
Even though 2017 was an off-year for them in terms of the number of lies, they still told enough to be named a runner-up.
Wellness Corporate Solutions
Next is Wellness Corporate Solutions, famous for its crash-dieting contests. WCS now offers a water-drinking contest. The idea is to set up a “challenge” for your team to drink more water than other teams. They call this a “healthy competition.” I guess they didn’t get the memo that forcing yourself to drink when you don’t want to drink, just to make more money, is anything but healthy. Here is a novel idea: drink when you are thirsty. Evolution 1, WCS 0.
Perhaps as an encore, WCS, Dr. Oz and the National Business Group on Health could team up to offer a chocolate-eating contest.
I looked into this outfit to see where they get their ideas. The CEO previously ran something called the Washington Document Service. That qualifies her to run a wellness company. As Star Wellness says, to run a wellness company successfully, your background needs to be in sales, or “municipality administration.” After all, what is more central to administering a municipality than documents?
Wellsteps
What fun would a list of runners-up be without Wellsteps, the proud recipient of the 2016 Deplorables Award? While their streams of consciousness weren’t as memorable in 2017 as in 2016 (“It’s fun to get fat. It’s fun to be lazy“), they get credit for trying. Their 2017 weight-loss campaign was headlined: “This campaign is not really about weight loss, it is about helping you apply the behavioral secrets of those who have lost weight.”
So if your kids ever want you to teach them how to ride a bike, say: “It’s not really about riding a bike. It’s about helping you apply the secrets of people who have ridden bikes.”
And what secrets are we talking about? What person who has lost weight doesn’t brag to everyone or even write a book? If there is a secret to weight loss, like eating chocolate, Wellsteps owes it to the country to tell them. Don’t make us beg.
Odds and Ends
No Koop Award winner this year, but an honorable mention to past winners and runners up for their commitment to wellness:
- McKesson, for flooding the country with opioids;
- Pepsi, for flooding the world with sugar.
Sounds like in 2018 the logical winners would be Philip Morris, or maybe The Asbestos Corporation of America.
Veering briefly into the public sector, kudos to Representative Virginia Foxx, (R-NC5) for introducing the Required Employee DNA Disclosure Act. Even HERO thought it was a dumb idea…and their threshold for thinking something that increases wellness industry revenues is a dumb idea is quite high, having all rallied behind the Johnson & Johnson Fat Tax, in which companies would be required to disclose the weight of their employees.
Next up…the winner of the 2017 Deplorables Award
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Wellness Stars of 2017
The good news about wellness is that many very well-intentioned people and groups are making some major, disruptive strides in replacing wellness done to employees with wellness done for employees. So we see less of this…
and more of this… (photo courtesy of Limeade)
The bad news is that nominees for this posting in previous years have been so few and far between that I used to be able to effuse at length about each of the winners. However, there are so many of them now that this will be more like a listing than a posting.
Nonprofit and Advocacy Organizations
Many honorable mentions here, but only one winner. First, the honorable mentions. The National Association of Healthcare Purchasing Coalitions and their affiliated groups, notably Philadelphia, one of the fastest-growing regional coalitions, with additional kudos to the Colorado Business Group on Health and the Northeast Oklahoma Business Group on Health for being way out in front of the move towards the intersection of culture of health and culture of health literacy. Despite great pressure from sponsors and vendors, these regional coalitions stick to their charter and actually represent the constituency they say they represent–the employers. Doing your job may seem like a pretty low bar, but it’s one that the National Business Group on Health needs a telescope to look up at, having invited Dr. Oz to give a keynote on the role of quackery in a wellness program.
Next, the US Preventive Services Task Force. “Screen according to USPSTF guidelines” remains the mantra of the Welligentsia. Conversely, wellness vendors brag about how they ignore guidelines. Along with often testing for far too many things, they ignore the frequencies set by USPSTF, instead testing annually, because they say: “We need to measure progress.” Two thoughts on that:
- They don’t need to “measure progress” for one simple reason: there is no progress to measure. Annual prying, poking and prodding employees generates virtually zero positive impact. Hence my reward for showing cost-effective progress using “pry, poke and prod” is now $3 million.
- Flouting the guidelines just to measure the cholesterol of the employees would be like burning the roast just to measure the temperature of the oven.
Since hyperscreening is one humongous medical error, it’s no surprise the The Leapfrog Group wins plaudits again this year.
On the conference side, both WELCOA and Global Health Resources hosted excellent conferences, with emphasis on wellness done for employees instead of to them. Here in Massachusetts, the New England Employee Benefits Council conference last week was also a big hit. The exhibit hall included only one antediluvian wellness vendor, but that only reminded attendees of how far we’ve come. In sharp contrast, the speaker roster featured Brian Klepper, one of the most disruptive people in healthcare.
Just in terms of sheer drama and enjoyment, though, the Rock Stars of Health conference would be the winner. Worth traveling all the way to Montana for.
However, among nonprofit and advocacy organizations, the hands-down winner for 2017 is AARP, specifically Debbie Chalfie. Unlike us here at TSW, who simply report the news, or HERO, which simply fabricates the news, AARP makes the news. In 2017 they got a court — and this should not have been a heavy lift, but it was — to agree that maybe, just maybe, the words “forced” and “volutary” are not synonyms, meaning that employers can’t make employees choose between submitting to vendors playing doctor or paying large fines. We still don’t know how this will turn out, ultimately, but at least it is now up for debate. The EEOC is supposed to propose new rules next year. For now, there are still no constraints on fining employees large sums for not participating in these programs.
Publications
As usual, the media is lined up 100% against the pry-poke and prod agenda. The winner this year is the law-medicine journal of Case Western Reserve, HealthMatrix. It is the oldest law-medicine journal in the country and arguably the most respected. This year they tried to do an issue on wellness with representation from both advocates and critics…but couldn’t find any of the former who weren’t conflicted out by their role in the industry. Literally, there is not one single non-industry-connected person who supports wellness on its merits enough to write about it. So all five articles were critical conventional wellness-done-to-employees-not-for-them, representing five different authors (or groups of authors) detailing five different major issues.
These articles are all available for download gratis.
Vendors and Other Groups
In wellness, the big news was the establishment of the Employee Health and Wellness Program Code of Conduct. Jon Robison, Rosie Ward and Ryan Piccarella get the credit for that. We just added our first Amendment, urging crash-dieting vendors to disclose the likelihood of weight regain and the possibility that weight-cycling could be harmful. As you can see if you visit the site, there are now many endorsers of the Code, and only three opponents — Optum, HERO and Wellsteps. Having seen data from all three, I can understand how ethics would be incompatible with their business model.
Looking beyond wellness, perhaps the year’s big news was the ascent of Dave Chase, Brian Klepper, and their disciples (of which I am one). Apparently, wellness is not the only industry sector in healthcare corrupted by greed at the expense of the employee and employer. The providers, PBMs, carriers and drug companies all have their hands in the cookie jar as well. The difference — as described in Dave Chase’s book — is that whereas employees actually need access to drugs, providers etc. and therefore employers are exposed to vendor rapaciousness as a byproduct, wellness is a self-inflicted wound. Simply cutting back from annual screenings to doing wellness according to guidelines immediately reduces wellness expense by about 60% – 70%. That is still frequent enough to identify issues to address — but without the hyperdiagnosis that some vendors salivate over. And it frees up far more than enough money to undertake other initiatives, such as employee health literacy.
And the Validation Institute continues to be seen as the “gold standard” for measurement of outcomes. No one else even close.
Some vendors distinguished themselves this year too. Sterling Wellness, It Starts With Me, Switchbridge, Sustainable Health Index, Impact Health, SelfHelpWorks, HealthAdvocate, Redbrick, Wellable, American Institute of Preventive Medicine, USPM, Healthcheck360, and Limeade, for starters.
Likewise some brokerages clearly distinguished themselves as well — Connect Healthcare Collaboration, Arthur J. Gallagher, Hayes (Boston Office), Gibson Group, AIA-BRG, Lake Norman Benefits, Axion-RMS, Benefits Services Group.
And kudos to Mercer for being the first major consultancy (second employee health services organization overall, after Quizzify) to address the elephant in the room, opioids.
Employer Workplaces
I would normally name a number of workplaces here — and there are many deserving ones — but in the public sector, it looks like a tie between Hilliard City Schools and the City of Chelmsford, MA, part of the innovative and equally deserving Massachusetts Interlocal Insurance Association. In both cases, the level of voluntary participation in a wide range of programs, with no coercion and surprisingly modest incentives, has been over the top. In the private sector jumbo employer category, there is only one: Cummins. There’s a reason that when Fortune asked me who they should profile for wellness, I recommended Cummins. Among mid-sized employers, Pace Industries and PTA Plastics lead the way.
Individuals
I’m sure I’m leaving some people out. If I did, just mention them privately and I’ll slip them in. I’m also not re-naming names of people in organizations already mentioned. Bob Merberg, Jayne Schmitz, Wendy Gammons, Tom Emerick, Bill McPeck, Mitch Collins, Kristie Howard, Julie Fulton, Justin Leader, Brian Uhlig, David Contorno, Marty Makery, Craig Lack, Andy Neary, Aaron Witwer, Cassidy Posey, Sean White, Kristie Howard, Samantha Gardiner, Matteo Zanella, Dan Cronin, Linda Riddell, Gretchen Day, Romy Antoine, Krisna Hanks.
Don’t miss the upcoming finale…
…In which a worthy 2017 successor to Wellsteps will be named as winner of the annual Deplorables Award.
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The reward for showing wellness works is now $3 million!
2021 Update — we aren’t just “outing” the worst. Instead we are claiming to be the best: The reward now applies to any behavior-change vendor — diabetes, wellness etc. — vs. Quizzify. $3 million is yours if found by the 5 judges (and remember, we only appoint one!) to be more cost-effective than Quizzify.
Here are the specific rules to claim the reward.
Almost any behavior-change vendor (e.g., Virgin Pulse, Bravo, Accolade, Livongo) is eligible to claim the reward. A “behavior change” vendor would be one whose value depends on employees doing something voluntarily or with an incentive/penalty, paid via an admin fee. Eligible categories include wellness, diabetes, weight loss, mental health, sleep, coaching, EAPs, “challenges” programs, fitness, nutrition, navigation, patient-centered medical homes, and price-shopping companies.
We say “almost any” because behavior change vendors that we work with are ineligible because we help them dramatically increase engagement. For instance, Sera Prognostics enhances its guarantee if Quizzify is also used, and we enhance ours.
Also ineligible are those featured favorably in Cracking Health Costs and Why Nobody Believes the Numbers. And Virta, which legitimately reverses diabetes.
If indeed a vendor considers itself to be a behavior change company and Quizzify looks at it and says, no, this is not behavior change, the vendor may announce that Quizzify rejected their application. The vendor may then apply to the Validation Institute to arbitrate whether it is a behavior change company or not. If it wins, Quizzify agrees to pay for its validation.
Selection of Judges
There will be five judges, selected as follows:
- Each side gets to appoint one, drawn from The Healthcare Hackers listserve with more 1000 people on it, from all walks of healthcare.
- Two are appointed objectively. That will be whichever health services researchers/health economists are the most influential at the time the reward is claimed. “Most influential” will be measured by a formula: the highest ratio of Twitter followers/Twitter following, with a minimum of 15,000 followers.
- Those four judges will agree on the fifth.
Using the criteria below, the judging will be based largely on value per dollar of the program spent on the program and incentives. In the event this is considered to be roughly a tie, the judges will consider the validity of their measurement and whether they are validated by the Validation Institute.
Written submissions
Each side submits up to 2,000 words and five graphs, supported by as many as 20 links; the material linked must pre-date this posting to discourage either side from creating linked material specifically for this contest.
Publicly available materials from the lay media or blogs may be used, as well as from any of the 10 academic journals with the highest “impact factors,” such as Health Affairs, published within the last ten years.
Each side must:
- list their average prices per employee per year
- speak to compliance with ACA, ADA, USPSTF, and Choosing Wisely;
- allow the other to test its materials (for example, taking the health risk assessment) and review them as part of the submission.
Each party may separately cite previous invalidating mistakes made by the other party that might speak to the credibility of the other party. (There is no limit on those.)
Oral arguments
The judges may rule just on the basis of the written submissions. If not, the parties will convene online for a 2.5-hour presentation (or, at the discretion of the judges, in-person at the World Health Care Congress), featuring:
- 10-minute opening statements, in which as many as 10 slides are allowed;
- 30-minute cross-examinations with follow-up questions and no limitations on subject matter;
- 60 minutes in which judges control the agenda and may ask questions of either party based on either the oral or the written submissions;
- Five-minute closing statements.
Entry process
The entry process is:
- Applicant puts $3000 into escrow, at which point an NDA is signed and Quizzify/Quizzify guarantors (“Quizzify”) demonstrate liquid assets exceeding $3 million. Applicant may either go forward at this point, or forfeit the $3000.
- Applicant adds $27,000, at which point earning assets exceeding $3,000,000 are placed in escrow, though the income from the escrow does not go to the applicant. Assuming the $3,000,000 is sufficiently secured, applicant may either go forward, or forfeit the $30,000. If not secured, Quizzify pays the applicant $100,000.
- Applicant adds $270,000 to the escrow within 30 days, at which point the entry process is completed. Both sides then have 30 days to submit materials and 7 days to rebut. Online argument then takes place, if needed.
- Judges are paid from the escrow, 50-50 from Quizzify’s and applicant’s shares.
- If the applicant pulls out after publicly announcing he or she is applying and before adding the $270,000, there is a $50,000 liquidated damages fee, tripled if it has to be procured through litigation. If Quizzify pull outs, there is a $150,000 liquidated damages fee in favor of the applicant, tripled if it is procured through litigation.
- The winner collects the escrow.
June 2021 Update: Virgin Pulse’s one-page outcomes report is eligible. They can win just by defending one single slide with as much backup as they want.
March 2021 Update: Wellsteps can claim double the reward ($6 million) for half the entry fee ($150,000) simply by showing that their ROI calculator is more accurate than Quizzify’s.
January 2021 Update: Omada is claiming outcomes on their home page that are textbook examples of both regression to the mean and participant bias. They are aware this is not valid. They can claim this reward by defending their specious claims.
December 2020 Update: This reward is now applicable to any actuary or other self-proclaimed expert who claims that their published analyses of the wellness/diabetes/disease management industries showing favorable outcomes and savings are better than mine showing losses and general cluelessness.
Here is the original offer and how it is changed.
As almost everyone in the wellness industry knows, we have offered a $2 million reward to anyone who can show that conventional annual “pry, poke and prod” wellness saves money. I’m feeling very generous today, what with the holidays upon us, so let’s make the reward $3 million.
Even more importantly, let’s loosen the rules — a lot — to encourage applicants. You’ll find the $3 million reward is not just more generous, but also far easier to claim than the previous $2 million reward.
Special Offer for HERO
Ah, yes, the Health Enhancement Research Organization (HERO). The belly of the beast.
Let me make them a special offer. Paul Terry, the current HERO Prevaricator-in-Chief, has accused me of the following (if you link, you’ll see they had enough sense not to use my name, likely on advice of counsel, given that I already almost sued them after they circulated their poison pen letter to the media):
I’m convinced responding to bloggers who show disdain for our field is an utter waste of time. I’ve rarely been persuaded to respond to bloggers [Editors note, in HERO-speak, “rarely” means “never” — except for that intercepted Zimmerman Telegram-like missive], and each time I did it affirmed my worry that, more than a waste, it’s counter-productive. That’s because they’ll not only incessantly recycle their original misstatements, but worse, they’ll misrepresent your response and use it as fodder for more disinformation.*
Tell ya what, Paul. let’s debate disinformation, including your letter.
I have asked you on multiple occasions to clue me in as to what my alleged disinformation actually is, if any. That way I can publicly apologize and fix it, should I choose to do so. Before applying for this award, you need to disclose this alleged disinformation. You can’t just go around saying my information is made up etc. without specifying what it is.
By definition, “disinformation” is deliberate misrepresentation. To my knowledge, as a member of the “integrity segment” of the wellness industry, I have never, and would never, spread disinformation.
On the other hand, if I did spread inadvertently incorrect information by mistake, it seems only fair to let me fix it — especially given that I have been totally transparent and generous with my time in explaining to you what yours is, and how to correct it. (I might have missed some. Keeping up with yours is a challenge of Whack a Mole-meets-White House press correspondent proportions.)
So perhaps it is time to man up, Mr. Terry. You and your cronies claim to have been collecting my “disinformation” for years, without disclosing any of it. I’m offering you a public forum and $3-million to present it…with only one of 5 judges on “my” side.
Otherwise, perhaps you should, in the immortal word(s) of the great philosopher Moe Howard, shaddap.
*As a side note, Mr. Terry writes: “We’re fortunate to work in an industry with a scant number of vociferous critics.” This “scant” number appears to include the entire media — left-wing, right-wing, centrist, and health policy. Apparently also most employees, according to Towers Watson. The good news about “pry, poke and prod” is that it truly bridges the partisan divide, in that everyone hates it.
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Aaron Carroll’s new book asks: Can “bad food” be good for you?
When I was a kid, there was a seasoning called Accent. Both its TV commercials and its canisters featured a little horn with the slogan: “Wake up the flavor.” We poured that stuff on everything (except for our Captain Crunch), often accompanying our culinary adventures by making little horn sounds.
It turns out Accent was pure MSG. Who knew? And yet we lived to tell the tale. Neither me nor my siblings ever got headaches as kids. Or ever get headaches as adults. Indeed, we seem to have acquired some headache immunity from using this stuff. (Correlation, not causation, a good researcher would say.)
The reason, as you’ll learn in The Bad Food Bible, is that MSG isn’t bad for you, even apparently in the quantities we devoured. (Yes, we know – you get a headache when you go to a Chinese restaurant. That could be your imagination, or you may be one of the few people with a sensitivity to it, just like a few people have sensitivities to other foods.)
MSG isn’t the only maligned food. Is butter good for you or bad? Milk? Artificial sweeteners? Organic foods? Sugar? Meat? Red meat? Tuna? Coffee? Wine? Eggs? Salt?
Oh, and don’t forget gluten. Turns out, virtually every one of these foods has been studied in depth…and here the studies in both directions are summarized and sourced.
How does this apply to wellness vendors?
Wellness vendors – and I’m looking at you, Interactive Health – want to micromanage our diet in so many ways that most employees just tune their advice out. This book reveals that tuning vendor wellness advice out is probably the right response in most cases. Not all, but most.
We’ve shown repeatedly that wellness vendors, once they move beyond eat-more-broccoli-olive oil-nuts-and-fruit, are usually peddling very controversial or decidedly incorrect unsolicited dietary advice. Not that they care, because they show huge savings no matter what they do. One study – so seminal that it became part of Kate Baicker’s infamous “Harvard study” meta-analysis – found massive short-term savings by advising diabetics to swap out fats in favor of carbs. Not surprisingly, that study qualified the author for a coveted spot on the Koop Award Committee. Apparently bad advice is part of the Koop Award’s DNA.
What that study did and what Interactive Health does should not be called “dietary micromanagement.” Rather, it should be termed “dietary micromismanagement.” Interactive Health’s advice to non-hypertensive diabetics and people at risk for diabetes is exactly that: swap out the whole milk for skim milk and cut way back on the salt. As a previous column noted, that turns out to be exactly the opposite of what they should do.
So what should we eat…and what shouldn’t we?
The great philosopher Dan Quayle once uttered the immortal words: “The role of the Vice President can be summed up in one word: to be prepared.” Likewise, with the exception of sugar and soon-to-be-extinct artificial trans fats, the book can be summed up one word: chill out.
Author Aaron Carroll, part of The Incidental Economist (the country’s leading health economics blog), lays out the case for OK-in-moderation for most controversial foods. This guy doesn’t have an ax to grind – except when it comes to skewering people who have an ax to grind. He goes after faddists, extremists, and people who ignore research with a zeal approaching ours in exposing dishonest wellness vendors (and I’m looking at you, Interactive Health…and Wellsteps and Fitbit and about 50 others).
Since The Incidental Economist’s positioning is that of arbiter, not advocate – the go-to place for evidence-based answers no matter what the evidence shows – their answers on these topics are highly credible and carefully sourced. (Hence their smackdowns of the Koop Award Committee and wellness vendors are even more credible than mine.)
The answers boil down to: stop knocking yourselves out trying to be perfect. You are probably stressing more over your diet than you are gaining from fine-tuning your diet. Yes, there are a few things to avoid, like added sugars (but you knew that, or if not you would as soon as you play a round of Quizzify). Or, if you have a predisposition to hypertension due to history or ethnicity, you might want to go easy on the salt. (Most people needn’t – there is a reason your taste buds welcome the flavor).
So live a little, let your employees live a little, and know there are really only a few things that all the evidence says you truly need to avoid: trans fats, added sugars, and Koop Award-winning wellness vendors.
They Said What? 