So many fallacies in Bravo’s recent webinar, so little space on the internet…

Consequently, this posting is tag-teamed with Jon Robison’s Pulse, covering different aspects of Bravo:

• Misunderstanding of the meaning of the word “voluntary”
• Confusion around the research on incentives and health behavior change
• Misinterpretation of the meaning of “successful” weight loss
• “Stuckness” to a mean-spirited, 20th century approach to employee wellness

Recently we noted that Ron Goetzel seems to forget everything he says as soon as soon as it becomes expedient to say the opposite. He is not alone. The wellness industry is full of people who forget things. Wellsteps famously forgot they had claimed costs decreased before admitting they increased. McKesson got a nice write-up in Employee Benefit News after they forgot that they had already admitted employers gained weight when they claimed employees lost weight. Vitality is offering its weight loss services to employers, forgetting that they couldn’t get their own employees to lose weight.

Apparently Bravo is equally forgetful. In their online webinar on the forthcoming change to the EEOC regulations (in which their self-proclaimed “aha moment” that screenings will be a risky business starting in January lagged our identical aha moment by about 9 months), they made two observations towards the end that seem to contradict what they said near the beginning.

Near the beginning, they said — quite correctly — that you can’t hide alternatives to screening from employees. Alternatives “must be clearly communicated.”

And yet at Minute 38:00, they say:

Just tell employees the alternatives are available upon request… You can just say ‘contact us and we’ll give you one.’  Or ‘There’s other ways to earn the full incentive. Contact Bravo.’

“Contact Bravo”?

Why would an employee voluntarily want to contact an outfit that brags about how much they fine employees? Maybe this is just me, but it seems like making employees contact a wellness vendor to beg for an alternative would seem to directly contradict the rule that alternatives be clearly communicated.

At Minute 29, they declare that biometric screenings need very hefty incentives because:

You aren’t going to get behavior change for $200. The incentive has to be meaningful. Anything under $400, you’re giving people money for something they would have done anyway.

But later in the presentation, they presented their EEOC-compliant menu of wellness options. The proposed incentive for biometric screens? That very same $200.

They also forgot that “coaching” is not an EEOC-compliant activity. You can’t coach someone without asking them all sorts of personal health questions. Otherwise you’re left with the fallback advice: take more steps, buckle your seat belts, and eat more broccoli.

They called a comprehensive, well-designed study “industry noise,” forgetting that it was conducted by the National Bureau of Economic Research, a group which knows slightly more about economics (and, apparently, wellness) than Bravo does:

Most importantly, when they claimed (Minute 31) “a poorly designed program is absolutely something you should avoid,” they forgot their own program may be one of them. Perhaps they might explain how the following three observations are incorrect?

1. the literature is unanimous in saying there is no chance that checkups prevent cancer and yet they want employees to get annual checkups in order to have “fewer cases of cancer“
2. the US Preventive Services Task Force recommends against doing many of the tests they do (creatinine and thyroid levels being two examples)
3. their own results show no impact of their own program.

To the third point, here is a case study on their own website. They compared the usual active motivated incentivized participant group to a passive control group of employees that preferred to pay a large fine than have anything to do with these Bravo people. By Year 7, claims in the two groups were identical (the white line of the control group intersected the yellow line of the participants) despite the obvious study design bias favoring participants, a bias proven by the NBER.

Lest anyone think that study was an outlier, Graco’s published study showed the same thing. The green line (children, no exposure at all to wellness) trended better than the participants in blue. (For some reason spouses’ costs soared but they didn’t seem to express any concern about that.)

And when claiming that wellness generated a large increase in sales, they forgot that most of Graco’s sales growth was generated by an acquisition When they decided to call the baseline 2009, in order to show the biggest possible impact of wellness, they forgot the program actually started in 2008.

In the past, I’ve recommended that Bravo have their results reviewed by a smart person before publishing them.  Let’s qualify that: it should be a smart person with a good memory.