They Said What?

Home » 2018 » November

Monthly Archives: November 2018

To screen or not to screen: the most coherent answer ever

I am a mere supplicant at the feet of the true experts in the field of screening.

Linked here is the single most coherent article on the subject I’ve ever seen, just came out today. Basically, it says: “Screen according to guidelines.” That simple sentence is the source of a great battle pitting Quizzify and the Welligentsia against the Wellness Ignorati and most of the screening industry (excluding It Starts with Me, Limeade, and US Preventive Medicine, all of which offer screening programs more or less aligned with guidelines), whose livelihood depends on employers not screening employees according to guidelines, and finding some of the wackiest tests in the world to foist onto unsuspecting employees.

Highlights of the article:

  1. Many people are overscreened and massive numbers of people get tests they don’t need
  2. Many people are underscreened
  3. Do not purchase B-to-C screenings like Star Wellness, the subject of a recent profile here, offers.

Specifically as to the third point, they called out AngioScreen as an example of companies trying to circumvent doctors by offering inappropriate screenings. AngioScreen is unique in that right on their website they acknowledge that their entire business model is built on an a screen the US Preventive Services Task Force calls inappropriate.

They also list an outfit called Matrix Medical Network as an example of a company offering inappropriate screens. Matrix Medical Network…hmmm…where have I heard that name before…oh, that’s right! I founded Matrix Medical Network. (Actually, co-founded and was an original board member and investor. And, yes, unlike wellness vendors, irony is not lost on me. See “Ironically, the wellness industry does not understand irony.“)

One way or the other, this article is worth a read because it truly draws a thoughtful line between appropriate and inappropriate screenings.

 

 

Al Lewis unplugged, uncut, uncensored…and uncombed

Wellness, Quizzify, you name it. We cover it in this Youtube episode #13 of Friends of Benefits.

Thanks to Dave Contorno and Jeff Bernhard for hosting.

Star Wellness Doubles Down on Ignorance

Once in every great while, when we’re least expecting it, a company comes along that makes us reconsider our viewpoint–and ponder the possibility that maybe we’re wrong about wellness. Maybe, finally, we’ve discovered a company that will motivate employees to get well.  Maybe a company that adheres to screening guidelines.  Maybe even a company that will solve America’s healthcare crisis.

Star Wellness is not that company.


Below, you’ll find a partial list of the clinical goodies in Star Wellness’s hyperdiagnostic candy jar. Most of these tests would never be ordered on an asymptomatic patient by a doctor, but not to worry. In 47 states, you can actually purchase these tests directly from the Star’s lab, without some pesky doctor with some silly medical degree observing that it’s a bad idea to subject healthy people to a barrage of mostly US Preventive Services Task Force C-and-D-rated tests. Instead, you can get your results reviewed by one of Star’s highly qualified, thoroughly vetted, well-trained…franchisees:

Star is seeking franchisees with backgrounds in sales, finance or (and we are using a screenshot because we don’t want to be accused of making this up):

Five whole days? Oh, wait — “up to” five whole days. So maybe a really smart municipality administrator could cover all the material in four days. That leaves one extra day to snooker employers and harm employees.


Here is a partial list of their tests. I say “partial” because you can click through on the “general health profile” and find even more tests. And many of these tests themselves include more tests. For instance, a complete blood count has 6 and the “comprehensive thyroid panel” has 7. In total, you can get more than 40 blood values measured. If these tests are 90% accurate and you are completely normal, 4 (10%) of those tests could return a value that is out of range, just randomly.

When I say they “doubled down on ignorance” of the fact that you simply aren’t supposed to go around hunting for diseases, it’s because they used to do only about half as many useless tests as they do now. So they have literally doubled down on ignorance, vs. this original list:

Where to start? First, no licensed doctor should “typically order” these tests “during a routine physical,” at least if they want to keep that license. (Star can order them because wellness vendors aren’t doctors. They only play doctor, so they don’t need a license.)

Second, these tests are not “over $350 value,” for many reasons. Besides most of them being worthless or harmful, a “routine physical” doesn’t cost $350. Capitated doctors would go bankrupt ordering these tests.

Then there is “Lyme’s Disease.” News flash: it’s called “Lyme Disease.” No apostrophe. Just as they are confused about basically everything else involving wellness, they may be getting confused about the origin of the name, so I’ll clue them in. It’s named for the town where an epidemiologist identified it, not for a Yankee who died of it.

And if they have figured out how to accurately diagnose Lyme Disease, they deserve a Nobel Prize. Finally, no doctor would order a test for “Lyme’s Disease” as part of a routine physical.

The US Preventive Services Task Force doesn’t rate Lyme Disease screening because no one should be screened for Lyme Disease, and everyone other than Star Wellness knows that. (Yes, people who have been exposed to ticks or who have symptoms should be tested. But those are tests done as part of a diagnostic workup, not screens that employees are forced to undergo if they don’t want to be fined. Tests are done by doctors, not municipal administrators.)


H. pylori: The worst wellness screen ever?

First, the US Preventive Services Task Force doesn’t bother to grade it, largely because no self-respecting doctor would ever screen patients for this.  Shame on the USPSTF for consistently failing to anticipate all the ways in which wellness vendors can misunderstand basic clinical science!

Second, most of us who harbor H. pylori have no symptoms.  So why screen for something that’s not causing problems?  That’s the very stable genius of Star Wellness. By expanding tests to include panels of no clinical value whatsoever, Star Wellness can make more money, which will please them, and hyperdiagnose more employees, which will please their clients.

The fact that a real doctor would only test someone who has an actual reason to be tested explains why H. pylori is a test, not a screen.  If you have an ulcer or symptoms that suggest an ulcer, go to the doctor. Even then, the doctor probably won’t even bother to test you, since most people get relief simply from well-tolerated, commonly used pills like Zantac.  It is only if the first-line medications fail that most doctors will even test you.

Third, H. pylori may be beneficial.  Screening us to try to get rid of something we generally want in our bodies represents a new frontier in hyperdiagnosis.

Fourth — ironically, given the wellness industry’s obsession with employees’ weights — it is even possible that killing off H. Pylori contributes to weight gain.

Fifth, what exactly are we supposed to do, if it turns out we harbor H. pylori?  Get a course of antibiotics to clear the bacteria out of our system?  That makes sense.  We’ve always maintained that one of the problems with America’s healthcare system is that patients aren’t prescribed enough antibiotics. (Not.)

The good news for the pharmaceutical industry is due to the nature of H. pyroli, hiding in our stomach mucus, it takes a lot of antibiotics to ferret it out, plus a bunch of other pills.  Is this a great country or what?

Finally, half the world’s population has it.   Given the expense and inaccuracy of the test and the prevalence of the bacterium, why not eliminate the middle step and just put all your employees on antibiotics?


And now let’s play Jeopardy 

Answer: Along with everything else, this is a topic Star Wellness knows nothing about.

Question:

Their random number generator is slightly off: 222,000 people under age 45 do not suffer a stroke every year. For 18-to-44-year-olds, the actual statistic is 14,835.  And yet Star is convinced that the number should be 14 times higher, judging by their choice of punctuation mark! Let’s test their hypothesis that you can make an utterly false statement true by adding an exclamation point to see how well that works: “Star Wellness Is Run by Geniuses!”

No such luck. We’ll try a few more exclamation points below to see if we get a different result, which is very likely!

Since there are more than 50,000,000 adults under 45, you would need to screen 3000 employees to find one person who would have a stroke. If their test is 90% accurate (in their dreams), for every person they find who needs to go to the doctor to prevent this stroke, 300 (10% of 3000 — the false positive rate is the inverse of the accuracy rate) would be sent to the doctor for no reason to potentially have their arteries reamed out or some such thing. And the only way that guarantees that you’ll prevent a stroke is if the treatment kills the employee first.

That is exactly why you shouldn’t be going around screening people for this stuff — especially people under age 45.


Let’s teach Star Wellness how to do their job

Take a looksee at this illustration of a Star Wellness health fair. I’m sure this picture will appeal to every employee!

Sal, Wyoming’s not a country.

Star Wellness, Vitamin B12 is not a vaccine.

And why any employer would want to go around poking employees with syringes full of vitamins would be a mystery to most doctors. But Star Wellness franchisees are way smarter than any doctor!

At least when it comes to knowing how to administer a municipality.

Yes, yes, of course: the Penske file

When it comes to wellness, the unwillingness of senior HR executives to search the internet continues to boggle my mind. As a result, Penske Automotive’s Executive VP of Human Resources somehow missed two of the most widely circulated memos of the last five years:

  1. Annual checkups provide no net benefit for most working-age people and are a total waste of money;
  2. As of January 2019, you can’t force employees to get them by tying them to large incentives or penalties.

As to the first, I will give him credit for one thing. He says: “We know that when you see a doctor, eye to eye every year, it has an impact.” Darn tootin’ it does — an immediate 2-3% increase in your health spending.

Later he says: “It’s too soon to see results of decreased costs to the company from the initiative.” Ya think? This is like the Comptroller of the state of Connecticut saying that, yes, of course costs went up when they made employees get physicals, but higher healthcare costs are “a good thing.”


More on The Penske File.

Having seen no savings, Penske’s EVP decided to take the obvious next step, the step that every executive takes once a wellness initiative has been shown to be a complete failure just like the literature predicts: roll the program out to more people. In Penske’s case, that would be spouses and domestic partners.

He added: “We are going to see over time our health care costs decrease… We may not see it this year or next year, but we’ll see it over time for sure.”

Start the wait…

Any sign of savings yet?

 

 

 

 

 

Ron Goetzel Spins Gold into Straw, Part 2 (a semi-guest post by Bob Merberg)

First, congratulations to Joe Andelin, who caught just about every fallacy, alternative fact and, if there were such a thing, alternative fallacy in yesterday’s presentation. I know he did because I was on the call.

Wait, Al, didn’t you say they blocked you? 

Yes, but displaying the same level of competence that they routinely bring to their day jobs, they managed to block only my video, not my audio.


Here were our predictions we got on the nose. We predicted he would say:-

  1. The study only covered the first year — he won’t mention that the authors also said the first year suggests nothing “is trending towards savings” in future years either;
  2. He said he study contradicts many of the other findings out there — except, of course, for all the other studies testing the par-vs-non-par study design against a benchmark, all of which showed results quite literally identical to the University of Illinois result, in that the wellness program accomplished zero;
  3. It wasn’t a good program. To hear Ron tell it (literally hear him tell it — you can listen to the tape), anytime a program fails, it’s because it wasn’t done correctly. “100 employers [have] programs with really smart ingredients…but thousands of others still don’t do wellness right,” are his exact words in print.  He is refusing to name any of them, other than the old Johnson & Johnson analysis. (J&J is a wellness vendor. Investigator bias, anyone?)

The last is his go-to excuse. He said the University of Illinois program, which consisted of screenings and incentives to use the gym, was a “throwback to the 1980s.”  In reality, the program was a “throwback” to every single Koop Award-winning program, all of which feature “pry, poke and prod” programs and some kind of fitness incentive. The only thing missing from this program was the broccoli.


I was wondering where to go with the rest of this posting but then into my comments box popped my old friend Bob Merberg, who is perhaps the smartest person I have ever met on the subject of wellness outcomes measurement. His comments are better than anything I could have written (assuming I had been allowed to see the slides).  Here they are in their entirety:

Al, I’m not usually one to comment on other people’s blog posts, and certainly not one to promote my own content, but I attended the webinar and found the conclusions drawn by the presenters to be egregious. One of the presenters correctly pointed out that subjects in the treatment group were, “More likely to report that the employer values worker health and safety.”

But then — bizarrely — he went on to say, “In other words, … people felt more engaged, and had better morale, and had better feelings of satisfaction working for the employer by being in the treatment group. In my mind, the headline ought to be ‘Wellness Program Increases Employee Engagement and Morale’ as opposed to ’37 Things We Didn’t Find Any Difference In.‘” Another presenter termed this the key finding.

But feeling like your health and safety are valued, while important, is by no means a the same as morale, engagement, or job satisfaction. In fact, the study did not measure morale or employee engagement. It did measure job satisfaction, self-reported “bad emotional health,” and changes in happiness at work, and found that the intervention group experienced no significant improvement compared to the control group.

If we were to jump to any conclusions from this study, they might be that feeling valued are NOT linked to job satisfaction and other psychosocial metrics.

To promulgate that the “key finding” was improved morale, improved employee engagement, and improved job satisfaction, is at best a sign of failure to understand the study, and at worst a deception. Under any circumstances, it’s a disservice to the study subjects who presumably consented to participate in good faith science, to the researchers — who were meticulous in their methodology and transparency — and to those of us in the wellness industry who are more interested in understanding what works rather than distorting facts to serve our own self-interest.


But wait…there’s more.

More in my blog post: https://www.linkedin.com/pulse/employee-wellness-truth-isnt-true-bob-merberg/

Mostly for fun, a time-lapsed video of my research and writing process on this subject: https://youtu.be/hQ6HqkN-VPw

 

Wellness News Roundup: Are Diabetes Management Vendors Doing the Wrong Thing?

Should a typical diabetic employees be incentivized to get his or her Hba1c down to 7?

Should copays on strips be waived to encourage diabetic employees to test their blood sugar every day?

Read this issue of Wellness News Roundup for the surprising new research.

Also in this issue: this will come as a big shock but it turns out — get ready — employees are not health literate.

 

 

Ron Goetzel Spins Gold into Straw, Part 1

I would invite everyone to join tomorrow (Tuesday’s) webinar by Ron Goetzel. He will be attempting to undermine the National Bureau of Economic Research’s (NBER) outstanding University of Illinois study, which showed — surprise — that conventional wellness programs don’t come close to changing behavior, let alone saving money. I would love to attend, but I, of course, am not invited to his events any more than he is invited to mine. Oh, wait a sec, I invite him to all my events and alert him to all my postings on linkedin so that he can correct any errors I’ve made. Sorry, my memory failed me there for a second.

Speaking of failed memories, he is being joined on this webinar by Jessica Grossmeier. If that name rings a bill, it’s because she claimed her company, Staywell, saved $17,000 per risk factor reduced — about $3000/pound shed — for British Petroleum, having forgotten that she herself claimed it is only possible to save $105/avoided risk factor. See “British Petroleum Wellness Program is Spewing Invalidity.”

Despite this being the Gold Standard of randomized control trials, he will be accusing the NBER of many errors.  (A cynic might note that being accused of making errors in a wellness study by Ron Goetzel is like being accused of cheating on your taxes by Paul Manafort. ) He will argue that:

  1. The study only covered the first year — he won’t mention that the authors also said the first year suggests nothing “is trending towards savings” in future years either;
  2. The study contradicts — you guessed it — Kate Baicker’s infamous 3.27-to-1 ROI, without mentioning that the NBER’s principal investigator, as coincidence would have it, reports to Kate Baicker, so it’s pretty unlikely he would diss her unless the data left him no choice;
  3. The study contradicts all the other findings out there — except for all the other studies testing the par-vs-non-par study design against a benchmark, all of which showed results quite literally identical to the University of Illinois result, in that the wellness program accomplished zero;*
  4. The participants outperformed the non-participants;
  5. They haven’t reported on the screening yet;
  6. It wasn’t a good program. To hear Ron tell it (literally hear him tell it — you can listen to the tape), anytime a program fails, it’s because it wasn’t done correctly. “100 employers [have] programs with really smart ingredients…but thousands of others still don’t do wellness right,” are his exact words in print.  He is refusing to name any of them, other than the old Johnson & Johnson analysis. (J&J is a wellness vendor. Investigator bias, anyone?)

What else will he argue? Tough to say. One thing for certain: he won’t mention my name — any more than Bravo did when they wrongly predicted that the EEOC rules would be replaced in January while I predicted the opposite.  Instead he uses a new vernacular for my postings:  “Industry chatter.”

He probably picked up this idea from Bravo, which uses the phrase “industry noise” to describe me.

 


Where’s Waldo-meets-Ron Goetzel: Spot the errors and you may win a big prize

So let’s make this interesting. Whoever comes up with the best smackdown of the webinar’s obvious fallacies (and omissions) automatically gets entered in the contest to win the Martha’s Vineyard vacation, with the house, car and private (well, semi-private) beach. It is otherwise open only to people who have won various Quizzify trivia contests, but being able to identify five or ten pieces of “chatter” or “noise” in this self-anointed “expert webinar” clearly counts as being health-literate.  To compete, send me an email with an attachment. I’ll pick a couple of finalists and put them on linkedin. (If you don’t want your name used — and Ron does bite back, so I don’t blame you — I will post on my own.)


*The result is also quite consistent with Ron’s observation that there is basically no change in behavior leading to risk reduction. If we are splitting hairs here, Ron found a 1-2% reduction, not 0%. Of course, that took three years.

 

 

 

 

A vendor’s guide to snookering self-insured employers

Dear Wellness, Diabetes, Clinic, Price Transparency, and Medication Therapy Management Vendors,

While most of you already know the majority of these tricks, there might be a few you haven’t deployed yet. So take good notes.

Sincerely,

Al Lewis

PS If you are an employer, just pass this along to your vendors…and watch your savings skyrocket. Or use “An Employer’s Guide to NOT being snookered” to see your savings become realistic.


Best practices for every vendor

Compare participants to non-participants. Using non-participants as a control for participants allows you to show massive savings without doing anything. This is not an overstatement. Here is a program — which naturally won an award for its brilliance from Ron Goetzel and his friends before I observed that they were a fraud according to their own data– that did just that. They separated participants from non-participants but didn’t bother to implement a program for two years—by which point the participants had already improved by 20% vs. the non-participants — without even having a program to participate in. (Note on this slide that the control and study group were set up in 2004 but the program didn’t start until 2006, when the cost separation had already reached the aforementioned 20%.)

Two other observational trials support this conclusion. Most recently, the National Bureau of Economic Research ran a controlled trial to test exactly this hypothesis. Sure enough, like the three observational trials, they found that virtually the entire outcome in wellness can be explained by that popular study design itself, rather than the intervention.

In any participation-based program, ignore dropouts. Assume that employees who drop out do so randomly, not because they are discouraged by their lack of progress or interest.

Draw a line upwards and then claim credit for the “savings” between the actual upward spending and the “trend” you drew. As Optum’s Seth Serxner stated so succinctly: “We can conclude that the choice of trend has a large impact on estimates of financial savings.”

Start with the ridiculously high utilizers, high-risk people, or people taking lots of drugs. Let the group regress to the mean, and then claim that as savings.

Never admit, like Wellsteps did, that you are familiar with regression to the mean, since most employers are not aware of it.  The higher the costs/risks of the original users, the more savings you can claim. Here are two verbatim claims:

  • A heavy equipment manufacturer found high use of the ER was a becoming a cost concern, so it send mailings that showed appropriate care settings to the homes of members with two or more visits to the ER in the past year. As a result, ER visits were down 59 percent those who got the mailing.
  • A pharmaceutical company saw a spike in ER claims was coming from repeated use by the same people, so two mailers were sent: one to households with one ER visit in the past year; another for those with two or more visits. Following the mailings, there was a 63 percent drop in ER visits.

Pretend not to notice that low utilizers can show an increase in utilization — or especially that low-risk people can increase in risk. Focus the mark (I mean, the customer) on the high-risk people who decline in risk. Never draw graphs to scale, or your customer might notice that 2/3 of their employees are low-risk in the first place.

Cigna chart

It doesn’t matter what your intervention is. Claim credit for the entire difference in trend. For instance, in this example, Community Care of North Carolina claimed credit for a huge reduction in PMPM costs for babies for their medical home program…but babies weren’t even included in the program. (Neonatal expenses didn’t decline either.)

Or do what Safeway did, launching the wellness craze: change to a high-deductible plan, and transfer a large chunk of costs to employees. Don’t even bother to institute a wellness program, but attribute all the savings (from the transferred deductible spending) to wellness anyway, so that you get invited to the White House.  And after that blows up on you, demonstrate that your very stable genius investment in wellness was not a fluke by investing your company’s money in Theranos.


Special Instructions for transparency tool vendors

Assume that every employee who uses your tool is looking to save their bosses some money, rather than (for instance) to find the closest MRI…and that none of them would have used a lower-cost venue absent your tool.

If only 10% of employees use your transparency tool, and only 10% of events are shoppable, nonetheless take credit for the entire difference in trend across the board, and ignore the literature showing online price-comparison tools don’t work.

If people who haven’t met their deductible shop more than people who have, attribute the former’s lower cost to use of the tool, rather than to the fact that by definition people who don’t meet their deductible spend less than people who blow through it.


Special instructions for wellness and diabetes vendors

If you are a wellness or diabetes prevention/management vendor, never ever let employers know that every year since statistics have been kept, fewer than 1 in 1000 employees/dependents end up in the hospital with diabetes.  (And another 1 in 1000 with a heart attack.) Always tell them how many employees are at risk and how many “newly discovered conditions” they have, and how they will all end up in the hospital, even though hospitalizations for heart attacks and diabetes in the employer-insured population have been declining for years.

Wellness vendors should always put the trivial percentage reduction in risk (for participants only, of course – and ignoring dropouts) on one page and the massive savings on another page. Most employers won’t bother to do the math to notice, for example, that Interactive Health claimed $50,000 in savings for every employee who reduced one risk factor, while the state of Nebraska won an award for claiming to save $20,000+ for every risk factor reduced, as did Staywell for British Petroleum.

If you didn’t reduce risk factors, present your outcomes in a format no one can make heads or tails of, like this one, from Wellsteps. If Wellsteps was able to snooker an entire committee of self-anointed outcomes experts to win an award for program excellence, surely you can snooker a few customers.

Claiming people lose weight is a big part of your outcome reporting, so make sure to do the following:

  1. Never count nonparticipants, and ignore dropouts.
  2. Don’t do any long-term follow-up to see who regained the weight (most participants)
  3. Give them time to binge before the initial weigh-in

Special instructions for diabetes vendors

In addition to measuring on active participants only, raise the bar for Hb A1c so that only people with high Hb A1c’s can be included. That belt-and-suspenders approach will ensure that you can’t fail to show savings, even if (as is likely the case) you don’t change anyone’s behavior other than the employees who were going to change anyway, which you might as well count.

Next — most diabetes vendors and a few wellness vendors have already figured this out — you can charge much more if you can submit claims, rather than just be an admin expense line item. You see, most employers focus much more on the 10% admin expense than they do the 90% medical expense, which they consider to be beyond their control.  Your claims expense – which would draw attention to itself as an admin cost — won’t get noticed in the 90% of medical losses, sort of like the dirt from the tunnel sprinkled around the Stalag in The Great Escape.


Special instructions for medication therapy management vendors

Only mention “gaps in care” that you close, not the ones that open up. And, as noted in the chart below, always use percentages. So in this chart (provided by one of the major PBMs), they claimed that twice as many gaps were closed (37%) vs opened (18%), and yet, as is almost always the case with MTM vendors, nothing happened to the total number of gaps, which remained at exactly 820:

 

Tally all the employees who were on large numbers of meds and now take fewer. But don’t mention all the employers who were on fewer meds and now take more.


What to do if you’re asked why you aren’t validated by the Validation Institute

Here are the most popular answers to that question:

  1. No one has asked us to. (Quizzify didn’t need to be asked.)
  2. We hired our own outside actuarial firm to validate us, and they concluded we save a lot of money.
  3. Sure, we’ll get validated as soon as you sign the contract with us.

 

Wellsteps stumbles into the truth

Seems like half our postings involve three vendors. These three very stable vendors — Interactive Health, Bravo and Wellsteps — constitute the wellness industry’s “Axis of Genius.”


 

In a recent video that we urge everyone to watch, Steve Aldana of Wellsteps (proud recipient of the 2016 Deplorables Award) recently admitted that “wellness is the most researched topic in healthcare.”

He is absolutely right about that. There are dozens of studies showing that wellness loses money and often harms employees.

And he would know because he has produced a ream of research showing that Wellsteps’ very own program is arguably the worst program on the planet. I say “arguably” because Wellsteps’ Boise program may not be the worst program on the planet. It is only the worst program on the planet according to its own documented findings.  I never thought I would say this, but I applaud Mr. Aldana! His willingness to tell the truth is admirable.

Funny thing about the wellness industry. Every other industry’s “research” always make their product look good. For years, cigarettes were safe–according to the tobacco industry. The oil and gas industry often publishes research showing there is no global warming.  And Monsanto executives are probably the only people on earth who think Agent Orange is harmless.

Sure, critics can and do “challenge the data” those other trade groups publish, but to the credit of those organizations, at least they don’t accidentally disprove their own message in their own “findings.”

Quite the opposite in wellness. About 40 seconds in, Mr. Aldana says: “Critics of the wellness industry say that the studies are flawed.” No, Mr. Aldana, we are not accusing you of being “flawed,” or even of lying. We are accusing you of telling the truth, for once. The wellness industry is unique in that its own data is its own worst enemy.  Remember the 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.”

While he showed great integrity by reporting the Boise outcomes accurately (and even exposed his results to a wider audience, albeit under duress), that display of integrity turns out to be out of character. Alternative fact-tellers need to have long memories, and his is apparently quite short. When he first reported the financial results, he made the impossible claim that Boise’s healthcare costs fell by a third, due to his forced wellness program even though flouting clinical guidelines and giving out questionable advice also caused a 20% increase in risk factors:

But his report was so long that by the time he got to the end of it, he had completely forgotten this alleged savings claim…and accidentally admitted costs actually increased. (He later suppressed the latter finding, but I always anticipate cover-ups by wellness vendors so I take screenshots before posting anything. It’s been said that the beginning of the end of “pry, poke and prod” was the day a millennial taught me how to capture a screenshot.)


Yes, you might note, the participants did marginally better than the non-participants (though the latter seem to have the momentum). And that brings us to his next claim in the video, where he laments the lack of randomized clinical trials. Actually, there have been two, the most recent one highlighted in the New York Times recently.  And, yes, of course, they show “pry, poke and prod” has no impact. The NYT article specifically demonstrated that participants-vs-non-participants is an invalid methodology that will always show savings even if nothing happens.  A vendor called Newtopia also did an RCT…and showed the same thing. 100% of savings was caused by the act of separating the two groups based on motivation…and when you re-combined them, there was no savings.

The wellness trade magazine had also previously admitted this, though as noted Mr. Aldana has a short memory.

Mr. Aldana closes by claiming that if I am right about wellness losing money, then all these CEOs and CFOs who still think it saves money are “idiots.”  Well, if he says so. And this is not the first time he has dissed his own clients. When he was caught flouting clinical guidelines, he claimed his customer made him do it.

This statement — that “we must be right or else we would have been outed before” — is akin to Paul Manafort’s original defense to tax fraud charges: “If he was committing such large-scale fraud, why didn’t the IRS audit him?” Manafort’s attorney quickly backed off that defense. Like Paul Manafort and the IRS, the only thing that a company still using one of these vendors in the “Axis of Genius” proves is that the wellness industry excels in snookering them.

Please feel free to email a colleague about Mr Aldana. Not because we are asking you to, but because he is:

 

<span>%d</span> bloggers like this: