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Monthly Archives: January 2019

Webinar on using the HCUP database

You probably have no idea what HCUP is.  But I can tell you it’s a great (free) tool for benchmarking vendor claims against reality.

If you want to know where I get the information needed to prove that wellness outcomes are made up and hence can offer a $3 million reward to anyone who can show I’m wrong, it’s here.

I will be giving a webinar on this topic Friday January 25th at 11 AM EST.  It will cover what HCUP is, how I’ve used it…and most importantly, how you can use it. We’ll do training with screenshares and lots of Q&A.

To sign up, click through here.  There is a brief registration form and then later today you’ll get the formal invitation with the dial-in information.





Breaking, shocking news: employees cheat in wellness programs

Do employees cheat in outcomes-based wellness programs? Of course not.  Who would ever gain weight in order to be paid to lose it? That would be dishonest and unhealthy.

Haha, good one, Al.

Yes, obviously employees cheat in outcomes-based wellness programs and crash-dieting contests. But here are two things that aren’t so obvious:

  1. Cheating is far more widespread than employers would like to believe;
  2. This massive scale of cheating — two-thirds of all employees cheat in wellness — is well-known but suppressed by self-proclaimed “scientists” in the field, whose livelihoods would be in jeopardy if they acknowledged the scale of the cheating.

Cheating is widespread

How do we know this? Bloggers receive data from WordPress on hits for each post. Not just the number of hits, but the specific sources of the click-throughs — other bloggers or else “search engines.”

In any given week, the current posts and the home pages get the most hits. However, for the year as a whole, it’s a different picture. Take a looksee at our total hits for 2018:

Our typical blog post — not including home pages and related pages — gets about 2500 hits over the course of the year in which it is posted. But you’ll see that #3 on the 2018 list is: “How to cheat in a corporate weight-loss contest.”  Almost every day that particular post racks up 15-25 hits, giving it 6388 for 2018. I used to assume that some other, more popular, blog was linking to it, but I can see linked blogs too on the Site Stats page, and there weren’t any.

Here are the 2019 stats through yesterday.. A new cycle of wellness programs and crash-dieting contests is about to start, so despite New Years week being a very slow week for TSW (like other HR blogs), that post is #1:

Further, even though these stats are 2018 and 2019, this blog was posted November 2016.`

What is driving this continuing popularity?

It turns out that the source of these click-throughs is indeed “search engines.”  Seems that even though the target audience for this posting was the narrow HR/benefits community, employees themselves are googling on “cheating in wellness programs” and finding this post right on the first page of hits:

That also explains how we could get so many hits and yet so few comments and Facebook reposts. No one wants to be caught.

You might say: “That’s only 6,388 employees for a full year. The rest are honest.” Nice try, but consider:

  1. “Only 6,388 employees” clicked through despite noting from the first lines (as you can see) that this article really wasn’t a guide to cheating.
  2. This post is way down at the bottom of the front page.
  3. This was only a single year — 2018 — and the 2019 rate arithmetically projects to about 20,000 hits (though much of this posting’s hits are seasonal)
  4. The #2 source of click-throughs to this article is Slate’s masterful expose called Workplace Wellness Programs are a Sham, also on the first page of google hits above, which itself links to us–meaning that employees are also clicking through on that article in the same search.
  5. The 6,388 excludes the gazillion employees who don’t need to google anything in order to realize that the winning strategy in any outcomes-based wellness program or crash-dieting contest is to binge before the initial weigh-in and crash-diet before the final one — and of course lie on the risk assessment.
  6. The keywords that drive traffic to this site, according to Alexa? #3 — after Bravo and Wellsteps, two vendors who are “in the news” constantly — is “Healthywage Cheating.” Healthywage is the leading crash-dieting contest vendor.


The scale of cheating…and the suppression of the evidence by the wellness industry

Employees who don’t drink, smoke, use drugs, or occasionally indulge in foods other than broccoli and kelp have no need to cheat. They will also derive no benefit from wellness programs and employers will save no money on them, not even any make-believe savings that wellness vendors routinely claim. It is estimated that only 3% of people do everything right, health-wise. That mean the pool of potential cheaters is 97%.

How many of the potential cheaters are actually cheating? Review your own statistics yourself. 70% of employees drink, including 10% who drink more than 30 drinks a week. How many of your employees indicated on their HRA that they drink that much? Zero, you say? What a coincidence! That’s what all the other employer-administered HRAs conclude as well.

How many employees admitted drinking at all? If you said 20%, that would match the number claimed by Wellsteps for their award-winning program. That means slightly more than 2/3 of all drinkers — half your employees — are lying. Not because they’re inherently dishonest, but because you are basically asking them to lie in order to stay out of trouble. What kind of trouble? Wellsteps called consumption of any alcohol a “worst health behavior,” shaming employees who admitted to even occasional social drinking. Nonetheless they fully accepted as fact the 20% drinking rate statistic.

By encouraging all this lying, Wellsteps helped this employer, the Boise School District, create a culture of deceit instead of a culture of health. Kudos.

Now consider smoking. For that we turn to the industry’s leading source of alternative facts, Ron Goetzel. He “found” that for the years 2012-2014, 5.5% of his surveyed workers smoked, overlooking the statistical 12.3% of employees — roughly 2/3 of all smokers — who lied. Yet, like Wellsteps with the drinking, Mr. Goetzel presented this statistically impossible 5.5% as fact.

It’s not a coincidence that roughly the same proportion of smokers and drinkers lie. Nor is it a coincidence that these two “scientists,” as they call themselves, decided not to disclose the lies. Since they claim to be “among the most credible and conscientious scientists and practitioners working in corporate wellness today,” this is much more likely to be a deliberate omission than a rookie mistake, especially since I’ve informed them of this disparity and many other obvious misstatements many times and they usually just doubled down.

Admitting that their data is basically worthless means their entire conclusions are basically invalid, which in turn means that outcomes-based wellness itself is a fraud, which by the way it is

Lying to employers about personal behaviors is human nature. Most employees don’t want to disclose potentially damaging information, and think, quite justifiably, that if they give their employer 100% during working hours, their off-hours behavior is none of their employer’s business.

How can cheating in wellness be prevented?

For those two studies, Mr. Goetzel and Wellsteps were only encouraging employees to lie to their employers and cheat on the programs. The majority of employees responded predictably. By contrast, when you run an outcomes-based wellness program with large fines, or hold annual crash-dieting contests, you’re not just encouraging employees to lie and cheat. You’re practically begging your employees to lie and cheat. In crash-dieting contests, employees form teams, and strategize on how to binge and then crash-diet, allowing them to lose far more weight in 8-16 weeks than is healthy. Any team not intending to cheat wouldn’t even bother to compete. Teams that do want to compete will visit websites teaching them how to cheat, and which appetite suppressants and weight-loss pills to buy in order to win.

Wouldn’t it be great if there were a wellness vendor which, instead of denying human nature about cheating, channeled it? Instead of bragging about ferreting out “fraudulent participants,” made cheating part of the fun?  There’s a word for that, and it’s not “impossible.” It’s “Quizzify.” Employees can rack up points for correct answers…and they are encouraged to look them up before selecting their response from the multiple-choice list. That way they are more likely to remember them.

And, unlike “how to cheat in wellness,” if you google on “How to cheat on Quizzify,” you won’t find any advice on cheating — other than Quizzify’s own rules urging employees to do exactly that.

Time to vote for the best comment on employee health literacy in Martha’s Vineyard contest

Dear TheySaidWhat Nation,

OK, so you didn’t win a Quizzify health-and-wellness trivia contest in 2018, so you aren’t going to be vacationing on Martha’s Vineyard this summer (at least, not on my nickel).

However, you can still vote on other people’s comments on the importance of employee health literacy and help one of them win the trip. Comments to their comments earn 3 points and likes to their comments earn one point.

Here are some samples:

As a physician, myself, I believe patients would be astounded how many decisions most doctors make based upon their own experience (aka anecdote) rather than controlled, well-designed scientific study. Worse yet, a health illiterate consumer risks their own life like the 51 year-old man in the 2017 article, “When Evidence Says No, But Doctors Say Yes” by writer David Epstein. In smaller but daily health interactions, patients abdicate important decisions about the medications and treatments they choose without understanding ‘number needed to treat’ vs. ‘number needed to harm’ statistics.

I understand how uncomfortable it can be to be a skeptical consumer especially when there is a large asymmetry in the level of knowledge between the provider and patient.  Personally, I spend more time teaching my patients about their conditions than operating on them and additionally  I applaud any and all efforts that individuals, employers, and third parties take to educate themselves in my domain.   I propose that there is no fix, there is no marketplace, there is no way to sustainably reduce cost and improve care until utilizers of healthcare take ownership of their own health and health literacy.

An educated patient, able to participate in decision making, is leading to cost reduction in medical service , to a more efficient  and sustainable healing act for the patients.

Several sound more like me than I do:

I am going to answer from a personal, not professional perspective. Growing up, my family and myself worked for doctors and hospitals, but were not trained medical professionals. With that background, I learned that most people took medical professionals at face value, giving them Total Control over health care decisions, rarely if ever questioning whether they needed a test, surgery, medicine, etc. Thankfully, my perspective was that they were people just like us with faults, and mistakes. I never learned to take at face value and have questioned these professionals at every opportunity. Unfortunately, I think I am the exception, not the rule.

Only by educating people on the ability to question, challenge, ask for another opinion, can we hope to change the direction of health care, and put the patient at the forefront. with the advent of HSA’s and HDHP’s we are asking patients to make critical care decisions, without the tools to do so.


Imagine being dropped in a foreign country with no fluency in the language, culture, or environment around you. And your very livelihood depends on how you navigate. This is what millions of Americans are faced with when stepping foot inside the healthcare system. They start with little to no knowledge on what just might be one of the costliest trips of their lifetime. That’s why proactive employee education – literacy – is a key fix. We (advisors and employers) must empower employees for the trip so they don’t get lost; physically or financially. The reality is that care providers are relied upon almost entirely for the journey. That solely makes the provider and the patient vulnerable to the abuses of unnecessary diagnoses, treatments and costs. To improve employees’ knowledge of how to use healthcare while also how to avoid having to use it by being healthier is to make them fluent. That will be an integral part of solving the problems that plague American healthcare.

One contestant is even tugging at the heartstrings of potential voters by adding a picture of his dog. I don’t know which I am more impressed by: his campaign strategy or his knowing how to add a picture to a linkedin comment:

While healthcare can be frustrating and slow to change, there is hope. Health literacy, especially with Quizzify, is fun, awesome, something we all need regular doses of.  Puppies are great too. Puppies and health literacy, both apolitical but totally cool. This is Musti (MOO-sti. It means “blacky” in Finnish).

Many share personal perspectives as well as professional ones:

Does Health Literacy Matter?  To me it does. I find that as a health insurance broker and as an advocate of my own family it is just as important to understand basic information as it is to find a way to implement this knowledge.  As a health insurance broker, I find myself hearing from mothers and caretakers stating that they find themselves at doctor’s offices making life changing decisions for their family in a split second with little to no time to research.  Most consumers value and lean on healthcare providers to have the most up to date resources at hand and it has been shown in study after study that lack of health literacy results in poor health outcomes for patients and a source of shame and confusion for their caregiver.

Once again, to vote, read the article and look for the brief essays (comments) that you like, and re-comment or share or like.

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