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Interactive Health gives clueless wellness vendors a bad name

Someone suggested that I call my Congressman to pass a law against Interactive Health, but I think the Justice Department is the more appropriate route. No, not because they’re harming employees — there is no law against employers harming employees in the name of wellness. Quite the contrary, the most recent Koop Award went to a vendor, Wellsteps, which did exactly that.

Rather, I would propose an antitrust action, because Interactive Health is attempting to create a monopoly on stupidity.

Yes, it seems like hardly a day goes by without the irresistible force of Interactive Health’s corporate IQ colliding with the immovable object of reality.  The thing is, their moles pop up faster than I can whack them on Linkedin, so here is a tasting menu of their greatest hits. You can’t find most of these observations on Linkedin for the simple reason that they delete them.

This was originally going to be a comprehensive retrospective of all their nonsense (Exhibit A for the Grand Jury to review), but in the two weeks since I started writing it, yet another mole popped up. This one could top the list if not for their “smoking recession program.”

  • An analysis of 2017 member data revealed that those clients who test all employees for Hemoglobin A1c identified up to 3 times more individuals at risk for pre-diabetes versus other testing. As a result, inclusion of Hemoglobin A1c testing for all employees is often a strategic recommendation for our clients. 

Since pre-diabetes is a risk factor for diabetes (and only a fraction of pre-diabetics become diabetic, after 5 to 10 years), they are hunting for employees who are “at risk for being at risk.” Who amongst us is not at risk being at risk for something? But that doesn’t mean they’ll end up with diabetes, any more than every kid who steals a cookie from a cookie jar becomes a bank robber — even if every bank robber did in fact at some point in their childhood steal a cookie from a cookie jar.

Using testing guidelines so contrary to the US Preventive Services Task Force that a beam of light leaving USPSTF guidelines wouldn’t reach them for several seconds, Interactive Health takes great pride in “identifying 3 times more individuals” than companies that test employees according to guidelines. Cue Inspector Louis Renault: “Owing to the seriousness of this crime, we are rounding up twice the number of usual suspects.”

One might be excused for assuming that the point of screening would be to “round up” the most appropriate employees, rather than the largest number of employees. One might also be excused for thinking Interactive Health is simply stupid, when in reality they are fully aware they violate guidelines, recognizing that their typical customer doesn’t realize this and is willing to, in the immortal words of that great philosopher the Queen of Hearts, believe six impossible things before breakfast.

Image result for queen of hearts alice in wonderland

in case anyone else is interested — we know Interactive Health isn’t — the USPSTF recommends screening only overweight/obese 40-to-70-year-olds for HbA1c. That’s to prevent exactly the kind of hyperdiagnostic employee harassment that comprises Interactive Health’s signature strategy: more tests = more revenues. They make Wellsteps look like an honest, intelligent vendor, which is no easy feat.

We also thought of contacting the Health Enhancement Research Organization (HERO), to let them know there was a vendor making the industry look bad (or look even worse), but it turns out that for HERO, cluelessness is a feature, not a bug.  Specifically, HERO has highlighted a case study by Interactive Health, which would be like Bernie Madoff highlighting his investment in Enron.


Update. Alas, I’m afraid there won’t be an investigation into their stupidity. At this point, they are so far ahead in the race to the bottom that it would be impossible to empanel a jury of their peers.

 

 

Podcast: Where wellness went wrong…and how to fix it

Dear TheySaidWhat Nation,

Here is our most recent podcast, courtesy of Insurance Thought Leadership.

Summarized as follows:

  1. Conventional “pry, poke and prod” wellness has failed
  2. Trying to morph those 3P programs into “Wellness 2.0” will also fail, largely because you can’t spin straw into gold no matter how hard you try
  3. However, wellness done FOR employees instead of TO employees, like Quizzify, is a welcome addition at most workforces.*
  4. You can’t do that with the same vendors who created 3P programs any more than you’d hire former East German border guards as tour guides.

Al

*That was not clear in the podcast. See the comment below and my apology.

Better sleeping through chemistry?

The wellness industry is now synonymous enough with epic fails to make a thesaurus writer blush.

11 in a row at last count, as this article documents. Money lost, risk factors increasing. Even employees getting fatter. And in case you haven’t already seen it, an expose of the wellness industry comprehensive enough that if you intend to read it, you better clear your calendar.

What’s even worse than their sins of commission are their sins of omission. While they can kill millions of electrons on the subject of broccoli, try finding even a few words in any HRA about opioids. Quizzify was first on the scene with an opioids awareness quiz 2 years ago, and even today the wellness industry is pretty much ignoring that particular elephant in the room.


It turns out that they are ignoring not just that elephant, but the entire herd. (In case anybody is keeping score at home — still trying to be the first person to find a mistake in my 500,000 words — a group of elephants can be called a “herd,” though “parade” is the more technical term.)

For example, tens of millions of people — including some of your own employees, statistically speaking, and also including me — rely on medicinal sleep aids nightly. There are so many things employees need to know about those pills that the sleeping-pill entry in Quizzify’s “Six Things Employees Should Know About…” blog series contains seven things.

Here are a few tidbits on the most popular sleep aid:

  1. 115 OTC drugs, typically the ones labeled with a seemingly harmless “PM” on a well-known brand, like “Advil PM” or “Tylenol PM” or “ZZZ-Quil,” contain benadryl;
  2. Nightly use of benadryl is pretty clearly linked to dementia. That doesn’t mean regular users will get it, just that their odds go up;
  3. Nightly use of benadryl also creates a dependence (a “dependence” is like “addiction-light”), just like other sleeping pills, but because these drugs don’t look like sleeping pills, employees aren’t aware of this risk.

There is probably no point in saying this, since I find whenever I offer advice to wellness vendors they tend to double down on the opposite. Nonetheless, here goes:  please urge your wellness vendor to start focusing on useful advice. Yes, we get it about the broccoli.


Here is the link.

 

 

 

New research: Why wellness programs make some employees fatter

All this time, I just thought that:

  1. employees got worse in wellness programs because
  2. wellness vendors, especially their CEOs, are stupid. (“In wellness, stupid is the new broccoli.”)

Here’s an example that would seem to fit the hypothesis like a glove:

  1. Wellsteps caused employee health to seriously deteriorate and
  2. their CEO needed to spend “11 years in college.” That’s four more than Bluto Blutarski (though I think Mr. Aldana did at least manage to graduate, possibly without even throwing up on the dean). Yet when he accused award-winning health writer Sharon Begley of dishonesty because she quoted Wellsteps’ outcomes report verbatim, he called her a “lier.”

So I put two and two together and thought: “stupid vendor equals program failure.” Turns out it’s much more complex than that.


A study published in Frontiers in Psychology examined the relationship between weight and wellness programs, with three studies, summarized here in their own words.

The present research focuses on a downside of workplace health promotion programs that to date has not been examined before, namely the possibility that they, due to a focus on individual responsibility for one’s health, inadvertently facilitate stigmatization and discrimination of people with overweight in the workplace.

    • Study 1 shows that the presence of workplace health promotion programs is associated with increased attributions of weight controllability.
    • Study 2 experimentally demonstrates that workplace health promotion programs emphasizing individual rather than organizational responsibility elicit weight stigma.
    • Study 3, which was pre-registered, showed that workplace health promotion programs emphasizing individual responsibility induced weight-based discrimination in the context of promotion decisions in the workplace. Moreover, focusing on people with obesity who frequently experience weight stigma and discrimination,
    • Study 3 also showed that workplace health promotion programs highlighting individual responsibility induced employees with obesity to feel individually responsible for their health, but at the same time made them perceive weight as less controllable.

Together, our research identifies workplace health promotion programs as potent catalysts of weight stigma and weight-based discrimination, especially when they emphasize individual responsibility for health outcomes.

This explains an awful lot. First and most obviously, why people gained weight in the award-winning Wellsteps, McKesson, and Vitality programs. In wellness, I observed three years ago, “fat-shaming is the new black.”

Second, it explains the futility of one of the two positive (albeit trivial) findings in the recent BJ’s Wholesale Club study — that more employees will “watch their weight.” Study 3 suggests that’s a bug, not a feature.

Third, it explains the harms being visited upon people who already have eating disorders. Especially because Ron says employees should weigh themselves daily, which naturally is the opposite of what the science says and is downright dangerous for people with eating disorders.

Finally, it explains why Ron Goetzel will be spending his entire life trying to turn lead into gold (or in his case, claiming he already has, by giving Koop Awards to a bunch of failed programs which he calls successes). Sustained weight loss as a result of wellness programs stigmatizing obesity has never happened in the past, and there is no possibility — none, zero — that workplaces trying to coax, cajole, bribe, fine, or shame employees into losing weight will ever be successful in the future.

No wonder virtually every single wellness program fails.

 

Wellness: It’s time to believe the research, not the “experts.”

In case you missed it, turns out that the last 11 wellness studies have all come to basically the same conclusion. This is the intro to Employee Benefit News listing them and linking to them.

And if anyone still thinks overscreening programs have merit, here is a complete expose from 2017 on “pry, poke and prod.” It’s pretty extensive so clear your calendar.

 


The highly-publicized, randomized control trial of the wellness program at BJ’s Wholesale Club published recently in the Journal of the American Medical Association found virtually no value in the program.

While most pundits applauded the study, wellness vendors — whose livelihoods, of course, depend on believing the opposite — attacked it. Two common threads among the attacks, including one right here in Employee Benefit News, were that the program was bad (“anachronistic” in this case) and that one can’t draw conclusions from one study. The specific argument: “Recent research has disappointingly focused on a single — typically anachronistic — program to make sweeping statements on wellness programs more broadly.”

Far from being anachronistic, the JAMA study was as mainstream as studies get — screenings, risk assessments, coaching, learning modules. This is what wellness has been all about. True, there are a few new things today — like employee health literacy education — which is my own business, but they are too early in the life cycle to be evaluated.

And far from being a one-off, this study’s finding of zero impact was completely consistent with the previous 11 (eleven) published studies for which data was provided. Let’s review those studies…

Read the rest of the article here.


Note: someone might say: “that doesn’t add up to 11.” There are plenty of others. My favorite is the self-immolation published by the Health Enhancement Research Organization in 2015.  Very stable geniuses that they are, they didn’t actually realize they showed wellness losing money until I pointed it out.

First, Mr. Goetzel claimed that he had never seen this study before (even though it was the centerpiece of his own organization’s guidebook) and that the data was fabricated (not sure how he knew that if he hadn’t seen it). When that defense was outed, he started vigorously defending the study, his principal defense being that HERO didn’t intend for costs to be compared with benefits.

Further, my suggestion that the costs should be compared to benefits was “mischievous,” according to Ron. That much I’ll gladly agree with…

Link to Employee Benefit News article.

Ron Goetzel meets Jethro Tull

We’ll go walking out
While others shout of war’s disaster
Oh, we won’t give in
Let’s go living in the past


A delegation from the Validation Institute attending the World Health Care Congress time-traveled over to the US Chamber of Commerce Monday to watch Ron Goetzel and a few acolytes try to re-create the shiny new wellness object from the 1980s. Just like in the 1980s, the theme was, and these are the exact words of one of the speakers: “Why aren’t more employers seeing the value in wellness?”

Um, because there isn’t any? 7 years after I first proved, and guaranteed, that none of this “pry, poke and prod” nonsense could possibly add up, the evidence has finally caught up with the conclusion.

Of course, there is value in wellness done for employees, rather than to employees. And far be it from me to discourage anyone from being screened according to guidelines.  But that’s not what the US Chamber is all about. The US Chamber is about pressuring the EEOC into restoring the punitive “voluntary” wellness penalties that a federal judge put the kibosh on in December 2017, effective this year.

The irony is, the Chamber is its own worst enemy. If the EEOC ever got hold of a recording of that session, it would constitute an irrefutable argument for the EEOC not to change the rules. The speakers other than Ron were all about improving employee well-being through autonomy, independence, responsibility for projects from beginning to end, and creating a culture of health.  All those are worthy goals. Goals which, more than coincidentally, have nothing to do with screening the stuffing out of the workforce and penalizing employees 30% for not losing weight. (Shame on Oprah Winfrey!) Quite the contrary, any organization trying to achieve those goals would never dream of manhandling their employees like that.


Ron Goetzel: Katherine Baicker is living in the past

If a fortune-teller had predicted the following as recently as three weeks ago, I would have demanded a refund: Ron Goetzel dissed Katherine Baicker., Specifically, he accused Professors Baicker and Song, along with BJ’s and their vendor, of “doing a program out of the 1980s,” saying that their outstanding study could safely be ignored. (These are the same 1980s in which wellness, according to its promoters, couldn’t fail.)

What horrible 1980s elements did the BJ’s program have? Coaching, screening, learning “modules” and HRAs. Of course, no one has included those things in a wellness program for at least 30 years. (not)

Curiously, Ron didn’t have any issue at all with Baicker’s original 2010 “Workplace Wellness Can Generate Savings” article, which was chock full of programs literally from the 1980s. Only 2 of the programs analyzed in that study were conducted in the 21st century.

If that fortune-teller had also predicted that Ron would start telling the truth someday, I would have demanded double my money back. But no fortune-teller would ever predict that. Fortune-telling industry malpractice insurers will no longer cover lawsuits arising out of that prediction.

And for good reason. It’s generally a safe bet, given Mr. Goetzel’s tenuous grasp on integrity, that he’s going to misrepresent something. Yesterday, as is his wont, he deliberately misrepresented the position of The Incidental Economist (TIE) on the subject of wellness. He quoted TIE as saying that wellness “usually” doesn’t save money. (As a sidebar, I’d note that it is a bit of a head-scratcher that even the misrepresented TIE position makes Goetzel’s position look bad.)

Perhaps I need new glasses, but  I can’t seem to find the word “usually” in the most recent TIE article on wellness savings:

We’ve said it before, many times and in many ways: workplace wellness programs don’t save money.

There’s another reason Ron doesn’t quote TIE, which is they completely dissed him and his Koop Award friends in that article. Totally worth a read.


What does a Goetzel program look like?

According to Ron, only 100 programs work and thousands fail. (“That’s not an industry,” I observed in our debate. “That’s a lottery.”)

So how do you succeed? How do you avoid programs “from the 1980s”? Maybe you avoid that by using a vendor where Ron has a “strong working relationship,” like Vitality. And just to be on the safe side, maybe you report only the results from Vitality’s own program for Vitality’s own employees. That way you can’t fail…

…and yet fail they did…

Even with the investigator bias and self-selection and “home court advantage,” Vitality employees got 2% fatter and their eating habits got worse after being coached.

Although maybe that counts as a success in the wellness industry, because employees weren’t too badly harmed, as they are in a typical Koop-Award winning program. Congratulations to Mr. Goetzel!

 

A feel-good wellness story for a change

Well, at least I feel good about it. This is Employee Benefit News on health literacy.

Turns out something works in wellness. And it’s quite logical. Healthcare is the only line item where every full-time employee gets an unlimited budget. It’s also the only budget item for which employees get no training in how to spend it. The combination of a (mostly) blank check and (near) total ignorance creates the perfect storm for massive overspending.  That of course is exactly what happens absent training in employee medical education.

Employees simply get too much healthcare, if they don’t pay the bills. Imagine if you only had to pay for 10% of your house, your car, your food. Would you buy more? Healthcare is the same way. The difference is that too much of it is bad for us…and we get way too much of it.

Your wellness vendor isn’t going to be much help here. They love screening the stuffing out of employees and then bragging about how many more tests they need to get.

Here is the link to the rest of the article.

 

 

 

 

The “back story” of the JAMA wellness smackdown, part 2

Part 2 picks up where Part 1 left off, as coincidence would have it.


Soeren Mattke (as mentioned in the last installment) and I were quite relentless in trying, quixotically, to get Professor Baicker to explain her results. Its popularity could have landed her many profitable speaking and consulting gigs, but she evinced no interest in cashing in, or even in defending her position. Indeed, the four times she spoke publicly on the topic, she didn’t do herself, or her legions of sycophants in the wellness industry, any favors. In each interview, she distanced herself more and more from her previous conclusion. Here are her four takeaways from her own study “proving” wellness has precisely a 3.27-to-1 ROI:

  1. It’s too early to tell (um, after 30 years of workplace wellness?)
  2. She has no interest in wellness anymore
  3. People aren’t reading her paper right (Shame on us readers! We’re only reading the headline, the data, the findings and the conclusion, apparently)
  4. “There are few studies with reliable data on the costs and the benefits” (um, then how were you able to reach a conclusion with two significant digits?)

Individually or in total, these comments sounded an awful lot like retractions, but she (and her co-author and instigator, David Cutler) claimed those comments didn’t constitute retractions. Whatever they were, she wasn’t exactly doubling down on this 3.27-to-1 conclusion.

The industry at this time — 2013 and 2014 — came under a lot of criticism for basically being somewhere between hilariously worthless and a fraud. (Here is some comprehensive documentation of the fraudulent and harmful activity in the wellness industry. Wellness is a classic example of the observation that every cause starts out as a movement, becomes a business, and degenerates into a racket, the poster company for the last being Interactive Health.)


Here’s where it gets interesting. Due to this relentless criticism, instigated and sometimes written by me (most of which is catalogued here) with credit to Soeren Mattke and Jon Robison as well (with Pulitzer Prize-winning LA Times columnist Michael Hiltzik piling on multiple times), Ron Goetzel and his colleagues urged Professor Baicker — who had previously claimed to have no more interest in wellness — to get a grant from Ron’s friends at the Robert Wood Johnson Foundation and do an actual controlled study of workplace wellness to set the record straight. As a strategic gambit, this showed a level of professional judgment worthy of Gary Hart.*

Obviously if you are perpetrating a fraud and you know it, you don’t urge people to investigate it. Mr. Goetzel at this point (or at least shortly thereafter) knew that his industry was a fraud, going so far as to erase some accurate data and disown inconveniently accurate conclusions he had forgotten to suppress.

He even forged a letter from the governor of Nebraska to cover his tracks. (To be completely accurate, he did not forge the signature on the letter. He merely doctored the wording in a letter that was already signed to say something much different than the letter said when it was actually signed. Maybe that’s not technically forgery. Who knows?)

And yet that’s exactly what Mr. Goetzel did. Maybe he thought she was as corrupt as he is, but she has an excellent reputation in this industry. My suspicion is that she accepted his offer for exactly the opposite reason that he made it — to clear her name after her ill-considered 2010 meta-analysis.

Way back in 2016, I predicted how this gambit would turn out — that Katherine Baicker was not going to mail it in this time but rather do a high-quality study of the type she is known for.

Her now-famous outcome was preordained for four reasons:

  1. In this industry, as Michael O’Donnell pointed out in the trade journal where he formally served as Prevaricator-in-Chief, the higher quality the study, the lower the ROI, to the point where RCTs invariably show negative ROIs. (Owing to the embarrassing accuracy of this unintended finding, Mr. O’Donnell walked it back in a subsequent editorial.)
  2. Kate Baicker was not going to sully her legacy by being known as the Typhoid Mary of wacky wellness programs, just to please her sycophants.
  3. She picked the most clueless vendor imaginable to carry their water. This selection couldn’t have been an accident.
  4. No wellness study since Johnson & Johnson (which was probably also wrong–just not obviously from the data presented) had shown even a remotely positive outcome. This list includes PepsiCo, Barnes Hospital, Nebraska, Vitality, Newtopia, Health Fitness Corp, Health Fitness Corp again, Boise School District/Wellsteps, McKesson, Connecticut, and the University of Illinois. All were epic fails, according to their own data. Not to mention that the wellness trade association itself published a case study showing wellness loses money and then ran away from it.

Where does the wellness industry go from here?  They’re hoping for Tiger Woods, wiser souls are channeling Gary Hart, and probably what we’ll get instead is Harold Stassen. (Look it up.)


*For those of you who aren’t old enough to remember, here’s what happened. Dogged by rumors of philandering, the front-running Democratic presidential candidate urged reporters to follow him around. It took about a day for reporters to discover he was indeed philandering. It only took another few weeks for him to withdraw from the presidential race.

As predicted, the wellness vendors are not conceding defeat

Like Japanese soldiers at the end of World War II (including the one who briefly took the seven stranded castaways prisoner), many wellness vendors are refusing to concede that the war is over. Here are three examples.

First is Vitality Group. Their oxymoronic Chief Actuarial Officer, writing in Employee Benefit News, claims that the BJ’s Wholesale Club study was inadequately focused on healthy behavior change

Healthy behavior change should be the central tenet of wellness programs, since short-termism is woefully inadequate for an area as complex as health. To this end, conceptually simply — yet scientifically-robust — interventions have been found to be effective drivers of behavior. 

One of the many things wellness vendors don’t understand, along with facts, data, math, and wellness, is irony. It is indeed ironic that a company which couldn’t get its own employees to lose weight is complaining because a program couldn’t get employees to lose weight.  Vitality’s “healthy behavior change” caused employee eating habits to deteriorate — once again, according to Vitality itself.

Next you have Steve Aldana of Wellsteps claiming in Kaiser Health News that:

for the efforts to be successful they must cut across many areas, from the food served in company cafeterias to including spouses or significant others to help people quit smoking, eat better or exercise more.

Except that his own study did exactly the opposite. It turned out that taking Wellsteps’ advice will increase your risk factors and cause your self-perceived health to deteriorate.

Finally, Jim Pshock of Bravo was also quoted in that article, complaining about the level of incentives not being great enough to get people to do things they weren’t going to do anyway. Urging employers to give away more money is exactly the opposite of what Bravo typically does, which is fine employees the maximum possible and then brag about how much money employees can save immediately because many employees refuse to participate, preferring to lose the money than to let Bravo play doctor with them.


They missed the best argument against the validity of this study

Ironically, the one legitimate argument that none of the wellness promoters have made is that Professor Baicker picked the dumbest wellness vendor imaginable, Wellness Workdays, to conduct the study. Along with Wellsteps, Bravo, and, of course, Interactive Health, they comprise the wellness industry’s Axis of Stupid.

Wellness Workdays is a classic wellness vendor. That is to say, they won’t be winning a Nobel Prize anytime soon, or even a spelling bee. Let’s start by examining their analytic and clinical prowess.

To start with, their “White Paper” doesn’t just quote the infamous 3.27-to-1. They’ve upped the ante to 6.00 to 1, maintaining the two significant digits while almost doubling the savings.  How? They’ve added the 3.27-to-1 for healthcare savings to the 2.73-to-1 for absenteeism reduction from that same 2010 study. Those two separate conclusions were reached from almost totally different studies. Anyone can tell that from reading the original.  Anyone, that is, except Wellness Workdays.

Their analytic qualifications are matched only by their clinical qualifications. One member of their medical advisory board is Chief of Allergy and Clinical Immunology at the Indian River Medical Center in Vero Beach, Florida.  While this expertise is not exactly central to the mission of the pry,poke, and prod industry, in all fairness it should be noted that the Indian River Medical Center runs one of the better allergy programs in all of Vero Beach.

Another is an OB-GYN in Colorado.  Perhaps this advisor will develop a protocol for employees who want to be screened and induced at the same time.  A third consults to orthopedists at “Lennox Hill Hospital,” a role that probably doesn’t require too much heavy lifting, because there is no hospital by that name.

lenox hill

This guy is also an expert on steroids and other performance-enhancing products, and has “published rseveral esearch studies.”

wellness workdays

So they can’t spell, can’t proofread, can’t understand study design, and can’t cobble together a qualified advisory board.  In other words, to paraphrase the immortal words of those great philosophers Gilbert & Sullivan, they are the very model of a modern clueless wellness vendor.

They also appear to have forgotten to update their website since they didn’t get the outcomes they are “driven” by:

As for BJ’s Wholesale Club, I suspect they got suckered into this. Who volunteers to become the next Pepsico, a case study of how wellness programs fail?

In any case, we think Professor Baicker’s study is first rate, and apparently there is another one coming up, a sequel.

Or perhaps, since this is in conjunction with Wellness Workdays, to rseveral esearch studies.

 

 

The “Back Story” of the JAMA wellness smackdown (Part 1)

Let’s climb into the WABAC Machine (and, yes, that’s the way it’s spelled) and set the dial for 2008.

Then-candidate Barack Obama, campaigning on the promise of universal health coverage, enlisted Harvard professor David Cutler as his key adviser on that topic. Business lobbying associations were not thrilled about their members having to cover all their full-time employees and incorrectly assumed, then as now, that the major drivers of healthcare cost were employees smoking, overeating, and not exercising. Prof. Cutler suggested, quite correctly, that one way to assuage that concern would be to allow employers to spend less money covering employees with those three health habits.

Fast-forward to 2009, when it appeared that — with enough concessions to enough vested interests — the Affordable Care Act (ACA) could become a reality. Business lobbying groups were, then as now, powerful entities. Using Prof. Cutler’s suggestion, they were pacified by allowing businesses to tie up to 30% of total premium dollars to employee health (in practice, largely employee weight). Generally, the business lobbying groups engineered this withhold in the shadows. It wasn’t until 2015 that one of those business groups, the Business Roundtable, publicly admitted that the 30% withhold was the main reason they bought into the ACA.

Since this 30% was basically a giveaway to corporations, the Obama Administration needed to justify it as a cost-savings measure. On the one hand, they had the Safeway experience “proving” that wellness could save money in practice. This alleged proof was met with open arms by both parties. Safeway’s CEO became a “rock star” on Capitol Hill.  (Of course, Safeway’s wellness program, like virtually every other great-sounding success in wellness, turned out to be a scam. In retrospect, just reading the Safeway CEO’s Wall Street Journal op-ed today* announcing these results, it’s amazing how the mind-blowingly fallacious statistics didn’t get called out back then, by me or anyone else.)

What the Administration needed in addition to the Safeway experience was some academic support. It happens there is an old joke among economists that the definition of “economist” is someone who, upon finding that something works in practice, wonders whether it will work in theory. Enter Professor Cutler again. He enlisted the then-little-known Katherine Baicker, of the Harvard School of Public Health, who had no background or apparent interest in wellness, to lead-author a meta-analysis to prove that wellness works (he was the second author).

She “proved” the theory that wellness works by citing basically every research study ever published. In those days, like today, essentially every published study — virtually all published by wellness promoters in wellness trade journals — showed savings, thanks to three rather transparent fabrications:

  1. Comparing participants to non-participants, which specifically the recent study did not do, nor did the NBER study in 2018.
  2. Looking only at the decline in high-risk members and not the increase in risk by the low-risk members
  3. Drawing a trendline straight up and saying how much cost was “avoided” because expenses didn’t rise that fast.

The resulting meta-analysis, Workplace Wellness Programs Can Generate Savings, was raced into publication in Health Affairs, peer review be damned. (Indeed it was published so quickly that Prof. Cutler didn’t have time to disclose his conflict of interest.)

The finding was quite definitive, to two significant digits: wellness produced a 3.27-to-1 ROI on cost savings alone. This is an almost unheard-of level of precision and conclusiveness in a population health analysis. Plus, an additional precise 2.73-to-1 on productivity.

The game was supposed to be over. That article was supposed to be the cherry on top of the ACA, academically blessing the one aspect of ACA which both parties supported. It was billed as a true win-win, saving money by getting employees to be healthier.  This article became the single most influential article in Health Affairs history, with 935 academic citations alone, plus an untold number of start-ups, corporate program implementations, and references in lay publications.

Unfortunately, when you attract that much attention with a finding that is basically fabricated, someone is bound to notice. In this case, the someone was me. (I also encouraged RAND’s ace wellness researcher, Soeren Mattke, to take part in the effort, which he expertly did.)  It turns out that most if not all of the studies in this meta-analysis never should have made it to peer review, let alone passed it.  One researcher credited wellness programs with a reduction in spending on blood-borne ailments — like hemophilia, Von Willebrand’s Disease, and cat-scratch fever. Another found that you could save millions within six months by encouraging diabetics to eat more carbs. A third found that annual mammograms for women under 40 and low-fat diets saved Procter & Gamble 29%.

Part 2 will cover how Prof. Baicker distanced herself from this result to the point of disowning it…and how withering criticism from myself and others (notably The Incidental Economist) created a chain of events which got her back in the game despite saying she had “no interest.”


*Safeway’s CEO, Stephen Burd, eventually got tired of wellness and focused his efforts on another shiny new object: Theranos. He has subsequently retired from Safeway to become the honorary chairman of Mensa. (not)

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