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In the immortal words of the great philosopher Roy Orbison: “It’s over. It’s over. It’s ooooo-verrrr.”
The Journal of the American Medical Association published an article today that — very much like the National Bureau of Economic Research’s conclusion — reported a controlled trial in which it was shown that wellness did nothing. Nada. Zilch.
Here is some of the exact language:
With respect to the clinical measures of health obtained using biometric screening, 29% of employees in the primary control group had high cholesterol, 23% had hypertension, and 43% were obese. No statistically significant differences were detected between the employees in the control group worksites and treatment group worksites at the end of the 18 months. Similarly, the authors found no significant differences in mean medical care spending or utilization.
So it looks like the only academic researcher who still believes this nonsense works is Prof. Katherine Baicker, whose 2010 “Harvard study” in Health Affairs launched the industry into the Affordable Care Act.
Wait a second…am I reading this correctly? Seems like this research was conducted and reported by Katherine Baicker. She invalidated her only earlier work, much like I did 12 years ago when I pointed out all my previous findings in disease management were wrong.
Needless to say, the wellness industry is not very happy about this. Here is their official response:
As every wellness professional knows, saving money in wellness programs can only be accomplished — if at all — by getting employees to take more steps and eat more broccoli.
As far as the former is concerned, Fitbit has already undertaken initiatives to demonstrate that using its product to increase steps can play an integral role in wellness. In other words, they’ve mastered the art of blatantly fabricating outcomes.
Fitbit also offers employers significant discounts for bulk wearables purchase for wellness programs. These discounts have led to enough employer contracts for Fitbits that the Broccoli Growers Association of America (BGAA) has taken notice, and decided to follow their lead.
Specifically, the BGAA just announced a partnership with two leading organizations in wellness — the Health Enhancement Research Organization (HERO), and Safeway — to distribute 20% discount coupons for broccoli to wellness program enrollees at participating employers. Thought leaders in wellness, notably Schlumberger, have already announced they are signing up.
A spokesperson for the BGAA noted that “for years, wellness vendors have been urging employees to eat more broccoli, but until now that goal has been out of reach financially for many. We are pleased to do our part to relieve this financial hardship on employees, and help employers coax, fine, or bribe employees into adopting a more broccoli-intensive diet. This will definitely help them lose weight.”
Ron Goetzel, never one to miss out on a claim of wellness program impact, added that broccoli can be part of a smoking cessation program too. “Just keep some broccoli nearby,” he advises, “and every time you feel like a cigaret, eat a floret instead. It’s easy to do because they both end in ‘ret.’ My data shows that it’s easier to stop smoking if you remember to eat broccoli anytime the urge arises to smoke — and my data is always very well-sourced and consistent.”
The BGAA will also be providing recipes to give employees ways to vary their diet while still consuming sufficient amounts of broccoli to let wellness vendors claim savings. Broccoli can be steamed, sauteed, or eaten raw. Here is another suggestion for preparation.
Charley Blue, a frequent reader of these columns, is embracing this collaboration and wants to see it go farther. “I’d like the government to get behind this with some focused subsidies,” he proposed. “We could call it The New Green Deal”
From Matt Jeffs:
In his third and final at-bat in this series, author / humorist / CEO provocateur Al Lewis hits one out of the park with the bases loaded. The Co-Founder and CEO of Quizzify, Al returns to remind us that employee health literacy can be delivered in delightfully humorous, trivia-style quizzes to simplify complex topics and help employees stay engaged in – and committed to – their own health and well-being.
This time, we cover:
- Why is health literacy so vitally important to employees?
- How reliable are some online health sources?
- What’s a good rule-of-thumb for health check-up frequency?
- Why is humor so crucial to retaining health information?
- Why is trivia so engaging when delivering health information?
- How is all this beneficial to employers?
Tune in here https://lnkd.in/e-pusGw to learn even more from this funny, distinguished and principled healthcare thought-leader. You’ll find it engaging and inspirational. Listen. Learn more at https://www.quizzify.com/.
Enjoy. Subscribe. Click for notifications. Share with colleagues, friends and associates. And learn more about learning more at https://thebackschool.net/ .
PS Worth tuning in just to see where the title comes from. Believe it or not, an important health literacy topic.
Ok, I don’t usually use this blog to write about myself because other folks make much better copy. However, this is a great interview. I hope you have as much fun reading it as I did doing it.
When you present at a conference exposing the inadequacies of “Disease Management” and then the industry begins to crumble, you might be a person whose opinion should be heard. Such is the perceived power of Al Lewis, who formerly taught economics at Harvard and ran Peer Review Analysis, a NASDAQ health care company, a man widely credited with inventing disease management, although he’s quick to say he didn’t. A more accurate description these days might be “Bouncer,” standing guard at the gate to discourage bad behavior.
Al has made a reputation for himself, especially on LinkedIn, promoting corporate wellness vendors whose methods have been validated, and calling out those who do not measure up to the standard. If you are on his naughty list, be warned. “I call out those who are lying through their teeth,” Al says.
Indeed, even the most cursory review of Al’s LinkedIn activity reveals his fearless cross-examination of people and companies who regurgitate bad data or make wellness promises they can’t keep. And he often does it by name, tagging the companies he is calling out.
“Aren’t you afraid of getting sued?” I asked him.
“Make my day,” he says. “Sue me, but I won’t be settling. And I’ll be blogging about it the whole time.”
Remember when the sergeant asked for a volunteer to step forward and Moe and Larry took a step back?
Looks like Virgin Pulse has won the best-HRA contest the same way. Yes, it is a complete waste of employee time and employer money. In HRAs, that’s table stakes. It earns a solid “C” not because anyone will learn anything of any value, but rather because the other two are worse. The VP HRA offers so little advice that none of it is really bad. It that sense it is better than Cerner’s (“F”) and Optum’s (F+).
Here’s what Virgin Pulse’s HRA gets points for not doing:
Tell employees to eat nonfat yogurt that is full of sugar (like Cerner):
Imply that employees on opioids should get more opioids (like Optum)
Advise employees against using olive oil (like Optum)
Further, it is actually coherent, instead of containing questions like… (Optum again)
…in which both non-asthmatics and completely uncontrolled asthmatics would give you the same answer.
Virgin Pulse’s “advice”
“Eat a healthy breakfast.” Who can argue with that? It’s like a manager advising the batter to hit a home run. Obviously the key is in the execution, and naturally Virgin Pulse provides none. In that sense, it is the best HRA because the others give such bad advice.
What constitutes a healthy breakfast? Can’t be just any old cereal. Those are full of sugar. Ah, maybe something like Kellogg’s Smart Start with Antioxidants, which is “heart-healthy.”
Oops. That’s on Eat This Not That’s “worst healthy cereals” list. Because it is — you guessed it — full of “heart-healthy” sugar.
Kellogg’s Special K Protein Snack Bars? 10 grams of added sugar apiece (and you’d likely eat 2–they’re small) with six different sugars dispersed throughout the ingredients label.
Eggs? For most people, eggs are a healthier choice than most packaged cereals. Of course, there are exceptions — a bit less than 1% of the population is genetically predisposed to high cholesterol. But wellness vendors would lose money if they actually spent the time to address these nuances. Of course, in this case, the “nuance” is that familial hypercholesterolemia (FH) is a much better predictor of cardiac events than anything in any HRA. As in about 40% of everyone with untreated FH will infarct before age 60.
Oatmeal? Probably the greatest consensus around that. (And that’s the breakfast of choice here at TheySaidWhat? World Headquarters.) Yet plenty of cereal companies, and fast food chains, have turned oatmeal into junk food. Dunkin’s “Brown Sugar Flavored Oatmeal” packs in 28 grams of sugar (none of which is actual brown sugar, as luck would have it).
Orange juice? That counts as a serving of a fruit according to the American Heart Association (AHA) and Virgin Pulse is a big one for telling you to eat up to 11 servings of fruits and vegetables a day, with “1/4 cup” of juice counting as a serving. Using the AHA math, an 8-ounce glass of juice would appear to get you 4/11ths of the way there.
And ads for “healthy” cereal sometimes show a glass of orange juice on the side:
On the other hand, NPR and Consumer Reports advise against considering juice as a healthy alternative. The sugar is “natural,” but there is an awful lot of it. (I myself am not a nutritionist, and don’t even play one on TV, so I don’t have an opinion on whether natural sugar is OK and added sugar isn’t. Except I would point out that grape juice contains natural sugar while grape juice concentrate is an added sugar. Both can’t be right.)
So which is it? Drink more juice, or don’t? Which constitutes “eating a healthy breakfast” ? I don’t know and I suspect neither does Virgin Pulse. The difference, of course, is that TSW isn’t charging lots of money to give employees advice.
Completing the Virgin Pulse HRA
Obviously, employees are going to lie on HRAs, and Virgin Pulse’s is no exception. I was invited to watch a group of employees completing theirs, For each answer, they gamed the system. What is the optimal amount of stress to claim? Too much might harm their career. Too little and someone might give them more work.
How much should they claim to drink? “Not at all” might cause their (well-known!) employer to think they’re lying, so they all decided to cut their true totals in half.
Servings of fruits and vegetables? Most of them just made up a number that would sound good to an employer.
Everyone seems to know employees lie on HRAs (including, of course, Virgin Pulse) except the employers that still use them, whose quest to create a culture of health ends up creating a culture of deceit. No need to take my word for this. Simply complete this chart to see what percentage of your employees with something to lie about are indeed lying — and what the odds are that an employee with something to hide will tell the truth about it:
Let’s try completing this chart, using the most recent winner of the C. Everett Koop Award, Wellsteps.
Result: in the so-called best wellness program, almost 2/3 of employees lie, though in all fairness to Wellsteps, some of those could be the same employee lying twice. And extrapolating from Wellsteps’ result, the odds of an employee coming clean about a bad health habit are about 1-in-4. That’s the average of smoking and drinking. Generally the more socially acceptable habits will show a higher percentage of employees telling the truth.
Keep in mind, too, that there is another way to lie on HRAs, which is understatement. You may recall from Wellsteps that the 23% who drink only imbibe 1.3 drinks a day, while 3% who do admit to smoking indulge in cigarettes only 4.27 times a week, perhaps taking a break on weekends and major holidays, such as Beethoven’s Birthday.
Due to the lying and uselessness, should employers drop HRAs altogether?
In the immortal word of the great philosopher Curly Howard, soitenly.
Incredibly, events unfolded almost exactly this way at Penn State during their well-publicized wellness debacle 5 years ago. It was even funnier in real life because while exercise does of course promote wellness, faculty and staff were very restricted in their use of campus recreational facilities. Making those free to employees and dependents was not part of their wellness initiative.
No, instead employees were being forced into an outcomes-based wellness program, one that was supposed to save “millions of dollars.”
Coincidentally, while the Penn State HR department — ably assisted by Ron Goetzel, who later denied having anything to do with them despite being in their press conference – was trying to force employees into these programs, the Penn State bakery announced an expanded selection of pastries and desserts for the upcoming semester.
Penn State’s was, to paraphrase the immortal words of the great philosophers Gilbert & Sullivan, the very model of a modern forced wellness program. Sure, they violated clinical guidelines. That seems to be the price of entry for wellness. More head-scratchingly, women had to disclose whether they intended to become pregnant, or else pay a $1200 fine. This requirement was designed to, in the Highmark representative’s own words in a rather contentious faculty meeting — “help” them. That would be like offering to “help” the proverbial little old lady cross the street — but if she declines assistance, saying: “OK, then pay me $1200. The choice is yours.”
Full disclosure: Highmark has now abandoned their old outcomes-based wellness program on which Penn State’s was based in favor of a much lighter and more appropriate program, and we wish them the best at it. All indications are that it is going very well and is a model for others. A total turnaround.
Back to the storyline…
There is something about forced outcomes-based wellness programs that brings out employers’ inner stupid, and Penn State was no exception. Consider: almost by definition women who are planning to become pregnant have thought about it and have done the basic research. It’s the women who accidentally become pregnant who may possibly have the need for assistance. And even the dumbest HRA wouldn’t ask the question: “Are you going to accidentally become pregnant?”
So, using the very unlikely assumption that women completed the HRA honestly, Penn State’s forced disclosure requirement would have identified 100% of the people who did not need “help,” while missing 100% of the women who might. If you’re keeping score at home, that’s 100% false positives and 100% false negatives. That’s a lot even by wellness industry standards. Eat your heart out, Interactive Health.
And did I miss the memo where carriers were anointed the prime providers of medical “help”? Has anyone ever said to you: “You don’t look so good today. Better call your health plan”?
See https://theysaidwhat.net/2016/04/22/the-story-of-an-employee-who-benefited-from-wellness/ for the back story.
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.
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:
- Cheating is far more widespread than employers would like to believe;
- 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:
- “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.
- This post is way down at the bottom of the front page.
- 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)
- 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.
- 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.
- 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.
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.