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Health Affairs Kills Wellness Dead

Do you know whether heartburn pills are safe for long-term use?

We will be doing a webinar on this very topic — June 30th at 2 PM EDT. Both camps have been invited to present. Register here.


 

Health Affairs just announced it. The conclusion of the impeccably designed three-year study conducted by Katherine Baicker and Zirui Song showed zero impact in a randomized control trial. This conclusion, of course, confirms exactly what we’ve been saying for almost a decade now–wellness programs have absolutely no impact (other than to occasionally harm employees, of course). In their words:

No significant differences were found in self-reported health; clinical markers of health; health care spending or use; or absenteeism, tenure, or job performance. Improvements in health behaviors after three years were similar to those at eighteen months, but the longer follow-up did not yield detectable improvements in clinical, economic, or employment outcomes.

No one can accuse the authors of having an anti-wellness bias. Quite the opposite, they wrote the seminal article that created the industry. As early as they were in supporting it, I was almost that early in realizing it was a sham (Slate’s word, not mine.)

One could also argue that wellness was already dead — the previous 11 articles had shown the same thing. Vendors excel at hiding these articles from their customers. (If only they were half as good at actually doing wellness…)


The Greatest Hits of the early days of wellness leading to this moment

April 2013

We knew back in April 2013, that wellness was worthless. We used some simple arithmetic to point out that it would cost a million dollars to prevent a heart attack by screening the stuffing out of employees. It turned out our estimate was wrong — the real number appears to be infinity.

My only question is, why did it take eight years for everyone else to figure this out?

Happily there is one exception to this conclusion. Just like 1 in 1000 money managers consistently beat the market, the 1 in 1000 conventional wellness vendor is: US Preventive Medicine. Their favorable outcomes were achieved without biostatistical sleight-of-hand. Hence they are validated by the Validation institute.  (This article concludes by showing how most vendors embrace biostatistical sleight-of-hand.) And yet even USPM doesn’t claim an ROI, so they aren’t validated for savings. Just outcomes.

Spring 2013 also saw the widespread acceptance of the award-winning trade bestseller Why Nobody Believes the Numbers, still used as a textbook in many graduate programs in population health.


July 2013

Here was our first smackdown naming names, also in 2013. Two recurring themes revealed themselves. First, Mercer’s fingerprints were all over wellness as they are now all over Livongo (which pays them handsomely), thanks to their revenue model of collecting money from vendors as well as buyers.

Second, naturally the program in question won a Koop Award, bestowed annually by Ron Goetzel and his cronies upon the company that best demonstrates what happens to kids who cut math class to smoke in the boys’ room. Our observation on their arithmetic was:

You need not “challenge the data” to invalidate claims that wellness saves money.  Instead, you can simply read the data as presented. You’ll find it usually invalidates itself.

Nowhere is that more true than in a study published this month by MercerStaywell and British Petroleum (“BP America”) in the Journal of Occupational and Environmental Medicine (JOEM).   As we’ll demonstrate, the results completely contradict Staywell’s own statements, and are also mathematically impossible.  Indeed, Mercer was a wise partner choice by BP America because their validations are often unconstrained by the limits of possibility. 

I’ve occasionally worried that the Health Enhancement Research Organization (the wellness industry’s Ministry of Truth) might hire away a smart person from the PBM industry who could make their lies believable. So far, fortunately, they’ve resisted that temptation.


November 2014

2014 brought our highest visibility article, when it was still news that wellness loses money. Health Affairs published our seminal Workplace Wellness Produces No Savings. This was picked up by Michael Hiltzik, the business columnist at the Los Angeles Times, who added that wellness is a “scam.”

And it got picked up by the New York Times‘ health economics bloggers, who added the observation that Mr. Goetzel’s analysis was “crap.” (Their word, not mine.) Their specific first paragraph leading into our analysis:

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

When Mr. Goetzel attempted to rebut our article, he interpreted  that statement as these economists saying wellness “usually” doesn’t save money. Not sure where you get “usually doesn’t save money” out of the quotation above, but you know an industry is in trouble when its #1 promoter has to lie in its defense, but even the lie itself is quite unflattering.


July 2017

The most comprehensive deconstruction was in July 2017, in Case Western Reserve’s Law-Medicine Journal, Health Matrix. It still ranks among their ten most popular articles of all time.

With 58 pages and 349 footnotes, it remains the go-to for health services researchers everywhere. If you can’t make the commitment to reading the entire thing, the executive summary says it all:

Wellness programs have conferred no measurable benefit on the American workforce.Further, vendors routinely disregard clinical guidelines that are designed to avoid overtreatment, inappropriate doctor visits, and increasingly ubiquitous crash-dieting contests. The economics follow the harms.

Essentially every dollar companies spend on vendor-administered workplace-wellness programs is lost. As a result, much of the wellness-vendor community has resorted to making demonstrably false claims about savings in order to maintain its revenue stream.


Why did wellness last so long?

As coincidence would have it, the Validation Institute wrote on that exact topic last month, explaining exactly how wellness, diabetes and other vendors fabricate their outcomes. It requires 7 installments to whack all of the moles, since while wellness and diabetes vendors may not know much about wellness and diabetes, they know a ton about fabricating outcomes.

They’ve figured out:

  1. their results should exclude low-risk (or low Hb a1c) members whose risk/scores increase
  2. participants will always outperform non-participants, “matched controls,” “propensity-scored matched controls” and basically every other passive cohort–especially if dropouts are ignored;
  3. drawing a line upwards (“trend inflation”) will give them the result they want by showing savings “vs. trend”
  4. no one actually ever reads these reports carefully to check their plausibility
  5. the highest ROI, for the vendor, is to bribe a consulting firm or journal to publish favorable results. Buyers will suspend disbelief when they see the words “actuaries” or “peer-reviewed”.
  6. they can inflate their own satisfaction scores by simply ignoring people who weren’t satisfied, instead of doing a real engagement survey, or simply citing Amazon. And no wonder — here are Livongo’s scores. (Livongo will no doubt swarm Amazon with five-star reviews once they realize other people are looking at these scores.)

The seventh installment covers how to put this all together into an RFP. Really there are two simple questions. You almost don’t need to ask any others.  If it’s a carrier program:

“What is the penetration of this solution in your own insured (or in the case of large consulting firms, covered) population?”

If it’s vendor-direct:

“If we promote your solution to half our population and not the other half (which will have access, but not promotion), how much of your fees will you put at risk that the first half will outperform the second half in the key metrics you are addressing?”

In the case of the first, most programs offered by carriers to ASOs are not offered to fully insureds at all. In the case of the second, the answer is 100%.


So what to do instead of wellness?

It is possibly to achieve a much better result with much less effort and expense, simply by using Quizzify.


1 Comment

  1. […] a somewhat more expansive blog post, he noted that the study had particular credibility because the authors had played a critical role […]

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