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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.

Or:

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.

Interactive Health breaks its own record for stupidity

In the wellness industry, 2018 is ending just like it began: Vendors Behaving Stupidly.


Along with about 12 other need-a-lifers, we traditionally attend a “Nerd-a-Thon” on New Years Eve (tonight), where we play board games, including home Jeopardy. One Jeopardy answer might be:

A: “Roughly 3 seconds.”

The correction question would be:

Q: “What is the length of time required for a beam of light leaving intelligence to reach Interactive Health?”

Yes, Interactive Health is ending the year just as they began it, by setting new standards for cluelessness. They started the year by offering unsuspecting and no doubt somewhat befuddled employees a “smoking recession program,” and are ending it by proving that their 2017 and 2018 Deplorables Awards were well-earned.

Here is their posting:

Let’s look at it carefully. They crammed four mistakes/fallacies, plus a unique hashtag (#HealthareCosts) into two lines. First, anemia is not “33% more likely” among women under 45. To the contrary, if they had wanted to step out of character and make an actual true statement, it would have been pretty much the opposite: “Women 15 to 40 are 26% less likely to be anemic than women 40 to 69.”

Perhaps this information will come as much of a surprise to them as it did to me — the difference of course being that I didn’t just post the opposite to 12,162 chronically misinformed followers.

There is an asterisk in case anyone is keeping score at home — pregnant women of any age are at higher risk for anemia. That is the most clinically significant factoid about anemia in the working-age population, a factoid which naturally Interactive Health overlooked. One of their specialties is finding issues that don’t exist while overlooking issues that do. Another one of their specialties is posting random statistics on Linkedin that even a college intern could debunk.  Or hyperventilating that the number of cases of Alzheimer’s is expected to double by 2060 without mentioning that the senior population as a whole is expected to double by that year as well. They also claimed that there was a dramatic increase in heart attacks, but in reality the actual rate is about half what it was 40 years ago.

Another possibility is that this anemia data isn’t a surprise at all to them. They are aware of it (it is pretty easy to come by), but telling the truth would have undermined their new revenue enhancement strategy, which is to convince companies to screen the stuffing out of millennials, by “debunking” the “commonly held misperception” that you should adhere to well-resesarched, widely accepted, official US Preventive Services Task Force (USPSTF) clinical guidelines, guidelines which say, unsurprisingly, that you should definitely not screen the stuffing out of millennials.


Second, it doesn’t cost $10,000/year to treat iron-deficiency anemia. It costs about 5-10 cents a day, or $36.50 a year. So Interactive Health is off by a factor of 300. That’s a lot even for them.

Oh, wait, maybe they were talking about hospitalizations for anemia, not garden-variety anemia. Hospitalizations would cost $10,000 or more. However, in the immortal word of the great philosopher Rick Perry, Oops. Looks like young women have far fewer hospitalizations than older women:

Previewing IMG_0099.jpeg

To help Interactive Health interpret this data since apparently they could use some assistance, 32.1 admissions per 100,000 women 18 to 44 means 0.3 admissions per 1000 female employees in that age bracket.

In other words, nobody.  The average company with 20,000 to 40,000 total employees of normal age and gender distribution would probably have 1 admission for anemia.

And we would bet that whoever is hospitalized for anemia already knew they had anemia before Interactive Health started harassing them. My guess is most of these admission longshots would be either complications of pregnancy or anemia of unknown origin, or a rare disease.

Third — no surprise given that statistic — the USPSTF does not recommend lining up women to be screened for iron-deficiency anemia. (Even for pregnant women, who are at much higher risk than non-pregnant women, they find insufficient evidence to screen them.)   “Hunting for disease,” which my colleague Alan Cassels has written extensively about, is rarely a good idea, and this is no exception — which is one reason it isn’t recommended.

Finally, why screen for something that you can’t easily address if someone fails the screen? The other reason it isn’t recommended is that iron supplements for women who are technically anemic but have no symptoms also aren’t a good idea.  Liquid iron, like this…

…can, among its many other charming attributes, blacken your teeth. (The good news is that, as the label says, this supplement is gluten-free!) Iron supplementation in general can cause side effects like nausea, vomiting, and diarrhea, while high doses are so downright dangerous that iron pill overdoses are the #2 reason for emergency room visits among all vitamin and mineral supplements.


The good news is, here is another Jeopardy A&Q:

A: “High.”

Q: “What is the likelihood that in 2019 Congress is going to pass a law preventing vendors from penalizing employees who refuse to participate in non-USPSTF-recommended wellness screens like Interactive Health’s?”

 

Breaking: EEOC wellness rule change now officially set…and Trump nominee withdraws, meaning no new rules coming in 2019

For the wellness industry’s “pry, poke and prod” vendors — Interactive Health, Wellsteps, Bravo, Wellness Corporate Solutions etc. — the Grinch has got nothing on the EEOC. For the second year in a row, the EEOC is spoiling their Christmas.

Today’s Federal Register contains the EEOC’s removal of the rules allowing forced “voluntary” clinical exams from the relevant law.


But wait…there’s more

And it looks like the EEOC might also miss their latest self-imposed deadline for proposing new rules, which is June 2019. (The interval from proposing rules to implementing them is measured in months, if not years.) The reason for this? The EEOC still hasn’t filled its open positions and may not have a quorum for rule-making in time to do this. Not to mention they have other fish to fry once they do.

Today, President Trump’s nominee, who would have created the quota, pulled his name from considerationThat makes the likelihood of a quorum for rule-making all the more remote.

So, as Bravo aptly put it in their letter begging Senators to allow them to continue to harass employees with forced screenings, any employer not using Quizzify’s elegantly designed indemnification or other solution faces the “Wild West of litigation” in 2019. And to these vendors I say: Happy Festivus.

 

 

The finals for the 2018 health literacy vacation prize are underway!

If you won a Quizzify health literacy trivia contest in 2018, you should be getting a “ping” from Linkedin right now, as I just posted the rules for finalists to win the Martha’s Vineyard vacation. If you are NOT getting that ping right now, and think you are in the finals, please let us know posthaste.

Otherwise, sign your organization up to host a trivia contest in 2019 so you can try your luck next year.

 

My trip into the “treatment trap” and the birth of Quizzify

Does wondering how Quizzify got started keep you up at night? Wonder no longer.

It was not obvious to combine overdiagnosis with Jeopardy.  That is, unless you were both on Jeopardy, and also were overdiagnosed, which describes me.

In 2012 I was hired to host a radio series for the NPR affiliate in Washington DC (The Big Fix). After the first taping, the producer said so far so good, but I’d sound better after I got over my cold. Unfortunately, I didn’t actually have a cold. Newsflash to those of you who have heard me on podcasts by Josh Luke, David Contorno/Jeff Bernhard, Jen Arnold, Zeev Neuwirth, or anywhere else: this is the way I sound. I’ve been told I have a face for radio and a voice for newspaper.

Nonetheless, not wanting to be fired my first day on the job, and recalling that a few years earlier a doctor told me I had a deviated septum (“we ought to do something about that”), I immediately called my PCP for advice.

My PCP immediately set up an appointment to see an ENT, who determined that my stuffiness was likely being caused not by the deviated septum, but rather by a raging case of the polyps. (“Your deviated septum is the least of your problems.”)

The ENT suggested surgery, Flonase, or Flonase combined with a three-week course of antibiotics. “So,” she asked after quite literally six minutes explaining the options, “which do you want to do?”

“Um, shouldn’t we do the most conservative therapy first?” I inquired.

“Well, you could,” she replied, using a tone of voice implying that only an imbecile would.

Why was this diagnosis and treatment problematic? Six reasons…

 

A tie! The 2018 Deplorables Award goes to Interactive Health and Wellsteps

For this year’s Deplorables Award, the winners were given a chance to fact-check in advance, and declined. No need for them to have wasted the effort — only one person, Keith McNeil, has ever found a material mistake in any They Said What posting


As in past years, we convened our panel of distinguished judges to address the age-old question about “pry, poke and prod” wellness programming: how is this stuff even legal?

After they get done contemplating that — and wondering why they’re the only people in the industry who seem to have ethics, an internet connection, and a triple-digit IQ — the judges reviewed the candidates for the coveted Deplorables Award.  While any wellness vendor is eligible, they ruled out It Starts with Me, and US Preventive Medicine, since those vendors, whose claims are validated by the Validation Institute, apparently didn’t get the memo that you can’t succeed in this business without lying.

Ruling out those two dramatically narrowed the field down, to only about 1000. Narrowing the field even more, a few, like Provant, took themselves out of the running by going bankrupt. (Individuals are not eligible for the Deplorables Award, so we also need to rule out Ron Goetzel, despite his best efforts to make a late run at the trophy.)

This year, as in previous years, it boiled down to a battle between the very stable geniuses at Interactive Health vs. the people with very good brains at Wellsteps — more than coincidentally the 2017 and 2016 winners respectively. It was a close one. There are very fine people on both sides. Together with Mr. Goetzel, they constitute the wellness industry’s Axis of Genius.They both fabricate outcomes, flout guidelines, and harm employees, so it came down to a simple race to see who, in the wellness industry’s epidemic of very stable geniusitis, would be Patient Einstein.


Wellsteps

The case for Wellsteps is compelling. To begin with, after a few proud possessors of high school diplomas observed that their fabricated ROI model will always return a “savings” of $1359 if you zero out inflation even if the smoking and obesity rates go from 0% to 99%, in 2018 they reprogrammed the model so that instead of always returning a “savings” of $1359 in the final program year regardless of what assumptions you input, an obvious rookie mistake that only an idiot wouldn’t notice when designing an Excel spreadsheet model, the model will always returns a “savings” of $1356 in the final program year, regardless of what assumptions you input.

Ah, much better, thank you.

Don’t take our word for it. Here it is. Note that for some reason the actual trendline on the graph doesn’t show up any more.  You need to read the fine print instead. Here is what happens if you reduce smoking and obesity from 99% to 0%…

…and here’s what happens if your population already has 0 smokers and no obesity, so no improvement is possible:

If those columns of numbers at the bottom of each chart look identical, it’s because they are. This happens no matter what numbers you enter. (You are no longer allowed to enter increases in smoking or obesity like I used to do, so don’t even try. SPOILER ALERT: If you could, you would still get $1356 in savings.)

And, almost a decade after they first posted their ROI model, it still doesn’t calculate an ROI. Hello, do you see an actual ROI on this screenshot? At this point we’d settle for a phony one. (A real ROI estimation model can be found here.)

Their CEO has been featured on They Said What this year, with his take on the National Bureau of Economic Research’s invalidation of wellness outcomes. He accidentally admitted it was valid.

He claims to have spent “11 years in college.” Yet, even though that’s 4 years longer than Bluto Blutarski, he still can’t add the two columns of numbers he published that showed how badly his Koop-award-winning program for the Boise School District failed.  Here are those two columns, a comparison of risk factors in the baseline year vs. one year into the Wellsteps program:

Here’s what happens when you actually add his two columns up — turns out there was a dramatic deterioration in Boise schoolteacher health status.

So it looks like that was, to paraphrase the immortal words of the aforementioned great philosopher Bluto Blutarski, 11 years of college down the drain.

Image result for Bluto Blutarsky food fight


Interactive Health

The case for Interactive Health is equally compelling. After winning the Deplorables Award last year, they decided to double down on cluelessness, and so in 2018, they started a “smoking recession [sic] program.”

No one could figure out what they were talking about — apparently including the creators of their smoking recession program, who eventually took it off their website. My hunch was that they were trying to get smokers to switch to Parliament, which features a recessed filter, on the theory that the smoke would take longer to get into people’s lungs.

Later in the year they solidified their front-runner status with three more postings.

  1. college intern was able to invalidate their claim that younger workers had more mental health issues than older workers, and that therefore you needed to pay Interactive Health to screen them;
  2. Next came Interactive Health-meets-Barbie, where they told someone whose HRA showed her to be severely anorexic that she was in a “healthy range.” We noted the irony that this is a company that wants to send almost half your employees to the doctor to treat “newly discovered conditions”…and yet here was someone who appeared to really have a condition that needed attention…and they missed it altogether;
  3. And just last week they cemented their candidacy by providing a cornucopia of misinformation about the EEOC.

That brings us back to the original question: how is it even legal to harm employees and completely disregard clinical guidelines, as these two companies are wont to do? Well, it turns out that, starting in 2019, it may very well no longer be. No, I’m not referring to the EEOC rule change. That will make companies liable to their employees for fining them, but it will still be legal to screen the stuffing out of them.

The good news is that apparently there will be a move afoot in the next session of Congress to prevent wellness companies from attaching penalties to screens that violate US Preventive Services Task Force guidelines — which is to say, most of Interactive Health’s and (according to Wellsteps’ CEO, Steve Aldana, himself), Wellsteps’.

If this bill were to pass, three things would likely happen:

  1. Employees would improve on health status;
  2. Employers would save money on wellness;
  3. Wellsteps and Interactive Health would throw up on Dean Wormer.

Image result for flounder throws up Animal House

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