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Wellsteps accomplished the impossible: they got stupider.


Readers of Why Nobody Believes the Numbers may recall that you can’t reduce a number by more than 100%. This is true no matter how hard you try. And just in case our friends Down Under were wondering, this is not one of those things that’s the opposite in the Southern Hemisphere.

Wellsteps is giving that assertion a run for its money.

Following that headline above (from a full-page spread in the Boston Globe) they’ve doubled down on stupidity to win the wellness industry’s race to the bottom, and, with the demise of Interactive Health, Wellsteps is easily the dumbest vendor in all of wellness.

Still, you have to admire their commitment to stupidity. I and others have pointed out maybe a dozen times that their entire business doesn’t accomplish anything other than harming employees, but they refuse to budge.

Calling them the dumbest vendor in all of wellness is quite a compliment. That’s because the alternative would be to call them the most dishonest vendor in all of wellness. Besides insulting their integrity, that’s not an easy feat to accomplish in this industry. It would be like calling out a specific entitled zillionaire as the most dishonest parent in the entire Varsity Blues scandal.

Perhaps disheartened by their loss of the uncoveted Deplorables Award to Angioscreen after having won or shared two of the last three, they have decided to take stupidity to a new plateau.


Their “Updated ROI Calculator”

The reason they’ve made the news today is that they’ve just published an “updated ROI calculator.” And a big thank you to Jon Robison for forwarding it to me, as Wellsteps has banned me from their linkedin group and everything else.

There are a few things you might want to know about their updated ROI calculator. As you’ll see once you expose it to light, this updated ROi calculator:

  1. is not “updated
  2. doesn’t show an ROI
  3. doesn’t calculate.

Three lies in three words. That breaks Ron Goetzel’s record of 14 lies in 45 minutes.

No need to take our word for any of this. Here’s the only thing that is updated:  the font. This makes it easier to see what happens if you actually try to enter data into this model. Sort of like actually trying to drive a Yugo


Start by zeroing out inflation as a confounder (“0”). Then, for simplicity and consistency, enter “1” into number of employees, as below. I entered $1000 into annual healthcare costs, just to use a round number.

Then let the games begin.

Let’s see how much they save in the best-case scenario. Enter 100% into the two fields “% Employees that [sic] are obese” and “% Employees that [sic] are smokers.”

As an aside, normally one would use “who” in this situation, but they don’t, for two reasons. First, One of Wellsteps’ signature moves is creative sentence structure, spelling, and mixed metaphors. The CEO, Dr. Steve Aldana, called the late award-winning journalist Sharon Begley a “lier.” He once accused me of violating the Law of Conservation of Matter, saying that I am “great at creating BS out of thin air.”

Second, perhaps the reason they preferred “employees that” to “employees who” is because another of their signature moves is to dehumanize employees. Their exact words, subsequently deleted after criticism, were: “It’s fun to get fat. It’s fun to be lazy.”


Back to the Calculator

Let’s see what happens if you do a fantastic job, and reduce the number of “employees that are obese” and “employees that are smokers” from 100% to 0%. So enter those two figures:

Then go to the right — directly on top of this “hockey stick” graph as you can see, and hit “savings from wellness programs.”

Congratulations. You’ve reduced the $1000 spend by $1379, which is a reduction of more than 100%. While I merely allegedly violated the Law of Conservation of Matter, they’ve just clearly violated a basic law of arithmetic, and those are strictly enforced.

You might say: “That’s not fair. Let’s use a more realistic risk reduction figure, like 0%, which is what all the literature says is achieved:

In the immortal words of the great philosopher Gomer Pyle: “Surprise, surprise, surprise.” You still show mathematicaly impossible savings.


You still show savings even if employees get worse. This is Wellsteps’ signature move in real life, as they harmed the employees at the Boise School district…and still fabricated massive savings:

The actual savings they fabricated — along with their inadvertent admission that costs actually increased — can be found here. Costs can’t go up and down at the same time. Yet another rule of math that is strictly enforced.


What if you don’t have any employees on your health plan, so you spend $0 to begin with? Turns out you can still save a bundle if you have no costs to begin with, even without reducing smoking or obesity.

Before you start fiddling with it, be aware that the very stable geniuses at Wellsteps who came up with this calculator once accused me of “entering false data” into it. So make sure your “data” isn’t “false.” To avoid that:

  1. use only arabic numerals…
  2. …in base ten.

Turns out no matter what data you enter, you save money. Don’t take my word for it–see it with your own eyes.

Stupid?  Well, let’s just put it this way. NASA engineers need not worry about their job security on account of Wellsteps, because these people are not rocket scientists.


Or Wellsteps’ CEO, Steve Aldana, actually dishonest?

Let’s examine the evidence both ways. Here are the three best arguments for stupid:

  1. He says he needed 11 years to get through college. (p. 7) That’s 4 more years than Bluto Blutarski.
  2. He thinks “even one more bite of a banana” will improve your health.
  3. He is friends with Ron Goetzel.


Here are the the three best arguments for dishonest:

  1. He admitted that his alleged savings at the Boise School District was just regression to the mean. (Scroll down.)
  2. He knows this “model” is fabricated and has criticized me for pointing that out.
  3. He is friends with Ron Goetzel.

And let’s not forget that Wellsteps’ claim to fame is actually bragging about harming employees. To this day, they are the only vendor willing to publish data admitting that employees got worse on their watch. And that puts them in a category all their own. Like Juan Garcia, whose espionage work won him the highest military awards from both Germany and Britain, this performance earned them both a Koop Award (see #3 above) and a Deplorables Award.

Does that mean they are dishonest, stupid, or both?  To slightly paraphrase the immortal words of the great philosopher Clarice Starling, there isn’t a word for what they are.


Update: Many of you know about the $3 million reward for showing wellness works. If Steve Aldana and his team of very stable geniuses with very good brains can show that their calculator is more accurate than Quizzify’s ROI calculator, I am doubling my $3 million reward and halving the $300,000 entry fee.  The rest of you can stop reading here. Steve, that would be a $6 million reward for a mere $150,000 entry fee.

“New” EEOC wellness incentive rules now DOA!

Within minutes of Quizzify’s blast email predicting that the EEOC’s rules released two weeks ago would be DOA, it is now a lock that they are toast. The White House made two announcements last week confirming this:

This means the huge loophole in the announced rules, allowing most outcomes-based wellness programs, will be closed.

Is this an existential threat to the wellness industry? At first glance, it would seem to be. But you can join our webinar to learn so this existential lemon can be turned into existential lemonade.


 

Leading wellness attorney Barbara Zabawa and I are hosting a webinar on this topic on Monday, February 1st, 1:00 EST. You can register here (and get access to the recording and slides as well.)  Focus will be on how to ignore the new rules, and maintain your program as is. Yep, just like with surprise bills, we’ve figured out how to game the system.


The EEOC has just released their rules for clinically based wellness programs.This step is called the “Notice of Proposed Rulemaking,” or NPRM, to be published in the Federal Register’s mellifluously named Notices of Proposed Rulemakings for public comment. “Public comment” is code for “the perps with the most to lose will flood the thread with disinformation.” Expect the US Chamber of Commerce, the vendors and Ron Goetzel and his cronies to weigh in heavily, each more shamelessly than the next. They have a lot of (your) money at stake here.

When NPRMs are posted for public comments, you know who never makes public comments? The public. So it’s up to you and me to pick up the slack, and point out that these perps have no clothes. Feel free to grab posts from TSW to add to the comments.


And the envelope please…

Most importantly,  incentives for participation-based programs need to be cut back to “de minimis.” And, unlike when the rules were first floated (and true to the intent of the judge who found that forced wellness programs were not voluntary), de minimis has been defined. It looks like the IRS definition — water bottles, t-shirts, small-denomination gift cards.  I had thought perhaps $200 would be OK. That is clearly outside the realm of de minimis. That could change if the perps flood the comments.

My own opinion: it is perfectly ok, even desirable, for organizations to offer employees screening.  Just don’t make them do it. I myself voluntarily get my Hb a1c screened every year, to make sure I’m playing enough ultimate frisbee to offset my consumption of LA Burdick’s insanely good chocolate.

And it is perfectly OK to educate employees on why they should want to get screened (or, in the case of younger, healther employees, why they shouldn’t). Screening would then be truly voluntary.

However, many organizations want to maintain their current participation-based programs with their current incentives or penalties…and many vendors want to keep their revenues intact.

For these groups, Barbara and I are offering this webinar, to show how to do exactly that.


So far, so good, but…

That was all about participation-based programs. Health-contingent, or outcomes-based, programs are a different story altogether. The EEOC is basically pro-employer these days. So they have figured out how to circumvent the spirit of Judge Bates’ December 2017 decision vacating the old rules in which forced programs were defined as “voluntary,” without violating the letter of his decision. But this massive loopholecould circumvent the ruling only for outcomes-based programs, not participatory ones.

This loophole allows you to continue to be able to subject employees to fines of thousands of dollars in outcomes-based programs. Most employees hate being forced to submit to these programs (“I’d like to punch them in the face,” said one), and they invariably lose money. However, the losses in program fees and employee morale — all admitted by the wellness industry trade association — is more than offset by the “immediate employer cost savings,” as Bravo puts it, generated by collecting the penalties from employees who refuse to let unlicensed wellness vendors play doctor.

However, most outcomes-based programs, while arguably complying with these new rules under the Americans with Disabilities Act, violate the Affordable Care Act. With the well-documented, Validation Institute-validated exception of US Preventive Medicine, they invariably fall short of the ACA’s standard of being “reasonably designed to reduce risk or prevent disease.”  That hurdle was set low enough to allow even the worst outcomes-based wellness vendors to clear it, and yet they don’t. They violate guidelines with impunity, forcing employees to undergo tests that no doctor would ever order and that get D ratings from the US Preventive Services Task Force (USPSTF).

Just too many epic fails, all documented for the last five years on this blog and sometimes in the media, including Koop award winners like Wellsteps, arguably the industry’s worst program now that Interactive Health has gone bankrupt. Ironically, Wellsteps is also among the best-documented programs. Why they insisted on publishing their own self-immolation is anyone’s guess. No one can argue that programs violating the USPSTF guidelines and, as we’ll see, harming employees, could possibly be considered “reasonably designed to prevent disease.”


This is not just about the money.

Outcomes-based programs can and do harm employees. Sometimes wellness vendors — I’m looking at you, Wellsteps — even admit their harms.

Yale employees sued Yale, for example, due to the psychological and physical harms of their program. One Yale breast cancer survivor was almost forced into getting a mammogram, even though she had already undergone a double mastectomy. Had it not been for Yale’s union and the AARP’s support, she would have been fined $1250.

TSW has published many stories of harms, summarized here. Not to mention what happens when you fine your employees for not losing weight. Guess what — they respond in very predictable fashion, packing on the pounds before the weigh-in and then crash-dieting to take them off. And our #1 most-searched phrase?  “How to cheat in a corporate wellness program.” https://dismgmt.wordpress.com/2019/01/07/breaking-shocking-news-employees-cheat-in-wellness/


Still, if you insist on keeping an outcomes-based program, the “hack” we’ve figured out of the new regs applies to outcomes-based programs as well. Seriously.

So if you have a program (and very few people with outcomes-based programs read this blog, or else they would have already dropped them), you’ll want to attend the webinar to figure out how to preserve it. And if you don’t have a program, you’ll want to attend just to understand what the EEOC tried to do with this massive loophole and how we got the better of them.

 

Answer Leapfrog’s 20th Birthday Trivia Question to win $100

Dear They Said What Nation,

To celebrate Leapfrog’s 20th Birthday Week, Leah Binder posted 3 questions in our chat on Linkedin. One of the 3 remains unanswered…and I am personally upping the ante to $100 for the first correct answer!

So have at it.  Here is a hint: this person was an overnight sensation before become the person with the most things un-named for him. The full question is in the interview.

Once again, Hppy 20th Birthday to Leapfrog!


Dear They Said What Nation,

Happy 20th Anniversary to The Leapfrog Group.  In 20 years they have become arguably the most untainted healthcare not-for-profit in DC.  It’s not easy to stay untainted for 20 years, but they have. By contrast, providers, PBMs and vendors “sponsor” other groups, and — get ready — the other groups advance their agendas instead of consumers and employers. Simply doesn’t happen with Leapfrog.


Even though it’s their birthday, you’re the ones getting the presents. Yes,  members of TSW Nation can actually win prizes. Not for blowing the whistle on dishonest wellness vendors (though that too), but rather by answering a couple of general interest trivia questions right. If someone does the Mary Wells thing and guesses ahead of you, you can still at least be entered in a runner-up drawing

As of this writing, there are no correct answers yet…though everyone has heard of the two people and you’ll kick yourself for not guessing right.

Once again, here is the link. No time to waste, as the deadline is 4 PM today.

I was caught making stuff up…again!

In the immortal words of the great philosopher Britney Spears: “Oops, I did it again.”


Another mistake caught! This time by the esteemed Scott Breidbart MD. I had written that the incidence of colon cancer in the 45-to-49-year-old population was 0.007%, having misread my own posting. I confused the total <50 incidence with the 45-to-49-year-old incidence, which is a whopping 0.035%, as Scott said.

I had cited the wrong number when Scott and I got into a kerfuffle about whether 45-to-49-year-olds should be screened for colon cancer. That is the new USPSTF guideline. Honestly, even at 0.035%, I still wouldn’t recommend that employers get involved in this decision. Here’s a wacky idea: let’s leave this one to the patient and the doctor! Oh, I know it sounds crazy but it just might work.

My logic would be that many folks in that 0.035% would already have had symptoms. So the percent findable with a screen is somewhat less than that.  Further, the complication rate from colonoscopies exceeds 0.035% by at least one decimal point.  Not to mention that, surely, as an employer, you can find better ways to spend your money.

Scott would say, quite correctly, that you don’t have to get screened using a colonoscopy. Cologuard and FIT testing are completely non-invasive. I myself recently did Cologuard. As instructed on the box, I took my “sample” to the local UPS store to mail back and as coincidence would have it, someone else was in the store doing the same thing.  Maybe this is catching on, because the UPS rep said he was shipping a fair number of Cologuard samples these days. (Sidebar: as far as I’m concerned, UPS can’t pay these guys enough.)

I would then observe back to Scott that many non-Quizzify users don’t know about alternatives to colonoscopies, and (like with Silver Diamine Fluoride for cavities), the providers aren’t telling them, in order to protect their revenues.  If you really want to get down and dirty on this topic, so to speak, here is the Quizzify writeup.

Still, we don’t go against the USPSTF. Color us neutral even though our gut, so to speak, says the opposite.  As far as this decision is concerned, I’d say let’s leave it to the doctor and the employee.

Scott and I are in total agreement on that point and this next point. (I checked with him just now. I make enough enemies on purpose without making any accidentally.) Our advice to employers is, so to speak again, to butt out.

Or, for those who prefer visual mnemonics…


If anyone is keeping score at home, Part 1

This is the second mistake (or at least the second time I’ve been caught) in the last two years.  At this rate, I will make 4 more mistakes during the 2020s, which will be a new record for me.

The leaders are tightly bunched for first place:

  • Scott Breidbart – 1
  • Keith McNeil – 1
  • Tom Milan – 1
  • Jeff Hogan – 1
  • Entire wellness industry – 0

 


If anyone is keeping score at home (Part 2), here are the previous ones…

For the fourth time in as many decades, I’ve been caught! This is not to say that I’ve only made 4 miscues in the most recent 4 decades. Just that I’ve only been caught 4 times in these 4 decades. Not including the time I caught myself actually thinking disease management (DM) saves money. Until then, basically everything I said was a lie, however unintentional, because in my naivete I thought DM worked. Silly me.

Jeff Hogan joins the few, the proud, who have called me out for saying things that aren’t exactly accurate. I’m putting this blog on top of the previous one to make it easier to track my cumulative miscues, in case you’re keeping score at home.

In this case, he referenced a study in Health Affairs showing that bundled payments reduced the cost of surgeries by 11%. I saw that abstract and immediately assumed that, like many other bundled payments, the reason the cost per procedure declined is that the number of procedures increased, by surgeons adding more “easier” and hence less costly procedures. This would reduce the cost/procedure but total costs would increase due to more procedures.

I couldn’t link through to that study (nor can you, most likely) from that abstract, to test that hypothesis. But since it is Health Affairs I just assumed that their peer review for that article is as sloppy as it is for wellness articles. Ron Goetzel published a nonsensical article there, which, among other things, concluded that only about 5.5% of the cohort smoked because only 5.5% of the cohort admitted they smoked, on a risk assessment.  Since the US smoking rate is more like 18%, the correct conclusion would have been that two-thirds of smokers lie on risk assessments. I would have caught that in peer review but Health Affairs allows authors to pick their own toadies as peer reviewers.

So, without actually reading the Health Affairs study, I assumed they applied the same lofty standard of peer review to this article as to Goetzel’s:

They don’t appear to have tracked the number of cases. A classic thing hospitals and doctors do when they get paid per case is to perform surgeries on people who may not have needed them. These people will have lower-than-average costs and complication rates…but be reimbursed the same.
Or, in the immortal words of the great philosopher Claude Rains, “Owing to the seriousness of this crime I’ve instructed my men to round up twice the usual number of suspects.

Jeff wrote back:

Al:  Did you read the same Health Affairs article that I did?  The citations and case tracking is quite detailed in the report and appendix.  Not only did they carefully examine the number of cases but they used some very intensive methodologies for doing disruption analysis.

He helpfully attached a pdf. It turned out they had indeed tracked the number of referrals not going to surgery, and almost a third did not, in fact, go to surgery. This factoid never made it into the abstract, but was buried in the article.

So kudos to Jeff and if he sticks around another 8 years, 9 months and 22 days, at my current pace, I’ll be due for another mistake.



Guilty as charged. Someone called me out on yet another mistake buried in my 500,000 words published to date.

Yep, the number of members in the most exclusive club in healthcare outcomes analysis just rose by 33%, as Tom Milam of TrueLifeCare joins Corey Colman and Keith McNeil in justifiably calling me out.*

To put this track record in perspective, Ron Goetzel has been caught 14 times. You might say, well, 14 isn’t that much different from 3 in absolute terms.  (In percentage, it is, but we’ll let that slide.)

Except that I needed an entire decade to rack up 3, while Ron needed only 45 minutes to tally 14.  Over the decade, his number would be more like approximately eleventy zillion. It depends how you count the ones where he doctored numbers that were phony to begin with and then doctored them back again to the original phony numbers, after insisting that the doctored numbers were real. If you’ve lost track on all the doctorings that I just now published a companion blog post on it.


So what was the mistake? 

[SPOILER ALERT:  The rest of this post is boring.]

It’s kind of anticlimactic, and quite obscure. By way of background, I routinely analyze wellness-senstive medical event (WSME) rate trends for large employers and health plans. It’s not rocket science, but it’s totally valid. Indeed, it’s the only population-based observational analysis that is valid. (RCTs are not observational. But you knew that.). It was even embraced by Ron Goetzel’s very own outfit: the Health Enhancement Research Organization — before they realized that valid measures are the wellness industry’s kryptonite.

The WSME tally is also the only observational methodology accepted by the Validation Institute for employers and health plans.

Here’s what the national WSME rate looks like. (I think there was a reporting or transcribing error by one of the reporting states in 2005-2006, to the extent anyone noticed the inflection in the graph, or cares.) This graph of WSMEs shows that, over the decade+ period of the greatest growth of workplace wellness, that there was no improvement in event rates relative to the US population that would not have had access to workplace wellness — Medicare, Medicaid and the uninsured. Obviously their raw rates were higher. This is a difference-of-differences analysis.

Quite the contrary, it appears that if anything the employer-insured cohort trended worse than the control.

Tallying this rate requires our data extraction algorithm to collect ER and IP events primary-coded both to the disease in question, or else are common complications of the disease in question. We pick common complications based on two factors:

  1. How likely is someone with the disease in question to get the complication?
  2. How likely is it that the complication in question occurs in someone with the disease?

Remember, we only tally primary codes because we want to simplify the analysis enough that we can be 100% sure of comparability between any given payor and other payors comprising the benchmark. So we look for an “80-20 rule” in what we include in the primary code data extraction.

Our diabetes rate includes quite a number of complications that fit that description., one of which is cellulitis. Diabetics are much more likely than non-diabetics to get cellulitis in their extremities — feet in particular — because they often can’t feel a cut. (Also the skin on their feet can be thinner than it should be.) Likewise, cellulitis of extremities is much more likely to be diagnosed in diabetics than non-diabetics.

If you can’t feel it, you won’t treat it. And therefore your odds of cellulitis in your foot are high. However, cellulitis in non-extremities would correlate much more loosely with diabetes, since diabetics can still feel and see skin issues elsewhere on their bodies. Therefore, not all cellulitis codes, by a longshot, are included in our analysis.

While we included cellulitis of the foot (and leg, also common enough), we somehow — despite having done these analyses 20 to 30 times a year for 15 years — omitted cellulitis of the toes. Sort of like the Matisse painting hanging upside down in the Museum of Modern Art for 47 days, no one else noticed either. Yet even the most intellectually challenged members of the wellness industry’s self-anointed awards committee understand the anatomical fact that, technically speaking, the toe is part of the foot.


Vintage HENRI MATISSE Original Lithograph 1958 Color Art image 0

Le Bateau, Henri Matisse


Honestly, when all is said and done, this won’t change anyone’s results much, and all the changes will be in the same direction vs. history (which is also going to be recoded) and vs. the benchmark/average, likewise recoded. This is especially true in the working-age population, which comprises most of our analysis. Nonetheless, kudos to Tom Milam for becoming the third member of this most exclusive club.


*Your chances of joining this club are quite remote, statisically speaking. They are even more remote if you didn’t notice the arithmetic error just now. n increase in membership from 2 to 3 is a 50% increase, not a 33% increase. And the painting is still upside down…

Six Things Employees Should Know about Antibiotics

Dear TSW Nation,

This month (meaning next month, but it already feels like December around here), we are donating this space to Quizzify, where we are reposting Quizzify’s Greatest Hits of their Six Things Employees Need to Know series. One a weekday for the next month, interrupted only by our annual awards.

As an alphabetical coincidence, we’ll be starting with Six Things Employees Need to Know about Antibiotics.


Antibiotics are America’s most overused prescription non-opioid. Here’s what your employees should know about them. [SPOILER ALERT: They don’t.]

(1) Do not demand an antibiotic if one is not offered

Americans get enough antibiotics without asking for more. Official statistics show that half of all antibiotics are the wrong dose, wrong duration, or wrong drug – including a quarter that should not have been prescribed at all.

My personal tally is probably 75% wrong, in one way or another, as in this harrowing example, one of the highlights of which is a dentist asking me; “So, what’s your favorite antibiotic?

There is nothing, nothing in Quizzify, that suggests the correct way to prescribe an antibiotic is to ask your patient what their “favorite” is. Quite the opposite, taking the same antibiotic multiple times is a good way to create antibiotic resistance.

Alexander Fleming himself predicted the rise of antibiotic resistance by using the same antibiotic repeatedly.


(2) Some specialties are worse offenders than others

Pediatricians often immediately prescribe these for earaches, when the best evidence clearly says this choice should be far from automatic.

Urgent care is the worst, with almost 50% overuse for respiratory issues. ERs, for all their faults in the billing department, seem to be much more responsible in this respect, with “only” 25% inappropriate.

Dentists, with Exhibit A being my former one as noted above, are major overprescribers. With a few exceptions, of course.

And if a telemedicine doctor prescribes one, consider this: how can they possibly be sure you have a bacterial infection? There’s no in-person exam and no culture. You guessed it – they are also major overprescribers.


(3) If an antibiotic is proposed, ask some questions

“Are you sure this is a bacterial infection?” is the best. If you get an answer like: “This is just to be safe,” or something similar, your best bet may be to get the prescription, but maybe only fill it once the culture is completed and is positive for bacteria. Or maybe whatever you have will go away on its own. Or ask (and call back if needed) what new symptoms might lead the doctor to think this is bacterial, and start taking the antibiotic then.

There is also a decent chance that whatever antibiotic the doctor guesses at before the culture is completed is the wrong one. Or is an overly powerful “broad spectrum” antibiotic when the culture reveals a specific organism that should be targeted.


(4) “Finish your entire course even if you are feeling better” is an urban legend

The one thing drilled into us when we are prescribed an antibiotic is that stopping early gives the hardier bacteria a chance to rebound.

Click Here for the rest…



Want more info on Quizzify?  Watch our video. Just to set expectations low enough that we can easily exceed them, this is the second-best vendor video ever produced.

Dog Bites Man! And Wellsteps fabricates its outcomes again!

At the risk of insulting the 76 million canines in this country, Wellsteps fabricating its outcomes is the “Dog Bites Man” headline of the wellness world. it really shouldn’t make the front page, especially in an industry as idiot-intensive as wellness. Yet transparently fabricating outcomes is their signature move, so I do like to make sure they get credit for it.

Even so, it’s impossible to do the “There’s nothing to see here. Move on” routine where Wellsteps is concerned.  Wellsteps’ problem is that they aren’t remotely smart enough to lie without being caught. They may or may not be the most dishonest vendor, and they may or may not be the stupidest vendor, but they are certainly the stupidest dishonest vendor. 

Exhibit A is their C. Everett Koop Award, given annually to the friend of Ron Goetzel who is willing to submit his company and himself to the most ridicule.

This time, in a last-minute quest to win their third Deplorables Award in 5 years, their very stable genius CEO, Steve Aldana, attempted to doctor the evidence of their cluelessness that won them their second Deplorables Award. His plot was foiled because he hadn’t realized that technology had advanced to the point that a skilled hacker, equipped with state-of-the-art hardware, could take screenshots.

Here is a screenshot of the original evidence of the harms done to teachers in the Boise School District:


You might ask: “What harms done?”

You can’t tell at first glance, because their original display scrambles the people whose risk scores increased with those whose risk scores decreased.  Wellsteps does deserve credit for obfuscating outcomes in this manner, a brilliant application of their limited intellect that completely fooled the Koop Award Committee.

Unscrambling those datapoints to discern the actual net change in risk scores requires use of another application of another advanced technology – a spreadsheet.  

Unscrambling those increases and decreases revealed that, in fact, risk scores had dramatically deteriorated on Wellsteps’ watch. This spreadsheet copies the the three columns from Wellsteps’ version and then unscrambles the improvements and deteriorations, to create totals of both:

6397 risks (red) increased, while only 5293 (green) improved. Of the 5293 that “improved,” 2134 were people with normal glucose reducing it further, potentially making some of them hypoglycemic.  Nothing screams “productivity improvement” like hypoglycemic teachers trying to control a roomful of kids who’ve just finished their juice-and-cookies.

In all other cases – BMI, blood pressure, cholesterol – the average low-risk person (or even middle-risk person, in two instances) showed an increase in risk factors (in red), as would be expected due to regression to the mean. Our suspicion in glucose is that Wellsteps simply miscalibrated their equipment or misadded their figures. Or they made some other rookie mistake, rookie mistakes being another of their signature moves. The reason you can be fairly certain of this is that it is statistically virtually impossible that an entire cohort of 2134 people whose glucose was already low would go even lower, especially when all the other “normal” starting values spiked higher.

So instead of teachers suffering from hypoglycemia, the likelihood is that Wellsteps was suffering from hyperstupidemia.

Removing those 2134 glucose decreases from the calculation means, almost literally, that twice as many risk factors inreased as decreased.

This was major news, a full-page article in the Boston Globe, as the headline below shows. But the Boise School District wellness coordinators, either embarrassed because they hadn’t realized their teachers were being harmed at considerable cost, or because they were suffering from Stockholm Syndrome, never reported this to the Boise media.

 


Now here is Wellsteps’ new spin on their outcomes. Wellsteps decided the only way they could show results that weren’t a complete embarrassment was to omit the large majority of participants, because their risk on the whole increased. Instead they would just show the small minority whose risk decreased, riding the regression to the mean (“RTM”) train to hoodwink gullible prospects into thinking they actually accomplished anything other than killing a few billion electrons. 

Ironically given their level of overall ignorance, they can’t claim ignorance of RTM.  Mr. Aldana himself, – whom epidemiologists have determined is Patient Zero in the wellness industry’s epidemic of cluelessness – actually admitted that he understands the concept of RTM and how it applies here:

“In just one year, many employees will move from one [risk] group to the other,” he explained, “even though they did not participate in any wellness programs or any intervention whatsoever.” That movement, he continued, “reflects changes in health risks that occur naturally,” making it possible that some high-risk people become low risk “even though your program didn’t do anything.”

He called the author of the article citing this quote, the late, esteemed, highly respected health/science writer Sharon Begley, a “lier.” Though he never said exactly what she was lying about, of course. 

He also accused Sharon and me of violating the Law of Conservation of Mass, “creating BS out of thin air.”


To close on a conciliatory note, in that very same article, Mr. Aldana made an observation which with I and readers of this column would concur: “I agree there is some real crap out there being sold under the guise of wellness.” 

Hear, hear! So I think we can also all agree that it’s time to rid the industry of “liers” that sell “real crap.” And we can also agree to apologize to all who have been victims of Wellsteps’ schemes or invectives: teachers, Boise taxpayers, Sharon Begley, honest vendors, relatives of the deceased electrons, and, of course, our collective 76 million dogs.

Teaching Employees how to be Patients

Ever visited a doctor and forgot what questions to ask? Or didn’t know? Or were too embarrassed to ask?*

If so, you’ll want to join our webinar tomorrow (Tuesday) at 1 PM EDT Quizzify has created a new product, Quizzify2Go, that solves those exact problems. Basically, we teach and encourage employees to be patients.

Quizzify2Go supports fifty common doctor/dentist conversations covering everything from abdominal pain to wisdom teeth with a “Cheat Sheet,” with a heading for context. Beyond that heading are 4 to 10 questions to ask.


Here is an example, for kids’ earaches:

The headings and questions often come with links to authoritative sources. And you can share particular questions with friends-and-relations using the “share-by-email”feature.

Before the formal January introduction date, Quizzify2Go will be linked to and from Quizzify quizzes, and will include almost twice as many Q&A Cheat Sheets, now in the works. Quizzify2Go will be the left shoe to Quizzify’s current right shoe, quite literally bringing the Quizzify knowledge right into the doctor visit, where it would be most helpful.

Even though we know the “right answers,” most of the material is in the form of questions, in order to enhance the doctor-patient relationship rather than threaten it. As you know, doctors get annoyed when patients think they are experts on a topic because they’ve searched it.

All this will be covered in our Tuesday webinar, so sign up now. Attendees will receive Quizzify2Go gratis through year-end.



*You may wonder, how does Quizzify2Go solve the problem of “feeling too embarrassed to ask”?

Simple:

 

 

 

Critics slam award-winning McKesson wellness program

Wellness programs are designed to make employees happy whether they like it or not.

And, using that criteria, McKesson’s is the best of the best. Let’s review some of the accomplishments of McKesson’s program:

  1. Employee weight increased and decreased at the same time;
  2. The program did not noticeably improve biometric risk factors among active participants (dropouts and non-participants aren’t counted, of course);
  3. A whopping 27% of their employees use tobacco;
  4. They set a record for the largest penalty ever paid for illegal opioid distribution.

Those accomplishments naturally won them a C. Everett Koop Award, given annually to the company whose application best exemplifies the IQs of the award selection committee. It also got them some great publicity in Employee Benefits News, where they explained how weight could increase and decrease at the same time:

“Health indicators in 2013 and 2014 were adjusted in the analysis, while several sensitivity analyses of the ‘inter-individual’ impact that used a matching approach confirmed the results.”

Of course, how silly of me!  This makes perfect sense, as explained here!


Lately, though, McKesson’s award-winning program has come under fire, with horrible things being said about it:

  • “Low participation rates”
  • “Inconvenient blood tests”
  • “Unsustainable results”
  • “Minimal health improvement”
  • “Silo’ed, inefficient programming”
  • “Unmet employee needs”
  • “Confusion of available services”

Who is responsible for such horrible, libelous insults, insults that would make us blush?

Why, McKesson, that’s who. Apparently, one of McKesson’s divisions, Canada, didn’t get the memo that their program is good:


So McKesson Canada switched to an outfit called “Sprout,” featured here:

Thanks to this picture, I’m sold on them already! That’s because they’ve apparently achieved the vaunted and elusive triple aim of wellness: reducing employee costs, increasing employee productivity, and poking employee cheeks.


Sprout also features REAL TIME DATA:

This is one of those “What is wrong with this picture?” pictures.  Review the caption, curiously juxtaposed with the laptop. Perhaps McKesson puts their employees on camera so the wellness coach can get REAL TIME DATA of employees doing situps because, without REAL TIME DATA, their “program won’t survive.”

This particular employee might not survive, either. Unless the coach is miked too — in which case this employee can be “coached” to move his water bottle before he impales himself on it.


Let’s dig a little bit deeper into these Sprout people, the wellness industry’s newest entrant in the competition to win the 2021 Deplorables Award, bestowed annually on the company that best reveals the IQs of their own customers.

Here’s their official description: [SPOILER ALERT: Contains cliches]

Sprout At Work is built using cognitive behavioural science, game theory, and behavioural economics to empower lasting behaviour change.

Two things come to mind. First, to raise money, Sprout could go on Wheel of Fortune to sell their surplus vowels. 

Second, speaking of coaches, perhaps they can use the proceeds from those sales to buy a coach. That coach could coach their coach to coach employees to [SPOILER ALERT–contains stupidity] stop doing situps.The 1980s called. They want their exercise back. Sit-ups are out, and have been out for years. 

Planks, of course, are the new situps.


Second, before they brag about using “game theory,” they need to google on what game theory is:

The branch of mathematics concerned with the analysis of strategies for dealing with competitive situations where the outcome of a participant’s choice of action depends critically on the actions of other participants. Game theory has been applied to contexts in war…and biology.

Biology???  Mathematics???  The only thing biology and mathematics have in common with wellness is that Sprout knows nothing about them.  We suspect they meant “gamification,” which has about as much to do with game theory as Sprout has to do with competence.

Luckily for Sprout, unlike real industries, wellness has very little to do with competence. And wellness vendor outcome data, REAL TIME or otherwise, is invariably wrong, so unlike this poor employee about to complete perhaps his last-ever rep of his last-ever exercise, Sprout will survive.



Please post all comments on Linkedin. I’m closing this comments section in order to have them all in one place. 

Can a mere vendor change your own health behaviors in an hour?

Most behavior-change vendors take months to show any impact at all anywhere in your population, so how can a vendor be so impactful, so innovative, that it can change your own health behaviors in an hour? Join our 9/28 webinar (1:00 PM EDT) and see for yourself. 

We often achieve behavior change even before people sign up for Quizzify, starting with webinars like this one. One of our favorite closing lines is: “See, you haven’t even signed up yet and we’re already saving you money.”

We’ll show plenty of examples, starting with our newest and most dramatic immediate savings opportunity. [SPOILER ALERT: Reducing ER expenses by 50% or more, cash on cash.] We’ll cover categories as diverse as screenings, fusions, pregnancy, scans, and of course: Cavities.

Cavities? If you haven’t seen our cavities material, it alone is worth the price of admission. Why submit to a century-old procedure when you can get one that is $30, painless, fast and more effective?

We even have a partner vendor whose own guaranteed savings increases if implemented alongside Quizzify!

In each case when we show what Quizzify teaches, we’ll do some “before and after” polling…and you can watch as the plurality of the webinar audience shifts attitudes and likely behaviors on the spot.

We’ll close by noting that you don’t even have to believe your own eyes: everything we say is 100% guaranteed.

Quizzify’s “Jeopardy-meets-health education-meets-Comedy Central” approach takes both employee engagement and cost savings to a new plateau. It’s so powerful that it simply isn’t believable unless you participate in it. Now is your chance.

Register here for our 9/28 1:00 PM webinar.

Please wish Tom Emerick a nice retirement


This is Tom’s last week on Linkedin and other work-related social media. He wrote me this note and asked me to post it.

Adding something of my own to the note below, it was great to work with him. We wrote an entire trade-bestselling book together, Cracking Health Costs, without ever meeting until it was published. He was disruptive before disruptive was a thing, and was the first champion of Centers of Excellence, back when everyone else thought they could save money by just “doing wellness.”

Dear Al,

As I am retiring from the industry today, I would like to ask you, as my best friend in healthcare, to post this note and send thanks to the many people who have also been great friends and supporters through the years.

First, at Walmart, I’d like to thank Sally Welborn for rolling out our Centers of Excellence model before it was a “thing” – during a time when everyone wanted employees to “do wellness” instead. I would also thank Adam Stavisky for taking it to the next level at Walmart.

And while we are on Centers of Excellence, thank Dr. Fred MacQueary and Dr. Alan Sparrow and especially Dr. Mary Bourland at Mercy Hospital in Springfield for avoiding so many unneeded and harmful spinal fusions. They are the classic Center of Excellence.

Next, special thanks to Leah Binder for the great work that Leapfrog Group does, and for introducing us. Without Leah there is no Cracking Health Costs, and that book launched my post-Walmart career. And thank you for graciously allowing my name to go first even though you did most of the writing.

So many other people to thank and support that I am only going to mention a few and hope they tell the others. Sandra Morris, Scott Haas, Mark Kendall, Rick Chelko, Paul Levy.

If you would like to write Tom a nice sendoff, please don’t do it in the comments here. Instead, go to linkedin https://bit.ly/3xRvxIB so all the comments can be in one place.

 

Are Accolade’s savings claims real? You make the call.

Attention, They Said What Nation:

We are available for forensic consulting (taking appellations and kicking posteriors), recoupment of fees, and expert witness work, hourly or on contingency (except for expert witness, where it is not allowed). So if you think a vendor has snookered you, who you gonna call?

We. Never. Lose.

And here is an example of why vendors fold… 


Accolade recently announced that they had paid Aon a zillion dollars for their actuaries to decide how much savings they could claim without leaving too many clues that the claimed savings figure is fabricated.

They drew that trendline at 8.3%, and decided the savings was also 8.3% in 2019.  Could this be an example of “trend inflation,” where, as Optum’s Seth Serxner says: “The choice of trend has a large impact on financial savings”?

Nah, an actuary would have to be both stupid and dishonest to inflate a trend willy-nilly. it would be too obvious a ruse. You’d show savings in:

  1. every single disease category
  2. every single comorbidity/risk category
  3. every single resource use category

To begin with, here is Aon’s trend vs. the sample Accolade clients:

We’re not calling Aon liars, or saying that Accolade’s payments to Aon create a conflict of interest for Aon’s consultants, or saying that Accolade chose Aon instead of the much less expensive and more credible Validation Institute, which backs its validations with a unique Credibility Guarantee, because they wanted Aon’s actuaries to fabricate savings. (The Validation Institute would have to pay out on a ton of Credibility Guarantees if they fabricated savings.) 

Quite the contrary, we’re sure that Accolade wanted Aon to publish results that were completely on the level. That’s why they paid them so much money, to check and double-check their work.


Every single disease category

Even so, as we pore through Aon’s report, we can’t help but see some questions that you might want to ask, just out of idle curiosity. By way of background, Accolade is a care coordination/navigation company. If you have an issue, like whether something is covered (benefits questions being the majority of the incoming phone calls), you could call them. They might be helpful. Come to think of it, they are so helpful that — get ready — they save money in every single disease category:

Accolade seems to save substantial sums of money in mental categories — “mental anxiety” and “mental mood” (as opposed to physical anxiety and physical mood, I suppose) — because massive numbers of mentally anxious and mentally moody employees are apparently calling them.

Hmmm…

Just suppose for a minute that you were mentally anxious or mentally moody? Would your first impulse would be to call a random number on the back of your insurance card and take a stranger’s advice to save your employer money? That course of action wouldn’t jump to my mind in that situation. But maybe that’s just me. So your question might be:

What do you tell these mentally anxious and mentally moody callers that saves all this money?

Maybe they advise these anxious and moody callers to stop spending money on therapists or meds, and instead just tell them to, respectively, calm down or cheer up. A few other categories might raise questions too, like:

How do you save money in “Upper GI/Esophagus”? Do employees call you and say: “My esophagus is acting up again”? 

And that brings us to cancer, where the mind-blowing 18% savings explodes still farther, in another chart showing 2 years of data, to 26%. How do you save 26% in cancer? On average you would be telling every employee — including the 38% to 50% who (according to Accolade) never call even with minor administrative claims issues — not to bother with that fourth round of chemo.  And I’m sure they’ll trust Accolade’s judgment on that.  


Every single comorbidity/risk category

Aon’s actuaries also sliced the data by number of comorbidities. Initially, they did not show savings in every single comorbidity category. For some reason they struck out with employees who have 3 comorbidities.

We’ll blow up the right-hand “Cost Ratio” column — meaning the % savings — for you:

You could ask:

Why do your phone-answerers do such a great job on people with two or four comorbidities, but strike out on people with three? 

And, my personal favorites are about people with, respectively, 0 or 1 chronic conditions:

How do you save 8% on people with (1) zero chronic conditions, (2) no reason to call Accolade, and (3) who already spend less than $2000/year on healthcare to begin with?

How do you save 9% on people with only 1 chronic condition, like maybe mental anxiety or mental moodiness, or perhaps a cranky esophagus?

Accolade/Aon’s answer to these questions on page 15 of their report is:

Only the results for members with 0 or 1 chronic conditions represented statistically credible reductions vs. market controls.

So, in other words, they are claiming savings only in the cohorts where there was basically no savings to be claimed.


Curiously, when you combine the 3 and 4+ comorbidities columns, you do end up with savings in every single comorbidity category. You get across-the-board savings of 8% to 11%, with both ends of the health spectrum showing roughly the same 8% in savings.

Before you assume this is a textbook example of trend inflation, you might ask:

How is it that you save roughly the same amount on the healthiest employees as on the sickest employees?

Surely the data is accurate — if you pay actuaries that much money it should be — but a cynic might expect that care coordination/navigation would be more effective where there is actually the need/opportunity to coordinate/navigate care. Just sayin’…


Every Single resource use category (almost)

Finally, Aon cut the data by resource use. 

The good news is that Accolade is keeping patients from using healthcare services, thus saving money in every category of utilization. There is 11% less inpatient use. Outpatient and physician expense declined as well.  So another question might be: 

Where are you sending employees to get their care?

By contrast, check page 147 of Why Nobody Believes the Numbers. There is an example from Quantum Health where inpatient use declined, but lower-cost resources like doctor visits increased. That increase is a “plausibility check” on Quantum’s shockingly valid claim to have reduced overall spending.  Their claim would not have been plausible if every category of resource use declined. As the book says: “if you insulate your house, you’ll save money, but not on insulation.” 

The best news?  At the very end, Accolade broke their streak of 16 diseases, 4 comorbidity categories, and 5 resources showing savings –by getting a whopping $13 more generic drug use per employee.  So, to paraphrase the immortal words of the great philosopher BIll Murray, they’ve got that going for them.


What does Aon have to say about all this?

Initially, they proudly announced the initial “savings” on the Healthcare Hackers group. (Ping me at al@quizzify.com if you want to join that group.) When I and others humbly pointed out just a few of these questions about their analysis, Aon’s Jim Winkler replied that they “stand by” their results. 

I learned long ago with the wellness industry not to bother to try to argue with these people because you can’t prove something to someone who just got paid a zillion dollars to “validate” the opposite. So I simply offered to bet a million dollars their results wouldn’t stand up to scrutiny from a panel of reputable health economists. 

And that’s when they folded. Not a peep out of them, though other people on the Hackers also asked. And then I noticed that Aon’s chief actuary looked at my linkedin profile.

Never heard from him either, to collect his $1 million. I guess he decided that instead of “standing by,” he should swallow hard and tacitly admit he goofed. (We will assume for now these were all honest mistakes. The way you’ll know is that, having now seen this posting, they will correct their errors.)

Speaking of swallowing hard, if you’re finding Aon’s analysis tough to swallow, you may be right. And you should also call Accolade to fix your esophagus.



Want a vendor that validly puts its fees 100% at risk for any combination of valid savings and employee engagement you choose? Who you gonna call?

Never Pay the First Bill, by Marshall Allen

Never Pay the First Bill is the best health policy book ever (maybe tied with The Price We Pay), largely because it’s not about health policy. It’s conclusion: we can’t depend on anyone to look out for our interests. Instead, individuals and employers are going to have to make our own “policies.” (I’m sure it is just coincidence that Quizzify is the only vendor featured in both, since we show people how to make their own “policy” on not getting surprise bills.)


SPOILER ALERT: When you read this book to truly understand this industry, you’ll be shocked, shocked to find that lying is going on in here!

And lest you think that this is for-policy-wonks-only, it’s quite the reverse. It is specifically written for “anyone who has been pushed around by the healthcare system.” This cohort of “anyone” would include me, before Quizzify taught me how to push back.

The first eight chapters are specifically for individuals. They act as how-to’s for winning appeals, dealing with collectors, and, of course, avoiding surprise bills using Quizzify’s consent language. As coincidence would have it, this surprise bill example involved a United Healthcare subsidiary called Golden Rule Insurance.  This is the same outfit that “negotiated” the in-network price of 28x Medicare (plus a $1700 tip for a no-show doctor) for the guy featured in our own surprise bill webinar in March.

One surprising lesson in the first eight chapters?  Find out what the cash price is. Frequently, it is quite a bit lower than the price that your national insurer, with tens of millions of lives, has negotiated on your behalf.


Employers are getting snookered too

These are followed by three chapters specifically for employers. SPOILER ALERT: employers get snookered without even knowing it. How true that is!  In addition to the multitude of examples in these chapters, I would cite my own experience with surprise bills and employers.  When I suggest that employers teach employees how to avoid them, an employer will often say: “My employees aren’t having a problem with surprise bills.”

What I then reply is: “Oh, OK.”

What I want to reply is: “The reason they aren’t having a problem with them is that you’re paying them.”

It’s not like these hospitals are saying: “Oh, this guy has good insurance. Let’s charge him less.”  

One thing you’ll learn as an employer is that the insurance company is not your friend. They auto-adjudicate bills that should never be paid, and then throw up roadblocks when you try to dig into these bills to identify the fraudulent ones that shouldn’t be paid.

Sometimes, they “find” the fraud themselves, congratulate themselves for finding it, and then take a big chunk out of the “savings” from reducing the bill that they themselves paid.

Further, each chapter ends with a summary of what you as a person or an employer can do. It is not just an exposé, but also a how-to.

Never Pay the First Bill (Random House) is available now on Amazon.

Webinar on Clash of the Wellness Titans: Health Affairs. vs. Leading Wellness Vendor

Register here for this June 30 webinar.

The June issue of Health Affairs reveals the conclusion of the definitive 3-year randomized control trial on wellness, conducted by the industry’s leading research team, Professor Katherine Baicker (now dean of the University of Chicago’s School of Public Health!) and Professor Zirui Song, of Harvard Medical School.


Their summary:

“No significant differences were found in self-reported health; clinical markers of health; health care spending or use; or absenteeism, tenure, or job performance. “


Conversely, a major wellness vendor released the results of their own internal study showing exactly the opposite. Highlights are an 84% reduction in people with high blood pressure, a 50% reduction in both obesity and employee turnover — and by far the greatest savings that have ever been achieved in a wellness program.

Both camps have been offered the opportunity to defend their diametrically opposed conclusions.

Along the way, you will have many opportunities to vote on aspects of these diametrically opposed conclusions.

And your votes will help determine, in the immortal words of the great philosopher Rick Perry, whether or not who is right.

Registration link.

Health Affairs Kills Wellness Dead

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.

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