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Wellness Vendors Dream the Impossible Dream

Alice laughed: “There’s no use trying,” she said. “One can’t believe impossible things.”

“I daresay you haven’t had much practice,” said the Queen. “When I was younger, I always did it for half an hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast.”


Six impossible things before breakfast?  The wellness industry would just be getting warmed up by believing six impossible things before breakfast. They believe enough impossible things all day long to support an entire restaurant chain:

Consider the article in the current issue of BenefitsPro — forwarded to me by many members of the Welligentsia — entitled: “Can the Wellness Industry Live Up to Its Promises?”  BenefitsPro rounded up some of the leaders of the wellness industry alt-stupid segment. Specifically, they interviewed US Corporate Wellness, Fitbit, Staywell, and HERO. Each is a perennial candidate for the Deplorables Awards — except US Corporate Wellness, which already secured its place in the Deplorables Hall of Fame (and Why Nobody Believes the Numbers) several years ago with these three paeans to the gods of impossibility.

In case you can’t read the key statistic — the first bullet point — it says: “Wellness program participants are 230% less likely to utilize EIB (extended illness benefit) than non-participants.”  Here is some news for the Einsteins at US Corporate Wellness:  You can’t be 230% less likely to do anything than anybody. For instance, even you, despite your best efforts in these three examples, can’t be 230% less likely to have a triple-digit IQ than the rest of us.  Here’s a rule of math for you: a number can only be reduced by 100%. Rules of math tend to be strictly enforced, even in wellness.  So the good news is, even in the worst-case scenario, you’re only 100% less likely to have a triple-digit IQ than the rest of us.

And yet, if it were possible to be 230% dumber than the rest of us, you might be. For instance, US Corporate Wellness also brought us this estimate of the massive annual savings that can be obtained just by, Seinfeld-style, doing nothing:

So assume I spent about $3500/year in healthcare 12 years ago, which is probably accurate. My modifiable risk factors were zero then and they are still zero — no increase. So my healthcare spending should have fallen by $350/year for 12 years, or $4200 since then. But that would be impossible, since I could only reduce my spending by $3500. Do you see how that works now?

To his credit, US Corporate Wellness’s CEO, Brad Cooper, is quoted in this article as saying: “Unfortunately some in the industry have exaggerated the savings numbers.” You think?

I’m pretty sure this next one is impossible too. I say “pretty sure” because I’ve never been able to quite decipher it, English being right up there with math as two subjects which apparently frustrated many a wellness vendor’s fifth grade teacher:

400% of what?  Is US Corporate Wellness saying that, as compared to employees with a chronic disease like hypertension, employees who take their blood pressure pills are 400% more productive?  Meaning that if they controlled their blood pressure, waiters could serve 400% more tables, doctors could see 400% more patients, pilots could fly planes 400% faster? Teachers could teach 400% more kids? Customer service recordings could tell us our calls are 400% more important to them?

Or maybe wellness vendors could make 400% more impossible claims. That would explain this BenefitsPro article.


Fitbit

We have been completely unable to get Fitbit to speak, but BenefitsPro couldn’t get them to shut up. Here is Fitbit’s Amy McDonough: “Measurement of a wellness program is an important part of the planning process.”   Indeed it is! It’s vitally important to plan on how to fabricate impossible outcomes to measure, when in reality your product may even lead to weight gain.  Here is one thing we know is impossible: you can’t achieve a 58% reduction in healthcare expenses through behavior change — especially if (as in the 133 patients they tracked in one of their studies) behavior didn’t actually change.

You can read about that gem, and others, in our recent Fitbit series here:


Health Enhancement Research Organization (HERO) and Staywell

I’ll consider these two outfits together because people seem to bounce back and forth between them. Jessica Grossmeier is one such person. Jessica became the Neil Armstrong of impossible wellness outcomes way back in 2013.  Not just any old impossible wellness outcomes — those have been around for decades. She and Staywell pioneered the concept of claiming outcomes they already knew were impossible.   While at Staywell, she and her co-conspirators told British Petroleum they had saved about $17,000 per risk factor reduced.  So, yes, according to Staywell, anyone who temporarily lost a little weight saved BP $17,000 — enough to clean up about 1000 gallons of oil spilled from Deepwater Horizon.

See British Petroleum’s Wellness Program Is Spewing Invalidity for the details.

Leave aside both the obvious impossibility of this claim, and also the mathematical impossibility of this claim given that employers only actually spend about $6000/person on healthcare.  Jessica’s breakthrough was to also ignore the fact that this $17,000/risk factor savings figure exceeds by 100 times what her very own article claims in savings. Not by 100 percent. By 100 times.

Fast-forward to her new role at HERO. In this article she says:

The conversation has thus shifted from a focus on ROI alone to a broader value proposition that includes both the tangible and intangible benefits of improved worker health and well-being.

Her memory may have failed her here too because HERO — in addition to admitting that wellness loses money (which explains its “shift” from the “focus on ROI alone”) — also listed the “broader value proposition” elements of their pry-poke-and-prod wellness programs. The problem is the elements of the broader value proposition of screening the stuffing out of employees aren’t “benefits.”  They’re costs, and lots of them:

When she says: “The conversation has shifted from a focus on ROI alone,” she means: “We all got caught making up ROIs so we need to make up a new metric.”  RAND’s Soeren Mattke predicted this new spin three years ago, observing that every time the wellness industry makes claims and they get debunked, they simply make a new set of claims, and then they get debunked, and then the whole process repeats with new claims, whack-a-mole fashion, ad infinitum.  Here is his specific quote:

“The industry went in with promises of 3 to 1 and 6 to 1 based on health care savings alone – then research came out that said that’s not true. Then they said: “OK, we are cost neutral.” Now, research says maybe not even cost neutral. So now they say: “But is really about productivity, which we can’t really measure but it’s an enormous return.”


Interactive Health

While other vendors, such as Wellsteps, harm plenty of employees, Interactive Health holds the distinction of being the only wellness vendor to actually harm me.  I went to a screening of theirs. In order to increase my productivity, they stretched out my calves.  Indeed, I could feel my productivity soaring — until one of them went into spasm. I doubt anyone has missed this story but in case anyone has

They also hold the distinction of being the first vendor (actually their consultant) to try to bribe me to stop pointing out how impossible their outcomes were. They were upset because I profiled them n the Wall Street Journal . The article is behind a paywall, so you probably can’t see it. Here’s the spoiler: they allegedly saved a whopping $53,000 for every risk factor reduced. In your face, Staywell!

Here is the BenefitsPro article’s quote from Interactive Health’s Jared Smith:

“There are many wellness vendors out there that claim to show ROI,” he says. “However, many of their models and methodologies are complex, based upon assumptions that do not provide sufficient quantitative evidence to substantiate their claims.”

You think?

Finally, here is a news flash for Interactive Health: sitting is not the new smoking.  If anything is the “new smoking,” it’s opioid addiction, which has reached epidemic proportions in the workforce while being totally, utterly, completely, negligently, mind-blowingly, Sergeant Shultz-ily, ignored by Interactive Health and the rest of the wellness industry.

There is nothing funny about opioid addiction and the wellness industry’s failure to address it, a topic for a future blog post. The only impossibility is that it is impossible to believe that an entire industry charged with what Jessica Grossmeier calls “worker health and well-being” could have allowed this to happen. Alas, happen it did.

And, as you can see from the time-stamp on this post, except at establishments favored by the Wellness Ignorati, breakfast hasn’t even been served yet.

And the envelope please. The best outcomes evaluator in wellness is…

The best outcomes evaluator in the wellness field is Dr. Iver Juster.*

*Among the subset of males not affiliated with They Said What.

Why Dr. Juster’s Case Study Is the Best Case Study Ever Done in This Field

Chapter 2 of the HERO Guide is a great study and deserves high praise. But before we get into the salient points of what makes this absolutely the best case study analysis ever done in this field, be aware the provenance is not a coincidence.  Dr. Juster is very skilled at evaluation. Indeed he was the first person to receive Critical Outcomes Report Analysis (CORA) certification from the Disease Management Purchasing Consortium. (Dr. Juster very graciously shares the credit, and as described in his comments below would like to be listed as “the organizer and visible author of a team effort.”)

Note: the CORA course and certification are now licensed for use by the Validation Institute, which has conferred honorary lifetime certification on Iver gratis, to recognize his decades of contribution to this field. (Aside from the licensure, the Validation Institute is a completely independent organization from DMPC, from They Said What, and from me. It is owned by Care Innovations, an subsidiary of Intel.  If you would like to take the CORA Certification course live, it is being offered next in Philadelphia on March 27.  You can take it online as well.)

Early in the chapter, Iver lists and illustrates multiple ways to measure outcomes. He dutifully lists the drawbacks and benefits of each, but, most importantly, notes that they all need to be plausibility checked with an event-rate analysis, which he provides a detailed example of–using data from his own work. In an event rate analysis, wellness-sensitive medical events are tracked over the period of time in question.

Wellness has never been shown to have a positive impact on anything other than wellness-sensitive events. Consequently, there is no biostatistical basis for crediting, for example, “a few more bites of a banana” with, to use our favorite example, a claimed reduction in cost for hemophilia, von Willibrand’s Disease and cat-scratch fever.

ted-nugent

By contrast, real researchers, such as Iver, link outcomes with inputs using a concept called attribution, meaning there has to be a reason logically attributable to the intervention to explain the outcome. it can’t just a coincidence, like cat scratch fever. As a result, he is willing to attribute only changes in wellness-sensitive medical events to wellness.

Event-Rate Plausibility Analysis

Event rates (referred to below as “PPH” or “potentially preventable hospitalizations”) are laid out by disease on page 22 of the HERO Report.  Note the finding that PPH are a small fraction of “all-cause hospitalizations.”  Though the relative triviality of the magnitude of PPH might come as a surprise to people who have been told by their vendors that wellness will solve all their problems, Iver’s hospitalization data sample is representative of the US as a whole for the <65 population, in which chronic disease events are rare in the <65 population.

hero page 23 total

Gross savings total $0.99 per employee per month.  This figure counts all events suffered by all members, rather than excluding events suffered by non-participants and dropouts. Hence it marks the first time that anyone in the wellness industry had included those people’s results in the total outcomes tally — or even implicitly acknowledged the existence of dropouts and non-participants. He also says, on p. 17:

For example, sometimes savings due to lifestyle risk reduction is calculated on the 20% of the population that supplied appropriate data. It’s assumed that the other 80% didn’t change but if some of the people who didn’t supply risk factor data worsened, and people who got worse were less likely to report their data, that model would overestimate savings.

Note that the PPH declined only in cardiac (“IVD”) and asthma.  Besides the event rates themselves being representative of the employed population in the US as a whole as a snapshot, the observed declines in those event rates are almost exactly consistent with declines nationally over that same period. This decline can be attributed to improvements in usual care, improvements that are achieved whether or not a wellness program was in place.  The existence and magnitudes of the declines, coupled with the slight increase in CHF, diabetes and COPD combined (likewise very consistent with national trends), also confirm that Iver’s analysis was done correctly. (Along with attribution, in biostatistics one looks for independent confirmation outside the realm of what can be influenced by the investigator.)

It is ironic that Ron Goetzel says: “Those numbers are wildly off…every number in that chapter has nothing to do with reality” when I have never, ever seen a case study whose tallies — for either total events or event reduction, let alone both — hewed closer to reality (as measured by HCUP) than this one.

Another factor that conveniently gets overlooked in most wellness analyses is that costs other than PPHs rise.  By contrast, Iver is the first person to acknowledge that:

HERO other costs increase

The implication, of course, is that increases in these costs could exceed the usual care-driven reductions in wellness-sensitive medical events. Indeed, Iver’s acknowledgement proved prescient when Connecticut announced that its wellness program made costs go up.

The $0.99 gross savings, and Connecticut’s healthcare spending increase, exclude the cost of the wellness program itself, of course. Factor in Ron Goetzel’s recommendation of spending $150/year for a wellness program and you get some pretty massive losses.


The old Al Lewis would close by making some reference to the dishonesty and cluelessness of the Health Enhancement Research Organization’s board. The new Al Lewis will do just the opposite. In addition to congratulating Iver Juster (and his co-author, Ben Hamlin) on putting this chapter together, I would like to congratulate the Health Enhancement Research Organization, for what Iver describes as the “team effort” in publishing it — HERO’s first flirtation, however fleeting and inadvertent, with integrity and competence.



Iver Juster Comments on the article

Iver reviewed this article and would like to add several points. I am only adding a couple of my own points, noted in indented italics:

  • It’s important to credit the work to a larger group than just myself. I was the ‘lead author’ on the financial outcomes chapter of the HERO/PHA measurement guide, but the work entailed substantial planning and review in collaboration with the chapter’s coauthor (Ben Hamlin from NCQA) and members of the group dedicated to the chapter (as well as the HERO/PHA authoring group as a whole).
    • Yes, I am more than happy to credit the entire group with this study, especially Ron Goetzel, Seth Serxner and Paul Terry.
  • Nonetheless the work does reflect my perspective and approach on the topic – the important points being (a) select metrics that are impactible by the intervention or program; (b) be transparent about the metric definitions and methodology used to measure and compare the; (c) assiduously seek out potential sources of both bias and noise (in other words, exert the discipline of being curious, which is greatly aided by listening to others’ points of view); (d) understand and speak to the perspective of the study—payer, employee/dependents, clinician/healthcare system, society.
  • Be particularly sensitive to the biologically-plausible timeframes in which your outcomes ought to occur, given the nature of the program. Even if optimally implemented with optimal uptake and adherence, we might expect ‘leading indicators’ like initial behavior changes to improve quickly; program-sensitive biometrics (lipids, A1C, blood pressure, BMI) and medication adherence to change in a matter of months; and a few program-sensitive ER/inpatient visits (like worsening heart failure or asthma/COPD exacerbations) to improve within several months (again, assuming the program is designed to address the causes of these events). Longer-term events like kidney failure, heart attack and stroke and retinopathy take much longer to prevent partly because they require sustained healthy behavior, and partly due to the underlying biology.
    • This is one excellent reason that the measured event rate decline mirrored the secular decline in the US as a whole over the period, meaning the program itself produced no decline over that period.  Possibly they might decline in future years if Iver is correct. Ron Goetzel would take issue with Iver’s assertion — Ron says risk factors decline only 1-2% in 2-3 years.
  • Event rate measurement in any but the largest Commercially-insured populations is subject to considerable noise. Though a challenge, estimating ‘ confidence intervals should at least shed light on the statistical noisiness of your findings. 
    • No need this time because your results hewed so closely to secular trend, reflecting the quality of the analysis.
  • It is very likely that the program used in the illustration did affect more than the events shown because it was a fairly comprehensive population health improvement initiative. For example, ER visits were not counted; and collateral effects of ‘activation’ – a very key component of wellness – were not included in this analysis. Assuming the 99 cents is an accurate reflection of the program’s effect on the events in the chart, I’d be willing to increase the actual claims impact by 50 to 75%.
    • If your speculation is accurate, that would increase gross savings to $1.49 to $1.73/month–before counting preventive care increases indicated on Page 22.
  • Nonetheless, to get effect from an effective program you have to increase both the breadth (number of at-risk people) and depth (sustained behavior change including activation) – but at a cost that is less than a 1:1 tradeoff to the benefit. In other words, you must increase value = outcomes per dollar. This cannot be done through incentives alone – as many researchers have shown, if it can be done at all, it must be the result of very sustained, authentic (no lip service!) company culture.
  • We are beginning to pay attention to other potential benefits of well-designed, authentic employee / workplace wellness programs (of which EHM is a part) on absenteeism, presenteeism, employee turnover and retention – and, importantly, company performance (which is after all what the company is in business to do). It’s early days but it’s possible research will show that companies that are great places to work and great places to have in our society will find financial returns that far outstrip claims savings. The jury’s still out on this important topic but let’s help them deliberate transparently and with genuine curiosity.
  • Did Ron really say you have to spend $150 per year PER MEMBER on a wellness program? I’d be thinking a few dollars (unless he’s including participation incentives)

 

And the Envelope Please. The Best Outcomes Evaluator in Wellness Is…*

*Among the subset of males not affiliated with They Said What.


Alert readers may recall that my New Year’s resolution was to balance my negative postings about the wellness industry with positive ones.  Like Diogenes searching for an honest man, I thought the finding the latter would be hard, but just as Romy Antoine also did earlier this month, The subject of this posting — to be named in Part Two — makes that easy.  Part One sets the stage for the review of his study.

By way of background, in preparation for bringing a possible lawsuit, I re-read the famous Chapter 2 of the equally famous HERO report. That was the chapter which inspired Ron Goetzel, Seth Serxner and Paul Terry (who was recently anointed as the American Journal of Health Promotion’s new Fabricator-in-Chief) to circulate their defamatory letter about me to the media, in a singularly self-immolating attempt to discourage them from publishing my material.  They insisted that Chapter 2 was pure fabricated nonsense, rather than a carefully analyzed report of real data.  Here is an excerpt from their actual letter, copies of which are available from me but which is summarized here:

A fabricated…absurd, mischievous and potentially harmful misrepresentation of our data.

Ron said it best in our Great Debate, minute 1:17 in the MP3 downloadable here:

Those numbers are wildly off…every number in that chapter has nothing to do with reality. 

However, the sun rises in the east, taxes are due April 15th, and Ron Goetzel is lying.  Quite the contrary, Chapter 2 turns out to be a carefully analyzed report of real data — almost certainly the best case study ever published.

How did I learn that Ron was fabricating a story that his guidebook had fabricated a story?

  1. This chapter says it’s a real report, on p. 22.
  2. Since this chapter’s analysis was so far above the pay grade of those three aforementioned HERO characters, I checked the acknowledgements in the HERO book. Sure enough, none of the HERO cabal wrote it. Someone else (to be named in the next posting) was the lead author, and I called to congratulate him on it. I also asked him some background questions, one of which proved very revealing. It turns out that…
  3. This real analysis of real data was — get ready — reviewed prior to publication by the exact same people who are disowning it now. Yes, among the people who peer-reviewed it prior to publication were the very same Ron Goetzel, Seth Serxner, and Paul Terry. (In addition to them doing the actual review, the lead author, very graciously sharing the credit, wanted to make sure that I indicate that he was only the “organizer and visible author of a team effort.”)

Yes, as is so often the case with these three, they lied about the lies that they lied about.  It’s quite ironic that their argument against my original praise of this analysis was to insist that because my source was their own lies, my own analysis was unreliable.  These lies above don’t include the actual lies I might sue them about, which were lies about me, which are totally separate from their lies about their previous lies. (Their lie about me was that I had a history of outrageously inaccurate statements, none of which they have ever been able to identify.)

These characters aren’t ordinary run-of-the mill alternative fact-type liars.  They’re way beyond that.

Their lies go to 11.

goetzel-on-fire


Coming soon, the reveal…

So many candidates for the Deplorables Award countdown, so few numbers between 1 and 10

Having covered the also-rans last week, here are the first runners-up, as we inch ever closer to the coveted top spot. (To read the original postings, click on the numbered headers.)

Today we are highlighting more people and organizations who’ve made the wellness industry what it is. Wednesday we will complete the listing of the Stars of Wellness, the people and organizations who are making the industry what it should be.


#5 Interactive Health

Interactive Health conducted what may be the head-scratchingest screen in wellness industry, a difficult feat given all the competition. For starters, they tested me for calf tightness. It turns out my calves are tight–and right on-site they loosened them. I could feel my productivity soaring…until the left one went into spasm that night and I couldn’t get back to sleep. Still, I can see their point — loose calves are a useful trait for many common jobs.

first-baseman

Next, Interactive Health shattered the record, previously shared by Total Wellness and Star Wellness, for most USPSTF non-recommended blood tests. I don’t know what half these things are, which means neither does Interactive Health.

interactivehealth

 


#4 Koop Award Committee

Where would a Deplorables Greatest Hits List be without the Koop Award Committee?

Every year, like clockwork, the industry’s biggest liars select the industry’s biggest lies.  2016 started with last year’s winning program, McKesson’s, being exposed as a joke in Employee Benefit News, and ended with this year’s winner, Wellsteps, being exposed as a joke in STATNews.

When bestowing this year’s award to their fellow Committee member, Wellsteps, they didn’t even pretend not to lie. And what lies they were! Not just regular-sized lies. Not even supersized lies. We’re talking lies that would make a thesaurus-writer blush.

To put their lies in perspective, I may not even know you, but if a Koop Committee member told me the sky was blue, and you told me the sky was green, I’d at least go look out the window.

PS  Not everyone on the Committee is a liar. One person is quite honest and can’t believe what goes on every year. I don’t want to name my source because in Koop-land, honesty is grounds for termination. As is getting validation. Or adopting the Code of Conduct. Basically ethical behavior is off-limits. An executive of one group, Altarum, published a blog critical of wellness and <poof> the Committee disappeared them.


#3 Michael O’Donnell

Michael O’Donnell seems to crave my attention. When he managed to go three whole months without being featured in a TSW posting, he came up with these irresistible nuggets:

  • “Wellness is indeed the best thing since sliced bread, up there with vaccines, sanitation and antibiotics.”
  • “[Wellness] can prevent 80% of all diseases.”
  • “The ROI from wellness is very strong.”
  • “Workplace health promotion may play a critical role in preserving civilization as we know it.”

If nothing else, Mr. O’Donnell presents the best argument for requiring educational standards, or at least a GED, in this field — by demonstrating his total lack of understanding not just of wellness, but also of vaccines, sanitation, antibiotics, percentages, diseases, ROIs, and preserving civilization as we know it.

Oh, yes, and multiplication as well. His article on how to increase productivity with wellness used an example demonstrating a productivity decrease. In 2016, he also went on an anti-employee jihad that should be read in its entirety. (Translation: some of my best work…)  Highlights:

  • Prospective new hires should be subjected to an intrusive physical exam, and hired only if they are in good shape.  OK, not every single prospective new hire — only those applying for “blue collar jobs or jobs that require excessive walking, standing, or even sitting.”   Hence he would waive the physical exam requirement for mattress-tester, prostitute, or Koop Committee member–because those jobs require only excessive lying.
  • He would “set the standard for BMI at the level where medical costs are lowest.”  Since people with very low BMIs incur higher costs than people with middling BMIs, Mr. O’Donnell would fine not only people who weigh more than his ideal, but also employees with anorexia.

If employees didn’t already have an eating disorder, what better way of giving them one — and hence extracting more penalties from them — than to levy fines based on their weight?  Employees above his ideal weight would pay per pound, sort of like if they were ordering lobster or mailing packages.


#2: Ron Goetzel, Seth Serxner, and Paul Terry (Health Enhancement Research Organization)

These three characters — naturally also on the Koop Committee — managed to pile more lies, sardine-like, into a single page than anyone else in this industry, in the “poison pen” about me they circulated to the media.

A good starting question would be, why on earth would anyone think that they can send a “confidential” letter to the media?  The media are in the business of disseminating information. You see, that’s why they call them “the media.”  Am I going too fast for you, Mr. Goetzel?

The funny thing about these Einsteins? Their defense to my observation that their very own numbers show wellness loses money was that their very own numbers were made up. Imagine being so dishonest that the way you defend yourselves is by claiming you fabricated your own report.

That’s not even the punchline.  It turns out that this allegedly fabricated report is in truth an actual non-fabricated report. So, in the immortal words of the great philosopher LL Cool J, they lied about the lies that they lied about.

How did I learn this? That will be the subject of a post early year.


Watch this space…soon we will be naming the industry’s #1 Deplorable of 2016.

Wellsteps: We don’t need your stinkin’ Code of Conduct.

Wellsteps has joined Michael O’Donnell, HERO and Optum in attempting to stonewall the Employee Health Code of Conduct, which started as a joint project among WELCOA, myself, and Salveo Partners and has attracted many hundreds of favorable responses.  Quizzify and It Starts with Me have both received validation from the Validation Institute for (among other things) our embrace of this simple minimum standard. In both cases, we think the bar should be set much higher, but apparently “do no harm” is already too high a hurdle for HERO, Wellsteps and Optum.  Hence their opposition.  And Kudos to WELCOA, a very fine organization that Quizzify intends to support for 2017, for standing up to Mr. Aldana’s bullying.

There is some irony in that it was Wellsteps’ harms to Boise employees that inspired my participation in the code-writing. Vendors should not be given awards for harming employees. That doesn’t seem like too much to ask.


Here is the Code, in its entirety.

The Employee Health Program Code of Conduct:  Programs Should Do No Harm

Our organization resolves that its program should do no harm to employee health, corporate integrity or employee/employer finances. Instead we will endeavor to support employee well-being for our customers, their employees and all program constituents.

Employee Benefits and Harm Avoidance

Our organization will recommend doing programs with/for employees rather than to them, and will focus on promoting well-being and avoiding bad health outcomes. Our choices and frequencies of screenings are consistent with United States Preventive Services Task Force (USPSTF), CDC guidelines, and Choosing Wisely.

Our relevant staff will understand USPSTF guidelines, employee harm avoidance, wellness-sensitive medical event measurement, and outcomes analysis.   

Employees will not be singled out, fined, or embarrassed for their health status.

Respect for Corporate Integrity and Employee Privacy

We will not share employee-identifiable data with employers and will ensure that all protected health information (PHI) adheres to HIPAA regulations and any other applicable laws.

Commitment to Valid Outcomes Measurement

Our contractual language and outcomes reporting will be transparent and plausible. All research limitations (e.g., “participants vs. non-participants” or the “natural flow of risk” or ignoring dropouts) and methodology will be fully disclosed, sourced, and readily available.


What’s there not to like?  Plenty, if you negatively impact employee health, as Wellsteps does, according to STATNews. Here is Wellsteps’ response to the code, complete with their signature name-calling.

The Wellness Bully Code of Conduct

Even though the wellness bullies claim that the wellness industry is a sham, they have announced a new code of wellness conduct.  I’m very interested in improving the quality and effectiveness of wellness programs. I don’t know any wellness professional who would say otherwise. But I think I speak for all of us when I say that I have no interest in a code of conduct written by a gang of bullies. The wellness industry does not need a code of conduct, we have HIPAA and other laws to do that. 

The Great Debate, Part 6: Goetzel Throws HERO under the Bus

The question-and-answer period is now underway.  

If you are just joining the thread, this is Part 6 of The Great Debate, a November 2015 exchange between Ron Goetzel and me, at the Population Health Alliance Annual Leadership Forum. Part 5 is here.  You can download the audio here


1:09:00

To the question: “What would you do to reduce healthcare costs?” Ron replies that he is “focused on prevention.” And that’s the issue.   I point out that “too much of anything is bad for you, ours is already the most over-prevented society on earth, and these programs are all out of compliance with guidelines.”  All these programs screen everybody far more than guidelines advise. Here are the guidelines. Find anything other than blood pressure where the wellness industry’s obsessive annual screens are recommended.

[Postscript: after the debate, the Connecticut study came out, showing that overprevention through wellness increases costs, as one would expect.]


1:12:20

The moderator asks how can Quizzify be the most effective company in employee health education.  He challenges our 100% guarantee of savings. This is ironic. No wellness company offers any meaningful guarantee of savings, for the simple reason that it is mathematically impossible to save money in wellness.

Somehow in wellness, guaranteeing savings is a bad thing but losing money is a “good thing.” (Really, a direct quote — click on it.)  It’s curious to challenge someone’s own willingness to guarantee their own results as part of their own business.  Obviously, if my business judgment is wrong, Quizzify will fail. And what I didn’t say because I didn’t want to brag, is that people questioned my last business venture too, Matrix Medical. Fast forward: Matrix is now the most valuable population health company start-up of this millennium.  (Before you ask me to lend you money, we mostly sold out on the “cheap” in 2013 to a private equity firm named Welsh Carson.)


1:13:40

Ron Goetzel endorses Quizzify. He went on the website and played the game. “It was a lot of fun. Very clever.”  Then he asks — quite justifiably — how Quizzify can make problems like obesity and smoking go away.  The answer, of course, is that Quizzify isn’t going to make obesity and smoking go away any more than wellness does.  For example, consider McKesson’s Koop Award-winning program, where both weight and smoking went up.  We can’t do worse than that. If we did, we could win a Koop Award.

Instead, Quizzify guarantees reductions in overall healthcare spending on “low value care.” As you can see from the demo on the website, we also educate people on hidden sources of sugar, of which there are more than you can count, but we don’t expect immediate savings from this and other nutrition/smoking education questions. Immediate savings are provided by our emphasis on avoiding low-value care.


1:15:00

Consistent with his theme of running away from his own work, Ron now runs away from his own HERO Report.  Keep in mind two things as you listen to this section:

  • Ron is disowning his own report. He is on the board of HERO, a tidbit which he overlooks in this hasty retreat;
  • Within days of this debate, he was circulating his famous poison pen letter to the media completely owning it, and accusing me of reading it too carefully.

The moderator (who otherwise moderated fairly) for some reason jumped in and said the HERO Guidebook just used an allegedly hypothetical example to show losses.  Since their “example” costs were $18/employee/year as opposed to the more typical $100 AND since the HERO example failed to control for the countrywide decline in wellness-sensitive medical events, the HERO example grossly underestimated losses from wellness.

Ron says “those numbers in [my HERO Guidebook] are wildly off,” and “have nothing to do with reality.”  He says I “misrepresented and misinterpreted” these figures.  But they are right there: A program costs $1.50 PEPM and saves $0.99.  What’s to misinterpret?   Ron apparently hadn’t noticed that his little Guidebook accidentally told the truth until I pointed it out — exactly like he hadn’t noticed that Eastman Chemical/Health Fitness self-invalidated. In both cases if fell upon me to point it out to these Einsteins.

Here is a posting showing what happens when you adjust those HERO figures for Mr. Goetzel’s alternative “reality” — losses skyrocket, just like Health Affairs showed in the Connecticut study.

Perhaps HERO would have more credibility telling us that wellness saves money if their own allegedly* “fabricated” example and any of the legitimate literature supported that claim. I’m just sayin’…


*The word “allegedly” is used because the example in the HERO guidebook is not a “fabricated” or “hypothetical” example. The words “fabricated” or “hypothetical” do not even appear in the chapter. Instead the example is an actual report. That’s why the Guidebook says it’s a report, and gives very specific details of the report–in the past tense, no less, as you would for a completed report. A “hypothetical” would use the present tense throughout, along with saying that it’s a hypothetical.

heroreportp22language-on-report

And like:

hero-report-language-p-23

So Ron’s whole argument about this being somehow a hypothetical is shot, just like all his other arguments, by showing his own data.



To summarize Ron’s view so far in this debate: everyone who thinks wellness is a total waste of money — including RAND, basically all the media and every economist who has looked at it in the last six years — is wrong.  Every time his own materials accidentally tell the truth and say wellness loses money, they’re wrong.  

And as we’ll see in the next installment, every employee who hates their company’s wellness vendor is either in a bad program or they are a bad employee.

Basically everyone is out of step but Ronnie.

 

 

How the 2016 Koop Award Raises Lying to an Art Form

If you were at the HERO conference, you witnessed a surreal experience.  Executives from Johns Hopkins, Mercer, United Healthcare and elsewhere willing to risk their jobs by perpetuating what has now been exposed as a bald-faced, presidential candidate-level lie: that Wellsteps deserves an award for a program allegedly benefiting Boise teachers so dramatically that costs fell by a third. They will not mention the article in STATNews that came out yesterday showing that school district employee health deteriorated.

You read the article, so you know they are lying.  And they know you know they are lying. And yet the whole thing just continues as though it is somehow all OK because no one is admitting it publicly.

Here is some more detail on the lies in question.


Sharon Begley’s article Wellness Award Goes to Workplace Where Many Health Indicators Got Worse does not lose anything in the re-reading. Quite the contrary, almost every quote in it is either a lie, or exposes the Wellsteps application as a lie. In each case, Wellsteps’ Steve Aldana, Johns Hopkins’ Ron Goetzel, United Health Care’s Seth Serxner, and all the other committee members know it’s a lie, because of the aforementioned article.

“Lie” might seem like a harsh term, but the alternative is to assume that Ron and his cronies have absolutely no idea how to read an outcomes report, even though I have already showed them how to read this report in particular.

True, one could argue that Ron has been known to use the “dumb and dumber defense” when giving his friends their awards, but in this case he can’t pretend he doesn’t know any better because he was quoted in the article.  Another argument that these are lies: no one — not even a member of the Koop Committee — can possibly be this stupid accidentally.


Let’s go lie by lie. Let’s start with the last quote from Ron “the Pretzel” Goetzel, because it sets the stage for the others. He got his moniker because he has a way of twisting and turning words to make himself sound like he isn’t lying.  In this case, he said if “an application said everything went exactly right,” it would certainly raise eyebrows on the Committee.

“Went exactly right”???  Ron, isn’t the entire point of wellness to make employees healthier?  So if a program makes employees unhealthier, we say it didn’t go “exactly right”?

Using this definition, here are a few other things that did not “go exactly right”: New Coke, Yugos, the 1962 Mets, Vietnam, subprime loans, Yahoo, and the 2016 presidential nominating process. And for that matter, Begley’s article points out that McKesson’s 2015 award also wasn’t “exactly right,” in that the program didn’t do anything and the data self-contradicted. It’s not just McKesson. I have been tracking these Koop Award-winners for years, and they all self-invalidate. Each is more hilariously not “exactly right” than the other.

Yessirree, if there is one thing that shouldn’t keep Koop Committee members up at night, it’s the fear that one of their award applications might be exactly right. So the good news is that no Committee member has to worry about contracting an acute case of over-raised eyebrows.


Another lie exposed: It turns out the Koop Estate licenses the name to this cabal in order to make money, just like Dr. Koop licensed his name to make videotapes. The award is now admitted to be “industry sponsored.” This is the first time this provenance has been disclosed in print. It is basically a marketing scheme for the committee members and sponsors. They had claimed to be a “private-public” organization. That Orwellian Pretzel-speak is a lot different from being admittedly industry sponsored.


Next, Dr. James Fries — whose major wellness expert credential is writing an article finding massive population-wide savings against a phony control group by getting a few diabetics to eat less fat — called this “an exemplary program” that “showed improvements in health behavior” leading to cost reduction. Yes, a few self-reported behaviors improved. We suspect the Boise teachers lied, because they clearly lied when they self-reported their smoking (only 2.5% admitted it) and drinking (only 20%).

But let’s assume they didn’t lie–meaning somehow they are different from everyone else when they complete workplace health assessments. Exercising three more minutes a day and eating 0.11 more fruits and vegetables/day cannot reduce health care costs at all, let alone by a third, especially when the employees became unhealthier overall.

This statement would therefore qualify as a mistake, assuming Dr. Fries is not bright enough to already realize it is wrong. If Dr Fries doesn’t retract it now that he knows it’s wrong, it becomes a lie.


That brings us to Steve Aldana.  He has been caught lying many times, including this example where he accidentally told the truth before retracting it.  (He and his friends burn a lot of time trying to explain away instances in which have to explain why they accidentally told the truth but didn’t really mean it.)

His biggest lie is his discussion of regression to the mean. Compare his quote to his application. First, the quote, which shows he is actually familiar with the concept:

“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.”

Contrast that to his application, in which he pretends he has never heard of regression to the mean, and instead attributes the “dramatic improvements” in the highest-risk Boise employees to the “program impact”:

wellsteps-worst-health-behaviors

He also contributed my favorite line of the article: even “one more bite of a banana” can make a difference in people’s health. This is true, of course, for the segment of the population that is starving to death. Otherwise, how dumb is this claim?  Let’s just say that if a college taught him this, it could lose its accreditation.

And that brings us to his biggest lie of all: He says I didn’t understand the program benefits because I didn’t read the data.  I did, of course. I even actually added up the datapoints, which no one on the Koop Committee did. I’ll give Committee members the benefit of the doubt and assume they failed to add the datapoints not because they didn’t want to expose the truth that Boise employees got worse in their friend’s program, but because calculators are not yet available in their cave.

Adding the data would have revealed to them — as it did to me — that they harmed employees. 6397 biometric indicators deteriorated, while only 5293 improved.  This conclusion shared by both Ms. Begley and the Boise consultant, Kellie Wirth, who helped set up the program. Apparently, the law of averages caught up with the perpetrators of this Boise scheme, because Kellie Wirth is honest. She calls the biometric results “very disappointing” and says my concerns “are valid.”


The biggest lie of all: that these extra banana bites and trivial improvements in self-reported health behaviors — combined with statistically significant deteriorations in self-rated health and risk scores — could have any effect, let alone an effect of mind-boggling magnitude, on overall spending:

wellsteps-cost-savings

Funny thing, Ron Goetzel insists that “most programs fail” because they aren’t done right, and that getting to a 1-to-1 ROI is a heroic accomplishment, only achievable when employee health is improved:

goetzel-roi-quote

And yet when it comes to giving his friends awards, failed programs harming employees but generating massive phony ROIs don’t seem to bother him at all.  Let’s see him Pretzel his way out of this one.


One thing vendors love to do is play blame-the-victim. The Pretzel pioneered this approach by saying he had “absolutely nothing to do with Penn State,” when in fact he was in the room when they defended their program to the media.

Seth Serxner stood up, on camera, and basically declared United Health Care/Optum hates it when employees spend too much money on their screening programs, and typically begs to do less. United Healthcare complained that I was making them look bad, but then couldn’t produce a single name of a single employer who would admit to deciding to spend more money for the express purpose of screening inappropriately.

And now here comes Steve Aldana, blaming the Boise school administrators for insisting on throwing taxpayer money away and harming their employees, by flouting US Preventive Services Task Force guidelines. My suspicion is that their Boise customers have an alternative view, but — despite the presumably obvious pride they must be taking in this award — they are refusing to comment on it.  One can only imagine the conversations taking place in Boise right now…and this is before the Idaho Statesman gets hold of this debacle.


And Ron wonders why the number of applications for the Koop Award was down by two-thirds this year…which brings us to yet another lie told by Mr. Goetzel in this article.  He attributes the decline to the following:

the application process, including the requirement that wellness programs submit statistics and rigorous data analysis, has become so strict that fewer programs want to go through the process.

However, if you actually look at the application form, it is exactly the same now as it has been every year this century. And indeed the data submitted, if anything, was more comprehensive then. For instance, the 2000 winner, Fannie Mae, clearly documented all the prostate, pulmonary function and other USPSTF D-rated tests they forced employees to submit to.

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