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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.

HERO’s Paul Terry, Ron Goetzel, Seth Serxner Admit to Fabricating Data

Update: It turns out that, notwithstanding the protestations of these three very stable geniuses to the contrary, their data that they claim (three times, below) to have “fabricated” was actually real…and the three of them reviewed it before it was published.

How do I know this? In addition to the chapter actually saying it was real data, and the guidebook saying each chapter was reviewed multiple times by multiple people, I simply asked the author.  He confirmed both that the data was real (“If I had made it up, I would have said so”) and that it was indeed reviewed multiple times by multiple people on the HERO board.

When I re-read the chapter, I thought: “This can’t have been written by someone at HERO. This is actual analysis and they don’t know how to do actual analysis.” Sure enough — the actual author is Dr. Iver Juster, who has taken all my courses and read all my books and has the advanced level of Critical Outcomes Report Analysis certification.

In other words, to quote a rapper whose name escapes me, they lied about the lies they lied about.



In an earlier column we indicated that we had gotten wind of a “poison pen” letter that the Health Enhancement Research Organization (HERO) board members (Paul Terry, Johns Hopkins’ Ron Goetzel and Optum’s Seth Serxner, among others) sent around to members of the media.  We just weren’t sure to whom it was sent or what exactly it said.

Eventually my attorney pried it out of them, after they first refused to admit this letter existed.

My attorney said he had never had a client who wanted to republish a defamatory letter written about him. I replied: “In the wellness industry, a defamation from HERO is, in the immortal words of the great philosopher Kenny Banya, ‘Gold, Jerry. Gold.’”  Indeed, this letter is the closest I’m ever going to come to achieving my boyhood dream of appearing on Nixon’s Enemies List.

Here are a few excerpts–along with my annotations in italics.


“The featured variables from the HERO report that these authors cites [sic] as ‘evidence’ begin with a statement that ‘HERO calculates gross wellness program savings of $0.99.’  As is obvious to even the most uninitiated reader of our report, the $0.99 amount is taken from page 23 of an 87 page report in a section which is clearly labeled as one example wherein the sum savings derives from a fabricated scenario…The authors go on to suggest that the HERO report provides ‘evidence’ of a negative return on investment from wellness programs because our ‘report estimates wellness programs costs at $1.50 pmpm.'”

Our math (meaning your own math in your “fabricated scenario”) is correct. True, we never in a million years realized that wellness economics are so hilariously poor that even when you “fabricate a scenario” in your own guidebook, you still manage to lose money.   And in any event, even though you never asked us to, we did correct that inaccuracy—by showing how much more money wellness loses if we substitute real numbers from HERO Committee members’ own writings for the “fabricated” ones.


“This variable is taken from page 15 of our report and the report’s authors in no way associated the two numbers. Furthermore, the cost number is again derived from a fabricated illustrative example…” 

So you’re saying that your report’s authors put these two numbers (costs=$1.50 PEPM and savings=$0.99 PEPM) in the very same chapter but readers aren’t supposed to compare them?  Bad readers! Shame on you for being discerning!

By the way, the example isn’t “fabricated.” Messrs. Goetzel, Serxner and Terry are now, in the immortal words of the great philosopher LL Cool J, lying about the lies they lied about.  This is not a “fabricated illustrative example.” It is a reproduction of an actual report, which is why Page 22 calls it a report and describes what it shows:

heroreportp22language-on-report


“The authors seem to indicate that their findings from these distinctly unassociated variables is an inventive disclosure of a negative ROI for wellness on their part by writing that ‘this loss was not an intentional finding in this document.'”

Leaving aside that both these “distinctly unassociated variables” appear in the exact same chapter, how can costs be “distinctly unassociated” with revenues? Isn’t that what business is all about, associating revenues and costs?  Example: Suppose your revenues are $2.  That’s GOOD if your costs are $1 but BAD if your costs are $3. 

I’ll use a sports analogy so that even the dumbest member of the HERO board can follow the logic. If my team scores 5 runs, we WIN the game if your team scores 4 runs.  But we LOSE the game if your team scores 6. It doesn’t do any good just to know my team scored 5 runs. The number we score MUST be “distinctly associated” with the number you score to get a meaningful result.

Am I going too fast for you, Mr. Goetzel? You did refer to yourselves in this letter as “among the most credible and conscientious scientists and practitioners working in corporate wellness today,” so hopefully the information above is not too technical for you. I tried to use short words where possible.


“We are confident that any discerning reader of our report would instead conclude that associating the variables as they were in this blog post was an absurd, mischievous and potentially harmful misrepresentation of our data.”

We took screenshots of your figures. I’m not quite sure how we could misrepresent screenshots. In any event, we don’t have to “misrepresent your data.” As Yogi Berra might say, you misrepresented it just fine all by yourselves. A trade association dissing its own product, and now bragging about fabricating data?  One doesn’t see that very often.

 


“A cursory vetting of these authors would have revealed a litany of inaccurate and outrageous writings over several years.”

Yikes! We apologize!  We had no idea that we’ve been publishing “a litany of inaccurate and outrageous writings.”  We have published about 450,000 words — more than all of Shakespeare’s tragedies combined.  Possibly a few inaccurate words slipped in.  Surely in order to make such an otherwise libelous statement, you have a list of these “inaccurate and outrageous writings.” A cynic would say you’re deliberately lying, but all we’d like to know is… 

clara peller

Since we are in the “integrity segment” of wellness, we would like to see this list, so we can acknowledge and correct any errors.

Alternatively, if there are no inaccuracies, then you are endorsing the accuracy of our work, which we will announce in an upcoming post. So please get back to us within seven days with the list. Otherwise, we thank you very kindly for your endorsement of our accuracy.  Additionally, we would like a written apology if you want to avoid a lawsuit.

Read Their Lips: An Apology to HERO Is Long Overdue

You may remember our series on the HERO Outcomes Guidelines Report.  We had observed that their own numbers showed wellness loses money. Specifically, they showed a program costing $18/person/year or $1.50 PMPM:

HERO list of costs

Gross savings were pegged at $0.99 PMPM:

hero p 23 99 cents with red bar

Silly ol’ me reasoned that if a program costs $0.51 more per month than it saves, that annual net losses would exceed $6.00. Of course, that’s before counting all the other costs that the HERO Guidebook listed (pp 10-11) but conveniently overlooked in their actual cost calculation:

HERO list of costs

Silly ol’ me also assumed these cost and savings figures had been approved by the 60 “subject matter experts” who reached “consensus” in this report, consensus being a word that appears 16 times. The report itself required “two years and countless hours of collaboration.” (p. 3)

Hopefully you can see how I might have been inadvertently misled into thinking the report actually did represent expert consensus, reached after two years and countless hours of collaboration.

I’ve since learned that the nice people at HERO are very upset with me for falsely assuming that the information in their report represents the information in their report.

They call my lapse of integrity “outrageous.” This adjective was contained in a letter read but not sent to me by a member of the HERO Board. (At the risk of blowing his cover, this is a guy known for his integrity.)  Staywell’s Paul Terry, whose own escapades have been well-chronicled on The Health Care Blog, had apparently circulated this letter around a while back on behalf of HERO.

Specifically, Terry stated it was “outrageous” that I had failed to mention that this money-losing scenario in the HERO Report was just one example of a wellness outcome.  For some unknown reason, HERO elected to illustrate the financial benefits of wellness with an example that loses money. That would be like a tobacco company illustrating the health benefits of smoking with this example:

smoking through a trach tube

Piling on, Ron Goetzel also disavowed the HERO report’s figures during our debate, stating that his numbers are “wildly different” from the ones in the report he co-authored.

Apology and Atonement

I apologize.

To atone, I will substitute Ron’s recommended “wildly different”  wellness budget of $150 per employee per year for the report’s $18 PEPY.  Then let’s adjust the $0.99 PEPM savings in reduced wellness-sensitive medical event (WSME) spending for the natural decline in WSMEs that occurred over the same period, according to Truven. Truven is Ron’s employer and hence is presumably the source of Ron’s “wildly different” figures for WSMEs.

hcup cvd 2009 and 2012

If you can’t read Truven’s numbers above, they show a decline in WSMEs in the working-age insured population between 2009 and 2012 of 23%. This actually greater than the 17% (3.14 down to 2.62 “potentially preventable hospitalizations” per 1000) decline in the HERO example over the same period:

hero total page 23 with red bar

But we’ll give HERO the benefit of the doubt and say doing wellness reduced wellness-sensitive events as much as not doing wellness would have reduced them.

That actually is the “benefit of the doubt” because a review of all the Truven data compiled for the government shows that indeed WSMEs have consistently trended more favorably in the non-exposed populations than in the”privately insured” population below (in green), much of which was exposed to wellness.

wsmecombined

Adjusting for the benefit-of-the-doubt secular decline in WSMEs wipes out gross savings — even without counting all the following claims costs that HERO says should actually increase:

HERO other costs increase

Or maybe those cost increases also only happen in this one rogue example in this one rogue chapter. And maybe this one rogue chapter (Chapter 1) just contains a terrible, horrible, no good, very bad example that somehow accidentally found its way into the HERO Guidelines Report even though none of the 60 subject matter experts believe it.  Or maybe two years wasn’t enough time for these experts to review it, though my review required only five minutes. Perhaps that’s because when I read, I don’t move my lips.

So…

Per HERO’s and Ron’s request, I’ll  replace their original estimate of $6 in annual losses PEPY with Ron’s new net loss estimate of $150 PEPY. And that’s without the multitudinous added costs that they also listed but never counted.

All in, my original estimate was off by almost two decimal points. However, I take responsibility only for the magnitude of the error, not for the delay in correcting it. If HERO had told me last year to substitute these real figures for their rogue example, I would have corrected the figures posthaste.

And my lips would have morphed into a great big smile.

That Was the Year that Was: Our Top Contributions of 2015

Our year-end jubilee has so far featured lists of the worst vendors and the funniest vendors.  To close out the year on a more serious note — if for no other reason than to show we are indeed capable of treating the extremely serious topic of wellness with the Extreme Seriosity it deserves — we’ll list the most influential posts of the year.

In terms of views, the top spot is shared by our two smackdowns of worthless employee weight control programs. Our peer-reviewed smackdown, in the American Journal of Managed Care, should end the year at #1 on their list too, of the most-viewed articles.  I say “should” because a lot will depend on people clicking through on it today or tomorrow (hint) and at least pretending to be enthralled by it, even though it is a bit dry.

The Reader’s Digest version got picked up on Huffpost.  Absent the constraints of peer review, we took the gloves off.  Our reward is that we are the most-widely read Huffpost of the year on wellness.


If “most shocking” is the criterion, the winner is our recent evisceration of Aetna’s employee DNA collection program.  This one is best viewed here, at Insurance Thought Leadership, but was also picked up by The Health Care Blog.  You know the old Woody Allen joke about the two ladies in the Catskills?  One of them says: “You know the food here is terrible.” The other replies: “Yeah, and the portions are so small.”

Collecting employee DNA is a shockingly stupid idea on many levels — the kind of program that someone would make up in order to make wellness look bad, but we didn’t have to. As if that weren’t enough, Aetna also decided to fabricate outcomes. And because the program was so expensive, to show a 2-to-1 ROI they had to concoct $1464/person in savings in the first year alone–on employees who, by Aetna’s own admission, weren’t even sick.   One of the editorial board members of the journal that published it wrote that it should never have passed peer review.


The biggest category — and the one where it would be hardest to pick a winner from among the many worthy entries — would be: “Most likely to show Ron Goetzel making things up.”

You might vote for yesterday’s post on how Ron said wellness programs increased stock price valuations when in reality they reduce stock prices.  (Ron also misused the word “valuation”.  It is not a synonym for “stock price.”  In all fairness, the only people who would be expected to know the distinction would be people who write articles about stock valuations that are actually intelligent and insightful.)  However, he probably didn’t make up that conclusion.  I reviewed 5 years and compared each company to its relevant sector index.  By contrast, he reviewed a longer period and has probably never heard of a sector index. We reached opposite conclusions about the correlation of wellness programs and stock prices. The real answer, though, is that wellness programs have absolutely no meaningful effect on either stock prices or stock valuations. If they did, one securities analyst somewhere, writing a report on one company anywhere, would have noted it. Not to mention that a hedge fund would have made a business out of buying shares in companies with the best wellness programs.

Another candidate would be our expose of the HERO report, in which we observed that HERO and their cronies accidentally admitteda la Robert Durst — that wellness loses money.  Despite co-signing this document — a document that required “two years and countless hours” of collaboration, and in which the word “consensus” appears 39 times, Ron insisted during our debate that he had nothing to do with anything in this document that he himself didn’t write.  (Of course, in the debate he also insisted that he had nothing to do with Penn State — meaning he just wandered into their press conference by mistake, or maybe I am confusing him with another Ron Z. Goetzel.)

Nonetheless our vote goes to the Unified Theory of the C. Everett Koop Award, in which we reverse-engineered the mathematically impossible formula (the “Goetzel Factor”) that Ron and his integrity-challenged cronies use to anoint award winners, whose programs are almost invariably hilarious and show a complete lack of understanding of the way healthcare and healthcare math work. To paraphrase the immortal words of the great philosopher Samuel Goldwyn, “If Dr. Koop were still alive, he’d be rolling in his grave.”

 

 

 

 

 

Albert Einstein Meets the C. Everett Koop Wellness Award

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Quizzify’s unified theory of healthcare: smarter employees use less

One of Albert Einstein’s great regrets was never having developed a “unified theory,” a consistent set of calculations that could explain the universe. That’s the bad news. The good news is that he did give us the word “Einstein” as in: “Ron Goetzel’s Koop Committee members are the biggest bunch of Einsteins in all of wellness, no easy feat considering the competition from WELCOA, HERO and others.”

Past postings have easily invalidated all the Koop awards since 2010.  This did not require breaking a sweat.  Rather, as Surviving Workplace Wellness observes: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data.  It will invalidate itself.”

Previously, we’ve had to content ourselves with pointing out the plethora of individual rookie mistakes in each award. Now, however, we have a Unified Theory of Koop Award Ludicrous Impossibility. It reveals a remarkably consistent set of ludicrously mathematically impossible outcomes across all this decade’s award-winners.  Not just any old ludicrously mathematically impossible outcomes but — and this is what excites my Inner Nerd — the same ludicrous mathematical impossibility pervades every award-winning outcome.  

In each case the award winner has documented a small risk reduction among active participants.  (They have also shown that willingness to participate, rather than the actual program, is what generates the savings, of course, but choose to ignore their own findings.)  And in each case that small risk reduction generates what we thought were fairly random claims of savings.  But it turns out that in 5 of the last 6 awards, the claims savings weren’t random at all but rather were essentially the same, using the same simple formula comparing risk reduction to claims savings.  (The missing year is 2013. We can’t do Dell because we don’t want to embarrass them due to our relationships.)

The Unified Theory of Koop Award Ludicrous Impossibility Revealed

In the real world, trivial reductions in risk among participants — excluding non-participants because they increase in risk — have no impact on spending discernible in the white noise of random claims variation. And if we could discern an impact, it would be even more trivial than the risk reduction, because risk-sensitive medical events are a small percentage of total events.  For instance, if risk-sensitive medical events comprise the typical 5% of total spending, and risk declines by 1%, the reduction in total spending would be 1% of 5%, or 0.05%.  And that’s before subtracting fees.

However, on Ron Goetzel’s planet — also inhabited by fellow Einsteins like Optum’s Seth Serxner, Wellsteps’ Steve Aldana, and Staywell’s David Anderson, and obviously Mercer and Milliman — the opposite is true: a trivial reduction in risk generates massive cost savings. For example, McKesson saved $13 million via a 1% overall risk reduction. At that rate of savings and their rate of spending, their entire health spend could be wiped out if risk factors fell 14%.   Not just their spending on wellness(risk)-sensitive medical events, but their total spending spending on healthcare.  Wiped out. Gone. Obliterated.

A simple example can demonstrate how the Unified Theory works.  Suppose the Koop Award goes to an outfit that claims to have achieved a 10% cost savings by reducing risks 2%.  Then it follows that a 100% cost savings (10 times the claimed amount) could be achieved if risks fell 10 times the claimed 2%, or 20% in total.

To give credit where credit is due, we shall call this resulting figure — 20% in this hypothetical — the Goetzel Factor. The Goetzel Factor is specifically defined as: “The percentage decline in risk factors projected to wipe out spending according to the Koop Award Committee validations of risk and cost savings.”

The Evidence

Let’s review the last five awards (leaving out 2013) using this formula to estimate a Goetzel Factor. Note that the risk reduction is cross-sectional, meaning it is averaged across the entire population, not just participants.  So if the stated or calculated risk reduction is 2%, as with McKesson, and half the employees participate (ditto), the figure in the table below for McKesson would be 1% (half of 2%).goetzel factor

Conclusion: the range of Goetzel Factors is remarkably tight–13% to 16%.  Given the ludicrous impossibility of wiping out spending by reducing a small minority of risk factors, the consistency of the result is amazing:  the Goetzel Factor reveals almost exactly the same ludicrous impossibility every time!

There are a few asterisks in this Unified Theory. In some cases, the award application itself wasn’t specific on some things, like total spending.  So we made assumptions and “showed our work” as they say in fifth-grade math. Or, in the case of British Petroleum, we defaulted to their article in JOEM, which had much more detail.  In any case, the spreadsheet calculations and sources are available to all legitimately qualified researchers, meaning those excluded from the Koop Award Committee because they aren’t Einsteins.

Wellness phooey!

Koop Award Shmoop Award!

 

Part 2 of the Proof: Even If Wellness Could Save Money, It Doesn’t

Recently we promised a Part 2 to our original proof that wellness savings are mathematically impossible. Commenters said: “How can you have a Part 2 to a proof?  You just proved it.”

Read on.

The previous proof showed wellness can’t save money, even if programs were perfect. This installment proves that even if wellness could save money, it hasn’t.  Meaning even if wellness were free, it couldn’t pay for itself.  So this proof is independent of the previous proof.  For wellness to save money, the wellness true believers would have to find fallacies in both proofs.  Either is sufficient to make our case…but we have both.

Quite literally, forcing employees to “do wellness” or lose money has avoided basically zero wellness-sensitive medical events in the 13 years ending 2013 (2014 data isn’t in yet), according to the federal government.  If the name “federal government” sounds familiar, it’s because it’s the very same federal government that has passed a law encouraging vendors to pitch “pry, poke and prod” programs to you despite their complete lack of evidence basis, lack of effectiveness, and potential for harm.

Here is the way our analysis was done.  We used the government database called the Healthcare Cost and Utilization Project, or HCUP. That database tracks all hospitalizations due to all causes, by population.  So it is possible to focus on just the commercially insured population, which they call “privately insured.”

The privately insured population is 100% sensitive, meaning everyone whose workplace “offers” wellness is in that database.  The database isn’t specific, meaning plenty of people in it do not have access to wellness.  Nonetheless, the dramatic increase over the 13 years in the number of people whose employers push wellness should produce an equally dramatic decrease in wellness-sensitive medical events.  While wellness was rare at the start of this analysis in 2001, today most large companies, nonprofits, and governments have wellness. In total, one can project from the Kaiser Family Foundation data that about 75-million people (or roughly half of all privately insured people) are subject to what Jon Robison has termed wellness-or-else.

Keep in mind that all hospitalizations have been declining over this 13-year period, due to shifts to outpatient, better usual care, etc.  So the question is not whether WSMEs have been declining, but whether they have been declining faster than the rates of all other hospitalizations in combination due to the large and increasing “dose” of wellness” being applied to them.

Instead, as you can see, these WSME admissions have trended essentially flat over the period, as a percentage of all admissions.  In other words, there is no difference between the decline in admissions for WSMEs – despite $7-billion/year being spent on vendors to prevent them – and the declines in every other category of hospitalization.  13 years ago about 6.9% of events were wellness-sensitive.  Now it’s about 7.0%.  (This is 2013. 2014 is also in, for our customers for whom we track WSMEs, and shows no change.)

This is based on ICD9s 401-405, 410, 430-438, and 250 — strokes, hypertensive events, heart attacks, and diabetes events.

WSMEs

To make the point visual, the “dose” of wellness probably quintupled, in total, over this period, so the directional expectation of the chart would be:


Prima facie, the debate is over, again, just like it was over after our last proof.

Needless to say, the true believers aren’t about to give up their revenue stream just because we’ve double-proved they’re fabricating savings.  They will make two arguments against this proof of their own ineffectiveness.  First, they’ll argue that wellness reduces all events and other costs equally, so really we should credit wellness for the total cost reduction, not the reduction in just wellness-sensitive admissions.  This might seem like a pollyannish view of wellness, but wellness true believers attribute everything that’s good to wellness. True believer Bruce Sherman has even argued that wellness actually reduces industrial waste, so to a wellness true believer, eating more spinach makes every employee a Popeye.

Unfortunately for Bruce and others, the wellness industry’s own HERO report says wellness can only reduce WSMEs.  Other costs go up, it says:

HERO other costs increase

Second, one could argue that there isn’t enough penetration of wellness yet to bend this trend, since the HCUP privately insured population includes tons of people without access to wellness, and even many people with wellness access refuse to participate.

Unfortunately, that argument self-immolates.  Vendor fees are $7 billion.  All these WSME ICD9s combined (using the HERO-estimated admission cost of $22,500) amount to about $11.3 billion. That $11.3 billion includes the half of privately insured people who don’t have access to wellness.   Already, when you cut that figure in half to account for those employees with employers who’ve decided not to “do wellness” to them, the $7 billion size of the wellness industry exceeds the size of avoidable events ($5.7 billion). This is consistent with our first proof, which showed the same thing, but on an individual company level.  Now—assuming participation is 50%, you need to cut the WSME hospitalization total in half once again.  You’re down to $2.85 billion in potentially avoidable events — that companies are spending $7 billion on vendors to avoid.

So, no matter how you look at it, “pry, poke and prod” programs have been singularly ineffective in reducing WSMEs.  And if the HERO Guide is right that these are the only admissions wellness can avoid (while other costs increase, as they admit), wellness does not and cannot save money.

Instead, wellness-or-else is basically a pile of, um, industrial waste.

Anyone still want to try to claim the million-dollar reward for showing pry, poke and prod programs aren’t a total waste of resources?  I didn’t think so.


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The thing most likely to save money is knowledge.

Note:  This graphical analysis is copyright 2015 to Quizzify.  However, any disinterested researcher or journalist may request a copy of the backup material from us.

Measuring Wellness-Sensitive Medical Events: The Grand Finale of the HERO Analysis

fireworks finaleThe eighth in the series deconstructing the HERO Outcomes Guidelines, covering Page 14. The full series can be found here. This installment in particular should be read in conjunction with installment #4  This Grand Finale will be presented in 3 parts…with a downloadable tool to help you calculated your wellness program savings as part 3.

PART ONE: HERO ACCEPTS OUR METHODOLOGY

In the stock market, no one is as valuable as the person who’s always right, except the person who’s always wrong. Therefore, until now we have greatly appreciated the opportunity HERO’s report has created for us to explain how to measure outcomes correctly.

So imagine our disappointment when one of their methodologies, the sixth of the seven listed, turned out to actually be valid. No surprise — this is the methodology I invented. Also no surprise given the industry’s standards for integrity, they didn’t acknowledge that particular factoid anywhere in their 88 pages. (And yet they accuse us of being impolite.) Here is the screen shot.

hero methodology 6

The philosophy of #6 is quite straightforward. If you were introducing a flu vaccine program, you’d measure the reduction in number of people who got the flu. If you offered a new program for conservative treatment of meniscal tears, you’d measure the reduction in the number of people who had meniscal surgery. That’s the way experimentation works. You hypothesize an outcome that the intervention should create…and then you measure that outcome to see if the experiment worked.

Except, of course, in population health, where any improvement in anything (cost, trend, utilzation) gets attributed to any wellness program that happened to be in place. The masters of this would be Mercer. Mercer once “found” massive, mathematically impossible, savings for North Carolina Medicaid’s medical home in a cohort that, as luck would have it, wasn’t even eligible for the medical home. And one wellness industry stalwart, Larry Chapman, says the simple act of completing a health risk assessment can reduce total healthcare spending by 50%, even when the information in the HRA is wrong, as is often the case.

And did you ever notice that when a company switches to a high-deductible health plan and adds some needle-poking, they attribute the reduction in spending to the needle-poking, not the fact that everyone in their company suddenly gets socked with a bigger annual deductible?

Enter wellness-sensitive medical event rates (WSMEs). This is the only methodology that tallies hospitalizations for conditions targeted by a wellness program – statistically avoided heart attacks etc. This is the only one of the seven HERO methodologies that would be acceptable to legitimate researchers. Hence, its use both in Health Affairs and by the GE-Intel Validation Institute. The former is the most respected health policy publication and the latter is the most (the only) respected outcomes evaluation organization.  Further evidence of its validity is that there is no mention of it in the leading wellness promotional publication, the American Journal of Health Promotion, perhaps because – as HERO has attested – it doesn’t show savings.

History of event rate-based plausibility testing

Even though it isn’t attributed to me in the HERO guidebook, I invented this methodology in 2007. This is incontrovertible. No one else had anything remotely close to it. Unlike the automobile, TV, the computer, etc., this was not one of a series of incremental improvements to or the amalgamation of existing technologies.

And none of the other invention clichés apply either. The Chinese didn’t invent it in 1000 BC. Leonardo DaVinci didn’t sketch it in 1541. The Germans and the Allies weren’t racing to develop it at the end of World War II. By contrast, I’ve been presenting on it and using it for validation since then (meaning 2007). It figured prominently in Why Nobody Believes the Numbers too, before being highlighted in Health Affairs and the Validation Institute. For a modest fee, the detailed how-to can be downloaded from our website, though a Reader’s Digest version appears below.

While a number of employers and health plans use it now, several health plans – more than coincidentally three of the highest-rated in the country (Harvard Pilgrim, Blue Cross of Massachusetts, and Providence Health Plans) – have been measuring hospitalizations for conditions targeted by wellness/DM programs since the methodology’s inception.

So needless to say I was surprised and totally flattered that the 88-page HERO Report contained no attribution to me as the inventor of the WSME plausibility test. As mentioned previously, the strategy of the Wellness Ignorati is to ignore facts (hence their moniker), especially including my very existence. That strategy reduces the likelihood that one of their customers might click through to the site. They aren’t much for our recommending that companies learn our helpful insights, which they call “bullying.

The wellness industry has had a love-hate flip-flopping relationship with WSME measurement.

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Click on the Q to try our demo

First, until 2013, the entire Wellness Ignorati, quite in character, ignored this methodology, which is a powerful testament to its validity.

Then, in 2013, that strategy took a body blow: the exact methodology was used in Health Affairs. You may recall the same thing happened with another epiphany of ours — the expose of the invalid Koop Award-winning Health Fitness Corporation fabricated results. The Wellness Ignorati completely ignored our whistle-blowing expose until it appeared in Health Affairs, when they were forced to admit we were right and the whole thing was made up, or to use Ron Goetzel’s phrase in the passive voice, “was unfortunately mislabeled” for four years.

Just as Ron Goetzel — the leader of the Wellness Ignorati — caved when the Health Affairs light was shined on the Koop-HFC debacle, he caved on WSMEs when the Health Affairs light was shined on them. In this case, “caving” was acknowledging the fact that this methodology existed. He reviewed the aforementioned Health Affairs article that specifically analyzed WSMEs — hospitalizations for conditions targeted by the wellness program. In September 2014, he wrote:

goetzel quote on BArnes article

But then he un-caved. Once the Health Affairs storm had passed, he invoked the Sergeant Schultz defense. In December 2014 he said: ,

goetzel quote on WSMEs

He may have just forgotten in December that he reviewed them in September. But in March he and his colleagues re-remembered wellness-sensitive event rates, and put them right in the HERO report, for which we are immensely grateful.

Hopefully they won’t re-forget in June. (Their memory appears to be correspond with the change of seasons.) Hopefully instead, to paraphrase the immortal words of the great philosopher George Gershwin, our methodology is here to stay.

How do I feel about HERO rewriting history so that I am no longer the inventor of this methodology? Honestly, having firmly staked out a niche in the small but growing “integrity segment” of the wellness industry, I prefer them staying out of that niche as long as possible. So I’m glad they show no interest in facts.

In part two, which we will post in a few days, we will explain how we do WSME plausibility testing and why it’s the essential method for assessing the impact of your wellness and disease management efforts.

Does HERO’s Model HRA Teach Employees to Lie?

Flaming_cocktails

When you’re hot, you’re hot; when you’re not, you’re a wellness vendor

This is the seventh in the series on the HERO Report, covering page 26 to 38.  Six previous installments can be found here.  A future installment will include a wellness savings calculator that you yourself can apply to determine whether the HERO report accurately captures your own economics or not.  To make sure not to miss it, “follow” us on WordPress.

Employers learn a lot about their own companies when employees complete health risk assessments (HRAs). For instance, HRAs ask employees how many ounces of alcohol they consume. Wellness vendors then produce reports showing the statistical difference between the number of ounces of alcohol employees say they consume vs. the number of ounces of alcohol that employees with similar demographics actually consume, to show the extent of that company’s workforce dishonesty.

Haha, good one, Al.  Obviously no wellness vendor does such an analysis. Doing that would require actual competence, one of two critical success factors — integrity being the other — conspicuously lacking in the wellness industry. (Exhibit A: this HERO report.) Instead, they summarize the self-reported drinking estimates with no qualification or comparison to national norms, as though these self-reported figures actually mean anything.

Not being wellness vendors and hence priding ourselves on our triple-digit IQs, we have done this analysis on multiple occasions.  Here is a typical result:

drinking rates

According to self-reported estimates from this company, literally no one has a drinking problem and very few people drink at all. Time after time, we get the same result. Hence, self-reported estimates of alcohol consumption on HRAs are useless at best. At worst, asking this question simply encourages employees to lie. Somehow wellness vendors have never figured this out, despite their extensive experience in the lying department.

This chapter contains three other head-scratchers as well.

First, why this obsession with body mass index (BMI)? It is probably more important to be “fit and fat” than to attempt to diet and not exercise. You can’t get people to change multiple behaviors. HRA advice should be focused on fitness, rather than weight.

Quizzify

At Quizzify, we know the difference between fruit and juice

Second, speaking of weight, why hasn’t HERO gotten the memo that most fruit juice is junk food? Why are they urging the consumption of more sugars? Why do they equate fruit juice with healthy vegetables? Where is the up-to-date nutritional guidance? This isn’t rocket science. Quizzify incorporated this revised dietary guidance into its health education tool when it was first released, in March.

Third, why do HRAs obsess with seat belts? Seat belt use in the U.S. is at all-tme highs, but distracted driving is a serious problem that no HRA we’ve seen even mentions. If you are routinely hiring employees who don’t buckle their seat belts, but are texting and talking while driving, then you have bigger programs, and a computer print-out telling them to buckle their seat belts isn’t going to save anyone.

The Good News

Still, credit where credit is due. For the first time ever, we see the advice that HRAs recommend the shingles vaccine for employees 60 and older. Of course, we’ve never seen that recommendation in an actual HRA itself, though Quizzify covers it. Once again, covering shingles would require competence on the part of wellness vendors. Were a wellness vendor actually to recommend this vaccine, it would be an example of exactly why people should take HRAs: to learn something that they didn’t already know, that is easily implemented and that could prevent a debilitating illness. (By the way, there is some controversy as to the vaccine’s effectiveness. However, that’s not why HRAs don’t recommend it. They disregard it because vendors don’t know about it.)

And, aside from the fruit juice, there is no demonstrably bad advice in this model HRA. HRAs, of course, are notorious for bad advice, like telling males to get prostate tests, telling females without genetic predispositions to get mammograms before the recommended age of 50. And, don’t forget WebMD’s infamous testicle checks, one of the late-night TV staples from the Highmark-Goetzel Penn State debacle. Men who didn’t say whether they check their testicles every month – a D-rated idea, according to the US Preventive Services Task Force – faced a $1200 fine.

And while we realize that offering “no demonstrably bad advice” isn’t exactly a ringing endorsement, this chapter is the first in the HERO Report that isn’t mostly wrong.

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