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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.

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.

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