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Does HERO’s Model HRA Teach Employees to Lie?
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:
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.
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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HERO vs. Huffpost: What do actual employees say about wellness?
Quizzify is very uniform. Uniformly smart and funny, that is
HERO (the wellness vendors’ trade group) says: “Employees are not uniform in their receptiveness to wellness programs.” That’s like saying: “Republicans are not uniform in their receptiveness to the Clinton campaign.”
Take a look at Huffpost — especially the comments— to see what employees really think, not what HERO wants you to believe they think. With more than 23,000 views, this Huffpost was probably the most widely read posting on wellness anywhere in all of 2015.
These comments are unexpurgated (except for Huffpost’s own obscenity filter, which we suspect got quite a workout). You can add your own.
Then urge your HR department to redesign your wellness program. Tell them to ax your “pry, poke, prod and punish” vendor. If the vendor makes a fuss, bring us in and we can find all the lies they’ve told you in their outcomes reports and threaten to sue them.
No one thinks Quizzify isn’t fun
Then your company can start doing wellness FOR its employees instead of TO them. Read Jon and Rosie’s book to get some guidance. If you get depressed by the amount of work you have ahead of you, take a breather and read Surviving Workplace Wellness to tickle your funny bone– If laughter were truly the best medicine, wellness would be a blockbuster drug.
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7 Take-Aways from the HERO-Goetzel Webinar in Defense of Wellness
This is the sixth in a series on the HERO disinformation campaign around wellness ROI. The other six installments can be found here.
They said what?
This afternoon HERO and Ron Goetzel conducted an entire Groundhog Day-type webinar as though They Said What, the entire media, and 2015 don’t exist.
They talked about the “confusion in the marketplace” (to quote their invitation) without once even mentioning the source (us) of the confusion in the marketplace. Actually all we did was point out that they contradicted themselves in their own report. They created the confusion by inadvertently telling the truth.
Time to make the pretzels
Here are some of the things they are still saying, that they know to be somewhere between misleading and lies. Apparently Mr. Goetzel lived up to his billing as Goetzel “the Pretzel” by basically twisting “wellness loses money” into wellness makes money,” though he admitted to some “controversy” around the latter point.
First, he is still quoting the Kate Baicker 3.27-to-1 ROI, that he knows to have been thoroughly discredited. We’ve blogged about that extensively–this link will take you to a series of other links. To wit:
- She’s walked it back 4 times.
- RAND’s Soeren Mattke has attacked it (and those of you who know Soeren–he is a very thoughtful and polite guy–you really have to be way off-base to get his dander up).
- Another researcher has pointed out that many of the studies in her meta-analysis were basically made up.
- Many of these studies were claiming reductions in diabetes expense and obesity at the same they were telling people to eat more carbs and less fat, exactly the opposite of what would reduce diabetes incidence and possibly obesity. And yet somehow money was saved…
Second, the Ignorati are still quoting the American Journal of Health Promotion meta-analysis and Mr. Goetzel pretzeled his way around the accidental conclusion of that paper that high-quality studies show a negative ROI.
Third, Mr. Goetzel strongly criticized the Penn State fiasco. Hmm…maybe we’re mis-remembering this, but we seem to recall he was one of the leaders of that jihad. Here is a article about a meeting in which he and several others “take the offensive” in the controversy. Or maybe that was another Ron Z. Goetzel.
Fourth, he said: “There’s some healthy debate going on.” But the irony is, there is no debate. Partly this is because they are steadfastly refusing to debate. And partly this is because there is nothing to debate–they admitted “pry, poke, prod and punish” wellness loses money and damages morale. The only places we disagree are how much money gets lost and how badly morale is damaged.
Fifth, he is still comparing participants to non-participants, as though he hadn’t been forced — by the existence of a “smoking gun” slide — to basically admit that participants significantly outperform non-participants even in the absence of a program.
Sixth, he pretzeled RAND’s Pepsico analysis in Health Affairs, overlooking the fact that the study concluded wellness loses money. Obviously we wouldn’t have congratulated Dr. Mattke on his huge success with that article (#2 article of the year in Health Affairs) if it had reached the conclusion Mr. Goetzel said it did.
Finally, the most notable feature was the dog-not-barking-in-the-nighttime. Not once was there any rebuttal to our observations. The Wellnes Ignorati have placed themselves in a difficult position. In order to rebut us, they would have to acknowledge our existence. But ignoring our existence — and the existence of facts generally — is the core component of the Ignorati strategy.
By the way, our source, expecting a spirited rebuttal, instead got supremely bored by the insight-free recycled and invalid material in the presentation, and dropped off before the slam-bang conclusion to the webinar. We doubt there were any other members of the Welligentsia on that webinar but if there were–and you have something to share about the closing minutes that you don’t see mentioned in here — please do.
No pretzels here
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Health Enhancement Research Organization (HERO) meets Raising Arizona
We blogged recently that HERO was going to rebut our observations that essentially none of their report makes any sense.
The good news about HERO is that they never step out of character. After we urged people to sign up, a few readers pointed out this webinar is a:
But HERO’s invitation also states:
Unless they don’t know how many members they have, how can their webinar run out of space? Come to think of it, how does anything on the web actually run out of space?
Perhaps HERO took a leaf out of John Goodman’s playbook in Raising Arizona. (You gotta click through on this, even if it means taking you off our site.)
At Quizzify, we have space for everyone
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HERO challenges us to a debate — Webinar April 22
This is the fifth in a series on the HERO report on wellness outcomes measurement. The previous installments can be found here
Doesn’t really need a caption, does it?
The Health Enhancement Research Organization (HERO) has invited us to debate the merits of “pry, poke, prod, and punish” wellness programs, on April 22. The invitation is reproduced below and available in full here.
Not.
They didn’t ask us to debate. (They didn’t even invite us to attend.) By contrast, we have offered to debate many times. We’ve even offered literally a million-dollar reward for them to debate their outcomes metrics with us.
Here’s what really happened. We received emails from many people giving us the heads-up that HERO is holding a webinar during which they will spin their information published in their report where they say wellness loses money and is bad for morale into the opposite conclusion. If this seems confusing, it is.
Ironically, they said that we have “created confusion in the marketplace,” when in reality they were the ones who created the confusion, by providing information that they are now trying to walk back. The report seems perfectly clear – wellness loses money. Nonetheless the Wellness Ignorati are befuddled by their belated observation that it was they who supplied this information. No surprise here. Through the years we have noticed that the Wellness Ignorati are easily befuddled, especially by information.
By contrast, no one can say we confuse anything. We have always been consistent: “pry, poke, prod and punish” programs are losers for all concerned, except the vendors and consultants who naturally are running this webinar. For the Wellness Ignorati, it’s all about the money.
Yes, this is our new company where we do wellness the right way…and guarantee savings
One of the fundamental differences between us and the Wellness Ignorati is that we are pro-transparency and have nothing to fear from publicizing them, so we are attaching their invitation below and urging people to attend, whereas even as they disparage our observations, they refuse to mention the existence of this website.
No surprise there either: if people find out this website exists, they might visit and learn actual facts. Facts, of course, are the worst nightmare for the Wellness Ignorati. That’s how they earned the appellation–by employing a strategy of ignoring facts.
This is even true when they themselves published the facts.
Curiously, this is the second time in recent months that the Wellness Ignorati have written that wellness loses money. At some point if they keep insisting wellness loses money, we have to believe them. The last time, Michael O’Donnell’s journal concluded (we’ll use a screenshot):
We would attend this webinar ourselves except that we are not invited. In any event, our attendance track record is not encouraging. The last time we listened to a Ron Goetzel webinar, we were disconnected after asking that he not use our copyrighted material without attribution. Ultimately we had to get our publisher, John Wiley & Sons, to make him cease and desist.
Still, we’d love it if you would attend, and here are some questions you could ask. First about the HERO Report:
- Why did they say wellness damages morale and corporate reputations if they are now saying that it doesn’t?
- Why did they say a wellness program only costs $18/year when the biometric screens alone cost more than $18/year?
- How can they say that companies should allocate only $18/employee/year to a wellness program when their own invitation below says that to be successful, a program must be “comprehensive” and “well-resourced”?
- Why did they omit their own carefully compiled list of 11 elements of cost other than vendor fees from that $18 figure?
- If wellness only saves $12/employee/year before fees according to their own figures, how can it save money if it costs $18?
- Why are there so many rookie mistakes in this report, like “forgetting” to adjust the decline in cardiac events for the secular decline in cardiac events that the entire country is enjoying?
- If their methodology is so sound, how come they haven’t collected their million-dollar reward when all they have to do was apply fifth-grade math to a simple word problem without lying?
When facts interfere, just twist and turn them, like a pretzel
And while you’re in attendance anyway, there are 11 still-outstanding questions for Mr. Goetzel himself, that he has steadfastly refused to answer. Here are a few you could ask:
- Why does he keep insisting that the Nebraska wellness program – whose vendor admitting lying about saving the lives of cancer victims – is a “best practice” or “exemplar” program?
- Why does he always give Koop Awards to customers and clients of his sponsors and board members, even when they claim 100 times as much savings as they themselves said was possible?
- Who “unfortunately mislabeled” the key slide that invalidates the industry’s obviously fallacious participant-vs-non-participant methodology and why did neither he nor any other analytical luminary on the Koop Committee notice it until we pointed it out four times?
- Why has he refused to answer these questions even though Al Lewis has offered to answer any questions you could ask him?
In one respect, though, the Ignorati are finally making progress in the integrity department. This invitation is 100% Kate Baicker-free. Maybe, finally, they are accepting the reality that she has walked back her 3.27-to-1 ROI not once, not twice, not three times, but four times. (Four seems to be the magic number of times needed to point out a fact to the Wellness Ignorati before they admit its existence.)
INVITATION:
Don’t Throw Out the Baby with the Bathwater – A Measured Response to Critics of Workplace Health Promotion and Disease Prevention Programs
April 22, 2015
1:00 PM – 2:00 PM Central Time
(Members only event)
Recently, several individuals have raised doubt about the efficacy and cost-benefit of workplace health promotion and disease prevention programs (otherwise known as wellness programs). These critics cast doubt on the very core of work site wellness efforts and have generated widespread publicity. They argue against the benefits of prevention and workplace health promotion, question the validity of ROI estimates, and aim to restrict the use of outcomes-based wellness incentives. These criticisms have created confusion in the market. This session will re-state the business case for adopting evidence-based, comprehensive, and well-resourced workplace health promotion programs. It will also review the methods used to evaluate these programs in “real world” settings, but also acknowledge the limitations of “average” programs that may not produce expected outcomes. Finally, Dr. Goetzel will comment on value-on-investment (VOI) approaches to assessment of workplace programs in contrast to the more traditional return-on-investment (ROI) models.
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HERO meets Trading Places: Wellness Saves One Dollar
This is the fourth installment of the series on interpreting the Health Enhancement Research Organization’s Outlines Guidelines report. It covers page 23. The full series can be found here
One Dollar.
23 pages into their report, HERO has finally benefitted from the law of averages and gotten an analysis right…and it shows savings of: one dollar.
HERO conducted a “wellness-sensitive event rate analysis,” otherwise known as a plausibility test. It’s the only valid way of measuring outcomes. Not coincidentally, I invented it. There is no ambiguity about this. It’s in all my old presentations and my first book, Why Nobody Believes the Numbers. No one else has even pretended to claim credit. Nor is this one of those situations where the usual invention cliches apply. The Chinese did not invent it in 1000 BC. 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. Nope, mine and mine alone.
Of course there is no attribution of that (or of any of my contributions to this field, anywhere, in their 88 pages). I find this “oversight” quite flattering.
Here it is.
Note a few things.
First, this methodology counts all the admissions, whether or not the patients/employees participated or didn’t participate in a program, or whether the admitted patients were even known to have the condition in the first place. This is how it should be. This eliminates the participation bias, one of the two biases (not including lying) that the wellness industry utilizes to sustain the fiction that it saves money. It also eliminates regression to the mean (the other bias).
Second, this exercise generates 99 cents PMPM in gross savings. Yep, basically one dollar, like the bet in Trading Places. The “problem” with measuring validly is that your savings essentially dwindle to nothing.
One dollar. The Duke brothers turned the lives of Dan Ackroyd and Eddie Murphy upside down over a one-dollar bet, and the wellness industry wants you to turn your entire employee relations strategy upside down — in their own words, damaging morale and your corporate reputation — in order to save: one dollar. (That of course is one dollar before costs, which are $1.50.)
Quizzify…where there is no need to fake results
Third, believe it or not, even that $1 in savings is grossly overstated. Focus on ischemic vascular disease or IVD (heart attacks, strokes etc.) They show a decline of 7 admissions, or 23%, from 32 to 25 admissions — easily the largest component of the 9 avoided admissions they are attributing to wellness and disease management. This decline took place over a 3-year period, as they averaged the two pre-program years and compared that to Program Year 2.
The problem is that, according to US Government data below, this set of IVD events declined everywhere over the same 3-year period by– as luck would have it– that very same 23%. Don’t believe us? Here is the data. The comparable group on the display below is the “privately insured” cohort, underlined in red, now that we have figured out how to do underlines on screenshots. (Even Medicare, where there is no workplace wellness and where the population grew almost 10% and aged quite a bit, showed a decline in IVD of almost 10%.)
Despite the fact that all their savings from IVD got eliminated by the simple step of seeing how much savings would have accrued even without a program, I don’t think this particular oversight was purposeful on HERO’s part. I’d give them the benefit of the doubt and say the abject failure to compare their performance to the obvious benchmark was a rookie mistake. The lesson is, before they write reports on outcomes analysis, someone should teach them how to actually do outcomes analysis. I’m just sayin’…
By the way, a similar secular decline transpired in asthma nationwide. The 2009-2012 decline was 21%, meaning that 2 of the 4 admissions HERO says wellness “avoided” over that period would have gone away on their own.
So when you take out the IVD decline of 7 admissions and 2 of the avoided asthma admissions, you are left with: no decline at all. Essentially HERO just proved that – even before taking costs into account – their vaunted “pry, poke, prod and punish” wellness programs are worthless.
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Johnson & Johnson accepts our analysis that wellness loses money
Newsflash: Someone from Johnson & Johnson named Michael Schmidt responded to our posting that the HERO Report shows wellness loses money. This is the first time anyone associated with HERO has strayed from the tried-and-true Wellness Ignorati strategy of ignoring us. We were concerned that he might have found a mistake in our math, which no one has ever done.
Fortunately, our math is OK with Mr. Schmidt, and — by implication, since he is writing on their URL — J&J itself. His point is different. He argues that we write these columns to do the following: generate business. Touche!
He also says that the headline is inflammatory and that we will turn off more people than we turn on. That is probably accurate. However, the people we would turn off — traditional “pry, poke, prod and punish” wellness vendors such as Johnson & Johnson — have had and would have no interest in paying us to find out that wellness is worthless.
In any event the headline “The Wellness Wars Are Over. Wellness Lost” captures exactly what the HERO report says — and was edited by the ITL editor. Headlines, as Mitt Romney found out when his New York Times op-ed was entitled “Let Detroit Go Bankrupt,” are the purview of the editor, not the author.
The curious thing is, Johnson & Johnson is listed as one of the “endorsers” of the HERO report. So as an endorser of the report, Johnson & Johnson is tacitly nonetheless acknowledging that the report is right–wellness loses money.
In case there is some ambiguity, here is the screenshot of the first set of comments
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Apologies to HERO and the Wellness Ignorati!
(March 18) Due to vacation schedules, we are taking a brief time-out from both our “profiles” of vendors and our serial analysis of the HERO report (Part 1 was our most popular posting ever — don’t forget to “Follow” us so as not to miss a single installment.).
Knowledge + fun + respect = happiness + health
This posting is to apologize to the HERO Wellness Ignorati. A comment our posting on the HERO report said we shouldn’t call the Wellness Ignorati “ignorant.” We aren’t calling them ignorant and we apologize if we were misunderstood. Since it has sold almost 6000 copies despite Wiley’s decision to price it to finance their retirement accounts, we thought by now most people had read Cracking Health Costs. That was the book in which the term was coined. It emphatically does NOT mean “ignorant.” We would never call them “ignorant” and the Ignorati are anything but. Quite the contrary, they are smart enough to realize that facts are their worst nightmare.
Or as Tom Friedman said in today’s New York Times, “We wouldn’t be human if we didn’t outright ignore facts that make a laughingstock of our hopes.” (I actually did the opposite. See the blog post: Founding Father of Disease Management Astonishingly Declares: “My Kid Is Ugly.” Dee Edington did something very similar. Both of us were simply not willing to sacrifice our integrity for filthy lucre.)
The Wellness Ignorati are more than smart. They are brilliant. They have elevated fact-ignoring to an art form.
They realize that enough people seeing this site will derail their HR-financed gravy train, so they keep to a strict strategy of not even acknowledging that facts exist. Example: us. Not a mention of our existence in their entire report. A brilliant strategy for them, and one that flatters us immensely. Obviously, in the massive tome they just published, if they thought we were wrong, they could have said: “They Said What and its authors offer a competing view, but it’s wrong because…”
Fact suppression is of course the opposite of what we do — we want facts to be front-and-center. We welcome transparency and debate, though the latter is tough because people either repeatedly decline (Ron Goetzel) or, after the debate, wouldn’t agree to release the recording (Michael O’Donnell).
Instead they simply disappear us. This is despite the fact that the two of us (plus our colleagues like Jon Robison and Tom Emerick) have sold more books, been interviewed in more major publications, authored more articles in high-impact journals than all the Ignorati combined.
Do you employees know when to just say “no” when it comes to medical care?
I’ll close with a f’rinstance. We copied a screenshot from that report showing that the Ignorati finally admitted that “pry, poke, prod and punish” programs damage morale. This guy looked at that screenshot, and put a comment on our post that this screenshot didn’t exist, but rather it was our propaganda. Someone else said the screenshot was out of context, so we invite everyone to read the context.
The bottom line is, of course the HERO Report is correct about the cost of morale damage. Coincidentally, I am writing this from State College, Pennsylvania. I am here as an honored guest of the Penn State Faculty Benefits Committee, feted for my role in helping to free them from the Goetzel/Highmark forced wellness program (featuring those immortal testicle checks). Try telling Penn State there’s no morale impact. (For those of you thinking of sending your kids here, do it! I’ve never been to a university where the professors were more passionate about teaching their students than PSU–despite what happened to them in 2013.)
“Everyone is entitled to their own opinions, but not to their own facts.”
–Daniel Patrick Moynihan
They Said What? 