They Said What?

Home » Koop Award Invalidity (Page 2)

Category Archives: Koop Award Invalidity

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.

The back story of the scathing STATNews smackdown of Wellsteps and Goetzel

This posting is for folks who found us via award-winning journalist Sharon Begley’s “Wellness Award Goes to Workplace Where Many Health Measures Got Worse.”  (Note that no one has ever challenged any of her two dozen awards.)

In the event that you are new to the Wellsteps./Boise School District debacle, here is the back story, very quickly.

  1. Wellsteps lied about savings.
  2. I predicted the combination of lying, incompetence and cronyism would win them a Koop Award.
  3. Wellsteps said: It’s fun to get fat. It’s fun to be lazy.
  4. Wellsteps showed a complete failure to understand wellness.

And so, inevitably…

Wellsteps won a Koop Award. Ron Goetzel and Seth Serxner have never let their friends down in the past, so why should integrity, competence and facts stand in the way this time?

 

Are you smarter than a Koop Award Committee member? Take this quiz to find out

Last week we asked if you were smarter than a wellness vendor. (SPOILER ALERT:  you are — assuming you can read this posting without moving your lips.)  I suggested taking the Interactive Health IQ test, just to be sure.

Now, see if you are smarter than a Koop Committee member. They all reviewed this Wellsteps application and decided it was award-worthy.*

Do you agree that this application is award-worthy? If not, see how many self-invalidators you can find. I don’t mean “challenges” to the data. I mean self-immolations. Remember the mantra: “In wellness you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”

After you’ve finished, review the answers to see what you got right and what you missed.  You may have read it before since it’s been getting lots of views for six weeks, but I’ve added several observations since the original posting.

You may even find things I missed, so let me know. The reason is that — aside from possibly the first Sunday in November — there aren’t enough hours in a day to identify everything that Koop Committee members “overlook” in their friends’ applications.

If this type of analysis interests you, I might recommend applying for Critical Outcomes Report Analysis certification. This program is run by the Validation Institute, the gold standard in all things analytical regarding population health and employee health. (Disclosure: while I am not an employee, they occasionally subcontract to me.)

There is nothing highly technical in the answer posting. In order to make it possible for a Koop Committee member to understand and hence decide to rescind the award, I used only fifth-grade math, simple declarative sentences, short words, and lots of pictures.


*Speaking of disclosures that don’t appear in the award application, the Wellsteps CEO also served on the awards committee itself until very recently. Indeed, until so very recently that he still says he is on it.

aldana-resume

The latest on Nebraska: Ron Goetzel covers up his cover up.

To our new readers, while 2016 marked the first instance in which a Koop Award was ever bestowed upon a company that harmed employees, 2016 wasn’t the first Koop Award ever to go to a company whose own data showed they fabricated results. Below is a history of one of the Koop Award’s Greatest Hits.


For those of you who haven’t been following the saga of the Nebraska state employee wellness program, here is a crash course, aka “Lies, Damn Lies, and the Nebraska State Wellness Program.”  If you have been following it, you can skip to the end for the latest installment, Mr. Goetzel’s cover-up of his cover-up.

By way of background, this program is called “wellnessoptions” (imagine e.e. cummings-meets-poking employees with needles-meets-a sticky spacebar).   They used to say the Holy Roman Empire was neither Holy nor Roman nor an Empire.  Likewise, wellnessoptions is neither optional, if you want a decent deal on healthcare, nor wellness. Instead of wellness, it features a hyperdiagnostic anti-employee jihad in which Health Fitness Corporation (HFC) diagnoses employees but does nothing about the diagnosis except take credit for it.

TIMELINE — PART ONE: HFC’S TROUSERS COMBUSTED

September 24, 2012, 2:00 PM

I read Health Fitness Corporation announcement that its customer, the state of Nebraska, won Ron Goetzel’s C. Everett Koop Award for program excellence.

September 24, 2012, 2:01 PM

I recognize that the cancer outcomes were obviously made up.  Until then, I hadn’t been following the Koop award closely enough to realize that making up outcomes was apparently one of the award criteria, as I later came to learn.

October 2012

I read the full write-up on the program and realize that not only were most of the other outcomes made up, but they had actually lied about saving the lives of cancer victims.  If you screen a few thousand people for colon cancer, you don’t find 514 cases of cancer, and you certainly don’t save their lives, as HFC was claiming.  And you absolutely don’t save money, as they were also claiming.  All this is even more true when you waive age-related guidelines and let anyone get screened, and encourage overscreening by sending out 140,000 letters to state employees graced with the picture of a beautiful young model way too young to be getting a colonoscopy.

age related colon cancer screenings

How this invalid nonsense ever got by all the eagle-eyed Koop Committee members would be a mystery, except that HFC is a sponsor of the Koop Committee.

December 2012

I review the entire application and all the marketing materials.  It becomes obvious that the entire thing was made up, not just the cancer part. They claimed to save $4.2 million because 161 of their roughly 6000 participants reduced a risk factor.

The math is quite self-evident.  Suppose you doubled the number of participants who reduced risks to 312.  It stands to reason that you could save $8.4-million. Double it again to 624 and you save $16.8.

Now double it one more time. If 1,248 people out of those 6000 reduced one single risk factor, you’d save $31.6-million, which is about equal to the entire spending for all 6000 participants.  And of course most medical spending has nothing to do with identifying previously unrecognized risk factors, so this would be quite a feat. (Do you even know anyone under 65 who had a heart attack that could have been avoided by one more workplace screening?)

I later learn that all the Koop Award-winning program outcomes are made up, using exactly the same math.

November 2012 to June 2013

I try to contact the authorities, like Roger Wilson, who allegedly runs this program for the state, but no one seems to care. The rule of thumb in the wellness industry is that what you say counts.  What you do is pretty irrelevant.

June 20, 2013

Breakthrough: The Wall Street Journal editors decide that I am correct, and that the outcomes were made up.  Vik and I are allowed to publish this on their op-ed page.

July 14, 2013

Breakthrough again: Another very well-read blogger professes shock-and-awe that any vendor could lie so blatantly and apparently get away with it.

July 15, 2013

Breakthrough yet again: Ace reporter Martha Stoddard of the Omaha World Herald gets Dennis Richling of Health Fitness Corporation to admit that the outcomes — at least the “life-saving catches” of “early stage cancer” outcomes — were indeed made up.  Richling tries to spin his gaffe by calling the difference between “life-saving catches of early-stage cancer” and saying someone might possibly get cancer in the future “semantics.”   So, according to Richling, having cancer and not having cancer are the same thing.

February 1, 2014

The hilarious wellness industry smackdown Surviving Workplace Wellness is published.  Since the HFC Nebraska program had too many lies to fit on a page or two, it gets its own chapter.  Here’s the opening paragraph, which in all modesty I must admit is one of my favorite in the book.

sww nebraska chapter

February 23, 2014

Nebraska political blogger ReadMoreJoe picks up the scent.  He points out that this wellness program is an obvious fraud.  The problem is that the same posting is also exposing several other equally obvious frauds, so this one gets overlooked.

TIMELINE–PART TWO: GOETZEL STRIKES BACK

Ron Goetzel isn’t about to sit back and let his friends/sponsors/clients be pilloried for a little white lie about saving the lives of cancer victims who didn’t have cancer.

June 2, 2014

At the Health Datapalooza conference, Ron Goetzel, while admitting the Nebraska cancer outcomes data was made up, claims they/HFC still deserve the Koop Award because he somehow didn’t realize the data was made up at the time the award was granted.  And it is true that HFC didn’t actually announce they had made up the outcomes.  Ron would have had to actually read the materials to figure it out, same as I did.

nebraska life saving catches

nebraska cancer cases

September 2014

Ron Goetzel calls the Nebraska program a “best practice” in the Journal of Occupational and Environmental Medicine but refuses to answer any questions about the obvious mistakes and inconsistencies in the article.

list of best practices

November 2014

After knowing for 16 months that they had lied, Ron Goetzel, writing in Employee Benefit Newsfinally drops Nebraska from his list of best-practice programs:

goetzel ebv 1

Being a fair-minded person, I take it upon myself to congratulate him on his newfound sense of ethics.  I don’t specifically agree that what he did was ethical, because the ethical thing would have been to admit complicity, apologize, and revoke their Koop Award.  But I do say that Nebraska being dropped from the list of best practices means ethical “progress is definitely being made,” albeit from a low base.

goetzel ebv 2

Only 29 minutes elapses before Ron erases all my illusions about his honesty and re-adds Nebraska to the list of “best practice organizations.”

goetzel ebv 3

He also adds PepsiCo to the list.  I guess losing only $2 for every $1 you spend qualifies as such in wellness, where most organizations lose much more.

May 2015

In a rally-the-base invitation-only webinar, we are told that Ron has promoted the Nebraska program from “best practice” to “exemplar.”  It seems like the more obvious it becomes that the whole thing was fabricated, the more Mr. Goetzel worships its outcomes.

TIMELINE–PART THREE: RON STANDS ALONE

September 2015

WELCOA finally takes the fabricated case study of Nebraska’s outcomes off their website, 26 months after the fraud was admitted. Perhaps some pressure is being put on them to come clean, given that this is Nebraska’s program and they themselves are based in Omaha.

Just for the record, I’m not saying that an organization founded by all-you-can-eat cafeteria magnate “Warren Buffet” knowingly kept a false document on their site for those 26 months. History suggests they might just be slow learners.  [2016 update: WELCOA is under new management, and they appear to be doing a great job, as exemplified by their development of the Employee Health Program Code of Conduct.]

This means Ron Goetzel is literally the only person left who thinks it’s perfectly OK — indeed, a “best practice/exemplar” — to lie about saving the lives of cancer victims.  Good luck with that in the upcoming debate.  It’s him against the world.

Or, as he sees it, everybody’s out of step but Ronnie.

October 2015

Nebraska tentatively re-awards the wellness contract to Health Fitness Corporation.  I am looking over the precipice towards utter humiliation.

TIMELINE–PART FOUR: THE ORIGINAL DATA DISAPPEARS

November 2, 2015–the original cover-up, on the morning of the Great Debate, in which Mr. Goetzel told 14 lies in 90 minutes, which is a lot even for him

At our urging, a third party alerted Mr. Goetzel to the fact that, his protestations to the contrary, the Koop Award Committee did know (even if they had somehow not seen the marketing materials quoted above) that Health Fitness Corporation was making fictitious claims about saving the lives of cancer victims.  It was right in the award application.  The original award application from Nebraska had originally stated (underlining is ours):

nebraska cancer original redlined

But then, a hour following the call from this third party the morning of the debate, the original award application suddenly read:

nebraska doctored application

In the original application, this excerpt appears in a letter from the Governor of Nebraska. Only now the Governor’s letter says the opposite what he actually wrote.  In the real world, this would be considered forgery.  In wellness, a forged cover-up of a blatant and admitted lie about saving the lives of cancer victims who didn’t have cancer is considered business as usual. Johns Hopkins and Truven (Ron’s employers) don’t seem to mind either.

April 2016

The state is rescinding its award to Health Fitness and terminating its wellness program. In the immortal words of the great philosopher Stewey Griffin, victory is mine.


September 2016: The cover-up of the cover-up

Mr. Goetzel finally acknowledges that Health Fitness Corporation told a whopper, and the Koop Committee overlooked it, allegedly by accident, for the four years during which I’ve repeatedly pointed it out.

He now calls this an “erratum.”  However, the word “erratum” is usually used to correct honest mistakes (in sharp contrast to this one),  usually within hours or days of their discovery (in sharp contrast to this one).   You can’t forge official state documents and then call the whole thing an “erratum.”  Is a robber allowed to give the money back after he gets caught and just uncommit the crime?

nebraska-erratum

So now, having admitted that the award-winning vendor told the biggest lie in wellness history (against stiff competition), and knowing that all Nebraska’s obviously fabricated savings were mathematically impossible, and that waiving age restrictions for screening is akin to waiving age restrictions for buying beer, the Koop Committee finally, after four years, rescinded the Nebraska award.

Haha. No one falls for that line any more.  Quite the opposite, they are doubling down. They say that whopping lies like this one don’t disqualify you, assuming you are an award sponsor. You get to keep your award.

Ditto, if your entire claim of “separation” between participants and non-participants is shown to be false but you are sponsor, Ron merely doctors the data and you get to keep your award.

Also, if it turns out you lied about your savings because there was no change in the biometrics to attribute the savings to, but Ron was a consultant on your project, you get to keep your award.

Likewise and as was confirmed in 2016, if you are a committee member, as Wellsteps’ CEO was until recently, despite your own data showing that you actually harmed employees, you get to keep your award.

Bottom line: as a friend-of-Ron, you might get to keep your award even if you shoot someone on Fifth Avenue.

Wellsteps Apologizes, Returns Koop Award, and Endorses Code of Conduct

Wellsteps has profusely apologized for harming Boise’s employees, according to objective and subjective health indicators, for overscreening the employees, for demonizing even the slightest consumption of alcohol, for suppressing their earlier acknowledgement that costs increased, and for mis-attributing the allegedly massive savings figures.

Not!

They’ve recognized that these smoking guns exist, of course — that much we’ve learned from other sources.  But obviously they haven’t apologized.  In case you haven’t noticed, these days refusing to apologizing is a thing. Indeed it’s more than a thing. It’s a Major Lifestyle Trend, potentially even bigger than quinoa, bidet toilets, and the Kardashians combined.

They (Wellsteps, not the Kardashians) aren’t going to give up their Koop Award voluntarily.  To paraphrase the immortal words of the great philosopher S.I. Hayakawa, they stole it fair and square. (Helps that Wellsteps’ CEO is on the award committee, of course, though you wouldn’t guess it from their announcement.)

And they (Wellsteps again, but probably also the Kardashians) certainly aren’t going to endorse the Code of Conduct.  They can’t, because they and their whole Koop Award cabal would be in immediate violation of its call for no harms to employees and no lying about outcomes.


However, the Code of Conduct is getting great reviews everywhere else, which is actually what this column is all about.

First, honest, well-intentioned, and competent vendors, brokers and consultants — none of which are connected with the Koop Committee or the Health Enhancement Research Organization — have shown their support in large numbers. The Code has garnered tons of “likes” and very supportive comments.  If you see your consultant or vendor on this list of “likers” and commenters, give them the kudos they deserve. And add your own too.

Quizzify

Second, Quizzify on Friday became the first vendor to endorse the Code, and will be incorporating it in every contract going forward.  Read the Quizzify statement, and urge other vendors to follow suit. Embracing the code should be easy for others like it was for Quizzify. Any honest, competent vendor should find the principles self-evident.

ConscienHealth

Third is a pleasant surprise twist, the one referred to in the Linkedin “tease” for this column.  On Sunday, I was delighted to see http://www.ConscienHealth.org pick it up.  By way of background, ConscienHealth is an advocacy group for the evidence-based treatment and prevention of obesity. In their own words:

We develop strategies that are based on sound science [and] public policy, and a deep understanding of consumer needs.”

Here is a summary of what they said, but we’d urge you to read the whole shebang, because they stated it better than we did. Alone among websites with an interest in wellness, ConscienHealth speaks specifically for the overweight employees who are victimized by crash-dieting schemes and other corporate fat-shaming activities:

We now have enough regulations on the subject of employer wellness programs to make your head spin…but the most encouraging development is a code of conduct based on a simple premise: act purely to improve health and do no harm.

The folks who developed this code – Ryan Picarella, Al Lewis, Rosie Ward, and Jon Robison – applied deep knowledge of the good and the harm that employer wellness programs can do. While others fight over the fine points, this code brings us back to the big picture with a few key principles:

  1. Wellness programs should work for the benefit of employees.
  2. Programs should not single out, fine, or embarrass employees for their health status.
  3. Employers should respect and protect employee privacy.
  4. Employers should measure and report program outcomes honestly.

If those considerations seem obvious, it’s because they are. And yet we have examples of “wellness” that have disrespected, humiliated, and financially exploited employees. Sometimes it’s been done out of ignorance. Sometimes it’s a subterfuge for cost shifting to people with chronic diseases – health problems that nobody wants to have.

We here at They Said What would urge Wellsteps and other “pry, poke and prod” vendors to develop programs that satisfy those same four criteria. Unfortunately, they aren’t quite there yet. Indeed a beam of light leaving criteria #1, and #4 wouldn’t reach them for several seconds.


Disclosure: Al Lewis, who co-maintains this site, is also a principal in Quizzify, which endorsed the Code.  Attention to Wellsteps: See how conflict-of-interest disclosures work?  It’s not that hard. Next time you win a Koop Award — and based on the number of consultants and vendors on the award committee (plus sponsors) who need to be win one too, it should be your turn again in about 6 years — try disclosing your presence on the award committee in your breathless announcement of how brilliant you are.

Or, as Mark Twain said: “Always tell the truth. This will delight some people and astonish others.” We will be both, if it ever happens.

Wellsteps Raises the Koop Award Standard for Outcomes Invalidity to a New Low

Wellsteps claims to have dramatically reduced the total cost of the Boise School District’s health spending. Their Koop Committee colleagues gave them an award for it, as they typically do for their fellow board members and sponsors.  (Yes, Wellsteps’ CEO, Steve Aldana is on the committee that grants the award, but, in accordance with Koop Committee tradition and Wellsteps ethical standards, there is no mention of this possible conflict of interest in the announcement from Wellsteps. This is not a violation of the Wellness Industry Code of Ethics, because there is none.)

Unfortunately for Wellsteps, three completely distinct observations from Wellsteps’ own data invalidate their analysis separately. In combination, these observations create a level of impossibility demonstrating that whoever invented the English language was unfamiliar with the wellness industry, or they would have come up with a word meaning: “Impossible doesn’t begin to describe it.”


First, as we saw in the last posting, employee health deteriorated over the course of the program, measured both subjectively and objectively.

There is a concept, covered in Health Services Research 101, called “causation.” Wellness vendors love taking credit for everything that happens during their program. Hence we can conclude that Wellsteps’ program caused employee health to decline.

Therefore, no reduction in costs due to a healthier employee population can be attributed to Wellsteps’ program.


Second, also covered in Health Services Research 101, is the concept of “fifth-grade arithmetic.” Potentially Preventable Hospitalizations (PPH), as described in the official Health Enhancement Research Organization (HERO) outcomes measurement guidelines (a report on which Wellsteps’ CEO claims to have collaborated), account for a very small percentage of all spending. Specifically, as described in the HERO report  and reproduced below, these events account for 2.62 hospitalizations per 1000.  Boise’s 3284 employees would therefore suffer about 9 PPH’s. If each PPH cost Boise the HERO-assumed cost/admission of $22,500, that’s about $202,000. Not enough to cover even the out-of-pocket fees for the Wellsteps program, assuming the Wellsteps did a perfect job. And as we’ve learned in the past, a beam of light leaving “perfect” wouldn’t reach Wellsteps for several seconds.

Still, we’ll never know because despite their endorsement of the HERO report, Wellsteps decided not to disclose the rates of Boise’s PPH’s, likely to obscure the fact that they didn’t reduce it.

hero total page 23 with red bar

And as the HERO guidebook says, any reduction in PPH’s is offset by more spending elsewhere. In Wellsteps’ case, “more spending elsewhere” is annual biometric screenings.  Curiously, Wellsteps admitted annual screenings are a stupid idea four whole days before they announced their Koop Award for doing exactly the opposite.

July 11 blog

wellsteps july 11 blog

July 15 announcement:

wellsteps july 20 blog biometrics

Yet Wellsteps reported annual savings ultimately exceeding $5-million, or about a third of Boise’s total spending.  This would be equivalent to wiping out every hospitalization unconnected with childbirth plus every ER visit.  Adding yet another layer of impossibility to this narrative, at the end of this, we show the rank order of the top 25 reasons people visited the ER or went to the hospital, which basically have nothing to do with corporate wellness programs. Hence the cost of these visits and admissions couldn’t be dented, let along wiped out, by massive overscreening or even by appropriate screening.

Compounding this impossible outcome (and wellness is one of the few industries in which there are degrees of impossibility, since a typical wellness vendor makes at least a dozen impossible claims before breakfast) is the surprising health of the Boise population to begin with. People rated their health as 7.98 out of 10, and only 2.5% reporting smoking (vs. 20% for Idaho as a whole) and only 20% reported drinking (vs. 70% for the US as a whole). These ridiculously low levels did not strike Wellsteps as suspicious, so we will assume they are accurate.

Further, most Boise employees had fairly normal blood pressure, glucose and cholesterol — at least before they got sucked into the program.

So, with impossibly smoking and drinking, excellent reported health status, and largely normal biometrics, how is there room to improve health enough to save money, especially when health status is declining and the population is being overdiagnosed?


Speaking of misunderstanding the concept of arithmetic, third and most important is the data Wellsteps suppressed between their initial report and their Koop Award application. Normally Koop Award Committee Chairman Ron Goetzel suppresses the invalidating data after the award is announced, as with Health Fitness Corp/Eastman Chemical, and then the state of Nebraska (technically actually incriminating, not just invalidating). That’s because in the past I haven’t predicted who would win the award. Rather I just pointed out all the obviously incorrect data after the fact. By predicting Wellsteps would win a Koop Award and pointing out exactly why their data was sufficiently fictitious to merit it, I gave Wellsteps itself the opportunity to suppress their own data, so Ron wouldn’t have to do it for them.

Contrast below the trend they reported for total spending for Boise against the claims cost per person for Boise. The former goes up. The latter goes down even though the number of employees stays the same.  Obviously, this is an impossible coexistence, as mentioned both in the first installment of this series and in every elementary school in the world. This time, we are going to transpose the bar graph, which separated participants from non-participants, onto the line graph, which included both cohorts, for the baseline and the first two years of the program. The assumption, as Wellsteps states, is that their participation rate is 80%, largely because of the massive $870/year incentive, which in classic wellness fashion is not included in the savings calculation. The number of employees seems to bounce around a bit between reports, but we’ll go with 3284 for this valuation.

By way of review from the first installment, here is total spending:

wellsteps overall trend

Also by way of review, here it total spending, participants vs. non-participants, going exactly the other way:

wellsteps cost per person

Now let’s overlay the second set of figures onto the first. In addition to trending in opposite directions during the wellness program years, the total spending on these dueling slides doesn’t even coincide in the baseline year.  Since the whole point of the exercise is to look at the trend subsequent to the baseline, we will add about $3-million to each year for the bar graph figures, so that the 2011 starting points coincide. That let’s us focus on the difference-of-differences in the program years. Starting at the baseline, costs increased about $1.7-million by 2013, putting the 2013 red endpoint almost exactly in line with their prediction.

wellsteps overlaid slides

In all fairness, let’s continue the analysis, by looking at the Wellsteps performance in 2014:

wellsteps overlaid through 2014

As you can see, costs did fall below the “prediction” in 2014, though still way above “Wellsteps Begins” and “Actual.”  The only problem?  More than 100% of the entire decline from the previous year was due to non-participants’ costs plummeting, while participant costs increased.

wellsteps 4 year view

So where do we stand? Wellsteps, by their own admission, overscreened and overdiagnosed this population. And their own admission, the population was quite healthy to begin with. By their own admission, the health of the Boise employees deteriorated. And, by their own admission, the only successful annual performance is attributable to a large improvement in non-participants.

To paraphrase the immortal words of the great philosopher Samuel Goldwyn, the title of this post, Wellsteps has raised the Koop Award standard for outcomes invalidity to a new low.



Top hospital discharge codes:

 

hcup rank order top 25 costs

Top ER visit codes:

er visits using ccs

 

 

Mr. Goetzel Covers Up his Cover-Up: The latest on the Nebraska Koop Award

To our new readers, while 2016 was the first time a Koop Award ever went to a company that harmed employees, 2016 wasn’t the first Koop Award ever to go to a company whose own data showed they fabricated results. Below is a history of one of the Koop Award’s Greatest Hits.


For those of you who haven’t been following the saga of the Nebraska state employee wellness program, here is a crash course, aka “Lies, Damn Lies, and the Nebraska State Wellness Program.”  If you have been following it, you can skip to the end for the latest installment, Mr. Goetzel’s cover-up of his cover-up.

By way of background, this program is called “wellnessoptions” (imagine e.e. cummings-meets-poking employees with needles-meets-a sticky spacebar).   They used to say the Holy Roman Empire was neither Holy nor Roman nor an Empire.  Likewise, wellnessoptions is neither optional, if you want a decent deal on healthcare, nor wellness. Instead of wellness, it features a hyperdiagnostic anti-employee jihad in which Health Fitness Corporation (HFC) diagnoses employees but does nothing about the diagnosis except take credit for it.

TIMELINE — PART ONE: HFC’S TROUSERS COMBUSTED

September 24, 2012, 2:00 PM

I read Health Fitness Corporation announcement that its customer, the state of Nebraska, won Ron Goetzel’s C. Everett Koop Award for program excellence.

September 24, 2012, 2:01 PM

I recognize that the cancer outcomes were obviously made up.  Until then, I hadn’t been following the Koop award closely enough to realize that making up outcomes was apparently one of the award criteria, as I later came to learn.

October 2012

I read the full write-up on the program and realize that not only were most of the other outcomes made up, but they had actually lied about saving the lives of cancer victims.  If you screen a few thousand people for colon cancer, you don’t find 514 cases of cancer, and you certainly don’t save their lives, as HFC was claiming.  And you absolutely don’t save money, as they were also claiming.  All this is even more true when you waive age-related guidelines and let anyone get screened, and encourage overscreening by sending out 140,000 letters to state employees graced with the picture of a beautiful young model way too young to be getting a colonoscopy.

 

age related colon cancer screenings

How this invalid nonsense ever got by all the eagle-eyed Koop Committee members would be a mystery, except that HFC is a sponsor of the Koop Committee.

December 2012

I review the entire application and all the marketing materials.  It becomes obvious that the entire thing was made up, not just the cancer part. They claimed to save $4.2 million because 161 of their roughly 6000 participants reduced a risk factor.

The math is quite self-evident.  Suppose you doubled the number of participants who reduced risks to 312.  It stands to reason that you could save $8.4-million. Double it again to 624 and you save $16.8.

Now double it one more time. If 1,248 people out of those 6000 reduced one single risk factor, you’d save $31.6-million, which is about equal to the entire spending for all 6000 participants.  And of course most medical spending has nothing to do with identifying previously unrecognized risk factors, so this would be quite a feat. (Do you even know anyone under 65 who had a heart attack that could have been avoided by one more workplace screening?)

I later learn that all the Koop Award-winning program outcomes are made up, using exactly the same math.

November 2012 to June 2013

I try to contact the authorities, like Roger Wilson, who allegedly runs this program for the state, but no one seems to care. The rule of thumb in the wellness industry is that what you say counts.  What you do is pretty irrelevant.

June 20, 2013

Breakthrough: The Wall Street Journal editors decide that I am correct, and that the outcomes were made up.  Vik and I are allowed to publish this on their op-ed page.

July 14, 2013

Breakthrough again: Another very well-read blogger professes shock-and-awe that any vendor could lie so blatantly and apparently get away with it.

July 15, 2013

Breakthrough yet again: Ace reporter Martha Stoddard of the Omaha World Herald gets Dennis Richling of Health Fitness Corporation to admit that the outcomes — at least the “life-saving catches” of “early stage cancer” outcomes — were indeed made up.  Richling tries to spin his gaffe by calling the difference between “life-saving catches of early-stage cancer” and saying someone might possibly get cancer in the future “semantics.”   So, according to Richling, having cancer and not having cancer are the same thing.

February 1, 2014

The hilarious wellness industry smackdown Surviving Workplace Wellness is published.  Since the HFC Nebraska program had too many lies to fit on a page or two, it gets its own chapter.  Here’s the opening paragraph, which in all modesty I must admit is one of my favorite in the book.

sww nebraska chapter

February 23, 2014

Nebraska political blogger ReadMoreJoe picks up the scent.  He points out that this wellness program is an obvious fraud.  The problem is that the same posting is also exposing several other equally obvious frauds, so this one gets overlooked.

TIMELINE–PART TWO: GOETZEL STRIKES BACK

Ron Goetzel isn’t about to sit back and let his friends/sponsors/clients be pilloried for a little white lie about saving the lives of cancer victims who didn’t have cancer.

June 2, 2014

At the Health Datapalooza conference, Ron Goetzel, while admitting the Nebraska cancer outcomes data was made up, claims they/HFC still deserve the Koop Award because he somehow didn’t realize the data was made up at the time the award was granted.  And it is true that HFC didn’t actually announce they had made up the outcomes.  Ron would have had to actually read the materials to figure it out, same as I did.

nebraska cancer cases

September 2014

Ron Goetzel calls the Nebraska program a “best practice” in the Journal of Occupational and Environmental Medicine but refuses to answer any questions about the obvious mistakes and inconsistencies in the article.

list of best practices

November 2014

After knowing for 16 months that they had lied, Ron Goetzel, writing in Employee Benefit Newsfinally drops Nebraska from his list of best-practice programs:

goetzel ebv 1

Being a fair-minded person, I take it upon myself to congratulate him on his newfound sense of ethics.  I don’t specifically agree that what he did was ethical, because the ethical thing would have been to admit complicity, apologize, and revoke their Koop Award.  But I do say that Nebraska being dropped from the list of best practices means ethical “progress is definitely being made,” albeit from a low base.

goetzel ebv 2

Only 29 minutes elapses before Ron erases all my illusions about his honesty and re-adds Nebraska to the list of “best practice organizations.”

goetzel ebv 3

He also adds PepsiCo to the list.  I guess losing only $2 for every $1 you spend qualifies as such in wellness, where most organizations lose much more.

May 2015

In a rally-the-base invitation-only webinar, we are told that Ron has promoted the Nebraska program from “best practice” to “exemplar.”  It seems like the more obvious it becomes that the whole thing was fabricated, the more Mr. Goetzel worships its outcomes.

TIMELINE–PART THREE: RON STANDS ALONE

September 2015

WELCOA finally takes the fabricated case study of Nebraska’s outcomes off their website, 26 months after the fraud was admitted. Perhaps some pressure is being put on them to come clean, given that this is Nebraska’s program and they themselves are based in Omaha.

Just for the record, I’m not saying that an organization founded by all-you-can-eat cafeteria magnate “Warren Buffet” knowingly kept a false document on their site for those 26 months. History suggests they might just be slow learners.  [2016 update: WELCOA is under new management, and they appear to be doing a great job, as exemplified by their development of the Employee Health Program Code of Conduct.]

This means Ron Goetzel is literally the only person left who thinks it’s perfectly OK — indeed, a “best practice/exemplar” — to lie about saving the lives of cancer victims.  Good luck with that in the upcoming debate.  It’s him against the world.

Or, as he sees it, everybody’s out of step but Ronnie.

October 2015

Nebraska tentatively re-awards the wellness contract to Health Fitness Corporation.  I am looking over the precipice towards utter humiliation.

TIMELINE–PART FOUR: THE ORIGINAL DATA DISAPPEARS

November 2, 2015–the original cover-up, on the morning of the Great Debate

At our urging (and we must confess to delighting in creating this “Sting” operation), a third party alerted Mr. Goetzel to the fact that, his protestations to the contrary, the Koop Award Committee did know (even if they had somehow not seen the marketing materials quoted above) that Health Fitness Corporation was making fictitious claims about saving the lives of cancer victims.  It was right in the award application.  The original award application from Nebraska had originally stated (underlining is ours):

nebraska cancer original redlined

But then, a hour following the call from this third party the morning of the debate, the original award application suddenly read:

nebraska doctored application

In the original application, this excerpt appears in a letter from the Governor of Nebraska. Only now the Governor’s letter says the opposite what he actually wrote.  In the real world, this would be considered forgery.  In wellness, a forged cover-up of a blatant and admitted lie about saving the lives of cancer victims who didn’t have cancer is considered business as usual. Johns Hopkins and Truven (Ron’s employers) don’t seem to mind either.

April 2016

The state is rescinding its award to Health Fitness and terminating its wellness program. In the immortal words of the great philosopher Stewey Griffin, victory is mine.


September 2016: The cover-up of the cover-up

Mr. Goetzel finally acknowledges that Health Fitness Corporation told a whopper, and the Koop Committee accidentally overlooked it. He now calls this an “erratum.”  The technical term for it is a “lie-um.”  You can’t forge official state documents and then call the whole thing an “erratum.”  Is a robber allowed to give the money back after he gets caught and just uncommit the crime?

nebraska-erratum

So now, having admitted that the award-winning vendor told the biggest lie in wellness history (once again, quite a feat), and knowing that all the obviously fabricated outcomes were mathematically impossible, and that waiving age restrictions for screening is akin to waiving age restrictions for buying beer, the Koop Committee finally, after 4 years, rescinded the Nebraska award.

Haha. No one falls for that line any more.  Quite the opposite, they are doubling down. They say that whopping lies like this one don’t matter, if you are an award sponsor. You get to keep your award.

Ditto, if your entire claim of “separation” between participants and non-participants is shown to be false but you are sponsor, Ron merely doctors the data and you get to keep your award.

Also, if it turns out you lied about your savings because there was no change in the biometrics to attribute the savings to, but Ron was a consultant on your project, you get to keep your award.

Likewise and as was confirmed in 2016, if you are a committee member, as Wellsteps’ CEO was until recently, despite your own data showing that you actually harmed employees, you get to keep your award.

Bottom line: as a friend-of-Ron, you might get to keep your award even if you shoot someone on Fifth Avenue.

 

%d bloggers like this: