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Rarely does a book come along where you can see the author changing his mind about the conclusion as he goes along. The Healthy Workplace Nudge, by Rex Miller (with Philip Williams, and Dr. Michael O’Neill) is such a book. (For politicos, here is another such book.) Don’t skim the first few chapters — enjoy watching his journey to enlightenment. Like him, I myself took the same journey. Until about 2007, I didn’t just drink the Kool-Aid. I also mixed it up and sold it…until I did a little fifth-grade math, reaching a conclusion summarized in an observer’s blog post entitled Founding Father of Disease Management Astonishingly Declares “My Kid is Ugly.”
Like virtually everybody including myself (and every member of Congress in 2010), upon first hearing the wellness industry elevator pitch, Rex starts out by assuming that wellness must save money — it seems so obvious. But the more he learns, through his extensive research, the more he realizes that the “pry, poke and prod” industry is a fraud. “My [initial] unfamiliarity with workplace wellness was a benefit,” he observed. As a tabula rasa, the more he looked, the more he saw: “A few studies have become major pillars of misinformation that have been repeated for more than a decade.”
Welcome to my world, Rex.
After that, the more he learned, the more he learned. Trying to get to the root of the ubiquitous $3-in-savings-for-$1-in-investment meme that permeates the field and predated Katherine Baicker’s subsequently retracted 3.27-to-1 ROI, here’s what he discovered:
When I reached the global health and wellness director for the most cited case study, he admitted he did not know where the numbers came from or even who had actually created the report. So the result seemed to be a very high profile…urban legend.
Meanwhile, back in the company of my new castaway friends, the misfit provocateurs [Tom Emerick, Soeren Mattke and me], I kept hearing simple declarative sentences and sourced data.
He is spot-on regarding the distinction. Here is how one of the Wellness Ignorati explains Koop Award-winner (and notorious opioid distributor) McKesson’s seemingly self-contradictory award-winning program results:
Health indicators in 2013 and 2014 were adjusted in the analysis, while several sensitivity analyses of the ‘inter-individual’ impact that used a matching approach confirmed the results… Lewis’s conclusion essentially compares apples and oranges by mingling overall summary statistics with an interpretive analysis section that’s descriptive. The latter is based on repeated cross-sections of McKesson employees.
By contrast, here is “Lewis’s conclusion” after observing the self-contradiction in the Koop Award application that prompted this Employee Benefit News smackdown, presented in a simple declarative sentence:
The average weight of McKesson’s employees can’t rise and fall at the same time.
As if Rex needed more data points, another red flag was being disinvited from speaking at one of the Wellness Ignorati-fests. This happens whenever a speaker subsequently admits to critical thinking after being “confirmed” to speak. Critical thinking is right up there with data, math, integrity, facts, analysis, grammar, wellness and me in the rogue’s gallery of damned spots the Wellness Ignorati attempt to wash out, out — or at a minimum pretend to ignore (hence their moniker).
That’s why allowing the noses of the Rex Millers of the world (among whose unforgivable misdeeds are quoting the Al Lewises of the world in their books) into their tents might nudge their bright-eyed and bushy-tailed, painstakingly sequestered, acolytes to use the internet, perhaps searching on keywords like “Koop Award.” If they do, they might learn that in 2016, the year after the Ignorati disinformed their flock that Koop Award-winning companies dramatically outperformed the stock market, the 2015 winner became 2016’s 14th-worst performer in the S&P 500.
Mr. Miller refers to the Ignorati as harboring “deep anger” about being exposed for “fabricating the data.” Rex says he “doesn’t know the intent of using false data,” but I can clue him in: false data is quite useful if you are selling a scam (the LA Times‘ word, not mine).
Mr. Miller’s expert interviewing style even enticed Ron Goetzel to come tantalizingly close to admitting what we’ve spent four years in TSW demonstrating: that his whole career — claiming huge amounts of money can be saved by coercing lots of employees into claiming to eat more broccoli — is one giant fabrication. Mr. Miller quotes Mr. Goetzel as saying: “Changing behavior is very very very very hard.”
Yes, Ron, your cordially-welcomed-but-ever-so-slightly-overdue Eureka Moment is very very very very accurate. I imagine you’ll retract it soon, because on the other occasion when you were accurate — when your guidebook accidentally admitted wellness loses money — you immediately tried to disown your findings as soon as I congratulated you on their (apparently unintentional) accuracy.
The Nudge…and the Real Estate
The essence of Mr. Miller’s thesis is that hammering people with forced behavior change is very very very very pointless.
Having concluded that prying, poking and prodding employees does likely more harm than good, Rex moves on to a totally different way of doing wellness, which is to say, passively rather than actively. Clearly Rex put a lot of time and shoe leather into researching this book, and it shows. Many examples are offered of how little steps — simply moving different snacks to different places or making stairways more appealing than elevators — nudge behavior.
Way beyond that, the most notable advances in this book concern the built environment. He observes we spend 90% of our lives indoors, and yet little attention is paid to the effect of indoor space on health, wellness and productivity. I suspect more attention is paid to it than he gives credit for, but certainly we have all worked in or visited stultifying workplaces, workplaces where you can’t imagine wanting to hang out in any longer than necessary.
He proposes taking the built environment to the next level. Upgrading a typical building to the WELL Certification standard costs between $150 and $500/employee, all-in. Contrast that to the math provided to him by Tom Emerick that Walmart estimated for a wellness program: accounting for all the administrative costs, false positives, and lost productivity from health fairs and “workshops” totals thousands of dollars per employee. On the “credit” side of the ledger, every pound an employee lost cost Walmart shareholders $50,000.
By contrast, what goes into that $150 to $500 spent on the built environment get you? Suddenly every employee is “participating” in your wellness program, with no penalties or incentives needed. Not just the food in the cafeteria, but everything down to the air that circulates can be optimized for health and performance. “At their best,” he concludes, “buildings can be inspiring and invigorating–with little additional expense.” For instance, office and factory interiors tend to be dry, which facilitates the spread of disease. They also often allow in little natural light, the lack of which can disrupt circadian rhythms. Both can be easily remedied, with humidification, and with lighting that mimics our circadian rhythms.
The beauty of his proposal on the built environment is that, unlike traditional wellness programs where even the promoters say you need to do everything right to get them to work (“Only 100 or so programs succeed, while thousands of programs fail,” according to Mr. Goetzel), you can solve this problem by throwing money at it…and not much at that. Mr. Miller does go on to point out the value of leadership, but I prefer solutions that anyone can implement, as opposed to solutions that require CEO behavior change, which is very very very very hard.
The built environment is one of several chapters he proposes on solutions, and all are worthy reading, but this section is my favorite because it was new ground at least to me, and because it is so accessible to the average company. Even in existing space as opposed to new construction, a large chunk of what he is proposing can be accomplished for the price of a few years of a “pry, poke and prod” program. As one CEO who made this investment observes: “Hardly a week goes by when I don’t get a thank-you.”
In conclusion, go to Amazon and buy this book. Do it very very very very soon. Plus, the more copies he sells, the more Ron Goetzel will get very very very very mad.
In the immortal words of the great philosopher Soeren Mattke of RAND:
“The industry went in with promises of 3 to 1 and 6 to 1 based on health care savings alone – then research came out that said that’s not true – then they said ok we are cost neutral – and now as research says maybe not even cost neutral they say but is really about productivity which we can’t really measure but it’s an enormous return.”
That’s two moles whacked in just one paragraph.
Then when the productivity thing didn’t pan out, they invented something called value-on-investment, which (even though they invented it specifically to show savings) turned out to show massive losses on even the most cursory examination. Third mole.
Bottom line: all their studies that do actually exist self-invalidate no matter what they claim because — get ready — wellness loses money. Now it looks like there is a fourth mole to whack — Mr. Goetzel’s latest charade is, yeah, maybe virtually all studies in existence reveal losses upon examination, but that studies that don’t actually exist show massive savings. Perhaps he was inspired by Wellnet, which shows massive savings in “undetected claims cost,” which also don’t exist. Google on “undetected claims costs.” The only hits you get are Wellnet and me making fun of Wellnet.
I was recently forwarded an email containing Ron’s latest musings. I’ve never met the originator of the email, so he could have fabricated the entire thing for all I know. But in terms of credibility, if Ron Goetzel tells me the sky is blue and someone I’ve never met tells me the sky is green, I’d at least go look out the window.
Ron “the Pretzel” Goetzel’s latest twist — since he can’t find fault with my work — is that all the studies I invalidate are published studies, which he acknowledges in this email to be of generally poor quality. He now claims there is a parallel universe of unpublished studies showing savings that are of high quality. For some reason, this special reserve collection of buried treasure is stashed in a secret hideaway drawer under lock and key in a safe room. (He says his clients don’t want competitors finding out how well they are doing, but could it be they simply prefer not to be publicly humiliated, like most of his other clients?)
The claim that unpublished studies show the greatest savings is ironic. Why? Because Ron previously stated: “Many unsuccessful programs are not reported.”
Where Ron and I would agree is that the published studies I have invalidated — like this one and this one and this one and this one and this one and this one and this one and this one and this one and this one — are definitely of low quality. Maybe that’s because Ron himself:
- wrote them;
- gave them an award; or
- both, since conflict of interest is his modus operandi, or
- in the case of Penn State, goaded them into creating a wellness program that became a national punchline.
He did name the three companies that:
- produce these alleged secret studies, and
- “pay Truven $250,000 to analyze their numbers.”
The latter would be quite impressive if they do — except that they don’t. I’m not naming them to protect their privacy, but suffice it to say I sent them both the snippet of that email with their names in it, and they got a kick out of it. (“I never, ever, thought this nonsense worked.”) I added that if Ron Goetzel went around bragging that I paid him $250,000 to analyze my numbers, I’d sue for defamation.
On the flip side, he is also telling people (privately, so that I don’t find out about it like this) that I am [blushing] “the least credible person in the industry,” perhaps having forgotten that he had already accidentally admitted that I am the most credible person in the industry. I’m in good company — he also disses the second-most-credible evaluator in the field, for the simple transgression of publishing a high-quality study that showed losses that Ron inadvertently validated, before trying to pretzel his way back from with a series of lies that would make a White House press secretary blush.
He would also have to explain why, if I am so non-credible, he begged to be on the advisory board of the Validation Institute (which I started with Intel-GE Care Innovations). We couldn’t have him on the board because the whole point of the Validation Institute was to be credible, which it is. It is now the official validator for the World Health Care Congress.
He even got David Nash to try to strongarm us. We could have just said no, but what fun would that have been? We said: “Sure, you just have to be certified in Advanced Critical Outcomes Report Analysis first.” The test at the time consisted of finding all the errors in his Nebraska analysis, so he couldn’t earn the CORA certification without admitting that all the claims in the study were fabricated, impossible, or represented industry-leading ignorance of the way prevention works. For example, the very stable Nebraska geniuses “waive[d] all age-related screening guidelines” so that young people could get screens intended only for older people, which would be like “waiving” the minimum age for getting a driver’s license to get more young drivers on the road.
How many errors were there? Eventually, with the help of people getting validated (we had missed a few errors ourselves because there were so many of them), we dedicated an entire chapter of Surviving Workplace Wellness to Nebraska, a chapter which opens as follows:
What follows is an analysis of all hospitalizations in the US from 2001 to 2014. Wellness–punitive, health-contingent wellness in particular–has apparently harmed more employees than it has benefited. Here’s the story in one simple graph, comparing the percentage of the hospital admissions that are wellness-sensitive (diabetes, heart attacks) to all hospital admissions. The blue line reflects that calculation for admissions covered by private (commercial) insurance, while the orange line combines Medicaid, Medicare and uninsured. They will have higher absolute rates of these events but it’s the difference of differences that matters:
What can we learn from this analysis?
- The point-to-point change is -.3% in the non-exposed population (orange) vs. +.1% in the exposed population (blue).
- The difference of differences should be going in the opposite direction, since essentially every known major factor that could impact this blue line more than the orange line is held constant, other than an increasing penetration of workplace wellness into the blue-line population. Spending about $6 billion more on wellness services in 2014 (vs. 2001) should have made a huge favorable impact on the blue line, given that the total spent on inpatient wellness-sensitive medical events in 2014 was roughly $7 billion, applying the Health Enhancement Research Organization’s estimate of $25,000/admission to the 285,000 relevant 2014 admissions.
- It’s actually worse. Only about half the employed population has access to screening and risk assessments, meaning that the size of the industry overwhelms the size of the addressable events even if one assumes that all the diagnoses leading to the events were found in screenings.
- It might seem absurd to assert that the wellness industry in total (almost $8 billion today) is double the size of the healthcare spending it is supposed to address, but a “bottoms-up” analysis gives the same answer: In the privately insured population, 4.1% of admissions were wellness-sensitive in 2014. Figure half these events take place in people who already know they are at risk or have the diagnosis. So 2% of all admissions involved employees who did not know they had the diagnosis when they had the event — and hence could conceivably have learned about it and avoided it through a wellness program. Admissions are about half of all costs, meaning 2% of admissions would consume 1% of costs. 1% of a typical $6000/individual employee spend is $60/employee/year. A wellness program, including the screening, likely costs $150. That means even a perfect program — one that finds every employee with a hidden diagnosis, avoids all false positives, and prevents every event without any added cost of prevention therapy– would lose money. Alas, as lovingly documented on this website through the years, a beam of light leaving “perfect” wouldn’t reach the “pry, poke and prod” industry for several seconds.
- The fairly dramatic upswing starting in events in the exposed population (the blue line) starting in 2012, even as the rest of the country was almost leveling off, correlates quite closely with the move towards health-contingent, or “outcomes-based” wellness, in which employees who don’t crash-diet hard enough before the final weigh-in get fined. So while a study by Redbrick showed no benefit to health-contingent programs, the truth is likely worse: many health-contingent programs actually do harm, as Interactive Health recently demonstrated and for which Wellsteps won a “best-in-industry” award. Much is this harm is visited upon employees with eating disorders.
In case you don’t believe punitive wellness programs could be this bad…
You can ask me for the raw data, and/or replicate this exact analysis, using ingredients you already have in your kitchen — an internet connection (which perhaps even Bravo has acquired by now) and the links below.
It happens that the nation’s hospital admissions data (through 2014) is all publicly available online. You can see for yourself how badly wellness has failed. First, go to the admissions database. Then under “Analysis setup” go “Trend>yes>yes.” That will bring you to a dropdown menu asking you to “choose how you want to classify the diagnoses or procedures.” Pick “Diagnosis ICD-9-CM codes.”
It will ask you to “Choose your diagnosis.” This is where it gets slightly labor-intensive. You’re gonna want to pick all the heart attack and uncomplicated diabetes codes, since those two categories represent by far the lion’s share of wellness-sensitive medical events (WSMEs), events that can be theoretically avoided through screening the stuffing out of employees. You might ask: “Why not include complications of diabetes, and heart failure etc.? Why just these two?”
That’s because we aren’t testing disease management. We’re testing to see if “playing doctor” to try to hunt for disease is worthwhile. Anyone with complications of diabetes, or a more serious condition like heart failure or COPD, obviously already knows they have it. No screen needed. We also can’t test stroke because the HCUP data prior to 2012 has some squirelliness in it. (In any event, there are far fewer strokes in the working age population than heart attacks, especially if one excludes those where atrial fibrillation was the likely cause.)
Diabetes and heart attack ICD9s begin with 250 and 410 respectively. Once you enter one of those 3-digit codes into the field, a ton of 5-digit codes will show up. Just keep hitting “CTRL click” until they all show up in the field. Then, hit “combine all codes.” Here is what the screen will look like before you do that:
After you enter these diagnoses, choose “Combine all codes” and then “Create analysis.” You’ll get a screen that looks like this. Do not attempt to adjust your TV set. I am just showing you this so you know you’re in the right place, not to try to see the results:
Once you’ve gotten to this point, you need to split the analysis into payer category and then pick multiple years, to show a trend. To find the payer, use the left-hand navigation bar and go to Patient Characteristics>Payer. You’ll want to do multiple years, and farther down that toolbar you’ll see “years.” You just check all the years from 2014 back to 2001 and hit “submit.” (There is some squirreliness in the years before 2001.)
Doing this by payer is critical. Almost every employee with access to workplace wellness will be commercially insured — or as HCUP puts it, privately insured.
You’ll then get a screen that looks like this:
It will give you all the admissions, by payer, for all the years. You are then given an option to drop this into Excel, an option you should take. (This is the definition of “voluntary,” by the way. Your employer won’t fine you if you don’t.) Once it is in Excel, you can copy-and-paste the actual year-by-year data into an easy-to-use format, like this little snippet that lists stroke-hypertension and then repeats the format for all admissions:”All admissions” becomes the denominator for those 15 years, split into “private insurance” (where over those 15 years members had gained increasing access to wellness programs) vs. the other five categories combined, which did not have wellness access.
After you complete this analysis, you will find that the reason I offered a $3 million reward to show wellness saves money is because there is no chance of anyone ever being able to claim it.
There is a lot more to this study than meets the eye.
Some tourist attractions feature an “A” tour for newbies and then a “behind-the-scenes” tour for those of us who truly need lives. For instance, I confess to having taken Disney’s Magic Kingdom underground tour, exploring, among other things, the tunnels through which employees travel so as not to be seen out of costume in the wrong “Land.”
Likewise, there have been many reviews of the recent wellness study conducted by the National Bureau of Economic Research (NBER), the first-ever randomized control study of a wellness program. This, however, is the first review to go beyond the “A” tour of the headlines.
By way of background, the headline is that the mainstream wellness program the investigators examined at the University of Illinois did not noticeably move the needle on employee health. They didn’t address return-on-investment (ROI), because there obviously was none. Achieving a positive ROI would require moving the health risk needle—not just by a little, but rather by enough to significantly improve the health of many employees. Then, since wellness-related events, such as heart attacks, would not otherwise have befallen these employees immediately, this improvement would have to be sustained over several years before there was a statistical chance of some events being avoided.
Finally, the magnitude of this improvement would have to be great enough to violate the rules of arithmetic, because it is not mathematically possible to avoid enough medical events to break even on wellness. For instance, it actually costs about $1 million to avoid a heart attack through a screening program.
This finding, therefore, represents an existential threat to conventional wellness programs.
It all boils down to: why would an associate professor (Damon Jones) publicly humiliate his own dean (Katherine Baicker — yes, the very same Katherine Baicker who always seems to be on the wrong side of every wellness debate) …unless he is absolutely sure he is right?
She can’t fire him now because that would get picked up by the lay media. Perhaps she should have paid him $130,000 not to disclose the results.
The Wellness Industry’s Terrible, Horrible, No-Good, Very Bad Year just got worse. Seems like CMS (Medicare) and Modern Healthcare are also ganging up on the Health Enhancement Research Organization (HERO) and all their cronies.
The headline in today’s Modern Heathcare turns out to be a bit of an understatement:
Wellness programs aren’t generating Medicare savings
Read farther the article and you’ll come up with gems like:
Utiization and expenditures actually increased among program participants… The results mirror those in the corporate world.
Asked for comment, the National Business Group on Health’s very stable spokesgenius, Steve Wojcik, said:
So, while it didn’t reduce healthcare expense or utilization, it seems to have had a positive impact…by preventing or delaying normal deterioration that comes with age.
Where Mr. Wojcik came up with this spin, creative even by wellness industry standards, is anyone’s guess. Nothing in the program suggests it and when he finds something that does prevent age-related decline, I will be the first to nominate him for a Nobel Prize.
The curious thing is this failed approach is not “wellness or else” as Jon Robison calls it. Instead these programs are truly voluntary. Also unlike corporate wellness programs, vendors aren’t harassing healthy employees to eat more broccoli but rather focusing on unhealthy ones. Instead of making healthy 30-year-olds get unneeded checkups, they’re encouraging 70-year-olds with chronic disease to get more medical care.
And yet the programs still don’t work. Color me surprised. I genuinely thought (and I honestly still think) that willing participants in voluntary programs who have chronic disease would benefit from these programs. Perhaps when they re-review another year’s data they will find a benefit.
Alternatively, instead of trying to maintain the revenue streams of their members, perhaps HERO could actually try to find a new model that does provide a benefit. Certainly there are plenty of vendors out there with possibly better mousetraps, but they all have one thing in common: they have no use for HERO’s pet vendors, any more than companies that make solar panels have a use for coal.
Speaking of HERO, let us review HERO’s comments from just last week:
Teddy Roosevelt said, “complaining about a problem without posing a solution is called whining.” It’s a quote that also reminds me why I’ve not thought of angry bloggers who target health promotion [vendors] as bullies. Though they relish trolling for bad apples, their scolding is toothless, more the stuff of chronic whiners.
Not to mention:
We’re fortunate to work in a profession with a scant number of vociferous critics. My take is that there is one thing these few angry loners want more desperately than attention: that’s to be taken seriously.
Just like wellness vendors like to define “voluntary” as “forced,” I guess in wellness-speak “scant number of vociferous critics and chronic whiners” mean “every commentator,” and an “angry blogger” is any blogger with a great big smile on his face.
OK, this time I’m not the one causing the kerfluffle in the wellness industry, though I will confess to being a force multiplier.
Not since 2014, when the very unstable morons at the Incidental Economist made fun of the very stable geniuses who give out the Koop Award and also unequivocally concluded wellness loses money — combined with continued fallout from the Penn State debacle and the Nebraska scandal — has the wellness industry had such a bad year. And it’s only February.
Let’s review what’s happened so far in 2018. First, a federal judge ruled that voluntary wellness programs need to be — get ready — voluntary. The EEOC’s responded with the legalese equivalent of: “Fine, be that way.”
Next, WillisTowersWatson did something that might get them in hot water with the very stable wellness industry leaders: they were honest. They published a study revealing that employees hate wellness even more — way more — than they hate waiting for the cable guy to show up.
Finally, the very unstable National Bureau of Economic Research conducted a controlled study finding basically no impact whatsoever of a wellness program. More importantly, they specifically invalidated the “pre-post” methodology. Even more importantly, they specifically invalidated 78% of the studies used in Kate Baicker’s “Harvard Study” meta-analysis.
Here is an interesting piece of trivia. The lead researcher is an assistant professor at the Harris School of Public Policy. Why is this interesting trivia? Because Katherine Baicker — the Typhoid Mary of Wellness, whose THC-infused 3.27-to-1 ROI is the basis for essentially every subsequent genius wellness outcomes claim — is now the dean of that very same Harris School. I’m just guessing here, but I’d say it’s gotta be a trifle embarrassing when your own subordinate publicly disproves your own study. I mean, it’s one thing for me, RAND, Bloomberg, and anyone else with five minutes, internet access and a calculator to do it, but…your very subordinate?
On the other hand, the researcher, Damon Jones, just demonstrated not just amazing competence, but amazing integrity as well. In other words, he has no future in wellness.
The Wellness Empire Strikes Back
How does the wellness industry respond to these smoking guns threatening their entire revenue stream? Apparently, there is little cause for concern on their planet.
Let’s start with America’s Health Insurance Plans (AHIP), the health insurance industry lobbying group. Here is AHIP’s oxymoronic Wellness Smartbrief (January 26), on the NBER research. Yes, it summarizes the same wellness-emasculating study as the one above, though you could never guess it from the headline:
Continuing, AHIP said:
Offering incentives for completing wellness activities might be more cost-effective than offering incentives for wellness screening, a recent study of a comprehensive program found.
Perhaps AHIP has been infiltrated by Russian trolls, because here’s what the NBER article actually said about “completing wellness activities”:
We…do not find any effect of treatment on the number of visits to campus gym facilities or on the probability of participating in a popular annual community running event, two health behaviors that are relatively simple for a motivated employee to change over the course of one year.
Wellness programs might attract mostly employees who are already fitness-conscious, but the potential to attract healthy employees whose medical spending is already low could nonetheless be a boon to employers, the researchers found.
And on the subject of “the potential to attract healthy employees” being a “boon to employers,” the authors actually said:
We further find that selection into wellness programs is associated with both lower average spending and healthier behaviors prior to the beginning of the study. Thus, one motivation for a firm to adopt a wellness program is its potential to screen for workers with low medical spending. Considering only health care costs, reducing the share of non-participating (high-spending) employees by just 4.5 percentage points would suffice to cover the costs of our wellness program intervention.
In other words, you can apply some workplace eugenics to your company by using wellness to weed out obese employees, employees with chronic or congenital diseases, and so on. Good for you!
Soon, if AHIP and others have their way, there will be no need for guesswork in eugenics: employer wellness programs will be able to screen these employees out based on their actual DNA.
AHIP’s take on AARP v. EEOC
And now, AHIP’s take on this landmark case, their ace reporters scooping everyone with this February 2 headline on the December 20th court ruling:
Here are more typical headlines on that court ruling, headlines that came out the same month that the court ruling came out. Perhaps AHIP used the interim six weeks to focus-group various verbs until they settled on…tweak???
AHIP: It’s not just the headlines
One prominent healthcare executive recently attended an AHIP conference and reports:
I just returned from one of the dumbest meetings I’ve ever attended in Washington. Report of a new “study” by AHIP. Turns out people don’t mind health costs all that much, they just want more benefits. And everything is hunky-dory with their health plans, people like them so much. They love wellness benefits and crave more. Prescription drug prices have been nicely controlled thanks to the competitive marketplace (no, I am not making this up or exaggerating for drama). For every $1 employers spend on benefits workers get $4 in value. Priorities for SHRM rep: Fitbits for all employees, solving the outrage that only 20% of her employees got an annual physical. 85 cents of every dollar spent on health care goes to chronic disease.
Over these same two hours, I’d estimate about a thousand employees were misinformed, harmed or harassed by wellness vendors, roughly equal numbers of employees got useless annual checkups, employers spent about $200-million on healthcare and 40 people died in hospitals from preventable errors. But I’m being such a Debbie Downer! I’m going home to read Why Nobody Believes the Numbers to remove myself from this alternative universe.
Enter the Health Enhancement Research Organization (HERO)
HERO’s Prevaricator-in-Chief, Paul Terry, is demonstrating his usual leadership abilities in this crisis, of course. After all, HERO is the wellness industry trade association and these three items — the NBER invalidating their product, employees hating their product, and a federal judge forbidding them to force employees to use their product — represent existential threats to his “pry, poke and prod” members.
Teddy Roosevelt said, “complaining about a problem without posing a solution is called whining.” It’s a quote that also reminds me why I’ve not thought of angry bloggers who target health promotion [vendors] as bullies. Though they relish trolling for bad apples, their scolding is toothless, more the stuff of chronic whiners.
I suspect he is talking about me here as the “chronic whiner” who is “scolding” them. Or perhaps he is referring to the “angry bloggers” at the Los Angeles Times, the New York Times, Slate, or STATNews, since those “toothless” publications seem to be scolding wellness vendors more than I ever have. For instance, I’ve never called wellness vendors’ offering a “scam” or a “sham.” I simply quote these very stable wellness geniuses verbatim, as above or below, or last week.
Being quoted verbatim, not angry bloggers, is their worst nightmare. (One thing I would concede, though, is that “Paul Terry and the Angry Bloggers” would be a great name for a rock band.)
Yep, looks like the implosion of his industry all my fault. Otherwise, I’m not quite sure who is the “angry blogger” he is referring to, other than to note that Mr. Terry himself seems to blog a tad angrily himself, both above, and here…
Why I choose to ignore the blogger critics: We’re fortunate to work in a profession with a scant number of vociferous critics. My take is that there is one thing these few angry loners [Editor’s note: the complete “scant list” of the 220 “few angry loners” who have been “vociferous critics” can be found here] want more desperately than attention: that’s to be taken seriously. What they fail to comprehend is that as they’ve gotten ever more farfetched and vitriolic in search of the former, they’ve cinched their inability to attain the latter.
Baiting people with misinformation and offensive insults (but just a tad under highly offensive) is a pesky ploy that trolls hope will eventually land a bite that confers credibility where there is none. Even reading such drivel is a form of taking the bait; responding is swallowing it whole. Some say dishonesty should not go unchallenged and I respect their view; nevertheless, I’m convinced responding to bloggers who show disdain for our field is an utter waste of time. I’ve rarely been persuaded to respond to bloggers, and each time I did it affirmed my worry that, more than a waste, it’s counter-productive.
…and especially here, a seemingly incongruous decision to “act out” by someone who claims to be “choosing to ignore the blogger critics.”
Having read years of my “drivel” alongside Mr. Terry’s posting explaining why you shouldn’t “swallow this bait,” perhaps readers might opine here: which of us, exactly, is the “chronic whiner”?
Coincidentally, when I run live health-and-wellness trivia contests, the first of our 3 rules is: No Whining. Seems to me that he would have just violated it. Indeed the only rule HERO hasn’t violated so far is #3 below. Not that I want to put ideas in their head.
Often I don’t have time to write a full blog in my own words, but fortunately I usually don’t need to. It’s enough to quote the words of the very stable geniuses in the wellness industry verbatim. Being quoted verbatim, of course, is one of these geniuses’ worst nightmares.
Among the most stable of the wellness industry geniuses is Steve Aldana, CEO of Wellsteps, winner of the 2016 Koop Award as well as the 2016 Deplorables Award. How does he report the National Bureau of Economic Research’s complete evisceration of wellness industry research methods? Let’s take a looksee at the highlights of his posting.
First, it appears that two opposing studies, “one for and one against wellness,” came out “at the same time.”
One the one hand, someone — apparently he doesn’t know who — seems to say that there “wasn’t much improvement” at the University of Illinois. And something must have been wrong with this result, because “these results contradict over 90% of publish [sic] studies.”
“At the same time,” a publication no one has heard of found the opposite: health behaviors improved for “over 2 full years” in — get ready — one of Wellsteps’ very own accounts.
This is a textbook example of a false equivalence, the wellness version of: “You also had some people that were very fine people on both sides.”
To begin with, the researchers in the first group weren’t just any old researchers. This was the National Bureau of Economic Research (NBER). And the NBER didn’t say “they didn’t see much improvement.” Their specific words were that the causal effects were — get ready — nearly indistinguishable from zero for nearly every outcome.
Further to say this conclusion “contradicts over 90% of published studies about wellness,” would be like saying Galileo’s findings “contradicted” over 90% of published studies about astronomy.
The study’s actual conclusion used a slightly different verb:
Our 95% confidence intervals rule out 78 percent of previous estimates [of the effect of wellness] on medical spending and absenteeism from the prior literature. [Let me translate that, in case the words are too long for the very stable geniuses at Wellsteps to understand: you and all your very stable friends have been geniusing about savings for decades now.]
The reason the NBER was able to be so conclusive is that, to quote one of our Alert Readers, Robert Dawkins: “They foolishly included a valid control group.” Kudos to Mr. Dawkins for that very unstable moronic observation. (In any event, far from contradicting other research, the study is quite consistent with most articles on wellness not written by someone feeding at the employer wellness trough.)
The other journal, which published an article “at the same time,” found an improvement in healthy behaviors. That journal is called Health Promotion Practice. And if you haven’t heard of it, you’ve got company. Their “impact factor” is the lowest in an industry whose journals are notable for low impact factors. I googled quite extensively, and it appears — get ready — that no article from this journal has ever been cited, excerpted or even had the fact of its very existence even grudgingly acknowledged in the lay or scholarly media.
By contrast, the NBER article has been picked up everywhere — except of course by the wellness industry. See if you can find any reference to this article — or AARP v. EEOC, which was also national news — on the Health Enhancement Research Organization website.
Turns out there’s a reason no one cites this journal. It’s because it’s so genius. Exhibit A is this very same article, a rehash of the Boise School District findings that somehow overlooked the key finding, which is that the employees got unhealthier during Wellsteps’ program. Instead, the author — displaying not the slightest intellectual curiosity as to how this could possibly be true — reports the most genius findings we’ve ever seen in a journal:
- only 3% of Boise School District employees smoke, and…
- …they smoke only 4 days a week.
Perhaps — just playing devil’s advocate here — the other 17% of Boise employees who smoke (Idaho has a 20% smoking rate) might have lied on their health risk assessment? The “tell” is that everybody knows smokers don’t smoke only 4 days a week. Obviously, they smoke 5 days a week, with time off for weekends, major holidays and Beethoven’s Birthday.
Very stable genius that he is, the author (both a friend of Wellsteps’ Mr. Aldana, according to the disclosure statement, and also a genius who has already been profiled on this site for his previous insights) also admits that with a high non-participation rate and a 20% dropout rate:
There exists the possibility of selection or dropout bias that could have influenced the results reported.
Ya think? Maybe just a tiny bit?
But wait…there’s more
We’ve highlighted Mr. Aldana’s phrase “at the same time” describing how these articles were simultaneously published. We repeated the phrase in three separate places above for emphasis because — get ready — these two results were not published at anything like the same time.
To begin with, Mr. Aldana has been very stably geniusing about his Boise results for more than two years now. (See my article from September 2015 accurately forecasting that, thanks to the number of obvious errors and self-immolating contradictions, this study would win a Koop Award. And of course the Boise employees got harmed.)
This article, using that same data set, was published last July, whereas the NBER article just came out a few weeks ago. Perhaps in some geologic sense July 2017 and January 2018 are “the same time,” but imagine if the rest of the world defined “at the same time” as “six months apart.” For instance, let’s join Sherman and Mr. Peabody in the Wayback Machine and set the dial for June 1944:
Eisenhower: “OK, we’ll storm Omaha and Utah Beaches, and you guys can storm Juno and Sword Beaches at the same time, and then we’ll hook up and say…”
Churchill: “…Merry Christmas, chaps.”
For a good time, try googling on Wellsteps.