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Wellsteps Stumbles Onward: Costs Go Up and Down at the Same Time
As our regular readers know, we have often had a very slight issue with Wellsteps’ math Nothing major. Just the fact that it’s completely made up.
So it’s no surprise that they’re at it again. Before we get to the math they’ve done for the Boise School District to justify costing taxpayers as much as adding a number of extra teachers, there is another little tidbit. They decided to use the classic fallacy of listing the improvements in the highest-risk sliver only –“those with the worst health behaviors.” These “improvements” of course, omit dropouts, and — more importantly — the deterioration in risk factors among the overwhelming majority, the ones who didn’t have the “worst health behaviors” to begin with. As the paper says: “There was consistent risk reduction among those who had the unhealthiest numbers at baseline.”
It’s not just us (and common sense) saying that. Dee Edington’s “natural flow of risk” model showed that the cohort with the worst health risk behaviors always improves, even in the absence of a program. (In this version below, Dee circled the low-risk bucket to make a different point. The point for Wellsteps is that a very significant portion of the 4691 initially high-risk people decline on their own, and are replaced by others whose risk is increasing. Wellsteps isn’t showing us the replacement people, just the cohort that declined on its own.)
There is a bit of irony in that this Wellsteps White Paper cites him several times…but somehow “forgot” to take account of Dr. Edington’s most important finding, which coincidentally disqualifies their own.
Fuzzy Math
Saving the best for last, Wellsteps once again demonstrates our mantra from Surviving Workplace Wellness: “In wellness you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
On one page, they show a declining overall cost trend by roughly 15% since the start of the Wellsteps program:
Now, compare that chart of the “actual” cost decrease among the entire population (participants + nonparticipants) since 2011 (“Wellsteps Begins”) to the chart below of cost/person, which shows a dramatic cost increase over the 2011-2013 period among the entire population (participants + non-participants):*
So which is it? Did overall population costs go up or down? Even using wellness math, which Wellsteps excels at, overall population costs can’t have both gone up and gone down at the same time.
There are four possible explanations for this, all of which are plausible given Wellsteps modus operandi:
(1) They are stupid;
(2) They are lying;
(3) Their program is so unappealing that employees are switching to their spouses’ coverage simply to avoid it;
(4) The number of employees in the school district declined, making it possible for total costs to decline even as costs/employee jumped. However, even the most dishonest wellness vendor wouldn’t claim credit for that, and even the most gullible customer wouldn’t let them if they did.
One explanation we can rule out: Wellsteps is doing a great job and telling the truth about it. But anyone who knows this outfit could have ruled out that possibility before we even posted this.
As of this writing, Wellsteps has now “rebutted” these findings. They say these dueling trendlines are “rock solid” and that we are full of “hot air.”
(Postscript: In 2014, for some undisclosed reason, non-participants costs dropped almost 40% while participant costs increased. No one has any idea why, and whatever the reason is has nothing to do with wellness. Total costs were still up from the start of the program.)
*Wellsteps didn’t mention the participation rate, so we are inferring a participation rate to the vector of this arrow based on them saying 60% were overweight of 3269 employees, but the number of overweight people listed in their report as participants is 1421.
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You Too Can Become a Wellness Vendor…in Just 5 Days
Anyone care to become a wellness vendor? Good news: you can buy a wellness franchise from Star Wellness without knowing a single thing about healthcare…
…as long as you have your checkbook handy.
They do, however, recommend a background in sales, finance, or municipal administration.
The other good news — for you salespeople, financiers, or city managers — is that Star Wellness will teach you everything you need to know about wellness:
Yes, in five days you too can learn everything that Star Wellness knows, like how to ignore USPSTF guidelines, which is one category in which Star leads the industry. (One place they lag is reading comprehension, since we have already pointed out that most of what they propose is more likely to harm employees than benefit them…and yet they continue to advertise these hazardous screens.)
In addition to “up to” 5 days in the classroom, franchisees also get 3 days of on-the job training. So in case anyone is keeping score at home:
- Training required to get a job as a wellness vendor: 8 days
- Training required to get a job as a housekeeper at the Four Seasons: 10 days
This intensive training has captured the attention of WELCOA, which has named Star a Premier Provider:
WELCOA has very high standards, as we have noted on They Said What. One thing they excel at is spelling the name of their founder, assuming their founder invented the all-you-can-eat self-service restaurant.
A commitment to excellence, like that displayed by Star Wellness and WELCOA, might explain why employers have gone all-in on the notion that teaching employees, for example, to drink eight glasses of water a day will reduce healthcare costs, and also increase productivity, at least between trips to the water coolers and the rest rooms.
You’d learn far more than the typical wellness vendor knows about wellness simply by taking the Quizzify quiz. You’d learn more just by taking the demo quiz on the landing page.
Heck, you’d learn more just by reading the Quizzify landing page itself.
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Show Wellness Isn’t an Epic Fail and Collect a $1-Million Reward
Executive Summary:
We are getting very frustrated with the failure of wellness advocates to show even the slightest net savings using a legitimate methodology. Therefore we are offering a million-dollar reward for the first person who does. To win this reward, there are specific rules that must be followed regarding data sources and the selection of panelist judges, all listed below.
Recently a group calling themselves the Global Wellness Institute Roundtable put out a press release and report criticizing us for “mud-slinging on ROI.” We are not familiar with this group. Their headliner seems to be a Dr. Michael Roizen, head of the Cleveland Clinic’s much-vilified wellness program. If that name sounds familiar, it’s because he used to work with Dr. Oz, though to Dr. Roizen’s credit, he avoided the Congressional investigation of Dr. Oz.
The report says we “impose a standard of evidence that doesn’t exist for any other workplace investment.” Um, like it needs to break even? Wouldn’t a company go bankrupt pretty quickly if it didn’t insist that its investments should break even?
Also, there are three very specific reasons why wellness needs a high “standard of evidence.” If Dr. Roizen doesn’t understand these reasons, he can get a smart person to explain them to him.
We get a little frustrated when we prove something, and then members of the wellness industry dress themselves up with words like “Global” and “Institute” and “Roundtable” and then say things like: “critics are misusing ROI science to castigate…workplace health efforts.” Then they cite articles that inadvertently undermine their own arguments and support the critics.
They also say things like: “93% of the workplace wellness return in the first year is in productivity gains, not reduced cost.” This is squirrelly even by the lax standards of wellness math. No company can measure its productivity gains with that precision. Still — assuming you exclude time wasted in filling out forms, being screened, and getting unnecessary checkups — maybe they’re right. After all, nothing focuses the mind on work-related issues like being told you’re sick.
And yet casual observers assume there are two sides to this “debate.” It doesn’t help that journalists need to print opposing quotes. However, pry, poke, and prod” wellness loses money, period–unless you count the money forfeited by employees who don’t participate, or don’t lose enough weight to earn their payment. Those payments are not counted for the purposes of this reward since they are transfers, not savings.
Leaving out employee forfeitures, the country as a whole has not even remotely approached breaking even on wellness spending vs. claims costs.
But don’t take our word for this. We are offering a million-dollar reward for anyone who can show that it is more likely than not that “pry, poke, and prod” wellness breaks even through healthcare claims savings.
Not” Show a 2-to-1 ROI” or “Defend the famous 3.27-to-1 ROI.” Just: “Show a breakeven.” Not “wellness is a success.” Just “wellness is not a epic fail.”
The Rules
Specifically, you just need to show, using publicly available databases (not private “case studies” or vendor reports), that:
- it is mathematically possible that the country’s employers can reduce their medical claims costs enough to cover the wellness industry’s $8 billion in annual billings by enough to offset internal costs and consulting fees (you can estimate those); and
- during this millennium the wellness industry has reduced costs (by avoiding wellness-sensitive medical events, which is the methodology HERO and us agree on) by enough to break even according to the first calculation;
- The so-called “best programs” in the country — Koop Award winners the last 3 years — are, if not exemplary, then at least good performers that earned the savings they claimed to save, by significantly reducing risk factors.
Here are the rules. This is a binding legal contract. We can’t offer something like this and then say we had our fingers crossed.
- You need to start out with a lie detector test, to be performed by the Boston police, as I will. The questions to be asked are: “Are you telling the truth?” and “Is the opposing party either deliberately lying, and/or has no clue how to measure outcomes?” Either side may submit either or both sides’ results, as they prefer.
- You must provide your view of the C. Everett Koop Award to Wellsteps and Boise (600 words, 6 hyperlink maximum), and rebut the other view (600 words, 6 hyperlink maximum). We will also both be asked: “Did the Wellsteps program reduce costs in Boise by roughly a third, as they claimed?” in the lie detector test.
- In order to facilitate your quest, you can use include the wellness industry’s own HERO Outcomes Guidelines, which represents the “consensus” (their word) of 39 “subject matter experts” who support wellness. (None who oppose wellness were invited to participate.) US Census Bureau information, Kaiser Family Foundation, and the AHRQ’s HCUP database can also be used. Other databases will be allowed in at the discretion of the panelist judges if they deem their probative value to be very strong.
- You may cite/quote any peer-reviewed article in rebuttal of the opposing view; however articles in support of the position in question must be sourced from one of the ten medical journals with the highest reported “impact factors,” and have been published within the last five years;
- Once an article is brought into the discussion, the opposing party may also cite it in cross-examination.
- We give you a lien on $1,000,000 as soon as you escrow $100,000 to cover the costs of the program (honoraria for panelists, venue etc). The loser pays this (meaning that if you win, you get it back). If the costs are less than $100,000, the winner keeps the difference.
- We each pick four panelists from Peter Grant’s “A-List” of the leading 260 health economists and policy experts (this is an invitation-only email list in which health policy and health economics concerns are addressed and debated) that are unaffiliated with the wellness industry or with Quizzify . Each party can veto two of the other’s picks. Together, the remaining four pick a 5th.
- Each side submits up to 2000 words and 5 graphs, supported by no more than 20 links;
- The material linked must predate the claim for the award by 6 months, in order to discourage either side from creating linked material specifically for this contest.
- Each party may separately cite previous invalidating mistakes made by the other party that might speak to the credibility of the other party.
- Either side may cite an unlimited number of “declarations against interest,” made within the last 4 years–meaning comments made by the other party so prejudicial to their own position that the other party would only have said them if they were true. Example: if I said, “Wellness definitely saves money” (except when I said it as an April Fool’s gag), you could cite that. There is no word limit on these.
- Each party can then rebut the other party with up to 2000 words and 5 graphs, and 20 links.
- The parties will be convened, in Boston (or another agreed-upon city, if the other party is willing to pay my travel expenses), for a two-hour finalist presentation in which the panelists (whose travel expenses and professional charges are paid for out of the entry fee) can ask questions of either party, and both parties can cross-examine the other for up to 40 minutes, with followup questions and no limitations on subject matter. Each party can make a 10-minute opening and 10-minute closing statement. Up to 20 slides are allowed.
- During their 40 minutes, each party that has not achieved Certification in Critical Outcomes Report Analysis by the Validation Institute must explain why they haven’t, and each party that has not signed the Employee Health and Wellness Code of Conduct must explain why they haven’t.
We invite the wellness industry leaders — the “Global Wellness Initiative Roundtable,” the Koop Award Committee, and the Business Roundtable (BRT) and of course the Health Enhancement Research Organization — to collect their million dollars. Or shut up.
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It’s not just us–every grownup thinks there is too much prevention
When you read articles on prevention and corporate wellness, you tend to notice a pattern. Articles written by people who make their money pushing this stuff always say that the answer is more prevention. Those written by everyone else always say the answer is less prevention.
Here is an excellent example of the latter. It’s basically everything we’ve been saying, minus our trademark snarkiness.
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Wellness promoter admits a 50% reduction in heart attacks needed to break even
Who do wellness vendors remind you of?
Next to a being a Red Sox fan, I can’t imagine anything more depressing than being a member of the Wellness Ignorati. ALL the news about wellness is bad, and can’t be spun, which is just as well because the strategy of the Ignorati is not to “spin,” It’s to ignore facts rather than debate them. This prevents a news cycle, and reduces the odds that customers find out wellness doesn’t work.
Still, I am not sure how they would spin their way out of their latest debacle even if they tried.
CFO Magazine just posted a set of four essays in a debate. Mine summarizes the “con” arguments in 600 words. Since most of the first-string Ignorati refuse to debate, the editors found Mike Tinney and Mike Booth to pen the “pro” side. (No, we haven’t heard of them either.) Mr. Tinney urges CFOs to “take a leap of faith” on wellness ROI. Not sure that’s a compelling argument for an audience of CFOs, to put it mildly.
Indeed, one might conclude that, like the Red Sox, apparently the Ignorati don’t have much of a bench.
But wait…there’s more. Once again, 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” proves true. Mr. Tinney says to assume you have 1000 employees, and they will have about 2 heart attacks. Then he says: “If even one less [sic] person has a heart attack,” you save enough to pay for the program. What he failed to note is, in that hypothetical, a reduction of one heart attack would be a 50% reduction in heart attacks. No wellness promoter, even the most dishonest ones, say you can achieve remotely close to a 50% reduction in heart attacks. Hence, he is admitting you need an impossible reduction in events just to break even.
While reducing the number of heart attacks by one sounds feasible on its face, multiply the size of the population by 100. Now you have 100,000 people generating 200 heart attacks. Mr. Tinney says you need to avoid a Nobel Prize-worthy 100 of those heart attacks just to break even. By contrast, the HERO report achieved a zero reduction in their study.
So much for Mr. Tinney’s argument. But, hey, it beats Mike Booth’s defense of wellness. Incredibly, Mike Booth is still quoting the Harvard study. At this point every member of the Wellness Ignorati knows that study has been thoroughly debunked and basically retracted by its author (who says she has no interest in discussing wellness any more, and blames readers for misinterpreting her conclusion), so quoting this study without mentioning these tidbits is basically lying. It’s only slightly better than quoting the study linking autism to vaccines without mentioning it’s a fraud.
So that’s who’s promoting wellness now: yet another guy who can’t do math, and yet another guy who is either deliberately misleading people or lacks access to the internet.
More big news is that RAND finally came out of the closet altogether against wellness. No nuances, no “on the other hands”, no chance of being misinterpreted: Wellness is a loser.
Quizzify has GE-Intel validation.
Basically, every posting, every article, whether pro or con, leads an informed reader to the conclusion that wellness is a dumb idea. By contrast, even the Red Sox occasionally win a game.
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The Graco-Goetzel-Bravo plot thickens…more twists and turns
The Graco-Goetzel-Bravo-Hopkins case study is turning into another Nebraska fiasco. As with Nebraska, the numbers all contradict one another. But unlike Nebraska, there has as yet been no admission of deliberate lying in the Graco case study. That’s why Graco only earned an honorable mention in the Koop Awards, instead of winning one outright like Nebraska did.
Consider Bravo’s case study on Graco covering the exact same population over the same period as Ron Goetzel’s study. Let’s assume Ron Goetzel is right in that the wellness program should be measured from 2009 rather than 2008, when the program started. (Bob Merberg’s brilliant analysis points out the cherrypicking of the date has a huge impact on claimed success, but let’s concede this start date choice to Ron, and use 2009 according to his wishes.)
Bravo’s case study displays the PMPM costs by year. The first thing to note is, they list employee healthcare costs at $328 PMPM, which actually makes sense, instead of the $190 PMPM in the Hopkins report. I don’t know why these two figures, purporting to cover the exact same population in the exact same period, are completely inconsistent, but I do know that $190 PMPM is an impossible figure, as any population health expert knows. (“Plausibility checking” would have caught that error but Ron has never taken our course in Critical Outcomes Report Analysis, which would have covered plausibility-testing and likely prevented him from making such a rookie mistake.)
Second, Bravo lists children’s healthcare costs in this report as well. Funny thing: over the same exact period in which Mr. Goetzel was claiming that the wellness program was responsible for controlling employee participant costs, children’s healthcare costs trended better than wellness participants’ costs. Mr. Goetzel obviously had access to this children’s cost trend data (we had no trouble finding it, thanks to Bob Merberg) but elected to — get ready to fall out of your seats — ignore it. The wellness ignorati rarely step out of character.
This children’s cost trendline appears to invalidate the entire Goetzel-Johns Hopkins conclusion that the healthcare cost trend was due to the wellness program, since not one single child participated in the wellness program.
For some reason Graco’s spouses cost about $7000 apiece a year. We’ll leave that for someone else to dissect.
As an aside, if anyone thinks they recognize the name “Bravo Wellness” from an earlier posting, it’s because they do. Bravo is the outfit that brags about their ability to save employers money by fining employees. Their website is disproportionately about their appeals process when those fines are levied. This sounds like a company that does wellness to employees instead of for them.
Not sure how bragging about fining employees is consistent with the positive culture that Mr. Goetzel says Graco has, but maybe I’m missing something here.
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Eureka! We got criticized! An entire blogful of harsh words
Please visit Michael Prager’s blog. Ironically, I don’t think we would take issue at all with his main point which appears to be that wellness should be done for employees instead of to them. (He is in the business of doing wellness for employees, not to them.) And, in fact, if he were actually thinking clearly about his own business success, he’d be pointing that out and trying to figure out ways to work together.
Second, note that our math and facts are never, ever criticized, even by our most virulent critics. What he criticizes is that we “mock critics who say that calling people ignorant is bullying.” Well, we call them the “ignorati,” not ignorant. “Ignorati” means they ignore facts, which is a brilliant strategy.
Third, he is breaking ranks with the ignorati, by not ignoring us. This creates a problem because he doesn’t actually point out a single thing we say that is wrong. Indecorous, perhaps, but wrong, no.
What’s both right and fun for employees? Quizzify, of course. Click and take our demo.
Michael, have at it: find a mistake in our math or a lie that we told about your integrity-challenged colleagues and we’ll apologize to it and link people to it. Go ahead, make our day. Because right now the fact that you, having shown that you are willing to criticize us, can’t find anything to actually criticize us about (other than our “bullying” observations that people who can’t do arithmetic shouldn’t be doing arithmetic), makes our case much better than we ever could.
Addendum: his is actually a very interesting blog on its own merits. He does do wellness for employees instead of to them ∞
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News flash: The Wellness Ignorati are ignoring facts for a change
There has to be a limit, even to deception
The Wellness Ignorati got their name by ignoring facts. Facts, of course, are the wellness industry’s worst nightmare. They ignore them In order to avoid creating news cycles that might reach human resources departments despite the best efforts of their consultants and vendors to shield them from actual information.
And they’re at it again.
First, Atul Gawande wrote a scathing article in the New Yorker about massive overscreening earlier this month. As Mitch Collins noted in The Health Care Blog, not a peep in response from the perpetrators of those hyperdiagnostic jihads. Nor has their been any response to Mitch’s article itself. Literally, no one defends wellness industry practices. And yet somehow all the laws are on their side.
Speaking of which, Mitch mentioned the famous Nebraska debacle, in which the vendor, Health Fitness Corporation, lied about making “life-saving catches” of “early-stage cancers.” Since HFC was a sponsor of Ron Goetzel’s Koop Award, Ron naturally gave them that prize for these lies.
However, we’ve thrown down the gauntlet. HFC, come on out and fight. Give us your side of the story. How was this not a deliberate lie designed to score political points in Nebraska? If it was a mistake, why didn’t you change it and apologize? How do those 514 cancer non-victims feel? And Mr. Goetzel, why do you not only keep defending HFC, but have even upped the ante? They’ve been promoted from “best practice” to “exemplar” in your most recent webinar.
As long as wellness vendors are silent, we won’t shut up.
Speaking of non-responses from Mr. Goetzel, where is the correction of or explanation for the massive mistake in Mr. Goetzel’s most recent wellness program evaluation? All those readers have been misled by his blog into thinking Graco’s costs/employee are $2280/year when in reality the cost per employee contract holder — according to Mr. Goetzel’s own blog — is about $11,100, like almost every other company. (That includes spouses and dependents but any reasonable dependent ratio would yield more like a typical $5000 to $6000 per employee rather than $2280.) I know he knows about this mistake because I’ve submitted a comment to his blog, which shockingly hasn’t been posted.
So, please, could someone actually respond for a change, even if it’s just to accuse us of bullying.
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Ron Goetzel reports on Graco, the company with the country’s most expensive spouses
Talk about “burying the lead.”
Need we say more?
Ron Goetzel just reported on a company called Graco, where employees were subjected to a “pry-poke-prod-and-punish” wellness program. These are line employees in an “old economy” company–exactly the type of company where healthcare spending would be high. And it is high. According to the article, Graco spent $29,000,000 on healthcare for 2600 employees. That’s about $11,100 apiece, roughly what you’d expect. This estimate is with or without a wellness program, since as Ron’s recent HERO report noted, wellness programs have no positive impact on spending.
Yet later on in the article he writes:
In the immortal words of the great philosopher Rick Perry, oops.
$190 per member per month (and we assume that he meant just for employees, not members) is $2280/year/employee. Here are the possibilities:
(1) Graco has the country’s mot expensive spouses, costing about $18,000/year (to bring the average spend to $11,000 per employee contractholder per year) but hasn’t noticed
(2) Graco has some magical special sauce that kept costs way below average even before the wellness program started that Ron failed to tell us about (hence “buried the lead”)
(3) Ron Goetzel made yet another rookie mistake in his math, thus invalidating the entire study, just like most of his Koop Awards.
You can rule out that this $190 had anything to do with the wellness program. Smoking rates (the only thing that really affects spending) remained unchanged, and obesity only fell a few points. And a company can’t save money by overscreening people, paying for their drugs, and making them get unnecessary checkups. In any event, it wasn’t $190/month. It was $11,100/year.
$2280 vs. $11,100… We look forward to Mr. Goetzel’s explanation of how both these figures could be true, since it appears they are completely at odds with each other. In the immortal words of the great philosophers Dire Straits, if two men say they’re Jesus, one of them must be wrong.
And once again, the mantra of Surviving Workplace Wellness holds true: In wellness, you don’t have to challenge the data to invalidate it. You simply have to read the data. It will invalidate itself.
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We will no doubt be accused of “bullying” him for invalidating this study, which he obviously spent a lot of well-compensated time on. So just to show our good intentions, we will offer him our course and certification in Critical Outcomes Report Analysis gratis. It seems he could learn a lot from it and we look forward to announcing his successful completion.
Update: Ron apparently “forgot” to include the actual data in his writeup, which showed that, um, how to put this tactfully, his entire conclusion is wrong. Looks like kids (who had no access to wellness) trended better than the adults who did have access. We added this as the second installment.
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Measuring Wellness-Sensitive Medical Events: The Grand Finale of the HERO Analysis
The eighth in the series deconstructing the HERO Outcomes Guidelines, covering Page 14. The full series can be found here. This installment in particular should be read in conjunction with installment #4 This Grand Finale will be presented in 3 parts…with a downloadable tool to help you calculated your wellness program savings as part 3.
PART ONE: HERO ACCEPTS OUR METHODOLOGY
In the stock market, no one is as valuable as the person who’s always right, except the person who’s always wrong. Therefore, until now we have greatly appreciated the opportunity HERO’s report has created for us to explain how to measure outcomes correctly.
So imagine our disappointment when one of their methodologies, the sixth of the seven listed, turned out to actually be valid. No surprise — this is the methodology I invented. Also no surprise given the industry’s standards for integrity, they didn’t acknowledge that particular factoid anywhere in their 88 pages. (And yet they accuse us of being impolite.) Here is the screen shot.
The philosophy of #6 is quite straightforward. If you were introducing a flu vaccine program, you’d measure the reduction in number of people who got the flu. If you offered a new program for conservative treatment of meniscal tears, you’d measure the reduction in the number of people who had meniscal surgery. That’s the way experimentation works. You hypothesize an outcome that the intervention should create…and then you measure that outcome to see if the experiment worked.
Except, of course, in population health, where any improvement in anything (cost, trend, utilzation) gets attributed to any wellness program that happened to be in place. The masters of this would be Mercer. Mercer once “found” massive, mathematically impossible, savings for North Carolina Medicaid’s medical home in a cohort that, as luck would have it, wasn’t even eligible for the medical home. And one wellness industry stalwart, Larry Chapman, says the simple act of completing a health risk assessment can reduce total healthcare spending by 50%, even when the information in the HRA is wrong, as is often the case.
And did you ever notice that when a company switches to a high-deductible health plan and adds some needle-poking, they attribute the reduction in spending to the needle-poking, not the fact that everyone in their company suddenly gets socked with a bigger annual deductible?
Enter wellness-sensitive medical event rates (WSMEs). This is the only methodology that tallies hospitalizations for conditions targeted by a wellness program – statistically avoided heart attacks etc. This is the only one of the seven HERO methodologies that would be acceptable to legitimate researchers. Hence, its use both in Health Affairs and by the GE-Intel Validation Institute. The former is the most respected health policy publication and the latter is the most (the only) respected outcomes evaluation organization. Further evidence of its validity is that there is no mention of it in the leading wellness promotional publication, the American Journal of Health Promotion, perhaps because – as HERO has attested – it doesn’t show savings.
History of event rate-based plausibility testing
Even though it isn’t attributed to me in the HERO guidebook, I invented this methodology in 2007. This is incontrovertible. No one else had anything remotely close to it. Unlike the automobile, TV, the computer, etc., this was not one of a series of incremental improvements to or the amalgamation of existing technologies.
And none of the other invention clichés apply either. The Chinese didn’t invent it in 1000 BC. Leonardo DaVinci didn’t sketch it in 1541. The Germans and the Allies weren’t racing to develop it at the end of World War II. By contrast, I’ve been presenting on it and using it for validation since then (meaning 2007). It figured prominently in Why Nobody Believes the Numbers too, before being highlighted in Health Affairs and the Validation Institute. For a modest fee, the detailed how-to can be downloaded from our website, though a Reader’s Digest version appears below.
While a number of employers and health plans use it now, several health plans – more than coincidentally three of the highest-rated in the country (Harvard Pilgrim, Blue Cross of Massachusetts, and Providence Health Plans) – have been measuring hospitalizations for conditions targeted by wellness/DM programs since the methodology’s inception.
So needless to say I was surprised and totally flattered that the 88-page HERO Report contained no attribution to me as the inventor of the WSME plausibility test. As mentioned previously, the strategy of the Wellness Ignorati is to ignore facts (hence their moniker), especially including my very existence. That strategy reduces the likelihood that one of their customers might click through to the site. They aren’t much for our recommending that companies learn our helpful insights, which they call “bullying.”
The wellness industry has had a love-hate flip-flopping relationship with WSME measurement.
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First, until 2013, the entire Wellness Ignorati, quite in character, ignored this methodology, which is a powerful testament to its validity.
Then, in 2013, that strategy took a body blow: the exact methodology was used in Health Affairs. You may recall the same thing happened with another epiphany of ours — the expose of the invalid Koop Award-winning Health Fitness Corporation fabricated results. The Wellness Ignorati completely ignored our whistle-blowing expose until it appeared in Health Affairs, when they were forced to admit we were right and the whole thing was made up, or to use Ron Goetzel’s phrase in the passive voice, “was unfortunately mislabeled” for four years.
Just as Ron Goetzel — the leader of the Wellness Ignorati — caved when the Health Affairs light was shined on the Koop-HFC debacle, he caved on WSMEs when the Health Affairs light was shined on them. In this case, “caving” was acknowledging the fact that this methodology existed. He reviewed the aforementioned Health Affairs article that specifically analyzed WSMEs — hospitalizations for conditions targeted by the wellness program. In September 2014, he wrote:
But then he un-caved. Once the Health Affairs storm had passed, he invoked the Sergeant Schultz defense. In December 2014 he said: ,
He may have just forgotten in December that he reviewed them in September. But in March he and his colleagues re-remembered wellness-sensitive event rates, and put them right in the HERO report, for which we are immensely grateful.
Hopefully they won’t re-forget in June. (Their memory appears to be correspond with the change of seasons.) Hopefully instead, to paraphrase the immortal words of the great philosopher George Gershwin, our methodology is here to stay.
How do I feel about HERO rewriting history so that I am no longer the inventor of this methodology? Honestly, having firmly staked out a niche in the small but growing “integrity segment” of the wellness industry, I prefer them staying out of that niche as long as possible. So I’m glad they show no interest in facts.
In part two, which we will post in a few days, we will explain how we do WSME plausibility testing and why it’s the essential method for assessing the impact of your wellness and disease management efforts.
They Said What? 