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Paul Terry, formerly of Staywell and the Health Enhancement Research Organization, has just been appointed the new editor of the wellness industry trade publication, the American Journal of Health Promotion. He replaces Michael “Let’s Charge Employees Insurance by the Pound” O’Donnell in that role.
Mr. Terry brings exactly the type of expertise to this job that AJHP readers have come to expect, in that very few people can claim to surpass Mr. Terry’s ability to fabricate outcomes.
I first became familiar with Mr. Terry’s work when Staywell claimed mathematically impossible savings for British Petroleum’s pry-poke-and-prod wellness program, which I dutifully reported on The Health Care Blog in the posting: “BP’s Wellness Program is Spewing Invalidity.” Staywell, as a preferred vendor of Mercer, was able to “convince” Mercer to fabricate savings, when their client, BP, asked for an evaluation. Staywell pretended to have saved almost $20,000 for every risk factor reduced among active participants (meaning dropouts and nonparticipants’ failures aren’t counted).
This was quite a feat considering that the average employee only spent about $5000 during the year in which this analysis was conducted. And of course only a tiny percentage of healthcare costs in the short term are attributable to risk factor reduction anyway. (Staywell was offered the opportunity to rebut, and didn’t.)
But the smoking gun here was that Mr. Terry apparently forgot that Staywell itself only claimed to be able to save $129/risk factor reduced. Magnanimous guy that I am, I was kind enough to point out that integrity chasm for him in the article.
Most people, when they are caught fabricating data, try to deny it. But Paul Terry brags about it. In case you haven’t already done so, take a looksee at his defamatory letter to the media that he sent, along with his cronies Ron Goetzel and Seth Serxner. He insists that they made up the data I reviewed — meaning his best argument against me is that I didn’t realize he was lying. If we take him to court, he could argue that the judge should apply the legal standard for negligence — that I “knew or should have known” their data was fabricated, because all their data is fabricated.
Although ironically it turns out the data they insisted was fabricated was, this time, legitimate — meaning that he was making up his claim that HERO had made up the data. That’s a topic for another blog. Suffice it to say that, in the immortal words of the great philosopher LL Cool J, he lied about the lies he lied about.
Most importantly, if you read the letter he wrote, you’ll see that another of his arguments is that when calculating ROI, you should not compare costs to savings. And a good thing because comparing costs to savings, and other feats of arithmetic, would be the wellness industry’s second-worst nightmare (next to facts).
Refusing to acknowledge the existence of basic arithmetic makes Mr. Terry a perfect choice to be editor of the wellness industry trade publication.
I would like to express my gratitude to the editor of the American Journal of Health Promotion, Michael O’Donnell. He recently decreed that “despite common lore, I am not an idiot.” Coming from a man brilliant enough to singlehandedly create entire alternative universes of arithmetic and statistics, “not an idiot” is mighty praise indeed.
I’m unsure exactly what “common lore” he is disputing, unless he means that the Phi Beta Kappa committee at Harvard also thinks I am an idiot, relatively speaking, because they snubbed me until I was a senior.
I will return the compliment. Michael O’Donnell is not an idiot either. Quite the contrary, he and his Koop Committee buddies knew exactly what they are doing when they gave their friends at Wellsteps awards for harming employees. Bottom line is, these people simply hate employees, and happily throw them under the bus whenever it’s profitable to do so. While Boise is a great example, Penn State still reigns supreme.
While we could write a post about almost any member of that Committee, this post focuses only on one member, Mr. O’Donnell. Still, it’s hard to dislike the man given all the kudos he throws my way. For instance, in addition to not being an idiot, I am also praised above as: “close to being accurate.” Since we disagree on everything, he is therefore acknowledging that he himself is many light-years from accurate — as Wellsteps and every other Koop award demonstrates.
Michael O’Donnell’s Anti-Employee Jihad
Michael O’Donnell also said, as you can see above, that I am not a “misanthrope.” However, in this case, I can’t return the compliment. His new editorial is a misanthropic anti-employee jihad. First, he says prospective new hires should be subjected to an intrusive physical exam, and hired only if they are in good shape. OK, not every single prospective new hire — only those applying for “blue collar jobs or jobs that require excessive walking, standing, or even sitting.” Hence he would waive the physical exam requirement for mattress-tester, prostitute, or Koop Committee member, because those jobs require only excessive lying.
Second, he would fine people for not meeting “outcomes standards.” In an accompanying document, he defines those “outcomes standards.” He specifies fining people who have high BMIs, blood pressure, glucose, or cholesterol.
Finally, he wouldn’t hire smokers at all, because they are so unworthy and untalented. Meaning Humphrey Bogart never should have been cast in Casablanca. Ernest Hemingway and George Orwell should have piled up rejection letters. Roger Maris should get his asterisk back.* Rihanna, Simon Cowell, Adele, Brad Pitt, Obama, Churchill, Einstein. Sinatra, Twain, Kidman. Sheesh! I agree with you, Michael. What a bunch of losers.
And thank goodness Watson didn’t smoke or Moriarty would likely still be at large.
A Unique Way to Charge Employees for Health Insurance: By the Pound
Almost every nonsmoker would be caught in his dragnet too, as he would “set the standard for BMI at the level where medical costs are lowest.” Since people with very low BMIs incur higher costs than people with middling BMIs, Mr. O’Donnell would fine not only people who weigh more than his ideal, but also employees with anorexia.
If employees didn’t already have an eating disorder, what better way of giving them one — and hence extracting more penalties from them — than to levy fines based on their weight? Hopefully, he would allow people with wasting diseases like cancer to appeal their fines.
Employees above his ideal weight would pay per pound, sort of like they were ordering lobster or mailing packages.
Yes, I have a hard time believing anyone would disdain employees that much too, so here is the screenshot:
He claims that all these fines will “enhance morale” for employees, whether they like it or not.
How would Michael defend his anti-employee jihad?
The Wellness Ignorati don’t engage with me, for obvious reasons given their self-immolating comments when they do. So I’ll provide his rebuttal. It would be, as he said in the first screenshot above, that I am once again “creating controversy where it does not exist.” Clearly, his editorial and white paper are mainstream, and I’m just causing trouble again for no reason.
Michael wonders why, in his own words (echoed by Ron Goetzel), 90% to 95% of wellness programs fail. He says it’s because employers don’t spend remotely enough money on them. He recommends up to $300/employee/year…and what better way to reach that spending target than to make them go to the doctor, and set up expensive weigh-ins, inspections and fining procedures?
While Michael O’Donnell may not be an idiot, I’m not sure I could say the same about any CEO who takes his advice.
*Maris should get his asterisk back because, as a smoker, he still holds the record for “Most home runs by a player who never should have made the team.”
Now that the myth that there is any ROI in wellness is thoroughly both debunked and also even acknowledged by the wellness industry, vendors often fall back on the “argument” that nothing else in healthcare needs an ROI. Why should workplace wellness be singled out? The editor of the American Journal of Health Promotion, Michael O’Donnell, even asked: “Who cares about an ROI anyway?”
The answer to Michael’s question? Everyone should care. And everyone should insist on an ROI from wellness, for three distinct reasons. Each reason is sufficient on its own. So even if there were a fallacy in two of the reasons (and there isn’t), the remaining reason would still be definitive.
First, consider an employee with appendicitis. You don’t calculate an ROI. You call an ambulance. But suppose a vendor says to you: “If an employee’s appendix bursts, the cost could be $100,000. So we propose taking out everyone’s appendix preventively.”
You’d ask: “What’s the rate of burst appendixes and how much do appendectomies cost?” While that’s an extreme example (and we didn’t mean to give these people any ideas), this is basically the calculation you should make when vendors propose screens. Here’s how to do the calculation. You’ll be shocked at how much it costs to avoid even one event by screening everyone.
Second, wellness is the only thing in healthcare that employees are forced to do, subject to a financial forfeiture of penalties or lost incentives. Other activities which people are penalized for not doing include: wearing helmets/life jackets/seat belts and getting kids vaccinated. In each case, the clinical evidence/science overwhelms considerations of personal choice. (Even then, in some states personal choice still rules.)
By contrast, the only thing that’s overwhelming about wellness evidence/science is how overwhelmingly the evidence eviscerates wellness, which of course is what this site is all about. Unfortunately, wellness vendors don’t understand evidence — or for that matter healthcare itself. Many vendors have no knowledge of basics like clinical guidelines, or even arithmetic. One wonders how they can do their jobs as wellness vendors without understanding healthcare. And that brings us to the third reason that wellness (unlike healthcare) needs an ROI, which is…
…Wellness isn’t healthcare. Quite literally every other provider of physical healthcare–from heart surgeons to acupuncturists–needs to train, pass a test, get a license, take continuing education, and be subject to review by an oversight board. Not wellness vendors. You can become a wellness vendor for $67,000. “Up to” eight days of classroom and on-the-job-training are also included in that $67,000. (To put that in perspective, Four Seasons housekeepers get ten days of training.) The vendor that offers these franchises, Star Wellness, brags about how no healthcare background is needed to be a wellness vendor. A background in “sales or municipal administration” is perfectly sufficient.
So if you’re wondering why wellness vendors know so little about wellness, there’s your answer: they aren’t required to know anything about wellness. Knowing just a little exceeds the minimum requirement.
To conclude, here is our advice to workplace wellness vendors trying to justify what popular healthcare blogger Paul Levy calls the “wellness tax“: shut up and just be happy you still get to collect it, and that the authorities haven’t shut you down. (A doctor doing all this overscreening and billing for it would have been shut down.)
Don’t try to justify your hyperdiagnostic jihad on the basis of ROI or any other purpose other than enriching your bank accounts. Every time you try, you provide yet another reason why whatever college gave you a degree in anything other than advanced idiocy should lose its accreditation.
RAND’s Soeren Mattke said it best:
The industry went in with promises of 3-to-1 and 6-to-1 ROIs based on health care savings alone. Then research came out that said that’s not true. They said, “Fine, we are cost-neutral.” Now research says: “Maybe not even cost-neutral.” So they say: “It’s really about productivity, which we can’t really measure, but it’s an enormous return.”
In other words, whenever you invalidate one metric, they come up with another one. We then have to shoot that one down, and the cycle repeats. It’s invalidity-meets-Whack-A-Mole. After the healthcare spending ROI fiction imploded, Michael O’Donnell, editor of the wellness industry trade journal, asked dismissively: “Who cares about ROI anyway?”
Since ROI wasn’t working, they then tried value-on-investment (VOI), which turned out to show even greater losses than a straight ROI calculation.
Continuing that tradition, Michael O’Donnell of the American Journal of Health Promotion presents: Return on Allocated Resources, or ROAR. ROAR counts everything, including productivity. By counting everything, ROAR shows far greater losses than VOI.
Michael says that a 1% increase in productivity is worth $1933:
However, a much greater 3.75% (90 minutes of a 40-hour workweek) reduction in productivity only costs $2184:
How did he accomplish this sleight-of-hand, where a 1% increase in productivity practically offsets a 3.75% decrease? Simple: by putting both thumbs and every other appendage on the scale. He accounts for lost work time at an employee’s hourly rate. So far so good. However, he then applies a magic multiplier to the hourly rate to calculate increases in productivity based on hypothetically enhanced corporate revenues due to the productivity increase. So if payroll is 30% of revenues, and productivity climbs 1%, then revenues would also automatically climb 1%. That means in dollar terms revenues climb more than three times faster than productivity.
Had he used the same revenue multiplier for the certain 3.75% productivity decrease due to wellness-induced lost work time that he used for his speculative 1% productivity increase, his time-off-for-wellness scheme would cost a whopping $7143/employee/year.
And wellness vendors wonder why line managers are so reluctant to allow employees to work out on company time.
So while per-employee losses from wellness based purely on added healthcare spending and program expense are “only” in the three figures, the net reduction in productivity from a (speculative) 1% increase less a (certain) 3.75% decrease due to lost work time amount to a mind-boggling $5210/year.
And that is probably an understatement. The 3.75% lost work time due to wellness doesn’t include the time employees spend changing clothes after their workouts, lying on HRAs, standing in line to be screened and “coached,” complaining to HR that they haven’t received their incentive checks yet, and hanging out at the water cooler dissing the program.
If you’re keeping score at home, this is the third time Michael O’Donnell has strayed off message. Just like some people are convinced that Donald Trump is a closet Democrat trying to torpedo the GOP, you would be excused for thinking that Michael O’Donnell is a member of our Welligentsia group, trying to sow chaos amongst the Wellness Ignorati.
He isn’t, but nonetheless I count him among our greatest assets. First, he admitted that up to 95% of wellness programs don’t work. Then he admitted that studies done using randomized control trials lose money. And now this one, detailing — using his own math — by far the greatest losses that a wellness metric has ever shown.
Ron Goetzel is probably tearing his hair out over his crony’s unforced errors on the eve of our debate. Or, in the immortal words of the great philosopher Warren G. Harding: “I can handle my enemies. It’s my friends who have me pacing the floor at night.”
Michael O’Donnell is devoting the entire editorial page in the March issue of his wellness promotion journal to a moving plea for me (and Vik) to stop bullying Ron Goetzel. (Several people were thoughtful enough to send me an advance copy.) It’s not fun to be bullied. I know how Mr. Goetzel feels because a number of Penn State’s employees told me how upsetting it was to be bullied into disclosing intimate details about their sex lives in order to avoid $1200 fines. Oh, wait a second! Hmm…that was a program conceived by Ron Goetzel (and his Highmark cabal).
Despite repeated requests from the targets of this anti-employee jihad, Mr. Goetzel never apologized for his role in the Penn State debacle. In sharp contrast, I will be the first to apologize for the specific instances of bullying that I’ve done. (See the “prequel” for how this all came to be.) After all, two wrongs don’t make a right. (As a brief aside, I’m not sure our interactions could be classified as “bullying.” Victims of bullying are people who have repeatedly expressed a strong interest in being left alone, like the Penn State faculty did. By contrast, if a boxer decides to step into the ring time and time again expecting not to be knocked out with one punch but keeps getting knocked out with one punch, he can’t claim the other boxer bullied him.)
I apologize for questioning Mr. Goetzel’s ethics after he called his sponsor Health Fitness Corporation a “best practice” in wellness after HFC admitted lying about saving the lives of 514 alleged cancer victims who it turned out never had cancer in the first place. (HFC also didn’t disclose their sponsorship of Mr. Goetzel’s award that they won.)
I apologize for asking him 11 questions about his own statements that would have been difficult to answer since they highlighted their inconsistencies. As penance, I am perfectly happy to answer 11 questions that he might have about my statements to be published alongside of his answers to my questions.
I apologize for forcing him to admit that his client (the very same Koop Award sponsor, Health Fitness Corporation) had snookered him and his Koop Committee (including Michael O’Donnell) another time as well, with an outcomes claim that was obviously falsified but that somehow none of the self-proclaimed analytical experts on that Koop Award Committee noticed until the 4th time I pointed it out.
I apologize for pointing out that yet another Koop Award winner (and, of course, board member), Staywell, was also making up outcomes and also snookered his Committee.
I apologize that the business and lay media has treated his industry badly as a result of my and Vik (and others) bringing their misdeeds to their attention. The LA Times was very mean in calling wellness a “scam.” Shame on them! And the Incidental Economist? Really, I’d expect more civility from the New York Times’ economics blog. Huffpost? All Things Considered? Sheesh! What do you expect from liberals! Newsmax? The Federalist? Those right-wingers should be ashamed of themselves! And Harvard Business Review? RAND? Seems like everyone in the media is bullying Mr. Goetzel’s wellness industry. They should apologize too.
I apologize for observing that almost every award that his Koop Committee has given out in the last 5 years went to a company that was somehow connected to the Committee, either as a sponsor or through the Board of Directors, but didn’t disclose that connection in their award announcements.
I apologize for noting the sharply constrasting irony that Dr. C. Everett Koop himself was a man of great integrity.
I apologize for offering (scroll to final paragraph) Mr. O’Donnell, Mr. Goetzel, and all the other members of the Koop Committee half-price for my course in Critical Outcomes Report Analysis, so that they could learn how to analyze outcomes, which given the number of times they’ve all been snookered and embarrassed, is training they apparently could really use. I’m not saying it’s their fault they can’t do simple outcomes analysis. It’s possible that their mothers simply didn’t listen to enough Mozart when the Committee members were in their respective wombs.
I apologize for taking exception to being compared to “a climate change denier” and a “tobacco executive lying to Congress” in Mr. Goetzel’s webinar in which my work was singled out for typically fallacious criticism.
I apologize for actually believing him when he said he wanted to “respect the dignity of employees,” and offering to co-author an open letter to the Business Roundtable and others saying exactly what Mr. Goetzel said–and he declined. (Read that thread and you make the call. I studied his essay and tried to capture it in this letter…and offered him the opportunity to edit it, rather than sign it as is. I also apologize for not realizing why this offer was objectionable.)
I apologize for asking the organizations Mr. Goetzel is affiliated with (as noted in Mr. O’Donnell’s plaintive plea, I did indeed ask them — that email is available on request) whether and how they wanted their names used in conjunction with my reporting on the Nebraska state wellness program hijinks, rather than go ahead and use the names without their permission. (They wanted nothing to do with the Nebraska ethical scandal, by the way.)
Finally, I apologize for what Mr. O’Donnell calls “slander” (since I put everything on the public written record to avoid misunderstandings, I suspect he means “libel” but doesn’t understand the distinction between the two words) against Mr. Goetzel, and would once again urge Mr. Goetzel to tell me – publicly, right here on this site — exactly what I’ve said that is false so that I can take anything off this site that isn’t true. He hasn’t done this despite two $1000 offers. Yes, we did offer him $1000 twice: the self-imposed penalty in the rules of our site means that perpetrators get one week to answer our questions or tell us why we are wrong to ask them. If they do so, they get $1000. (Not sure how many other bullies offer to pay their “victims” $1000 not to be bullied. One would expect it to be the other way around.)
I apologize for not already offering Mr. Goetzel the opportuntiy to bully me. I’d love for him to challenge my outcomes, invent a clever nickname for me that describes how I might react if my statements are ever proven to be made up, ask me questions, debate me. Exactly the type of “bullying” I do to him I’d ask him to do to me. Please, Ron, don’t make me beg!
Further, I am happy to apologize for anything else, too. Just ask me. While we are on the subject of apologies, Mr. O’Donnell deserves one too. I apologize for pointing out that the meta-analysis of wellness programs published in his own journal says that randomized controlled trials of wellness programs show negative ROIs. Obviously it was an oversight by Mr. O’Donnell that any statement admitting wellness doesn’t work would be allowed into his journal. Shame on Vik and me for pointing out that his key article actually acknowledged a fact!
Postscript: Michael O’Donnell said that he wasn’t going name me (and Vik) so he wouldn’t embarrass us. We wrote a comment and said, thank you for your graciousness but we are thrilled to be “embarrassed” by being named. My suspicion is that he didn’t name me and won’t print the comment for a different reason altogether: It might encourage people to come to this site and actually think for themselves, which is the Wellness Ignorati’s second-worst nightmare (next to facts). We’ll see.
Postscript 2: As predicted, Michael O’Donnell did not publish the comment. While it’s his publication and he is allowed to censor it, this is typical of the ignorati. My comment was only to waive my right not to be embarrassed and name myself, but we were right: publishing that would have sent a few people to this site, and they may have learned to think for themselves.