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It’s not just that Maryland is setting the record for most epic financial fail ever recorded in wellness. We are also bringing you an eyewitness account from the Belly of the Beast, an employee willing to give out her name in order to help spare other state employees and taxpayers the pain of this program.
The Most Epic Fail Ever?
Maryland is on track to miss its savings goals by 18 decimal places. To put that in perspective, the total economic output of the world sums to only 14 decimal places.
Here’s how the math works. The state is claiming that avoiding wellness-sensitive medical events will save $4 billion dollars — a number with 10 decimals. Thanks in part to Maryland’s lowest-in-country hospital rates of about $20,000/heart attack, the state would have to avoid 20,000 heart attacks a year to do this. No easy feat when the entire insured Maryland population — all private- and public-sector employees and their families combined — only suffer about 2700 heart attacks/year.
Plus, in the history of wellness, it appears that not a single heart attack, or for that matter, diabetes event, has ever been avoided. (More likely, a few have been avoided, but a few also have been caused by employees taking bad wellness vendor advice.)
Put yet another way, that’s $4000/family/year in savings. Achieving that outcome that would require wiping out all hospitalizations on all state employees and dependents, along with some of their closest friends.
Taxpayers, this is on you
Meanwhile, Maryland state taxpayers are paying Optum on the magnitude of $70,000,000 (8 decimal places) over this period, plus the cost of hundreds of thousands of useless and possibly counterproductive coerced checkups.
The best-case scenario? It’s a very safe bet–one I am willing to make to the tune of $3-million and give out 10-to-1 odds– that they will save nothing. That’s 10 decimals in missed savings targets and 8 decimals in fees — a truly epic fail of 18 decimal places.
And yet even this is an optimistic assessment. Like both other public sector employers — Connecticut and Boise — which have reported outcomes, Maryland’s program will likely drive up spending and possibly harm their employees. And if you guessed that Optum’s contract calls for them to receive bonuses based on invalid measurement of non-existent savings, then update your resume. You are too smart to be in this field.
Further, Optum (through its representation on the board of the wellness trade association), has already publicly admitted wellness loses money. Their cabal tried to take that back by pretending they lied when they admitted it, but it turned out they lied when they said they lied. The data was real, meaning the admission was real.
It happens that I know two state employees. One bragged to me about how their entire quasi-public organization was able to dodge this program because everyone hated it so much. The other shared her “wellness” story, a typical one rather than the stories of great harms, or the experiences of employees who make constructive comments in the lay media, such as: “I’d like to punch them in the face.”
Instead, her story sounds like every other employee wellness story — with the notable exception that she is allowing me to use her name, since she no longer works for the state and is concerned about the stress and potential harms caused to employees, including her former colleagues. (Plus, as a taxpayer, she’d like her $50 back, representing her share of the total program expense.)
Her name is Alice, and here is her experience. (Anyone who would like her last name and contact info may contact me and I will pass that along to her. She is willing to talk, though not for attribution.)
As a state employee and with my entire family being on the state plan, my husband and I have had the joy of recently completing our wellness assessments. Here is my rant:
First, it’s a giant pain in the butt. Second, the questionnaire could not have been more ridiculous and third, my doctor didn’t really do anything with it. She just gets to bill an unnecessary office visit to the state, in order to sign a form.
On the first topic, the questionnaire took 45 min for each of us, plus the inconvenience of having to schedule and go to an appointment we didn’t need. And in my case, having just gone through 9 months of prenatal care, labor and delivery care and postpartum care on top of all the newborn appointments, the last thing I needed was another doctor’s appointment.
On the second point, the questions they asked were terrible for assessing my actual health. There was an obvious right answer in every case, and it seemed to want to judge my mental health/level of happiness more than actual health. “Think of yourself on a ladder in terms of xxx (happiness, social status, personal accomplishments). What rung on the ladder would you place yourself, 1 being the lowest and 10 the highest?” How does that assess my health? It’s a personal fulfillment questionnaire that also asks if you exercise. At the end they ask for all these lab values which I don’t have and my doctor didn’t think she was supposed to request so they aren’t filled out at all.
And on the last point, my doctor never looked at the 30 page final assessment that I had to print and she just asked me if I think I’m healthy and I said yes. She was fine with that. The only thing she told me was that I could lose a few pounds to get my BMI in the right place – well OF COURSE! I just had a baby, which on a side note is not a part of the wellness assessment at all. There are all these questions about how much sleep I’m getting, am I stressed, etc… but no accounting for the natural things that happen in life like a newborn.
Shame, shame, shame on Alice!
Like every other Maryland employee, Alice needs to pull her weight, if she ever expects to account for her $40,000 share of the $4 billion in savings. Unfortunately, according to the actual arithmetic, she is already way behind in her quest. She hasn’t saved a nickel but has cost the state:
- 1 doctor bill
- 1 vendor fee
- 30 pages of paper from needlessly destroyed trees
- 45 minutes of lost productivity completing her kumbaya assessment, plus the time spent at the doctor
Fortunately, the doctor didn’t realize she was supposed to run (and charge for) a bunch of lab tests, so she saved the state some money there.
Where should the state go from here?
A quick plausibility test should determine that they didn’t save anything to speak of. Then Optum should be forced to give their money back, and issue an apology to Alice and others for wasting their time. The Attorney General should announce to overjoyed state employees that they are no longer required to do this — and that he just saved the taxpayers $70 million. Then he should run for governor. Alice could be his running mate.
Where will the state go from here? Like Connecticut and Boise, in exactly the opposite direction. The state HR people will claim they are heroes, using the classic combination of regression to the mean, ignoring dropouts, and participants-vs-non-participants study design, to pretend to show how much employees love the program and how much money it’s saving. When carefully read, of course, the data will show the opposite.
They will also find one state employee willing to claim he or she started eating more broccoli. As for the rest? For a more typical assessment of the Maryland program, I would recommend that the state, in the immortal words of those great philosophers Jefferson Airplane, go ask Alice.
This completes our year-end series on the Goofuses and Gallants of the wellness industry. See:
- Announcing the 2016 Deplorables Awards
- Wellness Industry Stars of 2016
- So Many Candidates for the Deplorables Award Countdown, So Few Numbers between 1 and 10
- Wellness Stars of 2016, Part 2.
Are you smarter than an award-winning wellness vendor? Take this quiz and find out.
Q: How is the first unlike the second?
The first, Wellsteps CEO Steve Aldana, claims that it’s bananas that provide magical powers. And unlike Popeye and spinach, he doesn’t think we need to consume massive quantities. “Even one more bite of a banana” is all it takes to reduce overall costs by fully a third, despite their admission that costs for individual employees increase by about the same amount over the same period.
Yes, you read that right, and, yes, is it mathematically impossible for a number to go up and down at the same time. I noted in Wellsteps Stumbles Onward that Wellsteps had accidentally told the truth on the second display showing increasing costs, thus totally contradicting the first. The second display subsequently disappeared.
Perhaps Wellsteps deliberately made up the first slide to fool people (in this case, the Boise School District). The more charitable explanation, which shows Wellsteps in a better light, is that they didn’t deliberately lie when they said costs increased and decreased at the same time. Instead, they were simply confused by their own stupidity.
Lying is a Business Strategy
Wellsteps’ Linkedin group is called Wellness is a Business Strategy. I was banned from posting on it, accompanied by the following invocation of the First Amendment:
“It has come to our attention that an outspoken critic has entered false data into these calculators in order to make a point. We certainly support free speech; however, we wonder how valid the point can be when it is based on false data?” [Where “false data” is defined as “any data”]
Sounds like they support free speech…except when they don’t. Speaking of supporting free speech, they claimed in bright red letters — for no apparent reason other than they were probably suffering withdrawal symptoms from having gone a whole week without lying — that they had convinced Linkedin to ban us from posting. And yet many of you clicked through from linkedin. So here we are, posting.
Stupid is a Business Strategy
Wellsteps’ ROI model doesn’t generate an ROI. It doesn’t even generate a savings projection. What does it “generate”? One number: $1359. Yes, it always gives the same answer ($1359 savings per employee) if you zero out “annual cost increases” in their model to control for inflation. So anyone can see this model simply makes no sense, notwithstanding Wellsteps’ insistence that it is “based on every ROI study ever published.”
How stupid is Wellsteps’ model? Even Ron Goetzel refused to defend it. And when Ron Goetzel won’t defend stupid data fabricated by his friends, you know it’s bad.
Harming Employees is a Business Strategy
To win the Deplorables Award, outlying and outstupiding other vendors is a dicey strategy due to all the competition trying to do the same thing. So Wellsteps decided to boldly go where no vendor has gone before: they acknowledged, even bragged about, harming employees. Sure, plenty of vendors harm employees–by enticing them into crash-dieting contests, flouting clinical guidelines or giving them worthless nutritional supplements and billing their insurers. But no one had ever documented the before-after harms of wellness as conscientiously as Wellsteps did, which I helpfully displayed in detail.
Insults are a Business Strategy
What the judges here at TSW especially liked about Wellsteps’ candidacy for the Deplorables Award was their track record of not just harms and deceit, but also insults. Very clever ones too.
For instance, Wellsteps’ rebutted my observation that all their data is fabricated by saying I’m full of “hot air.” Touche!
One would think that that this guy (Mr. Aldana’s crony) could have come up with a better counterargument, given that he claims to have spent “11 years in college.” If you’re keeping score at home, that’s four more years than Bluto Blutarski.
Here are a few more targets of their ripostes:
- Everyone who is overweight: “It’s fun to get fat. It’s fun to be lazy.” They skewered 2/3 of the population in 10 words. Bada-bing!
- Sharon Begley, arguably the best health/science journalist of our generation. Mr. Aldana called her a “lier.” Her crime? Quoting him verbatim.
- WELCOA‘s exemplary leader, Ryan Piccarello. For not wanting to harm employees, Ryan is apparently part of a “gang of bullies.”
Such brilliant repartee, in an earlier generation, would have landed them a seat at the Algonquin Roundtable.
Bananas are a Business Strategy
So, congratulations to Wellsteps for winning their first Deplorables Award. Darwin will take it from here, and maybe get them a new gig more appropriate to their capabilities.
We are going to make a prediction. We might be wrong, though, because in the immortal words of the great philosopher Yogi Berra, “It’s tough to make predictions, especially about the future.” We predict that the Boise School District, a Wellsteps customer, is going to win the 2015 Koop Award. At a minimum, they will get an honorable mention.
We base this prediction on three insights. First, as our previous posting shows, the award tends to go to the program that spews the most nonsense. Specifically, to the one that ignores both biostatistics and fifth-grade math most creatively. Obviously, Wellsteps misunderstands the statistical concept of regression to the mean. Misunderstanding biostatistics is a requirement for being a wellness vendor. What’s more surprising is that they were absent that day in third grade when the teacher explained the law of math that numbers can’t increase and decrease at the same time. Laws of math tend to be strictly enforced.
In all fairness, it is possible that both Wellsteps’ claims are true: total costs may very well have declined even as cost/person increased. The Boise School District might simply employ or insure fewer people in 2014 than in 2011. Or maybe the Wellsteps program was so unpopular and worthless that employees opted to get insurance through their spouses. But even the most dishonest wellness vendor with the most clueless customer wouldn’t claim credit for a reduction in costs due to fewer people being insured. And even the ethically challenged Koop Committee isn’t dishonest enough to endorse a claim that blatantly specious.
Second, the award almost always goes to a client or customer of a Koop Award Committee member, or to a client or customer of a sponsor of the Committee. Wellsteps’ Steve Aldana sits on the Committee. All the other vendors and sponsors on this Committee have already been graced with an award for one of their customers. So now it’s Wellsteps’ turn, as they have yet to win one for a customer of any size. (This partly reflects their lack of customers of any size.)
After all, why even bother being on this C.Everett Koop Award committee if you can’t give a C. Everett Koop Award to yourself? Isn’t that what Dr. C. Everett Koop was all about — self-dealing, cronyism and corruption? (not)
Third, the timing of the “White Paper” Wellsteps just published is quite fortuitous. Sort of like in World War I, when one side knew an infantry attack was coming because it was preceded by an artillery bombardment by the other side, Wellsteps is preparing us for more “over the top” claims of success in a program that — by their own admission — was a total failure at controlling costs through 2013, and only did OK in 2014 because the cost of non-participants declined precipitously.
Fourth, if the Committee was at all on the fence, our posting last month would have helped them decide in favor of Wellsteps. One thing this Committee enjoys doing is showing us that facts and math doesn’t matter because their customers don’t read our material. The more outrageous their claims, the more they like to rub our faces in the reality that very few people in human resources care what we have to say.
This isn’t because they have, to use Mr. Aldana’s hilariously misinformed term, I-don’t-care-itis. Instead it’s because most HR executives don’t hear what we have to say, as we are blocked from most linked-in groups run by members of the wellness ignorati.
We are actually quite proud of the enemies we’ve made…but even so would appreciate if you could re-post this.
Update: it is also possible that Wellsteps didn’t get their act together in time to apply for this award–applications were due in May and their White Paper just came out last month. In that case, we’ll look forward to revisiting this post next year.
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.
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.
Short Summary of Intervention:
“At Wellsteps, we’ve created a series of research-based ROI calculators to help you estimate the effect of well-designed wellness programs on health care costs, absenteeism, and presenteeism. Each of the three ROI calculators will examine a different employee expense and will help you determine whether investing in wellness strategies makes sense for your company. A well-designed wellness program is one that changes the health behaviors of employees, spouses, and dependents, and lowers health risks, reduces chronic disease, and helps worksites create a culture of health. The design of the WellSteps turnkey wellness solution was based partly on this body of evidence.”
Materials Being Reviewed:
Wellsteps ROI Calculator . You input your number of employees, health spending, and goals for obesity and smoking cessation. The calculator will tell you how much money you can save through the Wellsteps program.
Summary of key figures and outcomes:
Questions for Wellsteps:
In the first example above, your model calculated massive savings even with no change in obesity and smoking. In the second example, your model calculated the same massive savings even with a huge increase in obesity and smoking. It seems that no matter what smoking and obesity data we enter once we factor out inflation itself, your ROI calculator reduces healthcare costs to a level below zero by 2019. How is this possible?
ANS: Refused to answer
Shouldn’t a spike in smoking and obesity rates from 0% to 99% increase healthcare spending rather than reduce it?
ANS: Refused to answer
Your May 2014 email blast, sent out a few days after The Health Care Blog exposed your ROI model as being invalid, says your model is supported by “every wellness ROI study ever published” (a step up from being “research-based” on a “body of evidence” as your website says). We recognize that asking you to list “every wellness ROI study ever published” would be burdensome, but could you direct us to just one study that says increasing smoking and obesity can improve workforce health and/or reduce healthcare costs to below zero?
ANS: Refused to answer
Does “every wellness ROI study ever published” include the RAND studies in Health Affairs that have found negative ROIs?
ANS: Refused to answer
How are you able to “guarantee” this ROI, since it is impossible to reduce spending to a negative number?
ANS: Refused to answer
Since you’ve known that the Wellsteps ROI Calculator is invalid since this fact was pointed out to you in October 2013 and you have updated your model twice since then, how come you have elected to continue to overstate savings by a mathematically impossible figure?
ANS: Refused to answer
You lead your marketing blast by saying that “11,000 brokers and consultants” have used this ROI model? Are we the first of those 11,000 people to observe negative savings?
ANS: Refused to answer
Do you see any irony in publicly accusing one of the principals of this website, Al Lewis, of acting like a “tobacco executive lying to Congress” when even tobacco executives wouldn’t claim that smoking reduces healthcare costs like your model says it does?
ANS: Refused to answer
Where in your “ROI Calculator” can I find the ROI?
ANS: Their ROI Calculator doesn’t calculate an ROI so there was no point in even asking them to answer this question. The good news about Wellsteps is that NASA employees don’t have to worry about job security because these people are not rocket scientists.
Update: July 16, 2014
Addendum: Wellsteps accusation that I “entered false data” into the ROI calculator was posted on the “Wellness Is a Business Strategy” Linkedin Group
“It has come to our attention that an outspoken critic has entered false data into these calculators in order to make a point. We certainly support free speech; however, we wonder how valid the point can be when it is based on false data?”
“Use valid estimates for the percent of the current obese and smokers in an employee population. We provide the estimated default numbers based on national data of 33% and 20% respectively in all three calculators. In our combined 50 years of academic and consulting work, we cannot think of one employer with a 0% obesity AND 0% smoking rate. Again, valid estimates work best.”
Actually, we ran every combination of data from a reduction of 99% in smoking and obesity rates to an increase of 99% in smoking and obesity rates. Some of that data might have been “false” (whatever that means), but the result was always the same: $1358.85 in savings/employee by 2019. Here are two more examples, this time using the default numbers they recommended. The first is @$5000/employee in annual costs, with no change in smoking or obesity. The second is @50,000/employee. The answer is still the same.
How come, regardless of what assumptions get entered (and we have now entered many vastly different combinations of cost and success), the answer is always that by 2019, you save $1,358.85 per employee once you zero out inflation?
ANS: Refused to answer
Would you now admit that entering $5000/employee in spending and 33% obesity and 20% smoking (the national averages) constitute, in your words, “valid estimates that work best” ?
ANS: Refused to answer
Following my exposé, your model no longer allows a user to enter increases in smoking and obesity. Is this to prevent users from figuring out that even if the rates of smoking and obesity increase, the math underlying your model based on “every ROI study ever published” will still show a reduction of $1,358.85/employee in 2019?
ANS: Refused to answer
How come the model shows that very same $1358.85 (now finally “rounded” to $1359) potential savings from reducing obesity and smoking even if I start out with no smokers or obese employees?
Update–May 1, 2015: Wellsteps Doubles Down on Dishonesty
Two people forwarded us this, a sequel to their email that their ROI model is “based on every ROI study ever published”:
Update–September 10, 2015: Wellsteps Triples Down on Dishonesty
Somehow they reported costs going up and down at the same time. Even wellness industry math doesn’t allow that.