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Ron Goetzel’s “Dumb and Dumber” Defense Deflects Latest Koop Award Ethical Scandal

By Al and Vik

Oh, the twists and turns as Ron “The Pretzel” Goetzel tries to wriggle out of all his ethical stumbles.

This time around, we thought we had nailed both him and his cabal handing out the ironically named C. Everett Koop Award to themselves and their friends based on made-up outcomes.  Specifically, this time they gave their sponsor (Health Fitness Corporation, or HFC) an award based on data that was obviously made up, that no non-sponsor could have gotten away with submitting.  This was the third such instance we’ve uncovered of a pattern of giving awards to sponsors for submitting invalid data while making sure that the award announcement contains no reference to the sponsorship.  (There are probably others; we’ve only examined 3, which might explain why we’ve only found 3.)

How obviously was the data made up?  Well, take a looksee at this slide, comparing participants to non-participants.  This is the classic wellness ignorati ruse:  pretending that non-motivated inactive non-participants can be used as a valid control for comparison to active, motivated participants.  The wellness ignorati would have us believe that any healthcare spending “separation” between the two groups can be attributed to wellness programs, not to inherent differences in motivation between the two groups.   Unfortunately for the ignorati, their own slide invalidates their own argument:  in 2005, the label “Baseline Year” shows there was no program to participate in, and yet – as their own slide shows – participants (in blue) significantly underspent non-participants (in red) nonetheless.  In Surviving Workplace Wellness, we call this “Wellness Meets Superman,” because the only way this could happen is for the earth to spin backwards.

total savings chart

Given that the 2005 baseline label was in plain view, we just assumed that HFC did not indeed have a program in place for this customer (Eastman Chemical) in 2005, which is why they called 2005 a “Baseline Year” instead of a “Treatment Year.”  Not actually having a program would logically explain why they said that didn’t have a program, and why they used that display or variations of it like the one below for 4 years with the exact same label.  Presumably if they had had a program in 2005, someone at HFC would have noticed during those 4 years and relabeled it accordingly.

Originally we thought the Koop Award Committee let this invalidating mistake slide because HFC — and for that matter, Eastman Chemical — sponsor the awards they somehow usually win.  But while trying to throw a bone to HFC, the Koop Award luminaries overlooked the profound implication that the year 2005 separation of would-be participants and non-participants self-invalidated essentially the entire wellness industry, meaning that is is an admission of guilt that the industry-standard methodology is made up.

Slide1 (1)Goetzel the Pretzel to the rescue.  He painstakingly explains away this prima facie invalidation.   Apparently the year 2005 was “unfortunately mislabeled.”  Note the pretzelesque use of the passive voice, like “the ballgame was rained out,” seemingly attributing this mislabeling to an act of either God or Kim-Jung-Un.  He is claiming that instead of noticing this invalidator and letting this analysis slide by with a wink-and-a-nod to their sponsor, none of the alleged analytical luminaries on the Koop Committee noticed that the most important slide in the winning application was mislabeled — even though this slide is in plain view.  We didn’t need Edward Snowden to hack into their system to blow up their scam.  They once again proved our mantra that “in wellness you don’t need to challenge the data to invalidate it. You merely need to read the data.  It will invalidate itself.”

We call this the “Dumb and Dumber” defense.  Given two choices, Goetzel the Pretzel would much prefer claiming sheer stupidity on the part of himself, his fellow Koop Award committee members like Staywell’s David Anderson and Wellsteps’ Steve Aldana, and his sponsor HFC, rather than admit the industry’s methodology is a scam and that they’ve been lying to us all these years to protect their incomes.

Still, the Dumb-and-Dumber defense is a tough sell.  You don’t need Sherlock Holmes, Hercule Poirot or even Inspector Clouseau to detect a few holes in the Pretzel’s twisted logic:

  • How could no one – no member of the Koop Award Committee or employee of Health Fitness Corporation (which used this as its “money slide” for years) – have noticed this until we pointed it out for the third time (the first two times not being as visible to the public)?
  • In early 2012, this slide was reproduced–with the permission of Health Fitness Corporation–right on p. 85 of Why Nobody Believes the Numbers, with the entire explanation of its hilarious impossibility. We know Mr. Goetzel read this book, because he copied material out of it before the publisher, John Wiley & Sons, made him stop.  So we are curious as to why it has taken until now for him to notice this “unfortunate mislabeling.”  Hmm…would the fact that it was just exposed to the world in Health Affairs have anything to do with this sudden epiphany?  We’re just sayin’…
  • If indeed it was just an “unfortunate mislabeling,” how come HFC has now expunged all references to this previously highlighted slide from their website, rather than simply change the label?

As regards the third point, we would recommend that next time Mr. Goetzel invokes the Dumb-and-Dumber defense, he coordinate his spin with his sponsor.

But let’s not overlook the biggest point:  the entire Koop Committee – including “numbers guys” like Milliman’s Bruce Pyenson and Mercer’s Dan Gold — is apparently incapable of reading a simple outcomes slide, as they’ve proven over and over.

So, as a goodwill gesture, we will offer a 50% discount to all Koop Committee members for the Critical Outcomes Report Analysis course and certification. This course will help these committee members learn how to avoid the embarrassing mistakes they consistently otherwise make and (assuming they institute conflict-of-interest rules as well to require disclosure of sponsorships in award announcements) perhaps increase the odds that worthy candidates win their awards for a change.

Goetzel, Koop Committee, Staywell, Mercer, BP America meet Groundhog Day

Perhaps the strategy of the leaders of the wellness ignorati (who constitute the Koop Committee) is to overwhelm us with so many lies that we don’t have time to expose every one and still get home in time for dinner.

No sooner have we finished pointing out the numerous (and unrebutted) implausibilities and internal inconsistencies in Ron Goetzel’s posting on the value of workplace wellness, than the Koop Committee (Mr. Goetzel and his cabal) feeds us even more red meat:  They gave the 2014 Koop Award to British Petroleum.  However, apparently only British Petroleum wants to tell the world about it. The Koop Committee hasn’t even updated its own website to list 2014 award winners.

Recall that we’ve spent months excoriating Goetzel and his sidekicks (Wellsteps’ Steve Aldana, Milliman’s Bruce Pyenson, Mercer’s Dan Gold and the rest of them) for doing three things in the Nebraska award, for a program that prima facie seems to be in violation of Nebraska’s state contractor anti-fraud regulations:

(1)   Gave it to a program where the numbers were obviously fabricated and later admitted to be

(2)   Gave it to a program whose vendor sponsors the Committee

(3)   Forgot to disclose in the announcement that the vendor sponsors the Committee

Perhaps what you are about to read isn’t their fault.  Perhaps their mothers simply failed to play enough Mozart while the Committee members were in their respective wombs, but here’s how they applied the learning from the Nebraska embarrassment to their decision to award British Petroleum.  This time they:

(1)   Gave it to a program where the numbers had already been shown to be fabricated

(2)   Gave it to a program whose vendor sponsors the Committee

(3)   Forgot to disclose in the announcement that the vendor (Staywell) sponsors the Committee

(4)   Forgot to disclose in the announcement that the vendor sits on the Committee

(5)   Forgot to disclose in the announcement that the consulting firm (Mercer) sponsors the Committee

(6)   Forgot to disclose in the announcement that the consulting firm sits on the Committee

 

mercer staywell sponsorship

I suspect we will be writing a similar analysis again next year, when once again, the Committee will attempt to demonstrate the value of sponsoring a C. Everett Koop Award.

Is Mercer Cooking Staywell’s Books At British Petroleum?

StaywellMercer

Short Summary of Intervention:

Comprehensive wellness program offered to all American employees of British Petroleum.   Staywell was the vendor. Mercer was hired by British Petroleum to validate the savings claimed by Staywell.

Materials Being Reviewed

Summary of key figures and outcomes:

No visuals were provided. A review of the articles is recommended.

Questions for Staywell and Mercer

You claimed that spending would have increased by 10.5% instead of 7% across the entire company, absent the wellness program. Since only 1139 people reduced their risk factors (not including non-participants and dropouts whose risk factors might have increased), are you saying that by reducing a risk factor, those 1139 people were responsible for the entire difference in trend for the 62,000 employees and dependents versus the original trend you projected?

ANS: Refused to answer

The savings you are claiming works out to about $17,000 for each person whose risk factors declined, almost the equivalent of avoiding one heart attack for each person who reduced a risk factor. Are you suggesting that most of those 1139 would have had heart attacks otherwise, even though fewer than 200 American BP employees had a heart attack the previous year?

Note to Staywell’s and Mercer’s actuaries: if costs decline $17,000 every time someone reduces a risk factor and your spending is about a third of that level, you can wipe out your healthcare bill by getting a third of your employees to reduce a risk factor.

ANS: Refused to answer

How does $17,000 in savings for BP employee reducing a risk factor reconcile with Staywell’s own website claiming only $100 in savings for each person reducing a risk factor in a multi-employer study?

ANS: Refused to answer

How does this unprecedented savings reconcile with the PepsiCo findings, published in a leading journal (Health Affairs) by leading researchers (RAND), that concluded applying approximately the same interventions to PepsiCo’s workforce using the same consulting firm (Mercer) actually lost money?

ANS: Refused to answer

Did Mercer notice the discrepancy between Staywell’s alleged results and PepsiCo’s (and also Staywell’s own website) and inform British Petroleum of it, since Mercer’s job was to validate this program on behalf of British Petroleum and ensure that the savings were accurate?

ANS:  Refused to answer

Since a wellness program can only reduce wellness-sensitive medical events, how come you elected not to disclose the rate of wellness-sensitive medical events across the entire population before and after the program?

ANS:  Refused to answer

Did you inform British Petroleum that there was an article on The Health Care Blog about their program that reached the opposite conclusion you reached?

ANS: Refused to answer

Staywell employees Jessica Grossmeier (who authored the journal article) and Paul Terry (Chief Science Officer) were asked privately and by many of the people who posted comments to rebut The Health Care Blog and declined. Wouldn’t it have been a useful discussion to explain to readers how British Petroleum could have saved more than 100 times what you yourself said was possible?

ANS: Refused to answer

Health Fitness Corp wins a Koop award for curing non-existent cancers in Nebraska

C. Everett Koop National Health Award Committee,


Wellness Council of America and Health Fitness Corp.


Short Summary of Award:

The C. Everett Koop award committee’s mission is:

“…to seek out, evaluate, promote and distribute programs with demonstrated effectiveness in influencing personal health habits and the cost effective use of health care services. These programs have the objectives of

  • Providing appropriate quality care
  • Sharply reducing the alarming rate of health care inflation, by holding down unnecessary expenditures.”

Materials Being Reviewed:

The brochure in question describing the Nebraska program is downloadable from the WELCOA website.

Case Study of Award Winner for 2012: Health Fitness Corporation and Nebraska

Summary of key figures and outcomes:

Alleged cancer outcomes include the following:

cost-saving catches

Risk reduction outcomes include the following:

change in risk factors

Questions for C. Everett Koop Award Committee:

I: Alleged Cancer Outcomes

Were you troubled by the program sponsors’ decision to waive all age-related colon cancer screening guidelines established by the government, and send out 140,000 flyers, at taxpayer expense, featuring a beautiful woman much too young to have a screening colonoscopy?

age related colon cancer screenings

ANS: Refused to answer

How come, when the program reported that 514 of the 5000 (or fewer) people screened had colon cancer (in addition to the ones who would have been screened anyway), none of the Committee members with health informatics backgrounds from Truven Health Analytics and Mercer and Milliman (and from Wellsteps and Staywell, both of whose programs are also highlighted) were concerned that this alleged 11% colon cancer rate was at least 100 times greater than Love Canal’s?

ANS: Refused to answer

When Health Fitness Corporation admitted lying and reversed their story from making “life saving, cost-saving catches” of “early stage [colon] cancer” to revealing that those 514 people didn’t have cancer, why did the Koop Committee re-endorse what would appear to be outright data falsification, instead of rescinding the award?

ANS: Refused to answer

Even if the committee is allowing Health Fitness Corporation to keep its award and not even apologize, why does this claim of “life-saving, cost-saving catches” still appear on the WELCOA website even though the lie has been admitted?

ANS: Refused to answer

Wouldn’t the fact that the perpetrator of this acknowledged lie is also a sponsor of this Koop award that its own customers have won three times (including this incident) create the perception of a conflict of interest?

conflict of interest?

ANS: Refused to answer

Does anyone on the Committee think if Dr. Koop were still alive that he would endorse your position on data falsification of cancer victims?

ANS: Refused to answer

WELCOA’s website said it was founded by someone who appears to be the inventor of the self-serve all-you-can-eat restaurant. Despite his well-deserved reputation for integrity, did he endorse data falsification of cancer victims even after the perpetrators admitted it?

Warren Buffet?

ANS: Refused to answer (but did change the spelling)

II: Risk Reduction Outcomes

How do you reconcile the claimed savings figure exceeding $4-million with your own chart above showing that only 161 active participants (3.1%) reduced a risk factor? (That chart of course doesn’t include dropouts and non-participants, whose risk factors may have increased.)

ANS: Refused to answer

Dividing the total savings by 161 yields more than $20,000/person in savings. Wouldn’t that $20,000+ for each risk factor avoided imply that all 161 would have had a heart attack even though the entire eligible population only had about 30 heart attacks the previous year, while the participating population would have had about 7?

ANS: Refused to answer

How do you reconcile your statement that 40% of the population had previously undiagnosed high blood pressure or high cholesterol with your other statement that “the total number of prescription scripts [sic] filled within the Wellness Plan reduced [sic] 3% last year,” despite your reducing or waiving the copays? Shouldn’t prescriptions have gone up, if indeed 40% more people were at risk?

ANS: Refused to answer

How can you attribute the 3% reduction in prescriptions to “improved lifestyles” with the fact that your own graph shows only 161 people improved their lifestyles enough to reduce a risk factor? What happened to the thousands who were diagnosed but were neither medicated nor improved their lifestyles?

ANS: Refused to answer

How do you reconcile that same finding – that 40% had high blood pressure or cholesterol — with that same graph, showing that almost three-quarters of the population was low-risk?

ANS: Refused to answer

How do you reconcile the brochure’s claim that the “majority of employees touted how the program has improved their lives” with the brochure’s own admission that only a minority of employees (42%) even bothered to be screened once and only 25% twice despite the four-figure financial incentive?

ANS: Refused to answer


Follow-up response

Not-for-attribution response received August 1, stating that the reason the Committee let them keep their award was not because were a sponsor but rather because they did not make the life-saving claim on their application.  (They did make all the other invalid claims.)  Because they didn’t make the claim on the application, they are not in violation of the Committee’s ethical standards by making it in other venues.

Our reaction:

So it is OK if a ballplayer admits using steroids as long as he didn’t happen to test positive?


Follow-Up Response

September 2014: Nebraska listed as a “best practice program” by Ron Goetzel

Our Reaction:

Doesn’t this listing contradict your initial excuse — that you forgot to ask them about whether they made up their cancer statistics during your due diligence — because now you know about that lie and all the other lies in their outcomes measurement…and yet you still call them a best-practice program?

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