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Wellness Stars of 2016, part 2
Last week I highlighted the first cavalcade of Wellness Stars of 2016, deftly juxtaposed with the popular Wellness Deplorables Award annual countdown. (The actual countdown has to be done in three parts, with #1 still to come. So many candidates, so few numbers between 1 and 10.)
Today we again switch back from the Deplorables to the Stars, in nonprofits, government, and the private sector. We’ll end with shout-outs to some individuals.
Nonprofit Advocacy and Government Groups
A number of organizations have distinguished themselves in 2016. AARP is right out in front, advocating for employee rights. AARP is right out in front, advocating for employee rights. They see involuntary wellness poking and prodding as highly disproportionately discriminatory against older employees (which we would observe is just one of wellness’s many charming features). Since older people are more likely to weight more, have higher blood pressure, diabetes, and more trouble losing weight, etc., they are more likely to want to withhold health information from their employers for fear of discrimination, but instead will be penalized by these programs into surrendering it, with wellness promoters advocating even more penalties.
Next is NIOSH, the National Institute of Occupational Safety and Health. Withstanding the pressure from their CDC overlords who have gotten completely drunk on wellness Kool-Aid, NIOSH wrote an amazingly thoughtful vision for the next 10 years of “Total Worker Health“…without even mentioning the word wellness. Why? For the simple reason that hiring a vendor to pry, poke and prod employees in excess of US Preventive Services Task Force (USPSTF) guidelines has virtually nothing to do with real occupational health and safety — except, as in the case of crash-dieting contests and/or Wellsteps, to damage it.
And speaking of USPSTF, hats off to them. They have withstood the pressure from various specialty societies and the National Business Group on Health (NBGH is now the leading wellness vendor shill in Washington) demanding more screenings, and threatening to oppose their funding if they don’t deliver. The actual science always favors USPSTF in these debates, but the whiners have plenty of money to support their very specific agenda: overscreening today, overscreening tomorrow, overscreening forever. (Those with long memories recall when USPSTF revised its mammogram recommendations to be consistent with the evidence…and almost lost their funding as a result.)
Also on the nonprofit scene would be the former National Business Coalition on Health, now renamed the National Alliance of Healthcare Purchaser Coalitions, in order not to be confused with NBGH, and hence not be accidentally sullied by the latter’s reputation. The regional coalitions that comprise the national group also take their roles defending employers seriously.
In particular, the Midwest, Philadelphia, Northeast, Pittsburgh and South Carolina coalitions deserve extra plaudits. I’ve participated in each of those regional events and consistently have found them to be among the best of the employee health conference genre. The speakers are well-vetted, and it’s not a vendorfest. And the food is consistently good too. One was even covered by the local media.
And if there were an advocacy organization hall of fame, Leapfrog Group would be the first inductee. For years they’ve been getting hollered at by hospitals for ranking them objectively, and lobbying for more transparency in medical error reporting. Since “pry, poke and prod” overscreening is one humongous medical error, needless to say Leapfrog has been visibly opposed to it, and highly supportive of our efforts…and also can be as funny as we are on that subject.
The Private Sector
First is Medencentive. Whereas most employee health vendors generate tons of comments demanding the program’s removal (Penn State received about 2000 employee signatures demanding the removal of their Goetzel-inspired debacle before they finally caved), Medencentive generated over 3,000 users signatures in support of their program…out of only 21,000 eligible people, over a brief 45-day period. You might say: “Oh, well, their program must be tied to some huge incentive.” Actually, it’s only $15 per office visit.
A list of other companies worth of mention would include, as always, Quantum Health. When Cooperstown builds the Employee Health Program Hall of Fame, Quantum will be the first inductee. While what they do is most important, what they don’t do is also notable: they don’t chase down healthy employees to pry, poke and prod them. They focus only on employees who can benefit from their assistance. That shouldn’t be rocket science, and yet focusing only on employees in need who want help is the opposite of the typical wellness vendor “hyperdiagnosis” model.
I would also like to give a shout-out to Welltok, which received validation from the Validation Institute, for creating some of the best analysis I’ve ever seen to show noticeable and completely valid impact of their program.
Wellable, right here in Boston, publishes a newsletter that is a must-read, due to its sensible and literate takes on the wellness scene and speaking of sensible and literate, that brings us to…
People
…the industry’s drop-everything-and-read blog, when he actually gets around to writing it, is Bob Merberg’s In tEWn. To say Bob’s smackdown of Ron Goetzel’s Graco fiction was Al-worthy is an insult to Bob. He even found obvious lies missed by even the guy Mr. Goetzel calls “sharp-eyed Al Lewis.” (That explains it. All this time I thought Ron’s analysis was wrong all the time because he was dishonest. Turns out it’s only because he didn’t get LASIK and I did.)
To be sure, Mr. Goetzel’s reports in general — and Graco in particular — are a target-rich environment but even so, Bob’s was an impressive piece of peer review. Though to call this “peer review” is also an insult to Bob.
I am also a big fan of postings by Fred Goldstein, Bill McPeck and Dean Witherspoon even if I don’t always agree with them, and am pleased to add them to the Stars list despite the occasional disagreement. I am not interested in conformity but rather just in basing a debate on facts.
The up-and-comer on the scene among individuals? That would have to be Dave Chase. Dave is putting together The Big Heist, a documentary series on ripoffs in healthcare, naturally featuring wellness. You can look at his master list to find other “Good Guys.” Big Bang Health is such a Good Guy, also an up-and-comer. Phia Group, also a charter Good Guy, enjoys a well-deserved top-flight reputation in designing benefits plans incorporating state of the art cost and risk reduction techniques — and is also certain to be featured in Dave Chase’s magnum opus.
And three cheers for the industry’s #1 podcasters, James Kelley and Michael Prager. No one has ever found a material inaccuracy in this blog and I don’t want to start now so just for the record, Michael’s is on video. Speaking of which, Michael hasn’t found “inaccuracies” but he has made observations that helped me tighten or tweak my language, on two occasions, so thank you for that. Rachel Druckenmiller and Michelle Spehr have also contributed very insightful comments and postings and I look forward to highlighting them separately.
Meanwhile, more astute commenters on TSW worthy of mention: Dell Dorn and Doug Dame (I don’t think those are the same person, but then again, has anyone ever seen them in a room together?), and a big shout-out to Robert Dawkins for finding a fallacy in McKesson’s stillborn overvendored, underperforming, program that, as with Bob’s Graco analysis, even sharp-eyed Al Lewis missed. While McKesson’s program basically accomplished nothing, I did give them credit for a 1% reduction in tobacco use. Mr. Dawkins pointed out that over that same period, US tobacco use in general fell by that very same 1%. Frank Pennachio also has our backs and pushes out much of our material to the workers comp community.
Now that you are all done puking, rest assured that for my last post of the year, next week, I will step back into character and name the Winner of the 2016 Wellness Deplorables Award.
Until then, in the spirit of the season, we graciously offer all the Wellness Ignorati, Ron “the Pretzel” Goetzel, and all the Deplorables a very
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Koop Award Committee-meets-Sergeant Schultz
Ever wonder why no one notices that wellness results are completely made up?
Wonder no longer. it all starts with The Health Project, which gives out the C. Everett Koop Award. This month is award season, meaning some of the award’s sponsors or committee members gets to ingratiate themselves with customers. In honor of this month, let’s review previous years’ awards, and see the self-invalidating, but somehow unnoticed, details that call to mind the immortal words of the great philosopher Sergeant Wolfgang Schultz: “I know nothing. I see nothing. I hear nothing.”
To that iconic phrase, the Koop Committee adds: “I notice nothing.”
2014: British Petroleum (BP America)
Last year, the award went to British Petroleum. BP’s candidacy wasn’t exactly a longshot, since both its vendor (Staywell) and its consultant (Mercer) are on the Committee AND are “sponsors” of this volunteer committee. By the way, if you’re looking for any disclosure on the award announcement of those connections when you click through on the first sentence above, you’ll need x-ray vision, since there is none. No one seems to have noticed this omission.
Besides not understanding ethics, apparently Mercer and Staywell don’t understand arithmetic: their “rigorous analysis” claimed almost $20,000/person in savings for active participants who reduced a risk factor. Besides being mathematically impossible, clinically laughable, unchecked for plausibility in violation of their own HERO guidelines, and not adjusted for dropouts and non-participants, this figure, as the screen shot below shows, is over 100 times more than Staywell itself says is possible. Once again, no one seems to have noticed this glaring contradiction.
2013–GRACO (honorable mention)
Ron Goetzel has written at length about Graco, as have we and others. By starting the measurement in 2009, the year after the program started (as opposed to starting the measurement two years before the program started — see the 2011 award winner, Eastman Chemical), and “forgetting” to count revenues added by an acquisition. Mr. Goetzel was able to tie the growth in Graco’s revenues to the “bottom line performance” of its wellness program. Of course, when you actually start measuring the year the program actually started (2008) — which coincidentally was also the year before the recession knocked 29% out of Graco’s revenues — and then adjust for the 2012 acquisition’s added revenues, Graco organically grew at about the same rate as everyone else. Wellness had nothing to do with it. Graco’s salespeople did not exceed their quotas because they ate more broccoli.
Here’s what else didn’t happen due to its wellness program: savings. As our post showed, Mr. Goetzel didn’t notice that the cost trend for children (none of whom were in the wellness program) outperformed the cost trend for wellness participants. This means, of course, that the favorable trend among participants couldn’t be attributed to wellness, since the trend for a cohort without access to wellness was even more favorable. It’s all right here.
Oh, yes, and it also turns out that Graco’s insistence on making its employees go to the doctor was more likely to harm them than benefit them. That’s not us–that’s the New England Journal of Medicine.
2012: The State of Nebraska
We’ve already chronicled this one at length. There were quite a number of glaringly obvious rookie mistakes that escaped the notice of the award committee, either due to incompetence or perhaps the fact that the state’s vendor, Health Fitness Corporation (HFC), was also a sponsor of the award. See if you can find that sponsorship disclosure in their press release “congratulating” the State and LL Bean (the other winner, also a customer of HFC). You’ll need an electron microscope to go with your x-ray vision.
HFC actually admitted lying about saving the lives of cancer victims who as it turned out didn’t have cancer, but still got the award because, according to Ron Goetzel at the 2014 Datapalooza conference, apparently this particular lie didn’t count because it wasn’t on their application, just everywhere else. It was impossible to miss, but Ron said he didn’t notice. Is this a great country or what?
2011: Eastman Chemical
Another HFC customer. (HFC is really getting its money’s worth out of its sponsorship.) This was the one where — unlike 2013’s Graco, which started measuring outcomes the year after the program started in order to maximize the results — HFC started measuring outcomes two years before the program started in order to maximize the results. They separated participants and non-participants in 2004 but didn’t start the program until 2006. By 2005 the would-be “participants” were already 9% ahead…and by the time the program got underway in 2006, they were almost 20% lower-cost than the non-participants.
Once again, all this information was perfectly obvious at the time of the award submission, as well as highlighted in all of my books. It was also re-printed and re-presented multiple times, but somehow no one on the Koop Committee noticed until late 2014, when it was in Health Affairs. At that point, the light being shined on him being too glaring to hide from, Mr. Goetzel had to respond. Employing the passive voice to great advantage, Ron said the slide was “unfortunately mislabeled.”
Read that carefully. If it’s hard to read, here is the source. It’s towards the bottom. He says this slide and other data “convinced” the Koop Committee to give them an award. That’s his story and he’s sticking to it.
Recently, for the second time, he went back into the Koop Award submissions and rewrote history. Compare the original Koop submission screen shot with the photoshopped version. Note the missing X-axis:
The original was:
His explanation didn’t indicate who mislabeled this slide, why he didn’t notice until now, why he snuck into the old files to relabel it, what the labels should have read — or why HFC never apologized, as others outside the wellness industry do when mistakes are made.
I can explain the last — just look at the wellness industry motto, on YouTube: “A Koop Award means never having to say you’re sorry.”
2010: Pfizer
None of Pfizer’s outcomes figures stand up to even the slightest scrutiny, and Mercer did the analysis — making Pfizer a shoo-in for this award. By their own admission only 4% of people moved out of high-risk status. (Naturally this tally excludes non-participants and dropouts, who likely increased risk factors at a faster rate than participants reduced them.) In other words out of 30,000 employees, 1200 reduced a risk factor. And yet somehow Pfizer saved $9.4 million, almost $9000 per risk factor. So if everyone at Pfizer reduced a risk factor, they’d easily wipe out all their healthcare spending.
They did some secure messaging, but only about a quarter of the at-risk population even opened their messages…and only about a quarter of them clicked through to the messaging.
Smokers self-reported at 6% before the program and 3% after it. No one hazarded a guess that perhaps some employees were, oh, I dunno, lying?
However, no one can accuse Pfizer of lying about their weight loss results. In particular check out this comparison, which was offered with a straight face, of employees who read their weight-loss messages vs. employees who didn’t.
Over the course of the study, people who didn’t read their messages gained 1.6 ounces while employees who did lost 2.9 ounces. You could practically attribute that differential performance to the calories required to open the emails.
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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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Britney Spears Meets Ron Goetzel’s Institute for Health and Productivity Studies
In the immortal words of the great philosopher Britney Spears, oops, they’re at it again.
How this “study” gets published and why Johns Hopkins would allow its name to be used on it is anyone’s guess. In our last posting, we pointed out that in one place Graco’s employees cost $11,100 apiece to insure, just like other companies that offer competitive benefits. Yet later on in the story we see that employees only cost $2280. No mention of how these figures could be so inconsistent.
We let the rest of the study go, figuring we had already found the Macguffin. Ace reporter Bob Merberg, though, was not so easily convinced.
We’d urge reading his blog. Among the claims made by Mr. Goetzel was “revenues have doubled since 2009.” Well, yeah, but:
(1) it turns out Graco made a sizable acquisition in 2012, which might have had a teeny-weeny effect on revenues;
(2) revenues had plummeted in 2009, the year after the wellness program was introduced.
If you (a) measure from 2008, the year the wellness program was introduced, instead of cherrypicking the baseline year to give the best result, and (b) factor out the acquisition, revenues over the 2008-2014 period have pretty much tracked the economy as a whole. So nothing happened.
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We can’t make this stuff up. Fortunately we don’t have to.
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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.
They Said What? 