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Wellness Shock-and-Awe: Federal Court OKs 100% Non-Participation Fines
While most of us were buying supplies for partying down on New Years Eve (in my case, I was in charge of bringing broccoli and Boggle), the federal court in the Western District of Wisconsin quietly handed down an earth-shattering decision in the Flambeau case, which pretty much went unnoticed due to the timing. You may recall that this was the case where employees refusing wellness lost all insurance benefits. The case looked like a layup win for the EEOC. After all, the Affordable Care Act clearly states that penalties for non-smokers are capped at 30%, and this was 100%.
But here’s the rub: Flambeau conditioned the entire insurance benefit on participation in their “pry, poke and prod” program. They knew most employees hate “pry, poke and prod” programs to begin with. So they created a program so onerous that some number of employees would prefer to forego insurance altogether than participate in wellness. And indeed, that’s what happened at Flambeau. This decision means they’re getting away with it, saving thousands of dollars apiece for each employee who refused to submit.
Make sure you catch that distinction between the 30% penalties and the 100% penalties:
(1) It is not OK to penalize an employee more than 30% for refusing to submit to a “pry, poke and prod” program if they already have insurance, or they can get insurance through the employer without this requirement.
(2) However, it is OK to say: “There is no incentive or penalty for wellness once you have insurance, but you can’t have insurance at all unless you submit.” If that seems like an artificial distinction, well, that’s because it is. All an employer has to do is require pry-poke-and-prod before you get insurance.
Assuming other federal courts follow this district’s lead (as they usually do), employers create a 100% de facto non-participation penalty: If you don’t participate, you don’t get insurance, period.
The implications of this case:
(1) It will allow some vendors, like Bravo, to double down on bragging about the “savings” from wellness by creating programs that employees don’t like;
(2) Because the decision only applies to participatory programs and not outcomes-based programs, many companies will either not switch to outcomes-based programs or else maybe switch back.
It also puts pressure on the EEOC to put the kibosh on this end-run around the ACA’s wellness provision. Note that the decision can and should be appealed. Otherwise it is a de facto repeal of a big chunk of the Affordable Care Act.
The bottom line is, now there is universal agreement (albeit inadvertently in the case of HERO, which apparently didn’t mean to tell the truth, but failed to proofread their own document) that wellness loses money. So any pretense of “pry, poke and prod” being about the employee is gone. Obviously, forced wellness isn’t about trying to save the $0.99 PMPM (that’s before program fees!) that HERO Says can be saved with healthier employees. It’s about gutting the key ACA requirement that employers provide insurance.
And unless the EEOC steps up in its final regulations and/or prevails on appeal of Flambeau, they will have succeeded.
Part 2 of the Proof: Even If Wellness Could Save Money, It Doesn’t
Recently we promised a Part 2 to our original proof that wellness savings are mathematically impossible. Commenters said: “How can you have a Part 2 to a proof? You just proved it.”
The previous proof showed wellness can’t save money, even if programs were perfect. This installment proves that even if wellness could save money, it hasn’t. Meaning even if wellness were free, it couldn’t pay for itself. So this proof is independent of the previous proof. For wellness to save money, the wellness true believers would have to find fallacies in both proofs. Either is sufficient to make our case…but we have both.
Quite literally, forcing employees to “do wellness” or lose money has avoided basically zero wellness-sensitive medical events in the 13 years ending 2013 (2014 data isn’t in yet), according to the federal government. If the name “federal government” sounds familiar, it’s because it’s the very same federal government that has passed a law encouraging vendors to pitch “pry, poke and prod” programs to you despite their complete lack of evidence basis, lack of effectiveness, and potential for harm.
Here is the way our analysis was done. We used the government database called the Healthcare Cost and Utilization Project, or HCUP. That database tracks all hospitalizations due to all causes, by population. So it is possible to focus on just the commercially insured population, which they call “privately insured.”
The privately insured population is 100% sensitive, meaning everyone whose workplace “offers” wellness is in that database. The database isn’t specific, meaning plenty of people in it do not have access to wellness. Nonetheless, the dramatic increase over the 13 years in the number of people whose employers push wellness should produce an equally dramatic decrease in wellness-sensitive medical events. While wellness was rare at the start of this analysis in 2001, today most large companies, nonprofits, and governments have wellness. In total, one can project from the Kaiser Family Foundation data that about 75-million people (or roughly half of all privately insured people) are subject to what Jon Robison has termed wellness-or-else.
Keep in mind that all hospitalizations have been declining over this 13-year period, due to shifts to outpatient, better usual care, etc. So the question is not whether WSMEs have been declining, but whether they have been declining faster than the rates of all other hospitalizations in combination due to the large and increasing “dose” of wellness” being applied to them.
Instead, as you can see, these WSME admissions have trended essentially flat over the period, as a percentage of all admissions. In other words, there is no difference between the decline in admissions for WSMEs – despite $7-billion/year being spent on vendors to prevent them – and the declines in every other category of hospitalization. 13 years ago about 6.9% of events were wellness-sensitive. Now it’s about 7.0%. (This is 2013. 2014 is also in, for our customers for whom we track WSMEs, and shows no change.)
This is based on ICD9s 401-405, 410, 430-438, and 250 — strokes, hypertensive events, heart attacks, and diabetes events.
To make the point visual, the “dose” of wellness probably quintupled, in total, over this period, so the directional expectation of the chart would be:
Prima facie, the debate is over, again, just like it was over after our last proof.
Needless to say, the true believers aren’t about to give up their revenue stream just because we’ve double-proved they’re fabricating savings. They will make two arguments against this proof of their own ineffectiveness. First, they’ll argue that wellness reduces all events and other costs equally, so really we should credit wellness for the total cost reduction, not the reduction in just wellness-sensitive admissions. This might seem like a pollyannish view of wellness, but wellness true believers attribute everything that’s good to wellness. True believer Bruce Sherman has even argued that wellness actually reduces industrial waste, so to a wellness true believer, eating more spinach makes every employee a Popeye.
Unfortunately for Bruce and others, the wellness industry’s own HERO report says wellness can only reduce WSMEs. Other costs go up, it says:
Second, one could argue that there isn’t enough penetration of wellness yet to bend this trend, since the HCUP privately insured population includes tons of people without access to wellness, and even many people with wellness access refuse to participate.
Unfortunately, that argument self-immolates. Vendor fees are $7 billion. All these WSME ICD9s combined (using the HERO-estimated admission cost of $22,500) amount to about $11.3 billion. That $11.3 billion includes the half of privately insured people who don’t have access to wellness. Already, when you cut that figure in half to account for those employees with employers who’ve decided not to “do wellness” to them, the $7 billion size of the wellness industry exceeds the size of avoidable events ($5.7 billion). This is consistent with our first proof, which showed the same thing, but on an individual company level. Now—assuming participation is 50%, you need to cut the WSME hospitalization total in half once again. You’re down to $2.85 billion in potentially avoidable events — that companies are spending $7 billion on vendors to avoid.
So, no matter how you look at it, “pry, poke and prod” programs have been singularly ineffective in reducing WSMEs. And if the HERO Guide is right that these are the only admissions wellness can avoid (while other costs increase, as they admit), wellness does not and cannot save money.
Instead, wellness-or-else is basically a pile of, um, industrial waste.
Anyone still want to try to claim the million-dollar reward for showing pry, poke and prod programs aren’t a total waste of resources? I didn’t think so.
Note: This graphical analysis is copyright 2015 to Quizzify. However, any disinterested researcher or journalist may request a copy of the backup material from us.
Wellness isn’t only junk science. It’s also junk arithmetic.
Vendors of “pry, poke and prod” programs often wax rhapsodic about “Wellness 2.0.” Translation: HRA-screening-checkup programs have historically failed. Likewise, vendors talk about how more “wellness champions” or better “communications plans” or higher incentives/penalties are needed to make wellness work–as though it’s HR’s fault vendors are misrepresenting what their programs can do.
Unfortunately for those vendors, tinkering with wellness is like tinkering with alchemy. Nothing can turn “pry, poke and prod” lead into gold. Understanding that wellness is alchemy is why we’ve offered the million-dollar reward…and also why that reward has had no takers. Wellness outcomes measurement is junk arithmetic, to go with the junk science of screening the stuffing out of employees in order to hyperdiagnose them. All told, vendored wellness is the kind of junk that gives junk a bad name.
We’ve covered the junk science at length, showing how vendor after vendor ignores clinical guidelines either because they don’t understand healthcare or because they want to maximize profits. Today we are covering junk arithmetic.
Here is Part One of the very simple mathematical proof of why “pry, poke and prod” can’t possibly save money. All this information comes from the wellness industry’s own materials, notably the HERO Outcomes Guidelines Report. They can’t “challenge the data” because it’s their data. All we’ve done is fashion it into a proof.
The Size of the Pie: “Potentially Preventable Hospitalizations” (PPHs)
The HERO Report places the current PPH rate at 2.62 per 1000. (It was once higher — 3.14, as noted below — but usual care improvements continue to reduce admissions for both asthma and cardio/IVD, reducing the need for wellness even as vendors insist that all your employees are getting sicker.)
That same page (23) of that same report lists the episode costs of a PPH at $22,500.
The product of those two components? About $59,000 per 1000 people, or $59/person.
And alas you can forget about adding other healthcare cost savings from wellness to that $59. That’s wishful thinking. The Goetzel crowd not only admits they don’t decrease, but says they are likely to increase (p.22)
The Cost of Wellness
Against that $59, what is the cost of a wellness program? $150/employee, according to Ron Goetzel. (Your cost could be higher or lower, obviously. Wellness vendors collect about $7 billion by prying, poking and prodding about 70 million people, so typical vendor fees are about $100.)
Therefore even a wellness program that eliminates every potentially preventable hospitalization without increasing doctor visits or those other listed expenses would lose money–$91, if Mr. Goetzel’s advice is taken.
And this is according to the wellness industry’s own cost figures, which of course are highly suspect, largely because their costs count vendor fees only. Our figures would add in all the other costs of wellness. Though the HERO Report ignored these other costs in its own calculations, it nonetheless listed them on p 11. (This list overlooks the hefty consulting fees involved in making up positive outcomes figures to show to the C-Suite. This is no surprise given that Mercer was a co-sponsor of this report.)
Also remember that this $91 loss is for a perfect wellness program –one that eliminates all $59 in spending with no added preventive services cost. Coming soon is the second half of the proof, showing that wellness programs are anything but perfect.
Show Wellness Isn’t an Epic Fail and Collect a $1-Million Reward
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.”
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.
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.
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.
Does HERO’s Model HRA Teach Employees to Lie?
This is the seventh in the series on the HERO Report, covering page 26 to 38. Six previous installments can be found here. A future installment will include a wellness savings calculator that you yourself can apply to determine whether the HERO report accurately captures your own economics or not. To make sure not to miss it, “follow” us on WordPress.
Employers learn a lot about their own companies when employees complete health risk assessments (HRAs). For instance, HRAs ask employees how many ounces of alcohol they consume. Wellness vendors then produce reports showing the statistical difference between the number of ounces of alcohol employees say they consume vs. the number of ounces of alcohol that employees with similar demographics actually consume, to show the extent of that company’s workforce dishonesty.
Haha, good one, Al. Obviously no wellness vendor does such an analysis. Doing that would require actual competence, one of two critical success factors — integrity being the other — conspicuously lacking in the wellness industry. (Exhibit A: this HERO report.) Instead, they summarize the self-reported drinking estimates with no qualification or comparison to national norms, as though these self-reported figures actually mean anything.
Not being wellness vendors and hence priding ourselves on our triple-digit IQs, we have done this analysis on multiple occasions. Here is a typical result:
According to self-reported estimates from this company, literally no one has a drinking problem and very few people drink at all. Time after time, we get the same result. Hence, self-reported estimates of alcohol consumption on HRAs are useless at best. At worst, asking this question simply encourages employees to lie. Somehow wellness vendors have never figured this out, despite their extensive experience in the lying department.
This chapter contains three other head-scratchers as well.
First, why this obsession with body mass index (BMI)? It is probably more important to be “fit and fat” than to attempt to diet and not exercise. You can’t get people to change multiple behaviors. HRA advice should be focused on fitness, rather than weight.
Second, speaking of weight, why hasn’t HERO gotten the memo that most fruit juice is junk food? Why are they urging the consumption of more sugars? Why do they equate fruit juice with healthy vegetables? Where is the up-to-date nutritional guidance? This isn’t rocket science. Quizzify incorporated this revised dietary guidance into its health education tool when it was first released, in March.
Third, why do HRAs obsess with seat belts? Seat belt use in the U.S. is at all-tme highs, but distracted driving is a serious problem that no HRA we’ve seen even mentions. If you are routinely hiring employees who don’t buckle their seat belts, but are texting and talking while driving, then you have bigger programs, and a computer print-out telling them to buckle their seat belts isn’t going to save anyone.
The Good News
Still, credit where credit is due. For the first time ever, we see the advice that HRAs recommend the shingles vaccine for employees 60 and older. Of course, we’ve never seen that recommendation in an actual HRA itself, though Quizzify covers it. Once again, covering shingles would require competence on the part of wellness vendors. Were a wellness vendor actually to recommend this vaccine, it would be an example of exactly why people should take HRAs: to learn something that they didn’t already know, that is easily implemented and that could prevent a debilitating illness. (By the way, there is some controversy as to the vaccine’s effectiveness. However, that’s not why HRAs don’t recommend it. They disregard it because vendors don’t know about it.)
And, aside from the fruit juice, there is no demonstrably bad advice in this model HRA. HRAs, of course, are notorious for bad advice, like telling males to get prostate tests, telling females without genetic predispositions to get mammograms before the recommended age of 50. And, don’t forget WebMD’s infamous testicle checks, one of the late-night TV staples from the Highmark-Goetzel Penn State debacle. Men who didn’t say whether they check their testicles every month – a D-rated idea, according to the US Preventive Services Task Force – faced a $1200 fine.
And while we realize that offering “no demonstrably bad advice” isn’t exactly a ringing endorsement, this chapter is the first in the HERO Report that isn’t mostly wrong.
Dan Ariely on how the Wellness Industry Crowdsources Reality
We recommend that everyone listen to Dan Ariely’s interview on NPR and TED talk “Why We Lie.” It explains exactly why the Wellness Ignorati could decide to collectively self-publish an entire guidebook full of misinformation and disinformation designed specifically to increase the revenues of wellness vendors.
Here are our take-aways from Professor Ariely’s TED Talk.
Like Walter White in Breaking Bad, the Ignorati started out honest. They genuinely believed that wellness saved money and that they were doing good. It was very counter-intuitive to believe otherwise. If you look at page 201 of Why Nobody Believes the Numbers, you’ll see I even mildly supported biometric screens. I hadn’t done the math. I just assumed early detection was a good thing and that Ron Goetzel and others was telling the truth, for which on page 83 I professed my admiration. As another example, ShapeUp’s CEO Rajiv Kumar would never have attacked us (largely for refusing to believe Kate Baicker, who even RAND now dismisses and who herself no longer appears to believe her own claim) if he had realized his own outcomes claims were false.
Like Walter White, it was easy to justify the first transgressions. Since the Wellness Ignorati genuinely believed in what they were doing, when the numbers didn’t add up, they either justified to themselves that it was OK to fudge them (like ShapeUp’s now-retracted claims about Highmark) or ignored glaring invalidating mistakes. The best example of the latter: Ron Goetzel finally recanting Health Fitness Corporation’s infamous participants-vs-non-participants self-immolation after years of ignoring it.
Or wellness vendors create a parallel universe where numbers don’t have to add up (like Keas), or completely misquote industry experts saying the opposite (like Vitality).
Like Walter White, they don’t actually believe they are bad people. Ariely calls this a “personal fudge factor.” With the possible exception of Wellsteps’ Steve Aldana (who may be honest but simply unable to recognize that no matter what numbers you enter into his model you get the same answer), they really think what they are doing is OK—even though the math clearly dictates otherwise.
Also like Walter White, they kept getting drawn deeper in. The more they lied, the more they have to keep lying. They needed to continue to defend what was looking increasingly indefensible. After giving Nebraska’s program a much-publicized and ironically named C. Everett Koop Award, it’s hard for Ron Goetzel and his committee to say “We goofed—we need to take it back because they made up the data and defrauded the state” even after the vendor, Health Fitness Corporation, admitted it.
Like Walter White, the Wellness Ignorati “suspend reality” (to use Ariely’s term) and “buy into a new reality.” Essentially the Ignorati crowdsource reality. They peer-review one another’s work, give themselves awards, and decide (to use Michael O’Donnell’s term) that anyone who challenges them lacks the “credentials” to do so. Or, as Ariely says: “If you were getting well-paid by Enron, wouldn’t you want to see reality as they present it?”
Avoiding the media is an excellent strategy. Once again, like Walter White, the Wellness Ignorati want to keep a low profile. Exposure is bad if the facts all go the other way. That explains Ron Goetzel’s refusal to debate, ever, and the Ignorati’s characterization of us as name-calling bullies when all we do is ask questions.
Yep, you can read this site up, down and sideways. The fact is no names are called other than the “Wellness Ignorati.” We’ve offered them the opportunity to propose a different name for their practice of denying facts, which they’ve declined. We do use the term “pretzel” to describe the very impressive twists and turns that Mr. Goetzel uses to wriggle out when he’s been caught calling failed or fraudulent programs “best practies” because they are run by friends, sponsors or clients. The alternative word for what one would be called when all your claims are made up is less flattering, and we’ve never used it with respect to Ron.
This explains why the Ignorati steadfastly refused to answer questions for a $1000 honorarium. Once again, like Walter White, they have so much as stake that $1000 is chicken feed. At Enron, if you questioned Ken Lay at an analyst conference, he would accuse you or not understanding their business, and cut you off from future meetings, rather than answer the question. We of course were not invited to participate in or even listen to the “discussion” about the HERO report.
Like Walter White, at some point the Wellness Ignorati needed to commit to their chosen path. The Wellness Ignorati have gone too far in their insistence that wellness saves money. There is no turning back. The existence of this site makes turning back even harder because retracting their lies means acknowledging them. And as soon as they do that, we do what we do best other than invalidate the Ignorati’s misstatements, which is: gloat.
Like Walter White, they are now doubling down. Examples: Ron Goetzel calling Nebraska a best practice after they admitted lying about saving the lives of cancer victims, in order to justify his original award to them. Steve Aldana can’t create a real ROI model now without admitting that his original model was not “based on every ROI study ever published” as he has maintained, but rather always yields a savings of $1359/employee no matter what inflation-adjusted figures you enter.
As the house of cards collapses, people on the fringes who were sucked in (in this case HR and some brokers and consultants) wake up and ask: “How could I have believed what these people were saying?” Many major and mid-level figures connected with Enron did exactly this. We see this every week in wellness, as people come to us and say: “I get it. I can’t believe I fell for this.”
So thank you to Dan Ariely. In one 8-minute TED talk, he explained the entire alternative crowdsourced reality of the Wellness Ignorati – without once even mentioning them by name. But I’m sure the Ignorati nonetheless think he bullied them.
As a hot-off-the-presses example of what Professor Ariely is talking about, Wellsteps just updated their model so that now instead of saving $1359 per person in 2019, they save $1359 per person in 2020. As with previous iterations of their model, the success of the wellness program is irrelevant to the outcome of the model. Just enter a 0% inflation rate and “1” for covered people (“1” so you can see the $1359 reveal itself without having to do division) — and then whatever figures you want to enter for spending, obesity and smoking.
Here you started out with astronomical healthcare costs and got a 99% reduction in smoking and obesity…and saved $1359
Here you save $1359 without changing smoking or obesity at all:
And here you saved $1359 even though there was nothing to save. The costs are as low as the model will allow you to enter (until they got caught, you could enter figures low enough that they model would calculate negative costs), and there was no smoking or obesity to reduce:
Naturally, Wellsteps is prominent both on the Koop Award Committee and the HERO Report Committee. Wellsteps’ “back story” is here.
HERO vs. Huffpost: What do actual employees say about wellness?
HERO (the wellness vendors’ trade group) says: “Employees are not uniform in their receptiveness to wellness programs.” That’s like saying: “Republicans are not uniform in their receptiveness to the Clinton campaign.”
Take a look at Huffpost — especially the comments— to see what employees really think, not what HERO wants you to believe they think. With more than 23,000 views, this Huffpost was probably the most widely read posting on wellness anywhere in all of 2015.
These comments are unexpurgated (except for Huffpost’s own obscenity filter, which we suspect got quite a workout). You can add your own.
Then urge your HR department to redesign your wellness program. Tell them to ax your “pry, poke, prod and punish” vendor. If the vendor makes a fuss, bring us in and we can find all the lies they’ve told you in their outcomes reports and threaten to sue them.
Then your company can start doing wellness FOR its employees instead of TO them. Read Jon and Rosie’s book to get some guidance. If you get depressed by the amount of work you have ahead of you, take a breather and read Surviving Workplace Wellness to tickle your funny bone– If laughter were truly the best medicine, wellness would be a blockbuster drug.
7 Take-Aways from the HERO-Goetzel Webinar in Defense of Wellness
This is the sixth in a series on the HERO disinformation campaign around wellness ROI. The other six installments can be found here.
This afternoon HERO and Ron Goetzel conducted an entire Groundhog Day-type webinar as though They Said What, the entire media, and 2015 don’t exist.
They talked about the “confusion in the marketplace” (to quote their invitation) without once even mentioning the source (us) of the confusion in the marketplace. Actually all we did was point out that they contradicted themselves in their own report. They created the confusion by inadvertently telling the truth.
Here are some of the things they are still saying, that they know to be somewhere between misleading and lies. Apparently Mr. Goetzel lived up to his billing as Goetzel “the Pretzel” by basically twisting “wellness loses money” into wellness makes money,” though he admitted to some “controversy” around the latter point.
First, he is still quoting the Kate Baicker 3.27-to-1 ROI, that he knows to have been thoroughly discredited. We’ve blogged about that extensively–this link will take you to a series of other links. To wit:
- She’s walked it back 4 times.
- RAND’s Soeren Mattke has attacked it (and those of you who know Soeren–he is a very thoughtful and polite guy–you really have to be way off-base to get his dander up).
- Another researcher has pointed out that many of the studies in her meta-analysis were basically made up.
- Many of these studies were claiming reductions in diabetes expense and obesity at the same they were telling people to eat more carbs and less fat, exactly the opposite of what would reduce diabetes incidence and possibly obesity. And yet somehow money was saved…
Second, the Ignorati are still quoting the American Journal of Health Promotion meta-analysis and Mr. Goetzel pretzeled his way around the accidental conclusion of that paper that high-quality studies show a negative ROI.
Third, Mr. Goetzel strongly criticized the Penn State fiasco. Hmm…maybe we’re mis-remembering this, but we seem to recall he was one of the leaders of that jihad. Here is a article about a meeting in which he and several others “take the offensive” in the controversy. Or maybe that was another Ron Z. Goetzel.
Fourth, he said: “There’s some healthy debate going on.” But the irony is, there is no debate. Partly this is because they are steadfastly refusing to debate. And partly this is because there is nothing to debate–they admitted “pry, poke, prod and punish” wellness loses money and damages morale. The only places we disagree are how much money gets lost and how badly morale is damaged.
Fifth, he is still comparing participants to non-participants, as though he hadn’t been forced — by the existence of a “smoking gun” slide — to basically admit that participants significantly outperform non-participants even in the absence of a program.
Sixth, he pretzeled RAND’s Pepsico analysis in Health Affairs, overlooking the fact that the study concluded wellness loses money. Obviously we wouldn’t have congratulated Dr. Mattke on his huge success with that article (#2 article of the year in Health Affairs) if it had reached the conclusion Mr. Goetzel said it did.
Finally, the most notable feature was the dog-not-barking-in-the-nighttime. Not once was there any rebuttal to our observations. The Wellnes Ignorati have placed themselves in a difficult position. In order to rebut us, they would have to acknowledge our existence. But ignoring our existence — and the existence of facts generally — is the core component of the Ignorati strategy.
By the way, our source, expecting a spirited rebuttal, instead got supremely bored by the insight-free recycled and invalid material in the presentation, and dropped off before the slam-bang conclusion to the webinar. We doubt there were any other members of the Welligentsia on that webinar but if there were–and you have something to share about the closing minutes that you don’t see mentioned in here — please do.
Health Enhancement Research Organization (HERO) meets Raising Arizona
We blogged recently that HERO was going to rebut our observations that essentially none of their report makes any sense.
The good news about HERO is that they never step out of character. After we urged people to sign up, a few readers pointed out this webinar is a:
But HERO’s invitation also states:
Unless they don’t know how many members they have, how can their webinar run out of space? Come to think of it, how does anything on the web actually run out of space?
Perhaps HERO took a leaf out of John Goodman’s playbook in Raising Arizona. (You gotta click through on this, even if it means taking you off our site.)