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HERO meets Trading Places: Wellness Saves One Dollar
This is the fourth installment of the series on interpreting the Health Enhancement Research Organization’s Outlines Guidelines report. It covers page 23. The full series can be found here
One Dollar.
23 pages into their report, HERO has finally benefitted from the law of averages and gotten an analysis right…and it shows savings of: one dollar.
HERO conducted a “wellness-sensitive event rate analysis,” otherwise known as a plausibility test. It’s the only valid way of measuring outcomes. Not coincidentally, I invented it. There is no ambiguity about this. It’s in all my old presentations and my first book, Why Nobody Believes the Numbers. No one else has even pretended to claim credit. Nor is this one of those situations where the usual invention cliches apply. The Chinese did not invent it in 1000 BC. 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. Nope, mine and mine alone.
Of course there is no attribution of that (or of any of my contributions to this field, anywhere, in their 88 pages). I find this “oversight” quite flattering.
Here it is.
Note a few things.
First, this methodology counts all the admissions, whether or not the patients/employees participated or didn’t participate in a program, or whether the admitted patients were even known to have the condition in the first place. This is how it should be. This eliminates the participation bias, one of the two biases (not including lying) that the wellness industry utilizes to sustain the fiction that it saves money. It also eliminates regression to the mean (the other bias).
Second, this exercise generates 99 cents PMPM in gross savings. Yep, basically one dollar, like the bet in Trading Places. The “problem” with measuring validly is that your savings essentially dwindle to nothing.
One dollar. The Duke brothers turned the lives of Dan Ackroyd and Eddie Murphy upside down over a one-dollar bet, and the wellness industry wants you to turn your entire employee relations strategy upside down — in their own words, damaging morale and your corporate reputation — in order to save: one dollar. (That of course is one dollar before costs, which are $1.50.)
Quizzify…where there is no need to fake results
Third, believe it or not, even that $1 in savings is grossly overstated. Focus on ischemic vascular disease or IVD (heart attacks, strokes etc.) They show a decline of 7 admissions, or 23%, from 32 to 25 admissions — easily the largest component of the 9 avoided admissions they are attributing to wellness and disease management. This decline took place over a 3-year period, as they averaged the two pre-program years and compared that to Program Year 2.
The problem is that, according to US Government data below, this set of IVD events declined everywhere over the same 3-year period by– as luck would have it– that very same 23%. Don’t believe us? Here is the data. The comparable group on the display below is the “privately insured” cohort, underlined in red, now that we have figured out how to do underlines on screenshots. (Even Medicare, where there is no workplace wellness and where the population grew almost 10% and aged quite a bit, showed a decline in IVD of almost 10%.)
Despite the fact that all their savings from IVD got eliminated by the simple step of seeing how much savings would have accrued even without a program, I don’t think this particular oversight was purposeful on HERO’s part. I’d give them the benefit of the doubt and say the abject failure to compare their performance to the obvious benchmark was a rookie mistake. The lesson is, before they write reports on outcomes analysis, someone should teach them how to actually do outcomes analysis. I’m just sayin’…
By the way, a similar secular decline transpired in asthma nationwide. The 2009-2012 decline was 21%, meaning that 2 of the 4 admissions HERO says wellness “avoided” over that period would have gone away on their own.
So when you take out the IVD decline of 7 admissions and 2 of the avoided asthma admissions, you are left with: no decline at all. Essentially HERO just proved that – even before taking costs into account – their vaunted “pry, poke, prod and punish” wellness programs are worthless.
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Johnson & Johnson accepts our analysis that wellness loses money
Newsflash: Someone from Johnson & Johnson named Michael Schmidt responded to our posting that the HERO Report shows wellness loses money. This is the first time anyone associated with HERO has strayed from the tried-and-true Wellness Ignorati strategy of ignoring us. We were concerned that he might have found a mistake in our math, which no one has ever done.
Fortunately, our math is OK with Mr. Schmidt, and — by implication, since he is writing on their URL — J&J itself. His point is different. He argues that we write these columns to do the following: generate business. Touche!
He also says that the headline is inflammatory and that we will turn off more people than we turn on. That is probably accurate. However, the people we would turn off — traditional “pry, poke, prod and punish” wellness vendors such as Johnson & Johnson — have had and would have no interest in paying us to find out that wellness is worthless.
In any event the headline “The Wellness Wars Are Over. Wellness Lost” captures exactly what the HERO report says — and was edited by the ITL editor. Headlines, as Mitt Romney found out when his New York Times op-ed was entitled “Let Detroit Go Bankrupt,” are the purview of the editor, not the author.
The curious thing is, Johnson & Johnson is listed as one of the “endorsers” of the HERO report. So as an endorser of the report, Johnson & Johnson is tacitly nonetheless acknowledging that the report is right–wellness loses money.
In case there is some ambiguity, here is the screenshot of the first set of comments
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Apologies to HERO and the Wellness Ignorati!
(March 18) Due to vacation schedules, we are taking a brief time-out from both our “profiles” of vendors and our serial analysis of the HERO report (Part 1 was our most popular posting ever — don’t forget to “Follow” us so as not to miss a single installment.).
Knowledge + fun + respect = happiness + health
This posting is to apologize to the HERO Wellness Ignorati. A comment our posting on the HERO report said we shouldn’t call the Wellness Ignorati “ignorant.” We aren’t calling them ignorant and we apologize if we were misunderstood. Since it has sold almost 6000 copies despite Wiley’s decision to price it to finance their retirement accounts, we thought by now most people had read Cracking Health Costs. That was the book in which the term was coined. It emphatically does NOT mean “ignorant.” We would never call them “ignorant” and the Ignorati are anything but. Quite the contrary, they are smart enough to realize that facts are their worst nightmare.
Or as Tom Friedman said in today’s New York Times, “We wouldn’t be human if we didn’t outright ignore facts that make a laughingstock of our hopes.” (I actually did the opposite. See the blog post: Founding Father of Disease Management Astonishingly Declares: “My Kid Is Ugly.” Dee Edington did something very similar. Both of us were simply not willing to sacrifice our integrity for filthy lucre.)
The Wellness Ignorati are more than smart. They are brilliant. They have elevated fact-ignoring to an art form.
They realize that enough people seeing this site will derail their HR-financed gravy train, so they keep to a strict strategy of not even acknowledging that facts exist. Example: us. Not a mention of our existence in their entire report. A brilliant strategy for them, and one that flatters us immensely. Obviously, in the massive tome they just published, if they thought we were wrong, they could have said: “They Said What and its authors offer a competing view, but it’s wrong because…”
Fact suppression is of course the opposite of what we do — we want facts to be front-and-center. We welcome transparency and debate, though the latter is tough because people either repeatedly decline (Ron Goetzel) or, after the debate, wouldn’t agree to release the recording (Michael O’Donnell).
Instead they simply disappear us. This is despite the fact that the two of us (plus our colleagues like Jon Robison and Tom Emerick) have sold more books, been interviewed in more major publications, authored more articles in high-impact journals than all the Ignorati combined.
Do you employees know when to just say “no” when it comes to medical care?
I’ll close with a f’rinstance. We copied a screenshot from that report showing that the Ignorati finally admitted that “pry, poke, prod and punish” programs damage morale. This guy looked at that screenshot, and put a comment on our post that this screenshot didn’t exist, but rather it was our propaganda. Someone else said the screenshot was out of context, so we invite everyone to read the context.
The bottom line is, of course the HERO Report is correct about the cost of morale damage. Coincidentally, I am writing this from State College, Pennsylvania. I am here as an honored guest of the Penn State Faculty Benefits Committee, feted for my role in helping to free them from the Goetzel/Highmark forced wellness program (featuring those immortal testicle checks). Try telling Penn State there’s no morale impact. (For those of you thinking of sending your kids here, do it! I’ve never been to a university where the professors were more passionate about teaching their students than PSU–despite what happened to them in 2013.)
“Everyone is entitled to their own opinions, but not to their own facts.”
–Daniel Patrick Moynihan
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A Short Painless Primer on the Value of Screening
At the risk of knocking our second-most-widely viewed posting (the first of several analyses of the HERO report) off our front page, this is a brief and amusing lesson on the value of screening
If you like this, you’ll love this–it will also tickle your funny bone.
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HERO Report: Wellness Industry Leaders Shockingly Admit that Wellness Is Bad for Morale
The question is: how do you help employees spend less and get healthier at the same time?
(March 14) This is the first in a series looking at the strengths and weaknesses of the HERO Outcomes Guidelines report, recently released by the Wellness Ignorati. One explanatory note: A comment accused us of insulting the Wellness Ignorati by calling them that. It is not an insult. It describes their brilliant strategy of ignoring facts and encouraging their supporters to do the same. We are very impressed by the disclipline with which they have executed this strategy, and will be providing many examples. However, if they prefer a different moniker to describe their strategy, they should just let us know.
We encourage everyone to pick up a copy of this report, the magnum opus of the Wellness Ignorati. Unlike the Ignorati, we are huge advocates of transparency and debate (which they call “bullying”). We want employers to see both sides and decide for themselves what makes sense, rather than spoon-feed them selected misinformation and pretend facts don’t exist.
The latter is the strategy of the Wellness Ignorati. Indeed, they earned their moniker by making the decision to consistently ignore inconvenient facts. (This is actually a smart move on their part, given that basically every fact about wellness is inconvenient for them.) For example, they just wrote 87 pages on wellness outcomes measurement without admitting our existence, even though we wrote the only book — an award-winning trade best-seller — on wellness outcomes measurement. Observing the blatant suppression of facts and the loss of credibility that comes with blatantly suppressing facts is just one of the many reasons to read this report. In total, their report provides a far more compelling argument against pry, poke, prod and punish programs than we ourselves have ever made, simply by bungling the (admittedly impossible) argument in favor of them.
There is too much fodder for us to deconstruct in one posting, so over the next several weeks we will highlight aspects of this report that we think are especially revealing about the sorry state of the wellness industry.
In terms of getting off to a good start, the Ignorati are right up there with Hillary Clinton, with their first self-immolation appearing on Page 10. Remember 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.
And sure enough…
Ironically, the first self-immolation is the direct result of that rarest of qualities among the Ignorati: integrity. We were shocked by the revelation that the Ignorati actually realize that employee morale and a company’s reputation both suffer when companies institute wellness programs – but here is the screenshot. Both morale and reputation are listed, as “tangential costs.”
Try telling a CEO that the morale of his workforce and his corporate reputation are “tangential” to his business. We ourselves run a company, and we would not list low morale as a “tangential cost.” Quite the opposite — our entire business depends on our employees’ intrinsic motivation to do the best job they can. If their morale suffers, our profit suffers. That’s why we would never institute a wellness program. The last thing we want to do is impact our morale in order to measure our employees’ body fat. Obviously, it is harder to hire and retain people if you value body fat measurement over job performance, and we are pleased to see the ignorati finally admit this.
Why, having now read this revelation in the ignoratis’ own words, that wellness is bad for morale, would any company still want to “do wellness”? Or as we say in Cracking Health Costs, “If you’re a general, would you rather have troops with high morale or troops with low cholesterol?”
The fact that employees hate wellness isn’t exactly a news flash. Anytime there is an article in the lay press, the public rails against wellness — or “bullies” the wellness industry, to use the term that the Ignorati use for people who disagree with them publicly. You don’t have to look far—just back to HuffPost on Wednesday. Or All Things Considered.
Obviously, if you have to bribe employees to do something (or fine them if they don’t), it’s because they don’t like it. If employees would rather sacrifice considerable sums of money than be pried, poked and prodded, they are sending you a message: “This is a stupid idea we want nothing to do with.”
The news flash is that this whole business of “making employees happy whether they like it or not,” as we say in Surviving Workplace Wellness is now acknowledged – by the Ignorati as a group — to be a charade.
HERO seems to have exhausted their integrity quota pretty quickly, because after that welcome and long-overdue and delightfully shocking admission, they slip back into character.
To get good answers, you must ask good questions. We do.
Specifically, in their listing of costs, they conveniently forgot a bunch of direct, indirect and “tangential” costs. Like consulting fees. Generally, the less competent and/or honest the consultants, the more they charge. (For instance, we can run an RFP for $40,000 or less, and measure outcomes for $15,000 or less — and do both to the standards of the esteemed and independent GE-Intel Validation Institute. Most other consultants can’t match either the price or the outcome.) We’re not calling any consulting firm incompetent or dishonest other than pointing to a few examples that speak for themselves, but it does seem more than coincidental that the consultants involved in this report have conveniently forgotten to include their own fees as a cost.
And what about the costs of overdiagnosis caused by overscreening far in excess of US Preventive Services Task Force guidelines? The cost of going to the doctor when you aren’t sick, against the overwhelming advice of the research community?
Still, we need to give credit where credit is due, so we must thank the Ignorati for acknowledging that wellness harms morale. It took even less time for this acknowledgement than for the tobacco companies to admit that smoking causes cancer.
They Said What? 