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A word means whatever I want it to mean, neither more nor less.”
Like George Orwell and Humpty Dumpty, the wellness industry (thanks largely to the Business Roundtable pressuring the EEOC) has now managed to redefine wellness programs as their opposite: “voluntary” now means “required,” in the sense that if you don’t volunteer to submit to “wellness or else” you could be fined up to about $3600 (if you spouse is on your insurance), which is a little less than 10% of the median annual wage, and exceeds the amount in many people’s savings.
But the wellness program is still voluntary, according to the EEOC. Or as Surviving Workplace Wellness says: “wellness programs will make employees happy whether they like it or not.”
These wellness people have experience at redefining words as their opposites. Health Fitness Corporation’s Dennis Richling redefined “514 Nebraska state employees didn’t have cancer at all” to “we made life-saving catches of 514 employees with cancer.” He referred to this subtle difference as “semantics.”
Jon Robison and I just posted a “Pulse” on the wellness industry’s creative use of the English language, which rivals their creative use of fifth-grade math.
We hope you hate it, where “hate” means “love.”
No program epitomized conventional “pry, poke and prod” wellness more than Nebraska’s state employee wellness program. And by that of course I mean no wellness vendor has ever lied about outcomes more blatantly or won more awards than Nebraska’s state employee wellness program vendor, Health Fitness Corporation. (Blatantly lying about outcomes and winning Koop Awards, in the immortal words of the great philosopher Frank Sinatra, go together like a horse and carriage.) Their big mistake was admitting it. (See the timeline link.)
Not to mention the cover-up of the lies, that Ron Goetzel and his Koop Committee friends botched so badly that the state’s HR team and procurement department could no longer do the Sergeant Schultz thing. I guess now, finally, Mr. Goetzel will stop referring to this program as a “best practice.”
Now, the program is officially dead. It was close. On October 1, we thought we had lost:
But then last week, following a number of behind-the-scenes conversations and finally a bit of googling by the state:
In other words:
If corporate wellness didn’t already exist, no one would invent it. In that sense, it’s a little like communism, baseball, pennies, or Outlook.
After all, why would any company want to purchase programs that damage morale, reduce productivity, drive costs up…and don’t work 90%-95% of the time? And that’s according to the proponents. What the critics say can’t be repeated in a family publication such as ours.
Still, those are the employers’ problems. However, the employers’ problems become the employees’ problems when employees are “voluntarily” forced to submit to programs that are likely to harm them. (As the New York Times recently pointed out, there is nothing voluntary about most of these programs.)
Recently, the head of United Healthcare’s (UHC) wellness operations (Optum), Seth Serxner, admitted that Optum’s programs consciously ignore US Preventive Services Task Force (USPSTF) screening guidelines. Lest anyone was expecting a wellness vendor to actually apologize for bad behavior, Mr. Serxner went on to blame employers for insisting on overscreening and overdiagnosing their own employees…and (by implication) overpaying for the privilege of doing so. “Our clients make us do it,” were his exact words.
Funny thing, we first asked our own clients who use Optum about why they turned down Optum’s generous offer to do more appropriate screenings at a lower price. None of them remember receiving this offer. Go figure. Then a UHC executive wrote and said we were making them look bad. I softened some of the language (like the paragraph below), and said I would happily retract the whole thing if indeed they could introduce me to just one customer — one out of their thousands — who recalls insisting on overscreening and overpaying. Never heard back…
United Healthcare isn’t alone in harming employees. They are just the first company to admit it, and far from the worst offender, as the harms of overscreening for the usual suspects (glucose, cholesterol etc.) don’t hold a candle to some of the more creative ideas listed below. Here, in order, are the ten vendors most likely to harm employees in the name of wellness.
Healthmine’s CEO, Bryce Williams, isn’t blaming the victim like United did. He has publicly announced that Healthmine flouts clinical guidelines. He says he is right and everyone else — specifically including the “US Preventative [sic] Services Task Force” — is wrong. A real doctor acting on this pronouncement might be risking his or her license. Fortunately for Mr. Williams, being a wellness vendor doesn’t require a license, so regardless of the harms a wellness vendor inflicts on employees, no one can confiscate it because there is nothing to confiscate..
In addition to not misspelling the name of the group he is attacking, we might also recommend that he not misquote the sources on which his faulty argument is based. We’re just sayin’…
For starters Mr. Williams declares: “One out of every two people in America has at least one chronic condition according to the CDC…”
Here’s what the CDC really said: “One out of every two adults has at least one chronic condition.” And if you dig deeper, you’ll see that this list of chronic conditions cited by the CDC includes arthritis, mental illness, eye disorders and asthma, none of which Healthmine’s hyperscreening is going to reveal.
He also claims that “chronic diseases account for $3 out of every $4 spent on healthcare.” Here’s what the CDC really said: $3 out of every $4 “is spent on people with chronic conditions.” That is a much broader statement. It would include someone with borderline hypertension giving birth. In any event, we long ago eviscerated Mr. Williams’ cherished myth and just this week showed that essentially none of the top 25 hospital admissions has anything to do with screening, broccoli, or Fitbits.
The employee who recorded this blood pressure is essentially dead. Cerner’s diagnosis? Blood pressure “higher than what is ideal.” Cerner’s recommendation? “Talk to your healthcare provider.” A real doctor’s recommendation? “Call an ambulance. The guy barely has a pulse.”
This is not a random mistake. This is the front cover of their brochure.
USPSTF Screening age recommendations aren’t minimums. They are optimums, the ages at which screening benefits might start to exceed harms, even if they still fall far short of costs. Otherwise you are taking way too much risk. This is especially true for colonoscopies, one of this program’s favorite screens — complications from the test itself can be very serious.
Your preventive coverage is not supposed to be “greater than health care reform guidelines.” That’s like “rounding up twice the number of usual suspects.” And you aren’t supposed to waive “age restrictions.” That’s like a state waiving minimum “age restrictions” to get a driver’s license.
Yet despite or perhaps because of this and other examples of total cluelessness and pure dishonesty, this program won a C. Everett Koop Award for excellence in wellness, not to mention the unwavering support and admiration of leading wellness apologist Ron Goetzel.
Both these outfits pitch exactly the opposite of what you are supposed to do in weight control: unhealthy crash dieting. Attaching money to this idea and setting a start date makes it even worse: along with crash-dieting during these eight weeks, you’re incentivizing employees to binge before the initial weigh-in.
Here is ShapeUp:
Here is Wellness Corporate Solutions:
Both also made up outcomes. In ShapeUp’s case they had to rescind their “findings” after their customer, Highmark, skewered them in the press. And neither seems to care that corporate weight control programs are proven not to work.
In addition to its dystopian wellness program that collects employee DNA (partnered, ironically, with a company called Newtopia) and then makes up savings, Aetna owns the distinction of launching the only wellness program whose core drugs are specifically editorialized against in the Journal of the American Medical Association. This would literally be the most harmful wellness program ever, except that the only employees being harmed are (1) obese employees who (2) answer the phone when their employer’s health plan calls them to pitch these two drugs; (3) have a doctor who would willingly prescribe drugs that almost no other doctors will prescribe due to their side effect profile; and (4) not google them. Presumably in combination this is a very low percentage of all employees.
The good news is that these drugs, Belviq and Qsymia, should be off the market in a couple of years because almost no one wants to take them, so the harms of this Aetna program should be self-limited.
Star Wellness offers a full range of USPSTF D-rated screens. “D” is the lowest USPSTF rating, and means harms exceed benefits. Star gets extra credit for being the first wellness vendor to sell franchises. All you need is a background in sales or “municipal administration” plus $67,000 and 5 days of training and you too can poke employees with needles and lie about your outcomes. Is this a great country or what?
Also, their vaccination clinic features Vitamin B12 shots. We don’t know which is more appalling–routinely giving employees Vitamin B12 shots, or thinking Vitamin B12 is a vaccine.
Angioscreen doesn’t have the most USPSTF D-rated screens. In fact, it offers only one screen in total, for carotid artery stenosis. That screen gets a D grade from USPSTF, giving Angioscreen the unique distinction of being the only vendor 100% guaranteed to harm your workforce.
Angioscreen’s other distinction is that they admit right on their website that this screen is a bad idea. This is probably literally the only non-tobacco company in America to admit you are better off not using their product.
Total Wellness loses the wellness industry’s race to the bottom only because the winner, HealthFair, has out-stupided them. However, in addition to the usual assortment of D-rated tests, they offer screens that the USPSTF hasn’t even rated, because it never, ever occurred to them that anyone would ever use these tests for mass screening of patients or employees. Criticizing the USPSTF for not rating these “screens” (CBCs and Chem-20s) would be like criticizing Sanofi-Aventis for not warning against taking Ambien after parking your car on a railroad crossing.
Let’s leave aside for a fact that the majority of their other screens are harmful too, and focus on their screening for H.pylori, the strain of bacteria associated with ulcers. To say it is a stupid idea would be an understatement. As Clarice Starling replied when asked if Hannibal Lecter was a sociopath: “They don’t have a word for what he is.”
Likewise, this idea is too stupid for words, certainly for the small number of words we can allot to this overview blog. Visit our full treatment here. In a nutshell, the majority of us harbor H.pylori–without symptoms. It may even be beneficial. The screening test is expensive and notoriously unreliable, and the only way to get rid of it is with some very powerful antibiotics, a treatment rarely even used on patients with symptoms due to its inconvenience, ineffectiveness and potential long-term side-effects.
A Modest Proposal
So how should we as a country protect employees from these harms? Our policy recommendation is always the same, and very non-intrusive. We aren’t saying wellness vendors shouldn’t be allowed to harm employees. That would be too radical to ever pass Congress. If it did, the Business Roundtable would pressure the White House again, to preserve their hard-earned right to medicalize the workplace, and literally and figuratively, show employees who’s boss.
Instead, we recommend merely a disclosure requirement. The harms of screens or (in United Healthcare’s case) screening intervals that don’t earn at least a “B” from USPSTF should be disclosed to employees, and employees should get a chance to “opt out” into something that isn’t harmful (like Quizzify, perhaps?) without suffering financial consequences. Call us cockeyed optimists, but we don’t think employers should be able to force employees to choose between harming themselves and paying fines.
To our new readers, while 2016 was the first time a Koop Award ever went to a company that harmed employees, 2016 wasn’t the first Koop Award ever to go to a company whose own data showed they fabricated results. Below is a history of one of the Koop Award’s Greatest Hits.
For those of you who haven’t been following the saga of the Nebraska state employee wellness program, here is a crash course, aka “Lies, Damn Lies, and the Nebraska State Wellness Program.” If you have been following it, you can skip to the end for the latest installment, Mr. Goetzel’s cover-up of his cover-up.
By way of background, this program is called “wellnessoptions” (imagine e.e. cummings-meets-poking employees with needles-meets-a sticky spacebar). They used to say the Holy Roman Empire was neither Holy nor Roman nor an Empire. Likewise, wellnessoptions is neither optional, if you want a decent deal on healthcare, nor wellness. Instead of wellness, it features a hyperdiagnostic anti-employee jihad in which Health Fitness Corporation (HFC) diagnoses employees but does nothing about the diagnosis except take credit for it.
TIMELINE — PART ONE: HFC’S TROUSERS COMBUSTED
September 24, 2012, 2:00 PM
I read Health Fitness Corporation announcement that its customer, the state of Nebraska, won Ron Goetzel’s C. Everett Koop Award for program excellence.
September 24, 2012, 2:01 PM
I recognize that the cancer outcomes were obviously made up. Until then, I hadn’t been following the Koop award closely enough to realize that making up outcomes was apparently one of the award criteria, as I later came to learn.
I read the full write-up on the program and realize that not only were most of the other outcomes made up, but they had actually lied about saving the lives of cancer victims. If you screen a few thousand people for colon cancer, you don’t find 514 cases of cancer, and you certainly don’t save their lives, as HFC was claiming. And you absolutely don’t save money, as they were also claiming. All this is even more true when you waive age-related guidelines and let anyone get screened, and encourage overscreening by sending out 140,000 letters to state employees graced with the picture of a beautiful young model way too young to be getting a colonoscopy.
How this invalid nonsense ever got by all the eagle-eyed Koop Committee members would be a mystery, except that HFC is a sponsor of the Koop Committee.
I review the entire application and all the marketing materials. It becomes obvious that the entire thing was made up, not just the cancer part. They claimed to save $4.2 million because 161 of their roughly 6000 participants reduced a risk factor.
The math is quite self-evident. Suppose you doubled the number of participants who reduced risks to 312. It stands to reason that you could save $8.4-million. Double it again to 624 and you save $16.8.
Now double it one more time. If 1,248 people out of those 6000 reduced one single risk factor, you’d save $31.6-million, which is about equal to the entire spending for all 6000 participants. And of course most medical spending has nothing to do with identifying previously unrecognized risk factors, so this would be quite a feat. (Do you even know anyone under 65 who had a heart attack that could have been avoided by one more workplace screening?)
I later learn that all the Koop Award-winning program outcomes are made up, using exactly the same math.
November 2012 to June 2013
I try to contact the authorities, like Roger Wilson, who allegedly runs this program for the state, but no one seems to care. The rule of thumb in the wellness industry is that what you say counts. What you do is pretty irrelevant.
June 20, 2013
Breakthrough: The Wall Street Journal editors decide that I am correct, and that the outcomes were made up. Vik and I are allowed to publish this on their op-ed page.
July 14, 2013
Breakthrough again: Another very well-read blogger professes shock-and-awe that any vendor could lie so blatantly and apparently get away with it.
July 15, 2013
Breakthrough yet again: Ace reporter Martha Stoddard of the Omaha World Herald gets Dennis Richling of Health Fitness Corporation to admit that the outcomes — at least the “life-saving catches” of “early stage cancer” outcomes — were indeed made up. Richling tries to spin his gaffe by calling the difference between “life-saving catches of early-stage cancer” and saying someone might possibly get cancer in the future “semantics.” So, according to Richling, having cancer and not having cancer are the same thing.
February 1, 2014
The hilarious wellness industry smackdown Surviving Workplace Wellness is published. Since the HFC Nebraska program had too many lies to fit on a page or two, it gets its own chapter. Here’s the opening paragraph, which in all modesty I must admit is one of my favorite in the book.
February 23, 2014
Nebraska political blogger ReadMoreJoe picks up the scent. He points out that this wellness program is an obvious fraud. The problem is that the same posting is also exposing several other equally obvious frauds, so this one gets overlooked.
TIMELINE–PART TWO: GOETZEL STRIKES BACK
Ron Goetzel isn’t about to sit back and let his friends/sponsors/clients be pilloried for a little white lie about saving the lives of cancer victims who didn’t have cancer.
June 2, 2014
At the Health Datapalooza conference, Ron Goetzel, while admitting the Nebraska cancer outcomes data was made up, claims they/HFC still deserve the Koop Award because he somehow didn’t realize the data was made up at the time the award was granted. And it is true that HFC didn’t actually announce they had made up the outcomes. Ron would have had to actually read the materials to figure it out, same as I did.
Ron Goetzel calls the Nebraska program a “best practice” in the Journal of Occupational and Environmental Medicine but refuses to answer any questions about the obvious mistakes and inconsistencies in the article.
After knowing for 16 months that they had lied, Ron Goetzel, writing in Employee Benefit News, finally drops Nebraska from his list of best-practice programs:
Being a fair-minded person, I take it upon myself to congratulate him on his newfound sense of ethics. I don’t specifically agree that what he did was ethical, because the ethical thing would have been to admit complicity, apologize, and revoke their Koop Award. But I do say that Nebraska being dropped from the list of best practices means ethical “progress is definitely being made,” albeit from a low base.
Only 29 minutes elapses before Ron erases all my illusions about his honesty and re-adds Nebraska to the list of “best practice organizations.”
He also adds PepsiCo to the list. I guess losing only $2 for every $1 you spend qualifies as such in wellness, where most organizations lose much more.
In a rally-the-base invitation-only webinar, we are told that Ron has promoted the Nebraska program from “best practice” to “exemplar.” It seems like the more obvious it becomes that the whole thing was fabricated, the more Mr. Goetzel worships its outcomes.
TIMELINE–PART THREE: RON STANDS ALONE
WELCOA finally takes the fabricated case study of Nebraska’s outcomes off their website, 26 months after the fraud was admitted. Perhaps some pressure is being put on them to come clean, given that this is Nebraska’s program and they themselves are based in Omaha.
Just for the record, I’m not saying that an organization founded by all-you-can-eat cafeteria magnate “Warren Buffet” knowingly kept a false document on their site for those 26 months. History suggests they might just be slow learners. [2016 update: WELCOA is under new management, and they appear to be doing a great job, as exemplified by their development of the Employee Health Program Code of Conduct.]
This means Ron Goetzel is literally the only person left who thinks it’s perfectly OK — indeed, a “best practice/exemplar” — to lie about saving the lives of cancer victims. Good luck with that in the upcoming debate. It’s him against the world.
Or, as he sees it, everybody’s out of step but Ronnie.
Nebraska tentatively re-awards the wellness contract to Health Fitness Corporation. I am looking over the precipice towards utter humiliation.
TIMELINE–PART FOUR: THE ORIGINAL DATA DISAPPEARS
November 2, 2015–the original cover-up, on the morning of the Great Debate
At our urging (and we must confess to delighting in creating this “Sting” operation), a third party alerted Mr. Goetzel to the fact that, his protestations to the contrary, the Koop Award Committee did know (even if they had somehow not seen the marketing materials quoted above) that Health Fitness Corporation was making fictitious claims about saving the lives of cancer victims. It was right in the award application. The original award application from Nebraska had originally stated (underlining is ours):
But then, a hour following the call from this third party the morning of the debate, the original award application suddenly read:
In the original application, this excerpt appears in a letter from the Governor of Nebraska. Only now the Governor’s letter says the opposite what he actually wrote. In the real world, this would be considered forgery. In wellness, a forged cover-up of a blatant and admitted lie about saving the lives of cancer victims who didn’t have cancer is considered business as usual. Johns Hopkins and Truven (Ron’s employers) don’t seem to mind either.
The state is rescinding its award to Health Fitness and terminating its wellness program. In the immortal words of the great philosopher Stewey Griffin, victory is mine.
September 2016: The cover-up of the cover-up
Mr. Goetzel finally acknowledges that Health Fitness Corporation told a whopper, and the Koop Committee accidentally overlooked it. He now calls this an “erratum.” The technical term for it is a “lie-um.” You can’t forge official state documents and then call the whole thing an “erratum.” Is a robber allowed to give the money back after he gets caught and just uncommit the crime?
So now, having admitted that the award-winning vendor told the biggest lie in wellness history (once again, quite a feat), and knowing that all the obviously fabricated outcomes were mathematically impossible, and that waiving age restrictions for screening is akin to waiving age restrictions for buying beer, the Koop Committee finally, after 4 years, rescinded the Nebraska award.
Haha. No one falls for that line any more. Quite the opposite, they are doubling down. They say that whopping lies like this one don’t matter, if you are an award sponsor. You get to keep your award.
Ditto, if your entire claim of “separation” between participants and non-participants is shown to be false but you are sponsor, Ron merely doctors the data and you get to keep your award.
Also, if it turns out you lied about your savings because there was no change in the biometrics to attribute the savings to, but Ron was a consultant on your project, you get to keep your award.
Likewise and as was confirmed in 2016, if you are a committee member, as Wellsteps’ CEO was until recently, despite your own data showing that you actually harmed employees, you get to keep your award.
Bottom line: as a friend-of-Ron, you might get to keep your award even if you shoot someone on Fifth Avenue.