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Congratulations to RAND’s Soeren Mattke on PepsiCo study award

8758572616_64ec78d961_bWe are proud (but also insanely jealous) of our friend Soeren Mattke, whose PepsiCo article  was named the #2 most-read for the year 2014 in Health Affairs.  We, as our avid albeit narrow fan base may recall, ranked only #12–and even then that was just for blog posts, not articles in print.

Yes, we know it’s not always about Ron “The Pretzel” Goetzel and his twisted interpretations, but he seems to have come up with what appears to be exactly the opposite interpretation of what the PepsiCo study said.  Don’t take our word for it — we’ve cut-and-pasted both what the study says about PepsiCo’s results and what he says about the study.

Here is what the article says about the financial impact of health promotion at Pepsico:  ROIs well below 1-to-1, meaning a net financial loser, for health promotion. (DM, though, was a winner.)

mattke ROI graph pepsico

As low as these ROIs are, several major elements of cost were not available for the calculation — probably enough extra cost to literally make the financial returns so meager that even if the program had been free, PepsiCo would have lost money.

mattke ROI omitting consultant fees etc Pepsico

Clear enough?  Negative returns from health promotion at PepsiCo, even without tallying many elements of cost.  Nonetheless, Mr. Goetzel pretzelized that finding in his recent wellness apologia.  Listed under “examples of health promotion programs that work” as a program that is a “best practice” is:  PepsiCo.  It stands proudly beside the transcendant programs at Eastman Chemical/Health Fitness and the State of Nebraska.

quote from goetzel article on pepsico

We look forward to a clarification from Mr. Goetzel about how a program that lost a great deal of money on health promotion can be an “example of a health promotion program that work(s),” which we will duly print…but don’t be sitting by your computer screens awaiting it.

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

By Al and Vik

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

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

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

total savings chart

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

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

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

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

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

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

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

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

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

HealthFitness takes credit for program savings without having a program

HealthFitness

Short Summary of Intervention:

“When you partner with HealthFitness, we work collaboratively with you to develop a strategic plan for program implementation, which includes a cultural assessment and an operational plan. You can expect results-oriented programs and services delivered through a highly personalized strategy, matched to your employees and culture.”

Materials Being Reviewed:

Success at risk reduction and translation of that risk reduction into cost savings.  These excerpts are from the successful Koop Award application at http://www.thehealthproject.com/documents/2011/EastmanEval.pdf.

health fitness corp risk reduction form koop award

total savings chart

Summary of key figures and outcomes:

  • Reduction in risk factors from 3.20 to 3.03 — net change of 0.17 — over 5 years.  This success excludes dropouts.
  • 24% improvement in costs vs. non-participants, or $460/year at Eastman Chemical (currently up to >$500/year according to HFC website)

Questions for Health Fitness Corporation:

Since only about 20% of all inpatient events are wellness-sensitive, and you only reduced risk factors by 0.17 per person, and hospital expenses are at most 50% of total spending, how is it that you are able to reduce spending by 24%?

ANS: Refused to answer

Why did you take credit for savings in 2005, even though according to your own slide you didn’t have a program in 2005?

ANS: Refused to answer

Does starting the Y-axis at $1800 instead of $0 create the illusion of greater separation between the two cohorts?

ANS: Refused to answer

Your website says that comparing participants to non-participants “adheres to statistical rigor and current scientific standards for program evaluation” and “is recognized by the industry as the best method for measurement in a real-world corporate wellness program.”   Can you explain how non-motivated non-volunteers who decline financial incentives to improve their health are comparable to motivated volunteers, especially in light of the separation between the two groups that took place just on the basis of differential mindset in 2005, before you had a program?

ANS: Refused to answer

You and your customers have won three Koop Awards in the last 4 years. Do you think also being a sponsor of the Koop Award (along with Eastman, in this case) has helped you win these awards or is this just a coincidence?

wellness logos

ANS: Refused to answer

Why Nobody Believes the Numbers defines the “Wishful Thinking Multiplier” as “alleged cost saviings divided by alleged risk reduction.”  Your cost savings is $460 and your risk reduction in 0.17, for a Wishful Thinking Multiplier of 2700, the highest in the industry.  The book calculates that a risk reduction of your magnitude (even assuming dropouts also reduced risk by the same amount) could generate roughly a $8 reduction in annual spending.  To what do you attribute your ability to reduce spending by 50x what is mathematically possible?

ANS: Refused to answer

Help us with the arithmetic below, also from this Koop Award application.

eastman ROI

How is it mathematically possible to have a higher ROI ($3.62) when also including the cost of incentives in program expense than the ROI ($3.20) excluding the cost of paying incentives to employees to participate?

ANS: Refused to answer


 

Update December 2014:  Ron Goetzel admits HFC lied.  (See #5 and #6.)  The slide was “unfortunately mislabeled,” using the passive voice, as though it was an act of God (“the game was rained out” ) or else perhaps the North Koreans.  The geniuses at HFC apparently didn’t notice this “unfortunate mislabeling” for 4 years, despite it’s having been pointed out to them many times before this.

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