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Alice laughed: “There’s no use trying,” she said. “One can’t believe impossible things.”
“I daresay you haven’t had much practice,” said the Queen. “When I was younger, I always did it for half an hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast.”
Six impossible things before breakfast? The wellness industry would just be getting warmed up by believing six impossible things before breakfast. They believe enough impossible things all day long to support an entire restaurant chain:
Consider the article in the current issue of BenefitsPro — forwarded to me by many members of the Welligentsia — entitled: “Can the Wellness Industry Live Up to Its Promises?” BenefitsPro rounded up some of the leaders of the wellness industry alt-stupid segment. Specifically, they interviewed US Corporate Wellness, Fitbit, Staywell, and HERO. Each is a perennial candidate for the Deplorables Awards — except US Corporate Wellness, which already secured its place in the Deplorables Hall of Fame (and Why Nobody Believes the Numbers) several years ago with these three paeans to the gods of impossibility.
In case you can’t read the key statistic — the first bullet point — it says: “Wellness program participants are 230% less likely to utilize EIB (extended illness benefit) than non-participants.” Here is some news for the Einsteins at US Corporate Wellness: You can’t be 230% less likely to do anything than anybody. For instance, even you, despite your best efforts in these three examples, can’t be 230% less likely to have a triple-digit IQ than the rest of us. Here’s a rule of math for you: a number can only be reduced by 100%. Rules of math tend to be strictly enforced, even in wellness. So the good news is, even in the worst-case scenario, you’re only 100% less likely to have a triple-digit IQ than the rest of us.
And yet, if it were possible to be 230% dumber than the rest of us, you might be. For instance, US Corporate Wellness also brought us this estimate of the massive annual savings that can be obtained just by, Seinfeld-style, doing nothing:
So assume I spent about $3500/year in healthcare 12 years ago, which is probably accurate. My modifiable risk factors were zero then and they are still zero — no increase. So my healthcare spending should have fallen by $350/year for 12 years, or $4200 since then. But that would be impossible, since I could only reduce my spending by $3500. Do you see how that works now?
To his credit, US Corporate Wellness’s CEO, Brad Cooper, is quoted in this article as saying: “Unfortunately some in the industry have exaggerated the savings numbers.” You think?
I’m pretty sure this next one is impossible too. I say “pretty sure” because I’ve never been able to quite decipher it, English being right up there with math as two subjects which apparently frustrated many a wellness vendor’s fifth grade teacher:
400% of what? Is US Corporate Wellness saying that, as compared to employees with a chronic disease like hypertension, employees who take their blood pressure pills are 400% more productive? Meaning that if they controlled their blood pressure, waiters could serve 400% more tables, doctors could see 400% more patients, pilots could fly planes 400% faster? Teachers could teach 400% more kids? Customer service recordings could tell us our calls are 400% more important to them?
Or maybe wellness vendors could make 400% more impossible claims. That would explain this BenefitsPro article.
We have been completely unable to get Fitbit to speak, but BenefitsPro couldn’t get them to shut up. Here is Fitbit’s Amy McDonough: “Measurement of a wellness program is an important part of the planning process.” Indeed it is! It’s vitally important to plan on how to fabricate impossible outcomes to measure, when in reality your product may even lead to weight gain. Here is one thing we know is impossible: you can’t achieve a 58% reduction in healthcare expenses through behavior change — especially if (as in the 133 patients they tracked in one of their studies) behavior didn’t actually change.
You can read about that gem, and others, in our recent Fitbit series here:
- Springbuk wants employees to go to the bathroom
- Fitbit throws a bit of a fit, Part 1
- Fitbit throws a bit of a fit, Part 2
Health Enhancement Research Organization (HERO) and Staywell
I’ll consider these two outfits together because people seem to bounce back and forth between them. Jessica Grossmeier is one such person. Jessica became the Neil Armstrong of impossible wellness outcomes way back in 2013. Not just any old impossible wellness outcomes — those have been around for decades. She and Staywell pioneered the concept of claiming outcomes they already knew were impossible. While at Staywell, she and her co-conspirators told British Petroleum they had saved about $17,000 per risk factor reduced. So, yes, according to Staywell, anyone who temporarily lost a little weight saved BP $17,000 — enough to clean up about 1000 gallons of oil spilled from Deepwater Horizon.
See British Petroleum’s Wellness Program Is Spewing Invalidity for the details.
Leave aside both the obvious impossibility of this claim, and also the mathematical impossibility of this claim given that employers only actually spend about $6000/person on healthcare. Jessica’s breakthrough was to also ignore the fact that this $17,000/risk factor savings figure exceeds by 100 times what her very own article claims in savings. Not by 100 percent. By 100 times.
Fast-forward to her new role at HERO. In this article she says:
The conversation has thus shifted from a focus on ROI alone to a broader value proposition that includes both the tangible and intangible benefits of improved worker health and well-being.
Her memory may have failed her here too because HERO — in addition to admitting that wellness loses money (which explains its “shift” from the “focus on ROI alone”) — also listed the “broader value proposition” elements of their pry-poke-and-prod wellness programs. The problem is the elements of the broader value proposition of screening the stuffing out of employees aren’t “benefits.” They’re costs, and lots of them:
When she says: “The conversation has shifted from a focus on ROI alone,” she means: “We all got caught making up ROIs so we need to make up a new metric.” RAND’s Soeren Mattke predicted this new spin three years ago, observing that every time the wellness industry makes claims and they get debunked, they simply make a new set of claims, and then they get debunked, and then the whole process repeats with new claims, whack-a-mole fashion, ad infinitum. Here is his specific quote:
“The industry went in with promises of 3 to 1 and 6 to 1 based on health care savings alone – then research came out that said that’s not true. Then they said: “OK, we are cost neutral.” Now, research says maybe not even cost neutral. So now they say: “But is really about productivity, which we can’t really measure but it’s an enormous return.”
While other vendors, such as Wellsteps, harm plenty of employees, Interactive Health holds the distinction of being the only wellness vendor to actually harm me. I went to a screening of theirs. In order to increase my productivity, they stretched out my calves. Indeed, I could feel my productivity soaring — until one of them went into spasm. I doubt anyone has missed this story but in case anyone has…
They also hold the distinction of being the first vendor (actually their consultant) to try to bribe me to stop pointing out how impossible their outcomes were. They were upset because I profiled them in the Wall Street Journal . The article is behind a paywall, so you probably can’t see it. Here’s the spoiler: they allegedly saved a whopping $53,000 for every risk factor reduced. In your face, Staywell!
Here is the BenefitsPro article’s quote from Interactive Health’s Jared Smith:
“There are many wellness vendors out there that claim to show ROI,” he says. “However, many of their models and methodologies are complex, based upon assumptions that do not provide sufficient quantitative evidence to substantiate their claims.”
Finally, here is a news flash for Interactive Health: sitting is not the new smoking. If anything is the “new smoking,” it’s opioid addiction, which has reached epidemic proportions in the workforce while being totally, utterly, completely, negligently, mind-blowingly, Sergeant Shultz-ily, ignored by Interactive Health and the rest of the wellness industry.
There is nothing funny about opioid addiction and the wellness industry’s failure to address it, a topic for a future blog post. The only impossibility is that it is impossible to believe that an entire industry charged with what Jessica Grossmeier calls “worker health and well-being” could have allowed this to happen. Alas, happen it did.
And, as you can see from the time-stamp on this post, except at establishments favored by the Wellness Ignorati, breakfast hasn’t even been served yet.
This afternoon STATNews followed up with more criticism of HR 1313, the Preserving Employee Wellness Programs Act. As measured by comments to their previous article and the Washington Post’s article, public opinion is running about 999-to-1 against it. That’s a lot even for wellness.
Ryan Picarella, of WELCOA, jumped on this and got way ahead of HERO, which is not opposing it. They can’t. Aetna is a major dues-paying supporter, and Aetna loves genetically screening employees for defects. Naturally they fabricate their outcomes. This time we mean it literally when we say: “Lying is part of wellness vendor DNA.” Aetna even invested in a company to further their dystopian vision, a company ironically named Newtopia.
By contrast, this is the kind of leadership we’ve come to expect from WELCOA, filling the ethical vacuum created by HERO.
But, more importantly, this article is the first media mention of Ethical Wellness, our new website dedicated to putting the wellness back in wellness. You might recall the original Workplace Wellness Code of Conduct. Ethical Wellness has updated it. You can sign on to the website, join and endorse, all at no cost. You can also contribute, separately, and be highlighted as a contributor. Scott Life and Dan Keith have both pitched in $500, as compared by to my $10 (to test the donating mechanism — that’s my story and I’m sticking to it). I’ll be putting in the other $490 shortly. Really. There is also a linkedin group. No mass postings — a true discussion group.
We’ll be talking more about Ethical Wellness in the coming days. for now, it’s about not fining employees for refusing to have their children genetically screened for defects.
Rumor has it that within the next couple of days Health Affairs is going to release a paper in which Ron Goetzel admits that — even with his finger on the scale as it always is (along with the other nine and all his toes) — wellness loses money. This is total vindication for the years in which he has preferred to simply fabricate large savings, based on trivial risk impact, and then accuse me of “outrageous inaccuracies” and other such fanciful tales for observing — accurately, as it turns out — that all his savings are made up.
Yes, I know I’ve said he has admitted wellness loses money several times before, like in his HERO Guidebook, or in STATNews, or in the Chicago Tribune. But those were all gaffes. (A gaffe is defined as “accidentally telling the truth.”) The difference is, this time it’s deliberate.
And, no, he hasn’t sworn off lying. Lying is a thing these days. He was way ahead of the curve on that. Mind you, I have not seen the article, and I wasn’t allowed to peer review it. (Health Affairs allows authors to rule out certain peer reviewers, so he ruled me out — despite admitting not too long ago that I am the best peer reviewer in the field.) However, I anticipated that, given his level of integrity, he would use the completely invalid participants-vs-non-participants methodology, and so I invalidated it for him ahead of time, not that he didn’t already know.
Despite admitting losses, he still holds to the fiction that somehow risk factors decline, a claim which I intend to examine once I see the article. I suspect he didn’t plausibility-test the outcomes (even though his HERO guidebook says to do that) and/or he didn’t count dropouts and non-participants. But we’ll know soon enough.
However, by admitting wellness loses money even if risk factors improve, he just invalidated every single Koop Award he has ever bestowed on any of his buddies. The reason is that in those award-winning situations, risk factors either only improve a trifle (Staywell, 2014 and Nebraska, 2012), don’t decline at all (McKesson, 2015), or increase (Wellsteps and Boise, 2016). None of these non-improvements acknowledges dropouts, of course.
PS Remember my $2-million reward for showing wellness saves money? Let’s make it $3-million.
The best outcomes evaluator in the wellness field is Dr. Iver Juster.*
*Among the subset of males not affiliated with They Said What.
Why Dr. Juster’s Case Study Is the Best Case Study Ever Done in This Field
Chapter 2 of the HERO Guide is a great study and deserves high praise. But before we get into the salient points of what makes this absolutely the best case study analysis ever done in this field, be aware the provenance is not a coincidence. Dr. Juster is very skilled at evaluation. Indeed he was the first person to receive Critical Outcomes Report Analysis (CORA) certification from the Disease Management Purchasing Consortium. (Dr. Juster very graciously shares the credit, and as described in his comments below would like to be listed as “the organizer and visible author of a team effort.”)
Note: the CORA course and certification are now licensed for use by the Validation Institute, which has conferred honorary lifetime certification on Iver gratis, to recognize his decades of contribution to this field. (Aside from the licensure, the Validation Institute is a completely independent organization from DMPC, from They Said What, and from me. It is owned by Care Innovations, an subsidiary of Intel. If you would like to take the CORA Certification course live, it is being offered next in Philadelphia on March 27. You can take it online as well.)
Early in the chapter, Iver lists and illustrates multiple ways to measure outcomes. He dutifully lists the drawbacks and benefits of each, but, most importantly, notes that they all need to be plausibility checked with an event-rate analysis, which he provides a detailed example of–using data from his own work. In an event rate analysis, wellness-sensitive medical events are tracked over the period of time in question.
Wellness has never been shown to have a positive impact on anything other than wellness-sensitive events. Consequently, there is no biostatistical basis for crediting, for example, “a few more bites of a banana” with, to use our favorite example, a claimed reduction in cost for hemophilia, von Willibrand’s Disease and cat-scratch fever.
By contrast, real researchers, such as Iver, link outcomes with inputs using a concept called attribution, meaning there has to be a reason logically attributable to the intervention to explain the outcome. it can’t just a coincidence, like cat scratch fever. As a result, he is willing to attribute only changes in wellness-sensitive medical events to wellness.
Event-Rate Plausibility Analysis
Event rates (referred to below as “PPH” or “potentially preventable hospitalizations”) are laid out by disease on page 22 of the HERO Report. Note the finding that PPH are a small fraction of “all-cause hospitalizations.” Though the relative triviality of the magnitude of PPH might come as a surprise to people who have been told by their vendors that wellness will solve all their problems, Iver’s hospitalization data sample is representative of the US as a whole for the <65 population, in which chronic disease events are rare in the <65 population.
Gross savings total $0.99 per employee per month. This figure counts all events suffered by all members, rather than excluding events suffered by non-participants and dropouts. Hence it marks the first time that anyone in the wellness industry had included those people’s results in the total outcomes tally — or even implicitly acknowledged the existence of dropouts and non-participants. He also says, on p. 17:
For example, sometimes savings due to lifestyle risk reduction is calculated on the 20% of the population that supplied appropriate data. It’s assumed that the other 80% didn’t change but if some of the people who didn’t supply risk factor data worsened, and people who got worse were less likely to report their data, that model would overestimate savings.
Note that the PPH declined only in cardiac (“IVD”) and asthma. Besides the event rates themselves being representative of the employed population in the US as a whole as a snapshot, the observed declines in those event rates are almost exactly consistent with declines nationally over that same period. This decline can be attributed to improvements in usual care, improvements that are achieved whether or not a wellness program was in place. The existence and magnitudes of the declines, coupled with the slight increase in CHF, diabetes and COPD combined (likewise very consistent with national trends), also confirm that Iver’s analysis was done correctly. (Along with attribution, in biostatistics one looks for independent confirmation outside the realm of what can be influenced by the investigator.)
It is ironic that Ron Goetzel says: “Those numbers are wildly off…every number in that chapter has nothing to do with reality” when I have never, ever seen a case study whose tallies — for either total events or event reduction, let alone both — hewed closer to reality (as measured by HCUP) than this one.
Another factor that conveniently gets overlooked in most wellness analyses is that costs other than PPHs rise. By contrast, Iver is the first person to acknowledge that:
The implication, of course, is that increases in these costs could exceed the usual care-driven reductions in wellness-sensitive medical events. Indeed, Iver’s acknowledgement proved prescient when Connecticut announced that its wellness program made costs go up.
The $0.99 gross savings, and Connecticut’s healthcare spending increase, exclude the cost of the wellness program itself, of course. Factor in Ron Goetzel’s recommendation of spending $150/year for a wellness program and you get some pretty massive losses.
The old Al Lewis would close by making some reference to the dishonesty and cluelessness of the Health Enhancement Research Organization’s board. The new Al Lewis will do just the opposite. In addition to congratulating Iver Juster (and his co-author, Ben Hamlin) on putting this chapter together, I would like to congratulate the Health Enhancement Research Organization, for what Iver describes as the “team effort” in publishing it — HERO’s first flirtation, however fleeting and inadvertent, with integrity and competence.
Iver Juster Comments on the article
Iver reviewed this article and would like to add several points. I am only adding a couple of my own points, noted in indented italics:
- It’s important to credit the work to a larger group than just myself. I was the ‘lead author’ on the financial outcomes chapter of the HERO/PHA measurement guide, but the work entailed substantial planning and review in collaboration with the chapter’s coauthor (Ben Hamlin from NCQA) and members of the group dedicated to the chapter (as well as the HERO/PHA authoring group as a whole).
- Yes, I am more than happy to credit the entire group with this study, especially Ron Goetzel, Seth Serxner and Paul Terry.
- Nonetheless the work does reflect my perspective and approach on the topic – the important points being (a) select metrics that are impactible by the intervention or program; (b) be transparent about the metric definitions and methodology used to measure and compare the; (c) assiduously seek out potential sources of both bias and noise (in other words, exert the discipline of being curious, which is greatly aided by listening to others’ points of view); (d) understand and speak to the perspective of the study—payer, employee/dependents, clinician/healthcare system, society.
- Be particularly sensitive to the biologically-plausible timeframes in which your outcomes ought to occur, given the nature of the program. Even if optimally implemented with optimal uptake and adherence, we might expect ‘leading indicators’ like initial behavior changes to improve quickly; program-sensitive biometrics (lipids, A1C, blood pressure, BMI) and medication adherence to change in a matter of months; and a few program-sensitive ER/inpatient visits (like worsening heart failure or asthma/COPD exacerbations) to improve within several months (again, assuming the program is designed to address the causes of these events). Longer-term events like kidney failure, heart attack and stroke and retinopathy take much longer to prevent partly because they require sustained healthy behavior, and partly due to the underlying biology.
- This is one excellent reason that the measured event rate decline mirrored the secular decline in the US as a whole over the period, meaning the program itself produced no decline over that period. Possibly they might decline in future years if Iver is correct. Ron Goetzel would take issue with Iver’s assertion — Ron says risk factors decline only 1-2% in 2-3 years.
- Event rate measurement in any but the largest Commercially-insured populations is subject to considerable noise. Though a challenge, estimating ‘ confidence intervals should at least shed light on the statistical noisiness of your findings.
- No need this time because your results hewed so closely to secular trend, reflecting the quality of the analysis.
- It is very likely that the program used in the illustration did affect more than the events shown because it was a fairly comprehensive population health improvement initiative. For example, ER visits were not counted; and collateral effects of ‘activation’ – a very key component of wellness – were not included in this analysis. Assuming the 99 cents is an accurate reflection of the program’s effect on the events in the chart, I’d be willing to increase the actual claims impact by 50 to 75%.
- If your speculation is accurate, that would increase gross savings to $1.49 to $1.73/month–before counting preventive care increases indicated on Page 22.
- Nonetheless, to get effect from an effective program you have to increase both the breadth (number of at-risk people) and depth (sustained behavior change including activation) – but at a cost that is less than a 1:1 tradeoff to the benefit. In other words, you must increase value = outcomes per dollar. This cannot be done through incentives alone – as many researchers have shown, if it can be done at all, it must be the result of very sustained, authentic (no lip service!) company culture.
- We are beginning to pay attention to other potential benefits of well-designed, authentic employee / workplace wellness programs (of which EHM is a part) on absenteeism, presenteeism, employee turnover and retention – and, importantly, company performance (which is after all what the company is in business to do). It’s early days but it’s possible research will show that companies that are great places to work and great places to have in our society will find financial returns that far outstrip claims savings. The jury’s still out on this important topic but let’s help them deliberate transparently and with genuine curiosity.
- Did Ron really say you have to spend $150 per year PER MEMBER on a wellness program? I’d be thinking a few dollars (unless he’s including participation incentives)
- (1) Yes, he did say that; (2) no, he’s not including participation incentives; and (3) welcome to my world.
*Among the subset of males not affiliated with They Said What.
Alert readers may recall that my New Year’s resolution was to balance my negative postings about the wellness industry with positive ones. Like Diogenes searching for an honest man, I thought the finding the latter would be hard, but just as Romy Antoine also did earlier this month, The subject of this posting — to be named in Part Two — makes that easy. Part One sets the stage for the review of his study.
By way of background, in preparation for bringing a possible lawsuit, I re-read the famous Chapter 2 of the equally famous HERO report. That was the chapter which inspired Ron Goetzel, Seth Serxner and Paul Terry (who was recently anointed as the American Journal of Health Promotion’s new Fabricator-in-Chief) to circulate their defamatory letter about me to the media, in a singularly self-immolating attempt to discourage them from publishing my material. They insisted that Chapter 2 was pure fabricated nonsense, rather than a carefully analyzed report of real data. Here is an excerpt from their actual letter, copies of which are available from me but which is summarized here:
A fabricated…absurd, mischievous and potentially harmful misrepresentation of our data.
Ron said it best in our Great Debate, minute 1:17 in the MP3 downloadable here:
Those numbers are wildly off…every number in that chapter has nothing to do with reality.
However, the sun rises in the east, taxes are due April 15th, and Ron Goetzel is lying. Quite the contrary, Chapter 2 turns out to be a carefully analyzed report of real data — almost certainly the best case study ever published.
How did I learn that Ron was fabricating a story that his guidebook had fabricated a story?
- This chapter says it’s a real report, on p. 22.
- Since this chapter’s analysis was so far above the pay grade of those three aforementioned HERO characters, I checked the acknowledgements in the HERO book. Sure enough, none of the HERO cabal wrote it. Someone else (to be named in the next posting) was the lead author, and I called to congratulate him on it. I also asked him some background questions, one of which proved very revealing. It turns out that…
- This real analysis of real data was — get ready — reviewed prior to publication by the exact same people who are disowning it now. Yes, among the people who peer-reviewed it prior to publication were the very same Ron Goetzel, Seth Serxner, and Paul Terry. (In addition to them doing the actual review, the lead author, very graciously sharing the credit, wanted to make sure that I indicate that he was only the “organizer and visible author of a team effort.”)
Yes, as is so often the case with these three, they lied about the lies that they lied about. It’s quite ironic that their argument against my original praise of this analysis was to insist that because my source was their own lies, my own analysis was unreliable. These lies above don’t include the actual lies I might sue them about, which were lies about me, which are totally separate from their lies about their previous lies. (Their lie about me was that I had a history of outrageously inaccurate statements, none of which they have ever been able to identify.)
These characters aren’t ordinary run-of-the mill alternative fact-type liars. They’re way beyond that.
Their lies go to 11.
Having covered the also-rans last week, here are the first runners-up, as we inch ever closer to the coveted top spot. (To read the original postings, click on the numbered headers.)
Today we are highlighting more people and organizations who’ve made the wellness industry what it is. Wednesday we will complete the listing of the Stars of Wellness, the people and organizations who are making the industry what it should be.
Interactive Health conducted what may be the head-scratchingest screen in wellness industry, a difficult feat given all the competition. For starters, they tested me for calf tightness. It turns out my calves are tight–and right on-site they loosened them. I could feel my productivity soaring…until the left one went into spasm that night and I couldn’t get back to sleep. Still, I can see their point — loose calves are a useful trait for many common jobs.
Next, Interactive Health shattered the record, previously shared by Total Wellness and Star Wellness, for most USPSTF non-recommended blood tests. I don’t know what half these things are, which means neither does Interactive Health.
Where would a Deplorables Greatest Hits List be without the Koop Award Committee?
Every year, like clockwork, the industry’s biggest liars select the industry’s biggest lies. 2016 started with last year’s winning program, McKesson’s, being exposed as a joke in Employee Benefit News, and ended with this year’s winner, Wellsteps, being exposed as a joke in STATNews.
When bestowing this year’s award to their fellow Committee member, Wellsteps, they didn’t even pretend not to lie. And what lies they were! Not just regular-sized lies. Not even supersized lies. We’re talking lies that would make a thesaurus-writer blush.
To put their lies in perspective, I may not even know you, but if a Koop Committee member told me the sky was blue, and you told me the sky was green, I’d at least go look out the window.
PS Not everyone on the Committee is a liar. One person is quite honest and can’t believe what goes on every year. I don’t want to name my source because in Koop-land, honesty is grounds for termination. As is getting validation. Or adopting the Code of Conduct. Basically ethical behavior is off-limits. An executive of one group, Altarum, published a blog critical of wellness and <poof> the Committee disappeared them.
Michael O’Donnell seems to crave my attention. When he managed to go three whole months without being featured in a TSW posting, he came up with these irresistible nuggets:
- “Wellness is indeed the best thing since sliced bread, up there with vaccines, sanitation and antibiotics.”
- “[Wellness] can prevent 80% of all diseases.”
- “The ROI from wellness is very strong.”
- “Workplace health promotion may play a critical role in preserving civilization as we know it.”
If nothing else, Mr. O’Donnell presents the best argument for requiring educational standards, or at least a GED, in this field — by demonstrating his total lack of understanding not just of wellness, but also of vaccines, sanitation, antibiotics, percentages, diseases, ROIs, and preserving civilization as we know it.
Oh, yes, and multiplication as well. His article on how to increase productivity with wellness used an example demonstrating a productivity decrease. In 2016, he also went on an anti-employee jihad that should be read in its entirety. (Translation: some of my best work…) Highlights:
- Prospective new hires should be subjected to an intrusive physical exam, and hired only if they are in good shape. OK, not every single prospective new hire — only those applying for “blue collar jobs or jobs that require excessive walking, standing, or even sitting.” Hence he would waive the physical exam requirement for mattress-tester, prostitute, or Koop Committee member–because those jobs require only excessive lying.
- He would “set the standard for BMI at the level where medical costs are lowest.” Since people with very low BMIs incur higher costs than people with middling BMIs, Mr. O’Donnell would fine not only people who weigh more than his ideal, but also employees with anorexia.
If employees didn’t already have an eating disorder, what better way of giving them one — and hence extracting more penalties from them — than to levy fines based on their weight? Employees above his ideal weight would pay per pound, sort of like if they were ordering lobster or mailing packages.
These three characters — naturally also on the Koop Committee — managed to pile more lies, sardine-like, into a single page than anyone else in this industry, in the “poison pen” about me they circulated to the media.
A good starting question would be, why on earth would anyone think that they can send a “confidential” letter to the media? The media are in the business of disseminating information. You see, that’s why they call them “the media.” Am I going too fast for you, Mr. Goetzel?
The funny thing about these Einsteins? Their defense to my observation that their very own numbers show wellness loses money was that their very own numbers were made up. Imagine being so dishonest that the way you defend yourselves is by claiming you fabricated your own report.
That’s not even the punchline. It turns out that this allegedly fabricated report is in truth an actual non-fabricated report. So, in the immortal words of the great philosopher LL Cool J, they lied about the lies that they lied about.
How did I learn this? That will be the subject of a post early year.
Watch this space…soon we will be naming the industry’s #1 Deplorable of 2016.
Wellsteps has joined Michael O’Donnell, HERO and Optum in attempting to stonewall the Employee Health Code of Conduct, which started as a joint project among WELCOA, myself, and Salveo Partners and has attracted many hundreds of favorable responses. Quizzify and It Starts with Me have both received validation from the Validation Institute for (among other things) our embrace of this simple minimum standard. In both cases, we think the bar should be set much higher, but apparently “do no harm” is already too high a hurdle for HERO, Wellsteps and Optum. Hence their opposition. And Kudos to WELCOA, a very fine organization that Quizzify intends to support for 2017, for standing up to Mr. Aldana’s bullying.
There is some irony in that it was Wellsteps’ harms to Boise employees that inspired my participation in the code-writing. Vendors should not be given awards for harming employees. That doesn’t seem like too much to ask.
Here is the Code, in its entirety.
The Employee Health Program Code of Conduct: Programs Should Do No Harm
Our organization resolves that its program should do no harm to employee health, corporate integrity or employee/employer finances. Instead we will endeavor to support employee well-being for our customers, their employees and all program constituents.
Employee Benefits and Harm Avoidance
Our organization will recommend doing programs with/for employees rather than to them, and will focus on promoting well-being and avoiding bad health outcomes. Our choices and frequencies of screenings are consistent with United States Preventive Services Task Force (USPSTF), CDC guidelines, and Choosing Wisely.
Our relevant staff will understand USPSTF guidelines, employee harm avoidance, wellness-sensitive medical event measurement, and outcomes analysis.
Employees will not be singled out, fined, or embarrassed for their health status.
Respect for Corporate Integrity and Employee Privacy
We will not share employee-identifiable data with employers and will ensure that all protected health information (PHI) adheres to HIPAA regulations and any other applicable laws.
Commitment to Valid Outcomes Measurement
Our contractual language and outcomes reporting will be transparent and plausible. All research limitations (e.g., “participants vs. non-participants” or the “natural flow of risk” or ignoring dropouts) and methodology will be fully disclosed, sourced, and readily available.
What’s there not to like? Plenty, if you negatively impact employee health, as Wellsteps does, according to STATNews. Here is Wellsteps’ response to the code, complete with their signature name-calling.
The Wellness Bully Code of Conduct
Even though the wellness bullies claim that the wellness industry is a sham, they have announced a new code of wellness conduct. I’m very interested in improving the quality and effectiveness of wellness programs. I don’t know any wellness professional who would say otherwise. But I think I speak for all of us when I say that I have no interest in a code of conduct written by a gang of bullies. The wellness industry does not need a code of conduct, we have HIPAA and other laws to do that.
We are now in Ron’s wheelhouse, which is publishing peer-reviewed articles in third-tier wellness trade journals. Let’s see how he does.
For those who are new to this thread, Part 4 is here, and links to earlier installments. The recording is here. Time stamps roughly synch up.
Ron says he is a researcher, and publishes in peer-reviewed journals. He “applauds” me again for giving them the “opportunity” to correct their many errors, and says the comments I make are often “right on the money.”
It is indeed a creative use of the word “opportunity,” as in: “Last year the IRS gave me the opportunity to be subject to an audit.”
He says “that’s what the scientific method is all about, having peer reviewers critique your work and find problems.” And yet, I’ve never, ever been asked to peer review anything that he and his cronies have ever published. Go figure.
He would like “us” (meaning him and his cronies) to be able to review my work, even though I’m not allowed to peer-review theirs. He says he has “never seen an article by Al Lewis…to review.”
Hmmm…perhaps his internet is down?
Since all my work is right on this site (including links to other work, in “In the News” to Health Affairs, Harvard Business Review etc.) he is free to review it anytime, and we publish all comments. There isn’t really any need to for him to look at our material because mostly it’s his own and his cronies’ material. And you know the 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.”
As in his opening remarks and in his “secret” letter to the media, he once again criticizes my stuff as being “out there…outlandish,” but gives zero examples.
Ron, in the process of saying something he knows not to be true for a change, accidentally endorses me.
“Ron, would you say I am the most qualified person in peer review in terms of finding the most mistakes?”
“Well, who has found more mistakes than I have?”
[Silence and nervous laughter from the audience.]
I point out that — despite his tacit endorsement just now that I am the best peer reviewer — none of his friends’ wellness trade journals have ever asked me to peer review anything.
And he still refuses to say why he hasn’t claimed the million-dollar reward.
Peer reviewed or not, numbers need to add up, and Ron’s don’t. In one award-winning example, Eastman Chemical, $900/person in savings was shown — with risk factors changing by only 0.17 per person, excluding dropouts.
Ron did not rebut this. Eastman was one of the two Koop Award applications he had doctored when it turned out the applicant had accidentally told the truth but no one on the award committee noticed.
Ron has already run away from most of the industry’s claims, as earlier installments of this debate have observed. Now is he running away from Wellsteps’ Steve Aldana, whom he has co-presented and co-authored with and who naturally is on his Koop Award committee. Aldana recently wrote that I was “sick” because a colleague posted my Harvard Business Review article on his linkedin group and asked what people thought of it.
[2016 Update: Ron is now embracing Steve Aldana and Wellsteps, the first company to admit to harming employees.]
Ron is turning his blacklisting of me into my “plea” to do peer review in his trade journals. I have never “pled” to do peer review in his trade journals, which are mostly useful as punchlines. I merely observe that I’ve never been asked. “You’re very good at calling out mistakes, but you’re not very good at publishing your own research studies.”
He then cites the Johnson & Johnson study (that’s the same Johnson & Johnson that just proposed the Fat Tax). That is the only study he’s ever done that I’ve not been able to invalidate on its face, so he gets his first point of this round here. Not because the study is valid. There wasn’t enough data in it for me to automatically prove that it was invalid, which is a very high standard, but that’s my standard–“face invalidity.”
So there you have it: one company in the entire universe that might possibly have saved money on wellness. And as coincidence would have it, they also sell wellness services. No publication bias there…
November 4, 2016 Update: I just found this J&J study. It is even worse than the others. Employees lying on HRAs, trivial risk reductions…and of course massive savings. It appears that all they did was increase the deductible and then give employees $500 to do wellness, thus shifting the money out of the healthspend into the incentives account, which is not included in the “savings.”
I point out that even though I’m apparently not qualified enough to peer review for his friends who run low-impact journals, I do get called upon to peer review for Health Affairs and other high-impact journals. And most importantly, while I’ve done only two peer-reviewed articles, one led to the dismantling of the North Carolina Medicaid medical home. The other was #1 for 2015 in the American Journal of Managed Care and continues to be cited widely. My award-winning book was peer-reviewed by some of healthcare’s leading figures: Stuart Altman, James Prochaska, Tom Scully, Leah Binder, Bob Galvin, Regina Herzlinger, and Nortin Hadler (the same Nortin Hadler who apologized for poor peer review by one of Ron’s favorite trade journals).
Most importantly, speaking of peer review, Quizzify is the only population health company that may publicly say “our content is reviewed by doctors at Harvard Medical School.”
Ron — whose entire industry loses money and can’t even guarantee not losing money — is now lecturing me on Quizzify’s guarantee of savings and how it needs to be peer-reviewed. I was not expecting to be attacked for offering an incredible, unique, value proposition, so I didn’t have a good answer. Only in wellness is saving money for customers considered a bad idea.
He continues to harp on peer review by his friends-and-relations, but I won the round with one simple observation: “We are not here today because of Ron’s peer-reviewed articles. We are here today because of my non-peer-reviewed articles.”
I could fill a blog with all the nonsense that Ron’s friends who run so-called “peer-reviewed journals” have published. Come to think of it, I have. Examples:
AJHP’s proposal to tie insurance premiums to weight, like ordering lobster or mailing packages
JOEM’s Aetna debacle
AJHP’s “Randomized control trials show negative ROIs.” (I didn’t have to post anything here–this spoke for itself.)
I’ve raised the bar for getting “profiled” on this site. Life is too short to simply highlight every wellness outfit that tests inappropriately and then lies about their outcomes.
Nor can you get on this list simply with bold proclamations of fatuous statements, like Interactive Health does:
Hey, Interactive Health, we get that you don’t understand statistics in general, based on the mind-boggling excuses your consultant offered about your completely invalid savings report (“Al, the [massive] savings on Page 4 have nothing to do with the [trivial] risk reduction on Page 9. It’s a completely separate analysis.”).
Even so, maybe you can find a smart person to explain this particular statistic to you:
- According to the CDC, the number of annual deaths caused by smoking: 480,000
- According to the CDC, the number of annual deaths caused by sitting: 0
Here are some other differences between the two activities: Chairs don’t carry excise taxes or warning labels. If you’re under 18, you can buy a chair without a fake ID. Workers are allowed to sit inside the building. Chairs don’t make you clothes smell, cause lung cancer or dangle from the lips of gunslingers in old John Ford westerns. Sitters aren’t assessed health insurance penalties. Your Match date will not feel misled if he or she catches you taking a seat, even if your profile didn’t disclose that you sit.
Sitting isn’t the “new smoking.” Opioids are the “new smoking.” But since you don’t help employees understand the risks of opioid addiction, it’s probably because you don’t understand these risks yourselves. Quizzify has produced a painkiller/pain reliever awareness quiz that you might benefit from. Welcome to 2016. THIS is what’s harming and even killing employees, not sitting.
The Interactive Health IQ Test
Which of these images is most unlike the others?
No, these days to get into this column, you need to soar above and beyond ordinary wellness vendor stupidity and dishonesty, because Wellsteps has totally raised the bar…and yet Interactive Health has cleared it.
I was recently screened by Interactive Health. They were supposed to send me a standard summary writeup, which I asked for repeatedly but never received. Instead, weeks later, their lab sent me a lab report, with no interpretation. There are one of three explanations for this:
- They are too incompetent to send out summary writeups in a timely way;
- They think an unadorned, highly technical, lab report sent three weeks after the fact constitutes a useful summary writeup;
- They were about to send out their standard summary writeup, before someone noticed my name and said: “Whoa! That’s Al Lewis. He is nowhere near stupid enough to find our usual nonsense acceptable. He has already exposed our savings lies in the Wall Street Journal, and if we give him our usual writeup on his screening, he will expose our stupidity on his blog. We need to cover that up. So let’s just send him a lab report.”
By process of elimination, I originally landed on #3. Quite flattering really. I’d make a few observations.
First, I specifically asked them, in accordance with USPSTF guidelines, not to measure my PSA. They interpreted that — as you can see from the top of that page reproduced at the very end — as a request specifically to measure my PSA. (It is on Page 2 of the report, which I can’t put my hands on right this very moment. However, the Wellness Ignorati, who still think it predicts cancer, will be disappointed to learn that it was quite low.)
Second, the glucose is slightly high because some very generous folks had just treated me to a large and delicious breakfast. A classic false-positive, the type of reading that makes wellness vendors’ hearts go all aflutter, because then they can do a followup reading and show that they improved the outcome, after it improves on its own. Interactive Health’s lab report was completely unhelpful on this high reading. No advice offered.
Third, Interactive Health shattered the record, previously shared by Total Wellness and Star Wellness, for most USPSTF non-recommended blood tests. I don’t know what half these things are, which means neither does Interactive Health. (Total Wellness might win a second-place tiebreaker because they would still be testing for ovarian cancer — it’s still advertised on their website — except that the only company that makes the test has pulled it from the market following FDA warnings not to use it. Hopefully, Total Wellness stockpiled some assays ahead of the recall, like Elaine did with the sponges.)
Interactive Health also tested me for calf tightness, as I mentioned in an earlier blog. It turns out my calves are tight, and right on-site they loosened them. I could feel my productivity soaring…until the left one went into spasm that night. Still, loose calves are a useful trait for some jobs, such as first baseman.
Interactive Health may have also just assumed that because they don’t like me, no one else in the industry does either. That’s actually a fairly accurate assumption, one I am quite proud of given the integrity of most of them, with their trade association, the Health Enhancement Research Organization, leading by example in the pants-on-fire department. Indeed a good rule of thumb to determine if a wellness vendor is honest is to ask them what they think of me.
Nonetheless, I was able to find someone who was screened at a different screening and said he received an actual wellness outcomes report from these people, someone who likes me well enough to send it to me. Coincidentally, this individual had been urging me to post on Interactive Health for quite some time. I figured, cool, I could see what a real report from Interactive Health looks like, the kind that changes employee behavior enough to explain their whopping savings claims of $54,000 for each employee who reduced a risk factor.
No such luck. He sent me exactly the same lab printout that they sent me. Only he hadn’t lost the second page, so I could count the total: 43 lab values. “Knowing your numbers” could be a full-time job. One would think they had covered all the risk factors with all those lab values, but, curiously, the guy said his blood pressure was quite high, and they missed that altogether.
Hmm…how come he got the same completely unhelpful report I did? Did Interactive Health view my linkedin profile — as their executives are wont to do on a regular basis bordering on the obsessive –and decide that it wasn’t safe sending any of my connections their typical employee printout, on the theory that if I’m not stupid, neither are most of my connections? If so, that would be their second fairly accurate assumption.
The only other explanation is that everyone receives the same unadorned lab report, full of letters and numbers and signifying nothing, at least to the average person without a PhD in biochemistry. My feelings were shattered. I wasn’t special. Do they send everyone else incomprehensible lab reports with 43 different numbers in them along with assortments of letters most people would associate with Scrabble…and no interpretations or advice?
Whether incompetence or botched coverup, the explanation itself remains a mystery. Nonetheless here are a few numbers and letters from his report.
Maybe Interactive Health could interpret this for us, but I would be more confident of their ability to distinguish (for example) AST-SGOT from ALT-SGPT if they could distinguish (for example) a chair from a cigarette.
How is anyone supposed to make any sense out of this? Most employees would think a “negative risk factor” is a bad thing,” as in “telling the truth is a negative risk factor for the profitability of wellness companies, which is why most of them never do it.” And what does “VLDLCH” mean and why isn’t it reported? Still no interpretations.
And then of course there is the PSA test. If you don’t speak up — or even if you do speak up, as I learned — they’ll do one on you, even though the USPSTF rates it “D”, not to mention that the actual inventor of the test says the test is “inaccurate and a waste of money.” My friend’s PSA result is listed at the bottom of this apparently random number and letter generator…
And, yes, finally, an interpretation!
“Values obtained with different assay methods or kits cannot be used interchangeably. Results cannot be interpreted as absolute evidence of the presence or absence of malignant disease.”
In other words, the interpretation is that this test doesn’t explain anything, so we recommend ignoring the result.
It would have been even more helpful for them to recommend ignoring Interactive Health altogether– the calves, the chairs, the cigarettes, the AST and ALT, and, to be discussed in a future posting, the fabricated outcomes report.
Here is the entire first page of my own results, so that you know we are not taking this out of context…
As our more alert readers may possibly have noticed just a little bit, there is a battle taking place between advocates of doing wellness to employees (wellness vendors) vs. advocates of doing wellness for employees (the rest of the inhabited solar system). There are also those who want to do both, what my colleague Jon Robison calls “paradigm straddling”. This latter group consists of vendors who want to check off the culture-of-wellness box so they sound relevant and supportive and au courant, while continuing to charge employers large sums to screen the stuffing out of their employees. The most hilarious example of the last is Total Wellness. If you haven’t already read their “profile,” it’s well worth the wear and tear on your keypad to click through.
Now, along comes Stanford University’s Emma Seppala, writing “Good Bosses Create More Wellness than Wellness Plans Do” in Harvard Business Review, to draw a bright-line distinction between the two approaches.
Her first paragraph:
In the name of employee wellness, and in response to insurance company demands, corporations are offering well-being initiatives with financial incentives. Complete this cholesterol screening, say, and you’ll get $100 added to your paycheck; participate in some number of wellness programs, and you’ll receive another bonus. In this quest to increase employee wellness, however, organizations are often unwittingly making things worse. Is it any surprise that initial studies on wellness programs are showing they don’t lead to any visible results?
As an aside, even our less alert readers may recall that I got in a lot of trouble with the HERO crowd (Ron Goetzel, Staywell, and Seth Serxner) just for the crime of noticing that their own numbers in their own guidebook showed wellness loses money. Apparently, Ms. Seppala noticed the same thing, because the link in her article in support of the “wellness programs don’t lead to any visible results” comment goes directly to their report. I guess she’s going to be placed on their Enemies List as well, and she can probably also expect them to circulate a “poison pen” letter about her as well, perhaps using the one they wrote about me as a template. Congratulations, Emma! You’ve arrived.
These programs “can actually cause more stress,” she writes. And she notes that those employees who do take time off for the corporate yoga class etc. get dirty looks from colleagues who need to pick up their slack.
What to Do Instead
It won’t surprise even our least alert readers that Ms. Seppala advocates a Dee Edington-type “culture of wellness,” starting with the work environment itself:
A workplace characterized by humanity. An organizational culture characterized by forgiveness, kindness, trust, respect, and inspiration… Leaders set the tone for their organization, and their behavior determines whether interactions in their organization are characterized by trust, forgiveness, understanding, empathy, generosity, and respect.
I’ll leave the rest for you to read.
Where Does This Leave the Wellness Industry?
You’ll see a lot more paradigm-straddling. Once again, the wellness industry comes through with the quintessential example: a Pulse post from a wellness vendor called Dacadoo. (There are so many wellness vendors that I guess all the other names have been taken.)
Talking about all the “fun things” that a wellness culture can provide, Dacadoo writes:
[Health fairs] are professionally run events that are designed to provide education and basic medical screening at usually little cost or no cost for the employees. At these fairs employees can undertake some screening tests such as blood pressure, glucose cholesterol, height and weight, anemia, etc.
Speaking of the solar system, anyone from another planet would interpret this passage as employees thinking: “Wow, my employer can weigh me and test me for both ‘glucose cholesterol’ and anemia! At little or no cost to me? How cool is that?”
And I bet if employees are willing to pay them just a tiny bit more, Dacadoo will also allow them to paint their fence.