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HERO’s Paul Terry, Ron Goetzel, Seth Serxner Admit to Fabricating Data

Update: It turns out that, notwithstanding the protestations of these three very stable geniuses to the contrary, their data that they claim (three times, below) to have “fabricated” was actually real…and the three of them reviewed it before it was published.

How do I know this? In addition to the chapter actually saying it was real data, and the guidebook saying each chapter was reviewed multiple times by multiple people, I simply asked the author.  He confirmed both that the data was real (“If I had made it up, I would have said so”) and that it was indeed reviewed multiple times by multiple people on the HERO board.

When I re-read the chapter, I thought: “This can’t have been written by someone at HERO. This is actual analysis and they don’t know how to do actual analysis.” Sure enough — the actual author is Dr. Iver Juster, who has taken all my courses and read all my books and has the advanced level of Critical Outcomes Report Analysis certification.

In other words, to quote a rapper whose name escapes me, they lied about the lies they lied about.



In an earlier column we indicated that we had gotten wind of a “poison pen” letter that the Health Enhancement Research Organization (HERO) board members (Paul Terry, Johns Hopkins’ Ron Goetzel and Optum’s Seth Serxner, among others) sent around to members of the media.  We just weren’t sure to whom it was sent or what exactly it said.

Eventually my attorney pried it out of them, after they first refused to admit this letter existed.

My attorney said he had never had a client who wanted to republish a defamatory letter written about him. I replied: “In the wellness industry, a defamation from HERO is, in the immortal words of the great philosopher Kenny Banya, ‘Gold, Jerry. Gold.’”  Indeed, this letter is the closest I’m ever going to come to achieving my boyhood dream of appearing on Nixon’s Enemies List.

Here are a few excerpts–along with my annotations in italics.


“The featured variables from the HERO report that these authors cites [sic] as ‘evidence’ begin with a statement that ‘HERO calculates gross wellness program savings of $0.99.’  As is obvious to even the most uninitiated reader of our report, the $0.99 amount is taken from page 23 of an 87 page report in a section which is clearly labeled as one example wherein the sum savings derives from a fabricated scenario…The authors go on to suggest that the HERO report provides ‘evidence’ of a negative return on investment from wellness programs because our ‘report estimates wellness programs costs at $1.50 pmpm.'”

Our math (meaning your own math in your “fabricated scenario”) is correct. True, we never in a million years realized that wellness economics are so hilariously poor that even when you “fabricate a scenario” in your own guidebook, you still manage to lose money.   And in any event, even though you never asked us to, we did correct that inaccuracy—by showing how much more money wellness loses if we substitute real numbers from HERO Committee members’ own writings for the “fabricated” ones.


“This variable is taken from page 15 of our report and the report’s authors in no way associated the two numbers. Furthermore, the cost number is again derived from a fabricated illustrative example…” 

So you’re saying that your report’s authors put these two numbers (costs=$1.50 PEPM and savings=$0.99 PEPM) in the very same chapter but readers aren’t supposed to compare them?  Bad readers! Shame on you for being discerning!

By the way, the example isn’t “fabricated.” Messrs. Goetzel, Serxner and Terry are now, in the immortal words of the great philosopher LL Cool J, lying about the lies they lied about.  This is not a “fabricated illustrative example.” It is a reproduction of an actual report, which is why Page 22 calls it a report and describes what it shows:

heroreportp22language-on-report


“The authors seem to indicate that their findings from these distinctly unassociated variables is an inventive disclosure of a negative ROI for wellness on their part by writing that ‘this loss was not an intentional finding in this document.'”

Leaving aside that both these “distinctly unassociated variables” appear in the exact same chapter, how can costs be “distinctly unassociated” with revenues? Isn’t that what business is all about, associating revenues and costs?  Example: Suppose your revenues are $2.  That’s GOOD if your costs are $1 but BAD if your costs are $3. 

I’ll use a sports analogy so that even the dumbest member of the HERO board can follow the logic. If my team scores 5 runs, we WIN the game if your team scores 4 runs.  But we LOSE the game if your team scores 6. It doesn’t do any good just to know my team scored 5 runs. The number we score MUST be “distinctly associated” with the number you score to get a meaningful result.

Am I going too fast for you, Mr. Goetzel? You did refer to yourselves in this letter as “among the most credible and conscientious scientists and practitioners working in corporate wellness today,” so hopefully the information above is not too technical for you. I tried to use short words where possible.


“We are confident that any discerning reader of our report would instead conclude that associating the variables as they were in this blog post was an absurd, mischievous and potentially harmful misrepresentation of our data.”

We took screenshots of your figures. I’m not quite sure how we could misrepresent screenshots. In any event, we don’t have to “misrepresent your data.” As Yogi Berra might say, you misrepresented it just fine all by yourselves. A trade association dissing its own product, and now bragging about fabricating data?  One doesn’t see that very often.

 


“A cursory vetting of these authors would have revealed a litany of inaccurate and outrageous writings over several years.”

Yikes! We apologize!  We had no idea that we’ve been publishing “a litany of inaccurate and outrageous writings.”  We have published about 450,000 words — more than all of Shakespeare’s tragedies combined.  Possibly a few inaccurate words slipped in.  Surely in order to make such an otherwise libelous statement, you have a list of these “inaccurate and outrageous writings.” A cynic would say you’re deliberately lying, but all we’d like to know is… 

clara peller

Since we are in the “integrity segment” of wellness, we would like to see this list, so we can acknowledge and correct any errors.

Alternatively, if there are no inaccuracies, then you are endorsing the accuracy of our work, which we will announce in an upcoming post. So please get back to us within seven days with the list. Otherwise, we thank you very kindly for your endorsement of our accuracy.  Additionally, we would like a written apology if you want to avoid a lawsuit.

RIP for BMI — New Research Proves It’s Worthless for Employee Wellness Programs

Looks like a lot of you employees should be getting your employers to refund your penalties for not losing weight…or retroactively award you your incentives…read on. One way or the other, it’s time to end corporate fat-shaming.


 

Here is yet another in the unending stream of reasons to be certain all those Koop-award-winning savings claims and just about every other announced wellness savings figure are fabricated:  they are all based partially or totally on Body Mass Index (BMI) reductions among active motivated participants — but BMI turns out to be a worthless indicator of health status.  (We’ve already pointed out that the whole concept of measuring anything on “active motivated participants” is garbage anyway, as Aetna recently proved by accidentally telling the truth.)

How worthless?  A study due out in the International Journal of Obesity says 75-million Americans are misclassified, meaning their BMI doesn’t match their true underlying health status. (As an aside, this scoop comes from this morning’s STAT News, the new must-read healthcare daily.)  Many people with high BMIs are healthy, while many people with low BMIs are high-risk. Shocking! Who knew?

Naturally (cue the smirk on our faces), we did. As recently as in last month’s expose of The Vitality Group‘s squirrely outcomes claims, we pointed out that BMI is a 200-year-old construct based on faulty reasoning to begin with — and noted it has been challenged on multiple bases for years.  We were also the first to observe that BMIs don’t correlate with a company’s financial success.  And our series: “The Belly of the Beast” chronicled one vendor’s misunderstanding of BMIs as well, though I understand they are improving quite a bit now and we wish them the best and look forward to telling you about their improvements.

The implications of this new research are staggering:

  1. Companies need to refund penalties, and also award incentives retroactively, to people who were unfairly denied their money because wellness vendors don’t know how to measure outcomes;
  2. The “subject matter experts” who wrote the HERO Report need to retract basically their whole ball of wax, since it obsesses with BMI — and they need to apologize to me for inaccurately calling my claims “inaccurate” when they are specifically and relentlessly urging readers to do the wrong thing;
  3. Wellness vendors need to learn a thing or two about wellness, for a change.
  4. And guess who’s 3.27-to-1 ROI was based on studies obsessing with BMI?  Kate Baicker, that’s who.  Despite multiple hedges and walk-backs, she has yet to issue a formal retraction of her puff-piece on wellness economics. This gives her a good excuse.

Of course, in wellness, “the implications are staggering” means: “business as usual,” and they won’t do a thing to address these new findings.

The EEOC can’t ignore this.  How can they give employers more leeway — as they now intend to do — to fine employees based on a variable they now know to be wrong?

Quizzify 1, Wellness Vendors 0

Those of you who use Quizzify don’t have to fret, by the way.  The correct answers to the Quizzify question: “What is a BMI?” already include:

  • “A crude measure comparing your height and weight,”
  • “Can be very misleading if you in otherwise good condition,” and
  • “Is good to know but not to obsess with.”

(For those of you keeping score at home, Quizzify’s incorrect answer is: “It stands for ‘Bowel Movement Intensity,’ and indicates how much effort you required in order to stay regular.”)

Even so, we will be adjusting the answers going forward to take into account this new research, starting next week.  We expect the wellness ignorati will follow suit in a few years — once they stop advocating lowfat diets, PSA tests, and annual mammograms.  The good news is that they generally no longer recommend bloodletting.

 

 

 

Read Their Lips: An Apology to HERO Is Long Overdue

You may remember our series on the HERO Outcomes Guidelines Report.  We had observed that their own numbers showed wellness loses money. Specifically, they showed a program costing $18/person/year or $1.50 PMPM:

HERO list of costs

Gross savings were pegged at $0.99 PMPM:

hero p 23 99 cents with red bar

Silly ol’ me reasoned that if a program costs $0.51 more per month than it saves, that annual net losses would exceed $6.00. Of course, that’s before counting all the other costs that the HERO Guidebook listed (pp 10-11) but conveniently overlooked in their actual cost calculation:

HERO list of costs

Silly ol’ me also assumed these cost and savings figures had been approved by the 60 “subject matter experts” who reached “consensus” in this report, consensus being a word that appears 16 times. The report itself required “two years and countless hours of collaboration.” (p. 3)

Hopefully you can see how I might have been inadvertently misled into thinking the report actually did represent expert consensus, reached after two years and countless hours of collaboration.

I’ve since learned that the nice people at HERO are very upset with me for falsely assuming that the information in their report represents the information in their report.

They call my lapse of integrity “outrageous.” This adjective was contained in a letter read but not sent to me by a member of the HERO Board. (At the risk of blowing his cover, this is a guy known for his integrity.)  Staywell’s Paul Terry, whose own escapades have been well-chronicled on The Health Care Blog, had apparently circulated this letter around a while back on behalf of HERO.

Specifically, Terry stated it was “outrageous” that I had failed to mention that this money-losing scenario in the HERO Report was just one example of a wellness outcome.  For some unknown reason, HERO elected to illustrate the financial benefits of wellness with an example that loses money. That would be like a tobacco company illustrating the health benefits of smoking with this example:

smoking through a trach tube

Piling on, Ron Goetzel also disavowed the HERO report’s figures during our debate, stating that his numbers are “wildly different” from the ones in the report he co-authored.

Apology and Atonement

I apologize.

To atone, I will substitute Ron’s recommended “wildly different”  wellness budget of $150 per employee per year for the report’s $18 PEPY.  Then let’s adjust the $0.99 PEPM savings in reduced wellness-sensitive medical event (WSME) spending for the natural decline in WSMEs that occurred over the same period, according to Truven. Truven is Ron’s employer and hence is presumably the source of Ron’s “wildly different” figures for WSMEs.

hcup cvd 2009 and 2012

If you can’t read Truven’s numbers above, they show a decline in WSMEs in the working-age insured population between 2009 and 2012 of 23%. This actually greater than the 17% (3.14 down to 2.62 “potentially preventable hospitalizations” per 1000) decline in the HERO example over the same period:

hero total page 23 with red bar

But we’ll give HERO the benefit of the doubt and say doing wellness reduced wellness-sensitive events as much as not doing wellness would have reduced them.

That actually is the “benefit of the doubt” because a review of all the Truven data compiled for the government shows that indeed WSMEs have consistently trended more favorably in the non-exposed populations than in the”privately insured” population below (in green), much of which was exposed to wellness.

wsmecombined

Adjusting for the benefit-of-the-doubt secular decline in WSMEs wipes out gross savings — even without counting all the following claims costs that HERO says should actually increase:

HERO other costs increase

Or maybe those cost increases also only happen in this one rogue example in this one rogue chapter. And maybe this one rogue chapter (Chapter 1) just contains a terrible, horrible, no good, very bad example that somehow accidentally found its way into the HERO Guidelines Report even though none of the 60 subject matter experts believe it.  Or maybe two years wasn’t enough time for these experts to review it, though my review required only five minutes. Perhaps that’s because when I read, I don’t move my lips.

So…

Per HERO’s and Ron’s request, I’ll  replace their original estimate of $6 in annual losses PEPY with Ron’s new net loss estimate of $150 PEPY. And that’s without the multitudinous added costs that they also listed but never counted.

All in, my original estimate was off by almost two decimal points. However, I take responsibility only for the magnitude of the error, not for the delay in correcting it. If HERO had told me last year to substitute these real figures for their rogue example, I would have corrected the figures posthaste.

And my lips would have morphed into a great big smile.

Wellness Shock-and-Awe: Federal Court OKs 100% Non-Participation Fines

While most of us were buying supplies for partying down on New Years Eve (in my case, I was in charge of bringing broccoli and Boggle), the federal court in the Western District of Wisconsin quietly handed down an earth-shattering decision in the Flambeau case, which pretty much went unnoticed due to the timing. You may recall that this was the case where employees refusing wellness lost all insurance benefits.  The case looked like a layup win for the EEOC.  After all, the Affordable Care Act clearly states that penalties for non-smokers are capped at 30%, and this was 100%.

But here’s the rub: Flambeau conditioned the entire insurance benefit on participation in their “pry, poke and prod” program.  They knew most employees hate “pry, poke and prod” programs to begin with. So they created a program so onerous that some number of employees would prefer to forego insurance altogether than participate in wellness.  And indeed, that’s what happened at Flambeau. This decision means they’re getting away with it, saving thousands of dollars apiece for each employee who refused to submit.

Make sure you catch that distinction between the 30% penalties and the 100% penalties:

(1) It is not OK to penalize an employee more than 30% for refusing to submit to a “pry, poke and prod” program if they already have insurance, or they can get insurance through the employer without this requirement.

(2) However, it is OK to say: “There is no incentive or penalty for wellness once you have insurance, but you can’t have insurance at all unless you submit.” If that seems like an artificial distinction, well, that’s because it is.  All an employer has to do is require pry-poke-and-prod before you get insurance.

Assuming other federal courts follow this district’s lead (as they usually do), employers create a 100% de facto non-participation penalty: If you don’t participate, you don’t get insurance, period.

The implications of this case:

(1) It will allow some vendors, like Bravo, to double down on bragging about the “savings” from wellness by creating programs that employees don’t like;

(2) Because the decision only applies to participatory programs and not outcomes-based programs, many companies will either not switch to outcomes-based programs or else maybe switch back.

It also puts pressure on the EEOC to put the kibosh on this end-run around the ACA’s wellness provision. Note that the decision can and should be appealed. Otherwise it is a de facto repeal of a big chunk of the Affordable Care Act.

The bottom line is, now there is universal agreement (albeit inadvertently in the case of HERO, which apparently didn’t mean to tell the truth, but failed to proofread their own document) that wellness loses money.  So any pretense of “pry, poke and prod” being about the employee is gone. Obviously, forced wellness isn’t about trying to save the $0.99 PMPM (that’s before program fees!) that HERO Says can be saved with healthier employees.  It’s about gutting the key ACA requirement that employers provide insurance.

And unless the EEOC steps up in its final regulations and/or prevails on appeal of Flambeau, they will have succeeded.

 

 

That Was the Year that Was: Our Top Contributions of 2015

Our year-end jubilee has so far featured lists of the worst vendors and the funniest vendors.  To close out the year on a more serious note — if for no other reason than to show we are indeed capable of treating the extremely serious topic of wellness with the Extreme Seriosity it deserves — we’ll list the most influential posts of the year.

In terms of views, the top spot is shared by our two smackdowns of worthless employee weight control programs. Our peer-reviewed smackdown, in the American Journal of Managed Care, should end the year at #1 on their list too, of the most-viewed articles.  I say “should” because a lot will depend on people clicking through on it today or tomorrow (hint) and at least pretending to be enthralled by it, even though it is a bit dry.

The Reader’s Digest version got picked up on Huffpost.  Absent the constraints of peer review, we took the gloves off.  Our reward is that we are the most-widely read Huffpost of the year on wellness.


If “most shocking” is the criterion, the winner is our recent evisceration of Aetna’s employee DNA collection program.  This one is best viewed here, at Insurance Thought Leadership, but was also picked up by The Health Care Blog.  You know the old Woody Allen joke about the two ladies in the Catskills?  One of them says: “You know the food here is terrible.” The other replies: “Yeah, and the portions are so small.”

Collecting employee DNA is a shockingly stupid idea on many levels — the kind of program that someone would make up in order to make wellness look bad, but we didn’t have to. As if that weren’t enough, Aetna also decided to fabricate outcomes. And because the program was so expensive, to show a 2-to-1 ROI they had to concoct $1464/person in savings in the first year alone–on employees who, by Aetna’s own admission, weren’t even sick.   One of the editorial board members of the journal that published it wrote that it should never have passed peer review.


The biggest category — and the one where it would be hardest to pick a winner from among the many worthy entries — would be: “Most likely to show Ron Goetzel making things up.”

You might vote for yesterday’s post on how Ron said wellness programs increased stock price valuations when in reality they reduce stock prices.  (Ron also misused the word “valuation”.  It is not a synonym for “stock price.”  In all fairness, the only people who would be expected to know the distinction would be people who write articles about stock valuations that are actually intelligent and insightful.)  However, he probably didn’t make up that conclusion.  I reviewed 5 years and compared each company to its relevant sector index.  By contrast, he reviewed a longer period and has probably never heard of a sector index. We reached opposite conclusions about the correlation of wellness programs and stock prices. The real answer, though, is that wellness programs have absolutely no meaningful effect on either stock prices or stock valuations. If they did, one securities analyst somewhere, writing a report on one company anywhere, would have noted it. Not to mention that a hedge fund would have made a business out of buying shares in companies with the best wellness programs.

Another candidate would be our expose of the HERO report, in which we observed that HERO and their cronies accidentally admitteda la Robert Durst — that wellness loses money.  Despite co-signing this document — a document that required “two years and countless hours” of collaboration, and in which the word “consensus” appears 39 times, Ron insisted during our debate that he had nothing to do with anything in this document that he himself didn’t write.  (Of course, in the debate he also insisted that he had nothing to do with Penn State — meaning he just wandered into their press conference by mistake, or maybe I am confusing him with another Ron Z. Goetzel.)

Nonetheless our vote goes to the Unified Theory of the C. Everett Koop Award, in which we reverse-engineered the mathematically impossible formula (the “Goetzel Factor”) that Ron and his integrity-challenged cronies use to anoint award winners, whose programs are almost invariably hilarious and show a complete lack of understanding of the way healthcare and healthcare math work. To paraphrase the immortal words of the great philosopher Samuel Goldwyn, “If Dr. Koop were still alive, he’d be rolling in his grave.”

 

 

 

 

 

Part 2 of the Proof: Even If Wellness Could Save Money, It Doesn’t

Recently we promised a Part 2 to our original proof that wellness savings are mathematically impossible. Commenters said: “How can you have a Part 2 to a proof?  You just proved it.”

Read on.

The previous proof showed wellness can’t save money, even if programs were perfect. This installment proves that even if wellness could save money, it hasn’t.  Meaning even if wellness were free, it couldn’t pay for itself.  So this proof is independent of the previous proof.  For wellness to save money, the wellness true believers would have to find fallacies in both proofs.  Either is sufficient to make our case…but we have both.

Quite literally, forcing employees to “do wellness” or lose money has avoided basically zero wellness-sensitive medical events in the 13 years ending 2013 (2014 data isn’t in yet), according to the federal government.  If the name “federal government” sounds familiar, it’s because it’s the very same federal government that has passed a law encouraging vendors to pitch “pry, poke and prod” programs to you despite their complete lack of evidence basis, lack of effectiveness, and potential for harm.

Here is the way our analysis was done.  We used the government database called the Healthcare Cost and Utilization Project, or HCUP. That database tracks all hospitalizations due to all causes, by population.  So it is possible to focus on just the commercially insured population, which they call “privately insured.”

The privately insured population is 100% sensitive, meaning everyone whose workplace “offers” wellness is in that database.  The database isn’t specific, meaning plenty of people in it do not have access to wellness.  Nonetheless, the dramatic increase over the 13 years in the number of people whose employers push wellness should produce an equally dramatic decrease in wellness-sensitive medical events.  While wellness was rare at the start of this analysis in 2001, today most large companies, nonprofits, and governments have wellness. In total, one can project from the Kaiser Family Foundation data that about 75-million people (or roughly half of all privately insured people) are subject to what Jon Robison has termed wellness-or-else.

Keep in mind that all hospitalizations have been declining over this 13-year period, due to shifts to outpatient, better usual care, etc.  So the question is not whether WSMEs have been declining, but whether they have been declining faster than the rates of all other hospitalizations in combination due to the large and increasing “dose” of wellness” being applied to them.

Instead, as you can see, these WSME admissions have trended essentially flat over the period, as a percentage of all admissions.  In other words, there is no difference between the decline in admissions for WSMEs – despite $7-billion/year being spent on vendors to prevent them – and the declines in every other category of hospitalization.  13 years ago about 6.9% of events were wellness-sensitive.  Now it’s about 7.0%.  (This is 2013. 2014 is also in, for our customers for whom we track WSMEs, and shows no change.)

This is based on ICD9s 401-405, 410, 430-438, and 250 — strokes, hypertensive events, heart attacks, and diabetes events.

WSMEs

To make the point visual, the “dose” of wellness probably quintupled, in total, over this period, so the directional expectation of the chart would be:


Prima facie, the debate is over, again, just like it was over after our last proof.

Needless to say, the true believers aren’t about to give up their revenue stream just because we’ve double-proved they’re fabricating savings.  They will make two arguments against this proof of their own ineffectiveness.  First, they’ll argue that wellness reduces all events and other costs equally, so really we should credit wellness for the total cost reduction, not the reduction in just wellness-sensitive admissions.  This might seem like a pollyannish view of wellness, but wellness true believers attribute everything that’s good to wellness. True believer Bruce Sherman has even argued that wellness actually reduces industrial waste, so to a wellness true believer, eating more spinach makes every employee a Popeye.

Unfortunately for Bruce and others, the wellness industry’s own HERO report says wellness can only reduce WSMEs.  Other costs go up, it says:

HERO other costs increase

Second, one could argue that there isn’t enough penetration of wellness yet to bend this trend, since the HCUP privately insured population includes tons of people without access to wellness, and even many people with wellness access refuse to participate.

Unfortunately, that argument self-immolates.  Vendor fees are $7 billion.  All these WSME ICD9s combined (using the HERO-estimated admission cost of $22,500) amount to about $11.3 billion. That $11.3 billion includes the half of privately insured people who don’t have access to wellness.   Already, when you cut that figure in half to account for those employees with employers who’ve decided not to “do wellness” to them, the $7 billion size of the wellness industry exceeds the size of avoidable events ($5.7 billion). This is consistent with our first proof, which showed the same thing, but on an individual company level.  Now—assuming participation is 50%, you need to cut the WSME hospitalization total in half once again.  You’re down to $2.85 billion in potentially avoidable events — that companies are spending $7 billion on vendors to avoid.

So, no matter how you look at it, “pry, poke and prod” programs have been singularly ineffective in reducing WSMEs.  And if the HERO Guide is right that these are the only admissions wellness can avoid (while other costs increase, as they admit), wellness does not and cannot save money.

Instead, wellness-or-else is basically a pile of, um, industrial waste.

Anyone still want to try to claim the million-dollar reward for showing pry, poke and prod programs aren’t a total waste of resources?  I didn’t think so.


Quizzify Q in B and W

The thing most likely to save money is knowledge.

Note:  This graphical analysis is copyright 2015 to Quizzify.  However, any disinterested researcher or journalist may request a copy of the backup material from us.

Wellness isn’t only junk science. It’s also junk arithmetic.

Vendors of “pry, poke and prod” programs often wax rhapsodic about “Wellness 2.0.” Translation:  HRA-screening-checkup programs have historically failed.  Likewise, vendors talk about how more “wellness champions” or better “communications plans” or higher incentives/penalties are needed to make wellness work–as though it’s HR’s fault vendors are misrepresenting what their programs can do.

Unfortunately for those vendors, tinkering with wellness is like tinkering with alchemy.  Nothing can turn “pry, poke and prod” lead into gold.  Understanding that wellness is alchemy is why we’ve offered the million-dollar reward…and also why that reward has had no takers.  Wellness outcomes measurement is junk arithmetic, to go with the junk science of screening the stuffing out of employees in order to hyperdiagnose them.  All told, vendored wellness is the kind of junk that gives junk a bad name.

We’ve covered the junk science at length, showing how vendor after vendor ignores clinical guidelines either because they don’t understand healthcare or because they want to maximize profits.  Today we are covering junk arithmetic.

Here is Part One of the very simple mathematical proof of why “pry, poke and prod” can’t possibly save money.  All this information comes from the wellness industry’s own materials, notably the HERO Outcomes Guidelines Report.  They can’t “challenge the data” because it’s their data. All we’ve done is fashion it into a proof.

The Size of the Pie:  “Potentially Preventable Hospitalizations” (PPHs)

The HERO Report places the current PPH rate at 2.62 per 1000.   (It was once higher — 3.14, as noted below — but usual care improvements continue to reduce admissions for both asthma and cardio/IVD, reducing the need for wellness even as vendors insist that all your employees are getting sicker.)

hero262

That same page (23) of that same report lists the episode costs of a PPH at $22,500.

hero22500

The product of those two components?  About $59,000 per 1000 people, or $59/person.

And alas you can forget about adding other healthcare cost savings from wellness to that $59.  That’s wishful thinking.  The Goetzel crowd not only admits they don’t decrease, but says they are likely to increase (p.22)

HERO other costs increase

The Cost of Wellness

Against that $59, what is the cost of a wellness program? $150/employee, according to Ron Goetzel.   (Your cost could be higher or lower, obviously.  Wellness vendors collect about $7 billion by prying, poking and prodding about 70 million people, so typical vendor fees are about $100.)

Therefore even a wellness program that eliminates every potentially preventable hospitalization without increasing doctor visits or those other listed expenses would lose money–$91, if Mr. Goetzel’s advice is taken.

And this is according to the wellness industry’s own cost figures, which of course are highly suspect, largely because their costs count vendor fees only.  Our figures would add in all the other costs of wellness.  Though the HERO Report ignored these other costs in its own calculations, it nonetheless listed them on p 11.  (This list overlooks the hefty consulting fees involved in making up positive outcomes figures to show to the C-Suite.  This is no surprise given that Mercer was a co-sponsor of this report.)

HERO list of costs

Quizzify Q in B and W

Want proof that Quizzify is more fun & smarter than any wellness program? Take the quiz.

Also remember that this $91 loss is for a perfect wellness program –one that eliminates all $59 in spending with no added preventive services cost.  Coming soon is the second half of the proof, showing that wellness programs are anything but perfect.

 

Measuring Wellness-Sensitive Medical Events: The Grand Finale of the HERO Analysis

fireworks finaleThe eighth in the series deconstructing the HERO Outcomes Guidelines, covering Page 14. The full series can be found here. This installment in particular should be read in conjunction with installment #4  This Grand Finale will be presented in 3 parts…with a downloadable tool to help you calculated your wellness program savings as part 3.

PART ONE: HERO ACCEPTS OUR METHODOLOGY

In the stock market, no one is as valuable as the person who’s always right, except the person who’s always wrong. Therefore, until now we have greatly appreciated the opportunity HERO’s report has created for us to explain how to measure outcomes correctly.

So imagine our disappointment when one of their methodologies, the sixth of the seven listed, turned out to actually be valid. No surprise — this is the methodology I invented. Also no surprise given the industry’s standards for integrity, they didn’t acknowledge that particular factoid anywhere in their 88 pages. (And yet they accuse us of being impolite.) Here is the screen shot.

hero methodology 6

The philosophy of #6 is quite straightforward. If you were introducing a flu vaccine program, you’d measure the reduction in number of people who got the flu. If you offered a new program for conservative treatment of meniscal tears, you’d measure the reduction in the number of people who had meniscal surgery. That’s the way experimentation works. You hypothesize an outcome that the intervention should create…and then you measure that outcome to see if the experiment worked.

Except, of course, in population health, where any improvement in anything (cost, trend, utilzation) gets attributed to any wellness program that happened to be in place. The masters of this would be Mercer. Mercer once “found” massive, mathematically impossible, savings for North Carolina Medicaid’s medical home in a cohort that, as luck would have it, wasn’t even eligible for the medical home. And one wellness industry stalwart, Larry Chapman, says the simple act of completing a health risk assessment can reduce total healthcare spending by 50%, even when the information in the HRA is wrong, as is often the case.

And did you ever notice that when a company switches to a high-deductible health plan and adds some needle-poking, they attribute the reduction in spending to the needle-poking, not the fact that everyone in their company suddenly gets socked with a bigger annual deductible?

Enter wellness-sensitive medical event rates (WSMEs). This is the only methodology that tallies hospitalizations for conditions targeted by a wellness program – statistically avoided heart attacks etc. This is the only one of the seven HERO methodologies that would be acceptable to legitimate researchers. Hence, its use both in Health Affairs and by the GE-Intel Validation Institute. The former is the most respected health policy publication and the latter is the most (the only) respected outcomes evaluation organization.  Further evidence of its validity is that there is no mention of it in the leading wellness promotional publication, the American Journal of Health Promotion, perhaps because – as HERO has attested – it doesn’t show savings.

History of event rate-based plausibility testing

Even though it isn’t attributed to me in the HERO guidebook, I invented this methodology in 2007. This is incontrovertible. No one else had anything remotely close to it. Unlike the automobile, TV, the computer, etc., this was not one of a series of incremental improvements to or the amalgamation of existing technologies.

And none of the other invention clichés apply either. The Chinese didn’t invent it in 1000 BC. Leonardo DaVinci didn’t sketch it in 1541. The Germans and the Allies weren’t racing to develop it at the end of World War II. By contrast, I’ve been presenting on it and using it for validation since then (meaning 2007). It figured prominently in Why Nobody Believes the Numbers too, before being highlighted in Health Affairs and the Validation Institute. For a modest fee, the detailed how-to can be downloaded from our website, though a Reader’s Digest version appears below.

While a number of employers and health plans use it now, several health plans – more than coincidentally three of the highest-rated in the country (Harvard Pilgrim, Blue Cross of Massachusetts, and Providence Health Plans) – have been measuring hospitalizations for conditions targeted by wellness/DM programs since the methodology’s inception.

So needless to say I was surprised and totally flattered that the 88-page HERO Report contained no attribution to me as the inventor of the WSME plausibility test. As mentioned previously, the strategy of the Wellness Ignorati is to ignore facts (hence their moniker), especially including my very existence. That strategy reduces the likelihood that one of their customers might click through to the site. They aren’t much for our recommending that companies learn our helpful insights, which they call “bullying.

The wellness industry has had a love-hate flip-flopping relationship with WSME measurement.

Quizzify Q in B and W

Click on the Q to try our demo

First, until 2013, the entire Wellness Ignorati, quite in character, ignored this methodology, which is a powerful testament to its validity.

Then, in 2013, that strategy took a body blow: the exact methodology was used in Health Affairs. You may recall the same thing happened with another epiphany of ours — the expose of the invalid Koop Award-winning Health Fitness Corporation fabricated results. The Wellness Ignorati completely ignored our whistle-blowing expose until it appeared in Health Affairs, when they were forced to admit we were right and the whole thing was made up, or to use Ron Goetzel’s phrase in the passive voice, “was unfortunately mislabeled” for four years.

Just as Ron Goetzel — the leader of the Wellness Ignorati — caved when the Health Affairs light was shined on the Koop-HFC debacle, he caved on WSMEs when the Health Affairs light was shined on them. In this case, “caving” was acknowledging the fact that this methodology existed. He reviewed the aforementioned Health Affairs article that specifically analyzed WSMEs — hospitalizations for conditions targeted by the wellness program. In September 2014, he wrote:

goetzel quote on BArnes article

But then he un-caved. Once the Health Affairs storm had passed, he invoked the Sergeant Schultz defense. In December 2014 he said: ,

goetzel quote on WSMEs

He may have just forgotten in December that he reviewed them in September. But in March he and his colleagues re-remembered wellness-sensitive event rates, and put them right in the HERO report, for which we are immensely grateful.

Hopefully they won’t re-forget in June. (Their memory appears to be correspond with the change of seasons.) Hopefully instead, to paraphrase the immortal words of the great philosopher George Gershwin, our methodology is here to stay.

How do I feel about HERO rewriting history so that I am no longer the inventor of this methodology? Honestly, having firmly staked out a niche in the small but growing “integrity segment” of the wellness industry, I prefer them staying out of that niche as long as possible. So I’m glad they show no interest in facts.

In part two, which we will post in a few days, we will explain how we do WSME plausibility testing and why it’s the essential method for assessing the impact of your wellness and disease management efforts.

Does HERO’s Model HRA Teach Employees to Lie?

Flaming_cocktails

When you’re hot, you’re hot; when you’re not, you’re a wellness vendor

This is the seventh in the series on the HERO Report, covering page 26 to 38.  Six previous installments can be found here.  A future installment will include a wellness savings calculator that you yourself can apply to determine whether the HERO report accurately captures your own economics or not.  To make sure not to miss it, “follow” us on WordPress.

Employers learn a lot about their own companies when employees complete health risk assessments (HRAs). For instance, HRAs ask employees how many ounces of alcohol they consume. Wellness vendors then produce reports showing the statistical difference between the number of ounces of alcohol employees say they consume vs. the number of ounces of alcohol that employees with similar demographics actually consume, to show the extent of that company’s workforce dishonesty.

Haha, good one, Al.  Obviously no wellness vendor does such an analysis. Doing that would require actual competence, one of two critical success factors — integrity being the other — conspicuously lacking in the wellness industry. (Exhibit A: this HERO report.) Instead, they summarize the self-reported drinking estimates with no qualification or comparison to national norms, as though these self-reported figures actually mean anything.

Not being wellness vendors and hence priding ourselves on our triple-digit IQs, we have done this analysis on multiple occasions.  Here is a typical result:

drinking rates

According to self-reported estimates from this company, literally no one has a drinking problem and very few people drink at all. Time after time, we get the same result. Hence, self-reported estimates of alcohol consumption on HRAs are useless at best. At worst, asking this question simply encourages employees to lie. Somehow wellness vendors have never figured this out, despite their extensive experience in the lying department.

This chapter contains three other head-scratchers as well.

First, why this obsession with body mass index (BMI)? It is probably more important to be “fit and fat” than to attempt to diet and not exercise. You can’t get people to change multiple behaviors. HRA advice should be focused on fitness, rather than weight.

Quizzify

At Quizzify, we know the difference between fruit and juice

Second, speaking of weight, why hasn’t HERO gotten the memo that most fruit juice is junk food? Why are they urging the consumption of more sugars? Why do they equate fruit juice with healthy vegetables? Where is the up-to-date nutritional guidance? This isn’t rocket science. Quizzify incorporated this revised dietary guidance into its health education tool when it was first released, in March.

Third, why do HRAs obsess with seat belts? Seat belt use in the U.S. is at all-tme highs, but distracted driving is a serious problem that no HRA we’ve seen even mentions. If you are routinely hiring employees who don’t buckle their seat belts, but are texting and talking while driving, then you have bigger programs, and a computer print-out telling them to buckle their seat belts isn’t going to save anyone.

The Good News

Still, credit where credit is due. For the first time ever, we see the advice that HRAs recommend the shingles vaccine for employees 60 and older. Of course, we’ve never seen that recommendation in an actual HRA itself, though Quizzify covers it. Once again, covering shingles would require competence on the part of wellness vendors. Were a wellness vendor actually to recommend this vaccine, it would be an example of exactly why people should take HRAs: to learn something that they didn’t already know, that is easily implemented and that could prevent a debilitating illness. (By the way, there is some controversy as to the vaccine’s effectiveness. However, that’s not why HRAs don’t recommend it. They disregard it because vendors don’t know about it.)

And, aside from the fruit juice, there is no demonstrably bad advice in this model HRA. HRAs, of course, are notorious for bad advice, like telling males to get prostate tests, telling females without genetic predispositions to get mammograms before the recommended age of 50. And, don’t forget WebMD’s infamous testicle checks, one of the late-night TV staples from the Highmark-Goetzel Penn State debacle. Men who didn’t say whether they check their testicles every month – a D-rated idea, according to the US Preventive Services Task Force – faced a $1200 fine.

And while we realize that offering “no demonstrably bad advice” isn’t exactly a ringing endorsement, this chapter is the first in the HERO Report that isn’t mostly wrong.

Dan Ariely on how the Wellness Industry Crowdsources Reality

sierra-club-pants-on-fire-imageWe recommend that everyone listen to Dan Ariely’s interview on NPR and TED talk “Why We Lie.”  It explains exactly why the Wellness Ignorati could decide to collectively self-publish an entire guidebook full of misinformation and disinformation designed specifically to increase the revenues of wellness vendors.

Here are our take-aways from Professor Ariely’s TED Talk.

Like Walter White in Breaking Bad, the Ignorati started out honest. They genuinely believed that wellness saved money and that they were doing good.   It was very counter-intuitive to believe otherwise.  If you look at page 201 of Why Nobody Believes the Numbers, you’ll see I even mildly supported biometric screens. I hadn’t done the math. I just assumed early detection was a good thing and that Ron Goetzel and others was telling the truth, for which on page 83 I professed my admiration.  As another example, ShapeUp’s CEO Rajiv Kumar would never have attacked us (largely for refusing to believe Kate Baicker, who even RAND now dismisses and who herself no longer appears to believe her own claim) if he had realized his own outcomes claims were false.

Like Walter White, it was easy to justify the first transgressions.  Since the Wellness Ignorati genuinely believed in what they were doing, when the numbers didn’t add up, they either justified to themselves that it was OK to fudge them (like ShapeUp’s now-retracted claims about Highmark) or ignored glaring invalidating mistakes. The best example of the latter: Ron Goetzel finally recanting Health Fitness Corporation’s infamous participants-vs-non-participants self-immolation after years of ignoring it.

Or wellness vendors create a parallel universe where numbers don’t have to add up (like Keas), or completely misquote industry experts saying the opposite (like Vitality).

Like Walter White, they don’t actually believe they are bad people. Ariely calls this a “personal fudge factor.” With the possible exception of Wellsteps’ Steve Aldana (who may be honest but simply unable to recognize that no matter what numbers you enter into his model you get the same answer), they really think what they are doing is OK—even though the math clearly dictates otherwise.

Also like Walter White, they kept getting drawn deeper in. The more they lied, the more they have to keep lying. They needed to continue to defend what was looking increasingly indefensible.  After giving Nebraska’s program a much-publicized and ironically named C. Everett Koop Award, it’s hard for Ron Goetzel and his committee to say “We goofed—we need to take it back because they made up the data and defrauded the state”  even after the vendor, Health Fitness Corporation, admitted it.

Quizzify 4

Quizzify…truth serum for wellness.

Like Walter White, the Wellness Ignorati “suspend reality” (to use Ariely’s term) and “buy into a new reality.”  Essentially the Ignorati crowdsource reality. They peer-review one another’s work, give themselves awards, and decide (to use Michael O’Donnell’s term) that anyone who challenges them lacks the “credentials” to do so.  Or, as Ariely says: “If you were getting well-paid by Enron, wouldn’t you want to see reality as they present it?”

Avoiding the media is an excellent strategy. Once again, like Walter White, the Wellness Ignorati want to keep a low profile. Exposure is bad if the facts all go the other way. That explains Ron Goetzel’s refusal to debate, ever, and the Ignorati’s characterization of us as name-calling bullies when all we do is ask questions.

Yep, you can read this site up, down and sideways. The fact is no names are called other than the “Wellness Ignorati.”  We’ve offered them the opportunity to propose a different name for their practice of denying facts, which they’ve declined. We do use the term “pretzel” to describe the very impressive twists and turns that Mr. Goetzel uses to wriggle out when he’s been caught calling failed or fraudulent programs “best practies” because they are run by friends, sponsors or clients. The alternative word for what one would be called when all your claims are made up is less flattering, and we’ve never used it with respect to Ron.

This explains why the Ignorati steadfastly refused to answer questions for a $1000 honorarium. Once again, like Walter White, they have so much as stake that $1000 is chicken feed. At Enron, if you questioned Ken Lay at an analyst conference, he would accuse you or not understanding their business, and cut you off from future meetings, rather than answer the question. We of course were not invited to participate in or even listen to the “discussion” about the HERO report.

Like Walter White, at some point the Wellness Ignorati needed to commit to their chosen path. The Wellness Ignorati have gone too far in their insistence that wellness saves money. There is no turning back.  The existence of this site makes turning back even harder because retracting their lies means acknowledging them. And as soon as they do that, we do what we do best other than invalidate the Ignorati’s misstatements, which is: gloat.

Like Walter White, they are now doubling down.  Examples: Ron Goetzel calling Nebraska a best practice after they admitted lying about saving the lives of cancer victims, in order to justify his original award to them. Steve Aldana can’t create a real ROI model now without admitting that his original model was not “based on every ROI study ever published” as he has maintained, but rather always yields a savings of $1359/employee no matter what inflation-adjusted figures you enter.

As the house of cards collapses, people on the fringes who were sucked in (in this case HR and some brokers and consultants) wake up and ask: “How could I have believed what these people were saying?”   Many major and mid-level figures connected with Enron did exactly this. We see this every week in wellness, as people come to us and say: “I get it. I can’t believe I fell for this.”

So thank you to Dan Ariely. In one 8-minute TED talk, he explained the entire alternative crowdsourced reality of the Wellness Ignorati – without once even mentioning them by name.  But I’m sure the Ignorati nonetheless think he bullied them.


As a hot-off-the-presses example of what Professor Ariely is talking about, Wellsteps just updated their model so that now instead of saving $1359 per person in 2019, they save $1359 per person in 2020. As with previous iterations of their model, the success of the wellness program is irrelevant to the outcome of the model. Just enter a 0% inflation rate and “1” for covered people (“1” so you can see the $1359 reveal itself without having to do division) — and then whatever figures you want to enter for spending, obesity and smoking.

Here you started out with astronomical healthcare costs and got a 99% reduction in smoking and obesity…and saved $1359

wellsteps2

 

Here you save $1359 without changing smoking or obesity at all:

wellsteps1

And here you saved $1359 even though there was nothing to save. The costs are as low as the model will allow you to enter (until they got caught, you could enter figures low enough that they model would calculate negative costs), and there was no smoking or obesity to reduce:

wellsteps3

Naturally, Wellsteps is prominent both on the Koop Award Committee and the HERO Report Committee.  Wellsteps’ “back story” is here.

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