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Does HERO’s Model HRA Teach Employees to Lie?


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.


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.

Larry Chapman Meets Where’s Waldo


Questions for The Chapman Institute’s Larry Chapman:

We are looking all through the study you cited in defense of Health Risk Assessments (HRAs) and cannot find the 50% savings from HRAs that you say is hidden in here somewhere. This study, despite your CAPITALIZED insistence to the contrary, seems to show the opposite: In 4 of the 6 study periods — and in all 6 periods combined compared to baseline — the control group spending was actually lower than the study group.  So where is the 50% savings that we can’t find?

chapman cuts costs in half

HRA savings over time

ANS:  Refused to Answer

You say HRAs should be treated like “one of your children or at least a beloved pet”.  Have you taken into account the possibility that some HRA respondents may lie, as Professor Woessner advised his Penn State colleagues to do, and as most of the people I know do since most people feel their personal lives should not be the concern of their employers?

ANS:  Refused to Answer

Many people have questioned your understanding of arithmetic even before you found a 50% total healthcare cost reduction due to HRAs by reading the data excerpted above, so here is your chance to enlighten them.  In this article below, you originally stated that Baicker’s analysis (which she has now backed off) reduced medical claims by “327%” and absenteeism costs by “273%”.   How is it possible to reduce a number by more than 100%?

chapman cfo article

ANS: “Workplace Wellness Management” January 10 comment:

“You seem to conveniently forget that the editor of the CFO blog made the error, not me.”

Followup:  You submitted, reviewed and signed off on the original “327% savings” and “273% reduction.”  However — after a commentator pointed out the impossibility of those figures — the editor does acknowledge that you did notice at that point that 327% and 273% reductions in any number are not possible, and asked him to change the figures, first to the above 32.7% and 27.3%, but then to the 3.27-to-1 and 2.73-to-1 (now discredited) figures that were in the Baicker article.  So in the narrowest sense of the word — after you made the initial, most revealing,  mistake by misunderstanding that “3.27-to-1 ROI” and “327% savings” are not interchangeable figures — the editor of the CFO blog is acknowledging “the error,” by not making the final correction in a timely way.  The larger point is that you did submit “327% savings” and “273% reduction” originally, raising the question of why anyone should believe the research findings of someone who doesn’t know that you can’t reduce a number by more than 100%.

ANS:  Refused to answer

You also wrote in 2012 that studies show you can save 25% through wellness.  Most of these studies took place in decades (1980s and 1990s) when dietary advice consisted of telling people to eat more sugar and less fat, and when the AHA gave Kellogg’s Frosted Flakes a “heart-healthy” label?.  How could that kind of misinformed advice show not just savings, but savings 6x greater than the total amount that employers spend  on wellness-sensitive medical events, which is 4%?

ANS:  Refused to answer

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