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Wellsteps Raises the Koop Award Standard for Outcomes Invalidity to a New Low
Wellsteps claims to have dramatically reduced the total cost of the Boise School District’s health spending. Their Koop Committee colleagues gave them an award for it, as they typically do for their fellow board members and sponsors. (Yes, Wellsteps’ CEO, Steve Aldana is on the committee that grants the award, but, in accordance with Koop Committee tradition and Wellsteps ethical standards, there is no mention of this possible conflict of interest in the announcement from Wellsteps. This is not a violation of the Wellness Industry Code of Ethics, because there is none.)
Unfortunately for Wellsteps, three completely distinct observations from Wellsteps’ own data invalidate their analysis separately. In combination, these observations create a level of impossibility demonstrating that whoever invented the English language was unfamiliar with the wellness industry, or they would have come up with a word meaning: “Impossible doesn’t begin to describe it.”
First, as we saw in the last posting, employee health deteriorated over the course of the program, measured both subjectively and objectively.
There is a concept, covered in Health Services Research 101, called “causation.” Wellness vendors love taking credit for everything that happens during their program. Hence we can conclude that Wellsteps’ program caused employee health to decline.
Therefore, no reduction in costs due to a healthier employee population can be attributed to Wellsteps’ program.
Second, also covered in Health Services Research 101, is the concept of “fifth-grade arithmetic.” Potentially Preventable Hospitalizations (PPH), as described in the official Health Enhancement Research Organization (HERO) outcomes measurement guidelines (a report on which Wellsteps’ CEO claims to have collaborated), account for a very small percentage of all spending. Specifically, as described in the HERO report and reproduced below, these events account for 2.62 hospitalizations per 1000. Boise’s 3284 employees would therefore suffer about 9 PPH’s. If each PPH cost Boise the HERO-assumed cost/admission of $22,500, that’s about $202,000. Not enough to cover even the out-of-pocket fees for the Wellsteps program, assuming the Wellsteps did a perfect job. And as we’ve learned in the past, a beam of light leaving “perfect” wouldn’t reach Wellsteps for several seconds.
Still, we’ll never know because despite their endorsement of the HERO report, Wellsteps decided not to disclose the rates of Boise’s PPH’s, likely to obscure the fact that they didn’t reduce it.
And as the HERO guidebook says, any reduction in PPH’s is offset by more spending elsewhere. In Wellsteps’ case, “more spending elsewhere” is annual biometric screenings. Curiously, Wellsteps admitted annual screenings are a stupid idea four whole days before they announced their Koop Award for doing exactly the opposite.
Yet Wellsteps reported annual savings ultimately exceeding $5-million, or about a third of Boise’s total spending. This would be equivalent to wiping out every hospitalization unconnected with childbirth plus every ER visit. Adding yet another layer of impossibility to this narrative, at the end of this, we show the rank order of the top 25 reasons people visited the ER or went to the hospital, which basically have nothing to do with corporate wellness programs. Hence the cost of these visits and admissions couldn’t be dented, let along wiped out, by massive overscreening or even by appropriate screening.
Compounding this impossible outcome (and wellness is one of the few industries in which there are degrees of impossibility, since a typical wellness vendor makes at least a dozen impossible claims before breakfast) is the surprising health of the Boise population to begin with. People rated their health as 7.98 out of 10, and only 2.5% reporting smoking (vs. 20% for Idaho as a whole) and only 20% reported drinking (vs. 70% for the US as a whole). These ridiculously low levels did not strike Wellsteps as suspicious, so we will assume they are accurate.
Further, most Boise employees had fairly normal blood pressure, glucose and cholesterol — at least before they got sucked into the program.
So, with impossibly smoking and drinking, excellent reported health status, and largely normal biometrics, how is there room to improve health enough to save money, especially when health status is declining and the population is being overdiagnosed?
Speaking of misunderstanding the concept of arithmetic, third and most important is the data Wellsteps suppressed between their initial report and their Koop Award application. Normally Koop Award Committee Chairman Ron Goetzel suppresses the invalidating data after the award is announced, as with Health Fitness Corp/Eastman Chemical, and then the state of Nebraska (technically actually incriminating, not just invalidating). That’s because in the past I haven’t predicted who would win the award. Rather I just pointed out all the obviously incorrect data after the fact. By predicting Wellsteps would win a Koop Award and pointing out exactly why their data was sufficiently fictitious to merit it, I gave Wellsteps itself the opportunity to suppress their own data, so Ron wouldn’t have to do it for them.
Contrast below the trend they reported for total spending for Boise against the claims cost per person for Boise. The former goes up. The latter goes down even though the number of employees stays the same. Obviously, this is an impossible coexistence, as mentioned both in the first installment of this series and in every elementary school in the world. This time, we are going to transpose the bar graph, which separated participants from non-participants, onto the line graph, which included both cohorts, for the baseline and the first two years of the program. The assumption, as Wellsteps states, is that their participation rate is 80%, largely because of the massive $870/year incentive, which in classic wellness fashion is not included in the savings calculation. The number of employees seems to bounce around a bit between reports, but we’ll go with 3284 for this valuation.
By way of review from the first installment, here is total spending:
Also by way of review, here it total spending, participants vs. non-participants, going exactly the other way:
Now let’s overlay the second set of figures onto the first. In addition to trending in opposite directions during the wellness program years, the total spending on these dueling slides doesn’t even coincide in the baseline year. Since the whole point of the exercise is to look at the trend subsequent to the baseline, we will add about $3-million to each year for the bar graph figures, so that the 2011 starting points coincide. That let’s us focus on the difference-of-differences in the program years. Starting at the baseline, costs increased about $1.7-million by 2013, putting the 2013 red endpoint almost exactly in line with their prediction.
In all fairness, let’s continue the analysis, by looking at the Wellsteps performance in 2014:
As you can see, costs did fall below the “prediction” in 2014, though still way above “Wellsteps Begins” and “Actual.” The only problem? More than 100% of the entire decline from the previous year was due to non-participants’ costs plummeting, while participant costs increased.
So where do we stand? Wellsteps, by their own admission, overscreened and overdiagnosed this population. And their own admission, the population was quite healthy to begin with. By their own admission, the health of the Boise employees deteriorated. And, by their own admission, the only successful annual performance is attributable to a large improvement in non-participants.
To paraphrase the immortal words of the great philosopher Samuel Goldwyn, the title of this post, Wellsteps has raised the Koop Award standard for outcomes invalidity to a new low.
Top hospital discharge codes:
Top ER visit codes:
We called it! We predicted the combination of invalidity and cronyism would win Wellsteps a Koop Award!
We cannot, cannot make this stuff up.
Wellsteps, which could take lessons in integrity from the presidential candidates, was obviously fabricating the outcomes for its Boise School District. How do we know this? Simple. Costs can’t rise and fall at the same time, even using wellness industry math. And yet Wellsteps claimed they did.
As soon as we saw how obviously, hilariously invalid their result was, we predicted that Wellsteps would win a Koop Award for the Boise School District. We based this prediction on the combination of data fabrication, cronyism, nonsense, and cluelessness which are the DNA of both that award and of Wellsteps’ phony outcomes. Our only mistake was thinking they would win in 2015, but you’ll see at the end, we said that if they didn’t win in 2015, it was because they were late, and would win in 2016, which is what they just did.
Note when you compare Wellsteps Stumbles Onward: Costs Rise and Fall at the Same Time to their current press release, you’ll see there is something missing from the latter. They removed the “smoking gun,” which invalidates the entire program. In both documents, they said costs absolutely declined across the whole population, including non-participants…
…but on a per capita basis the costs of both participants and non-participants increased, at least in their initial writeup. This slide below has now been conveniently disappeared from their press release. I suspect this is not an accident. Here it is:
Participants’ cost rose just a little while non-participants’ cost rose a lot. This separation is due to the proven fallacy of the participants-vs-non-participants methodology. Even so, the line graph says the whole enchilada at Boise declined, not just the participants.
The only way per capita costs could increase AND total costs decline is if the program is so bad that employees prefer to join their spouse’s health plan, or if the number of employees declines. But even the most dishonest wellness vendor wouldn’t credit either of those changes to their wellness program, and no member of the Koop Award Committee could “overlook” that impossibility.
Or would they?
Be sure to read the second installment, where we dive even deeper into the Wellsteps doodoo.
Ironically, the wellness industry doesn’t understand irony.
The wellness industry is about nothing if not irony. Ironically, wellness vendors and consultants don’t understand irony, so they keep doing and saying things they think are being taken seriously. Ironically, they are being taken seriously, but only by students of irony.
For example, these wellness people don’t understand that it is ironic that employees can be forced to submit to “voluntary” wellness programs, or face fines of thousands of dollars. They say this unabashedly. Whereas when we make an ironic comment, such as: “Wellness vendors make employees happy whether they like it or not,” we do it deliberately.
The May issue of Managed Care displays a cornucopia of unintended irony, in a debate between myself and Harris Allen, of Navistar fame, on the effectiveness of wellness programs in preventing diabetes.
Speaking of Navistar, Mr. Allen was already famous for irony before this debate. He showed Navistar how to claim a wellness ROI of 400-to-1, later reduced to 40-to-1, before jumping again to 400-to-1. That by itself — adding/removing extra zeros in your ROI but claiming it’s real the whole time — is ironic, but that’s not even the ironic part. The irony is that he was concocting these figures even as Navistar itself was making up $4-billion of phony shareholder equity, perhaps including these wellness savings. A lot of the perps (excluding Harris) are ending up in jail over this caper. Ironically, despite his pride in his work on wellness for Navistar, he didn’t cite their results in his counterpoint.
Not being Navistar shareholders ourselves, we found this whole escapade highly amusing, so it is recounted in This Is Your Brain on Wellness, our humor column.
Back to the debate irony. The irony is that, in his attempt to justify wellness, he cited two examples that lead to the opposite conclusion. First, he cited US Preventive Medicine (USPM). USPM did indeed achieve an excellent result, and it is validated by and displayed by the Validation Institute. On that everyone can agree. I myself just wrote a column praising their performance. The thesis of the column: “See, not every wellness vendor fails.”
He cites that exact same company and exact same validation to conclude: “See, wellness vendors can succeed.” Yeah, one wellness company has succeeded while the staggering number of failures — companies that couldn’t get validation or didn’t even bother to apply — is in the thousands, a statistic I noted just yesterday.
Using the same logic as Mr. Allen, one might profile Powerball winners and say: “See? Powerball works.”
The other irony is that he cited the Koop Award-winning companies as examples of successes in preventing diabetes, when — according to their own applications — they basically failed. Ironically, I also cited that very same award in my argument. Specifically, McKesson won an award for preventing diabetes even though its employees’ glucose and BMIs increased. Mr. Goetzel’s and his Koop Award committee cronies never been much for fact-checking, even when the facts are right on the application itself:
The final irony is that Mr. Harris ends his argument with a call for “evidence-based” wellness programs. Ironically, the “evidence” is overwhelming…in the other direction: wellness programs have not avoided a single wellness-sensitive medical admission, according to US government figures. The green line below represents the wellness-exposed population while the red line represents the rest of the country. There is no separation, meaning that the wellness-exposed population has achieved zilch.
Actually, there is slight separation –but ironically it goes the other way. You’d statistically be better off not being exposed to wellness.
This graph is part of my proof of the ineffectiveness of wellness vendors, and allows me to offer a million-dollar reward to anyone who can show wellness doesn’t lose money.
Where did the government get the data for this graph? It was compiled by Truven Health, the division of IBM that — you guessed it, ironically — employs Mr. Goetzel.
Nebraska’s Award-Winning Wellness Program Meets an Ignominious Demise
No program epitomized conventional “pry, poke and prod” wellness more than Nebraska’s state employee wellness program. And by that of course I mean no wellness vendor has ever lied about outcomes more blatantly or won more awards than Nebraska’s state employee wellness program vendor, Health Fitness Corporation. (Blatantly lying about outcomes and winning Koop Awards, in the immortal words of the great philosopher Frank Sinatra, go together like a horse and carriage.) Their big mistake was admitting it. (See the timeline link.)
Not to mention the cover-up of the lies, that Ron Goetzel and his Koop Committee friends botched so badly that the state’s HR team and procurement department could no longer do the Sergeant Schultz thing. I guess now, finally, Mr. Goetzel will stop referring to this program as a “best practice.”
The complete timeline, including all the screenshots, “best practice” references, and the cover-up, is here.
Now, the program is officially dead. It was close. On October 1, we thought we had lost:
But then last week, following a number of behind-the-scenes conversations and finally a bit of googling by the state:
In other words:
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:
- 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;
- 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;
- Wellness vendors need to learn a thing or two about wellness, for a change.
- 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.
And Another One Bites the Dust: Employee Benefit News Eviscerates McKesson’s Koop Award
Believe it or not, I do have a Day Job (www.quizzify.com), but it’s hard to focus on it when the Wellness Ignorati keep throwing me red meat. I would suspect a conspiracy to distract me masterminded by the Ignorati and my competitors, except that Quizzify doesn’t have competitors. No company except Quizzify seems to employ executives who know how to read. Otherwise, vendors would have read that insured Americans already consume far too much healthcare, so the solution should not be to force them to get even more of it, via bribes and fines.
Employee Benefit News just published a smackdown of McKesson’s 2015 Koop Award. It is based largely on our own smackdown of McKesson. The article itself predated our Unified Theory of Koop Award Cluelessness, which shows that McKesson has lots of company in fabricating outcomes — all Koop Award winners overstate savings by roughly the same mathematically and clinically impossible multiple. We call this multiple the “Goetzel Factor.”
McKesson made a big deal out of their principal investigator being a graduate student at the Harvard School of Public Health named Andrea Feigl. However, I don’t recall Ms. Feigl being in class the day I guest-lectured on wellness outcomes evaluation. Had she shown up that day, she might have avoided some of her rookie mistakes. (Bada-Bing!)
As is always the case with wellness evaluators, her defense merely confirms our findings. She is still claiming $13 million in savings, but says it’s based on a “cohort” of roughly a third (14,000) of McKesson’s 43,000 employees, whose risk collectively declined by 2%. We had observed that $13 million is about 7% of McKesson’s total spending on all 43,000 employees. Watch what happens if we accept her argument that we should only allocate the savings only to the third of McKesson’s employees who participated. In that case, instead of being 7% of total spending on the whole population, $13MM is 21% of the spending on that third. 21%! Not bad –wiping out a fifth of all McKesson’s spending by urging people to eat more broccoli. (There is no mention of their off-the-charts 27% tobacco use rate, which barely budged, and seems just slightly off-kilter for a company with an award-winning wellness program.)
This figure of course is a massive multiple of all spending on wellness-sensitive medical events (WSMEs). To achieve that savings, the program would have to wipe out WSMEs not only on all participants but also all non-participants — plus about 160,000 of their closest friends. Plausibility test, anyone?
To support that finding, she said:
“Health indicators in 2013 and 2014 were adjusted in the analysis, while several sensitivity analyses of the ‘inter-individual’ impact that used a matching approach confirmed the results.”
In other words: “I can’t explain it in English so you’ll have to take my word for it.”
She also said that I confused the narrative, that said McKesson employees lost weight, with the data, which said McKesson employees gained weight. Those would seem to be opposite results, which she calls “apples and oranges” because the narrative and the data are different. One is “descriptive” and the other is based on “repeated cross-sections.” So it’s OK for these results to completely contradict each other. Got it.
In any event, neither gaining a little weight nor losing a little weight generates a 21% cost savings, especially when tobacco use is basically unchanged (-1%).
The bottom line: there was no plausibility test, no attempt to reconcile the narrative findings with the data, no curiosity about how such a trivial risk reduction could generate such a substantial reduction in total costs, no understanding of participation bias, no understanding of population health, and no concern that neither tobacco use nor weight changes could possibly support the financial findings.
In other words, McKesson was a shoo-in for a Koop Award.
Update, January 9: Actually it’s even worse than I thought. Kudos to Robert Dawkins, for pointing out on Linkedin that I was crediting McKesson with a 1% decline in tobacco usage over this period…but if you look at the CDC data, it turns out that the rest of the country declined by a greater percentage over the same period. So McKesson quite literally achieved less than nothing both in weight and in tobacco.
Listen to Ron Goetzel’s Stock-Picking Advice…and then Do the Opposite
A good rule of thumb is that when Ron Goetzel publishes something, you should reach the opposite conclusion. TEASER: In this case, had you done the opposite 5 years ago of what he (retrospectively) recommends now, you’d be sitting on a pile of cash.
Yesterday, the Journal of Occupational and Environmental Medicine, fresh off its Aetna wellness DNA collection debacle (which, in all fairness, one of their board members did candidly admit should never have passed peer review — see the comments), published Ron Goetzel’s article claiming that Koop Award-winning companies outperform the averages, thus showing that outstanding wellness programs “favorably affect a company’s stock valuation.”
Try telling that to Gary Loveman. He was the head of the Business Roundtable’s Health and Wellness Committee. As such, he was the biggest supporter of wellness among all corporate CEOs. He even leveraged the Business Roundtable’s formidable financial resources to convince a bunch of senators to take time off from their real jobs in order to host a fact-finding committee hearing with the title: “Employer Wellness Programs: Better Health Outcomes and Lower Costs.”
Ask Mr. Loveman how his company, Caesar’s Entertainment, is enjoying their bankruptcy proceedings. (He might not know because he is no longer allowed to run the company.)
But we digress…
Let’s look at what happens if you had invested in other companies with “outstanding” wellness programs five years ago. Below is the entirety of companies that have won Koop Awards since 2010 — all of which made up their outcomes, as we’ve noted — that are also publicly traded. (There might be 1 or 2 more. The Koop website is down this morning, so I am going off the list I have.) In each case we tracked 5 years of stock prices ending yesterday, and compared to industry indexes. We’ve linked to the indexes.
2010 — Pfizer.
Pfizer stock has risen about 85% — but simply investing in a drug company index would have made you a 156% return.
Highlight of their wellness program: participating employees lost 3 ounces over a year while non-participants gained 2 ounces. Or maybe it was the other way around.
2011 — Eastman Chemical
Eastman Chemical has outperformed the chemical industry index by 33% over this period.
Highlight of their wellness program: Ron Goetzel doctored the original application recently and then covered it up, because this was the company that “showed savings” 2 years before the program even started. Removing the embarrassingly accurate x-axis labels of the original while claiming “the original is still online and available for review” would have been a very effective cover-up had we not kept a screenshot of the original original.
2013 — Dell (the 2012 winners are not publicly traded)
Dell underperformed the tech stock index by 31% before it stopped trading in October of 2013. (We don’t comment on their wellness program so as not to embarrass them, so there aren’t highlights.)
2014 — British Petroleum
Long after underperforming due to the oil spill before this most recent 5-year period, they continued to underperform the oil stock index by 13%.
Highlight of their wellness program: Mercer “validating” outcomes that were not only mathematically impossible, but were also 100 times greater than what the vendor itself, Staywell, had said was possible. Staywell never explained this discrepancy, shockingly.
2015 — McKesson
There is no good drug distribution stock price index, but McKesson did outperform the drug stock price index by 12%. The closest thing to an “index” might be its close competitor, Cardinal Health. McKesson outperformed them over the 5-year period, but over the most recent 3-year period, Cardinal did somewhat better.
Highlight of their program: They boast one of the highest tobacco use rates in the country, but that didn’t stop them from winning an award because employees who attended a bevy of Weight Watchers meetings lost a few ounces.
Put it all together, and you would have been much better off shorting these companies and hedging with the industry index than actually buying stock in them. As noted at the beginning of this article, had you done this hedge, you’d be sitting on a pile of money right now. As they say in the stock market, the only person as valuable as the person who is always right is the person who is always wrong. Perhaps Mr. Goetzel has a future in securities analysis.
Albert Einstein Meets the C. Everett Koop Wellness Award
One of Albert Einstein’s great regrets was never having developed a “unified theory,” a consistent set of calculations that could explain the universe. That’s the bad news. The good news is that he did give us the word “Einstein” as in: “Ron Goetzel’s Koop Committee members are the biggest bunch of Einsteins in all of wellness, no easy feat considering the competition from WELCOA, HERO and others.”
Past postings have easily invalidated all the Koop awards since 2010. This did not require breaking a sweat. Rather, as Surviving Workplace Wellness observes: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
Previously, we’ve had to content ourselves with pointing out the plethora of individual rookie mistakes in each award. Now, however, we have a Unified Theory of Koop Award Ludicrous Impossibility. It reveals a remarkably consistent set of ludicrously mathematically impossible outcomes across all this decade’s award-winners. Not just any old ludicrously mathematically impossible outcomes but — and this is what excites my Inner Nerd — the same ludicrous mathematical impossibility pervades every award-winning outcome.
In each case the award winner has documented a small risk reduction among active participants. (They have also shown that willingness to participate, rather than the actual program, is what generates the savings, of course, but choose to ignore their own findings.) And in each case that small risk reduction generates what we thought were fairly random claims of savings. But it turns out that in 5 of the last 6 awards, the claims savings weren’t random at all but rather were essentially the same, using the same simple formula comparing risk reduction to claims savings. (The missing year is 2013. We can’t do Dell because we don’t want to embarrass them due to our relationships.)
The Unified Theory of Koop Award Ludicrous Impossibility Revealed
In the real world, trivial reductions in risk among participants — excluding non-participants because they increase in risk — have no impact on spending discernible in the white noise of random claims variation. And if we could discern an impact, it would be even more trivial than the risk reduction, because risk-sensitive medical events are a small percentage of total events. For instance, if risk-sensitive medical events comprise the typical 5% of total spending, and risk declines by 1%, the reduction in total spending would be 1% of 5%, or 0.05%. And that’s before subtracting fees.
However, on Ron Goetzel’s planet — also inhabited by fellow Einsteins like Optum’s Seth Serxner, Wellsteps’ Steve Aldana, and Staywell’s David Anderson, and obviously Mercer and Milliman — the opposite is true: a trivial reduction in risk generates massive cost savings. For example, McKesson saved $13 million via a 1% overall risk reduction. At that rate of savings and their rate of spending, their entire health spend could be wiped out if risk factors fell 14%. Not just their spending on wellness(risk)-sensitive medical events, but their total spending spending on healthcare. Wiped out. Gone. Obliterated.
A simple example can demonstrate how the Unified Theory works. Suppose the Koop Award goes to an outfit that claims to have achieved a 10% cost savings by reducing risks 2%. Then it follows that a 100% cost savings (10 times the claimed amount) could be achieved if risks fell 10 times the claimed 2%, or 20% in total.
To give credit where credit is due, we shall call this resulting figure — 20% in this hypothetical — the Goetzel Factor. The Goetzel Factor is specifically defined as: “The percentage decline in risk factors projected to wipe out spending according to the Koop Award Committee validations of risk and cost savings.”
Let’s review the last five awards (leaving out 2013) using this formula to estimate a Goetzel Factor. Note that the risk reduction is cross-sectional, meaning it is averaged across the entire population, not just participants. So if the stated or calculated risk reduction is 2%, as with McKesson, and half the employees participate (ditto), the figure in the table below for McKesson would be 1% (half of 2%).
Conclusion: the range of Goetzel Factors is remarkably tight–13% to 16%. Given the ludicrous impossibility of wiping out spending by reducing a small minority of risk factors, the consistency of the result is amazing: the Goetzel Factor reveals almost exactly the same ludicrous impossibility every time!
There are a few asterisks in this Unified Theory. In some cases, the award application itself wasn’t specific on some things, like total spending. So we made assumptions and “showed our work” as they say in fifth-grade math. Or, in the case of British Petroleum, we defaulted to their article in JOEM, which had much more detail. In any case, the spreadsheet calculations and sources are available to all legitimately qualified researchers, meaning those excluded from the Koop Award Committee because they aren’t Einsteins.
And the Envelope Please. The Goetzel-Lewis Debate winner was:
It wasn’t even close. I offered a proof that wellness has not avoided a noticeable number of hospital admissions this century. Ron Goetzel accepted that the data was accurate and declined to claim the million-dollar reward for finding a mistake in it.
Here is the first post-debate coverage. Highly favorable. Quoted Ron as saying employees like wellness. Try telling that to an employee…
The exchange I will be dining out on for years will be when Ron admitted I am the best peer reviewed in the industry. After he accused me of not being qualified to do my job, the following transpired:
“Ron, will you admit I am the best peer reviewer in the industry?”
“Then who is?”
Silence, followed by laughter from the audience.
Ron’s biggest points are:
- Wellness works if you do it right
- Almost nobody does it right. Maybe Procter & Gamble did it right a quarter-century ago (yes, he cited a 25-year-old study) but unless you are Ron’s client or a few others, you’re doing it wrong
- You can only expect a 1-to-1 return, and he cited an example to that effect
Ron’s other points were (in no particular order):
(1) He had nothing whatsoever to do with the Penn State program even though he was one of four people in the conference room holding the press conference titled: Penn State Takes Offensive in Health Plan Controversy.
(2) Four people stood up to say how bad their program was. In each case, Ron’s answer was that it was their own fault or it was a lousy program. In one case when someone complained about the typically cliched advice given to them by a wellness coach, he said: “You should listen to them and then maybe you will change your behavior.” He and Michael O’Donnell agree that most programs (95% in Michael O’Donnell’s estimation) are done badly.
(3) I was castigated because Quizzify has a 100% guarantee of savings. In the wacky world of wellness, companies that don’t guarantee anything because they can’t achieve savings are better than companies that guarantee savings because they can achieve them.
(4) Companies do not screen according to guidelines, but that is their fault. Wellness vendors would be perfectly happy to cut their fees by 70% and just screen the people who the USPSTF says to screen.
(5) He said none of my stuff is peer-reviewed so I am not qualified to do peer review. That’s why I’ve been blacklisted. Never mind that my most recent peer-reviewed article is trending #1 for the year in a major journal. Never mind that all of their stuff is full of obvious rookie mistakes, and never mind that legitimate journals like Health Affairs ask me to peer-review. And never mind that Ron himself admitted I have found many mistakes in his stuff.
I also named all the household names (in healthcare, at least) who had reviewed our stuff–Stuart Altman, Tom Scully, Regina Herzlinger, Jim Prochaska, Bob Galvin, Leah Binder, Norton Hadler. Oh, yes–and Quizzify is the only company in population health whose content is reviewed and approved by doctors at Harvard Medical School. (Formal announcement forthcoming.) And then finally I observed that we weren’t standing up there today because of his peer-reviewed stuff. We were standing up there today because of my non-peer-reviewed whistleblowing.
(6) They will still be quoting Katherine Baicker’s “Harvard Study” with the 3.27-to-1 ROI for years to come. They claim the authors haven’t backed off it one iota, regardless of what Baicker has said. And since there are no other studies to cite other than their own (which accidentally found wellness loses money), they’re stuck with this one.
(7) RAND, the NY Times Incidental Economist, and the rest of the world are all wrong because they oppose wellness. His view is: “Everyone’s out of step but Ronnie.”
(8) Even though it appears that every employee in a “pry,poke, and prod” program thinks it’s a joke or worse (and that’s why the bribes and fines have to keep rising), employees really do love wellness and want more of it, according to Ron.
(9) He accused me of spreading lies and misformation but didn’t actually name any.
(10) He admitted to doctoring original applications in the Koop Award file after my exposes, but didn’t apologize either for doctoring them or for writing in Health Affairs that they weren’t doctored, but rather that the “original application is online and available for review.”
(11) He is still defending the lies told in the Nebraska program about saving the lives of cancer victims, and still thinks Health Fitness Corporation deserves their Koop award, even though only 161 state employees improved a risk factor and the state also lied about their savings.
(12) He says 80% of costs are due to preventable diseases like cancer. I have had cancer and it was not preventable. It is frustrating to see someone tell people that my disease was preventable, when it wasn’t. He is referring to the old urban legend, thoroughly debunked on this site, that 75% of cost is preventable…but, what the heck, why not add 5%? 75% or 80%, we had already shot this fallacy down anyway.
(13) Even thought the HERO Guidelines which he co-authored and which represent “countless hours of collaboration” say wellness loses money, he doesn’t believe that section. He didn’t write it or (I guess) read it during the “two years” of this guidebook’s development. And maybe the person who conducted the webinar defending it was a different Ron Z. Goetzel.
My points–none of which were rebutted except where noted–were:
(1) I proved (using the proofs on this site) that wellness loses money and that if he thought it made money he would claim his million-dollar reward. He accepted the proof (no choice — the database that the proof was based on is maintained by another part of his company) and didn’t rebut it. One of his cronies in the audience, Seth Serxner, tried to rebut the proof but we were fully prepared for that and already had the data. We apologize to Seth for making him look bad. So the proof that wellness has lost money for 14 years is established.
(2) I proved that his entire participants-vs-non-participants methodology is made up. This was not rebutted. So all the savings in all the Koop Awards are toast.
(3) There was no rebuttal to my observation that most programs don’t work according to their own data. The rebuttal was that their own data was only one case study.
(4) I showed that basically everybody who does not make their living off wellness is opposed to it, like the left wing media and the right wing media. (Wellness supporters are running out of wings.) See the In the News section.
(5) I also made the unrebutted point that his own allies on his own committee have strayed off the reservation too — Debra Lerner and Altarum and of course Michael “95% of programs don’t work and RCTs have negative ROIs” O’Donnell.
Conclusion: nothing will change. He and his cronies — even though they have now admitted my proof, and have all passed on claiming the $1-million award — will still attempt to shove programs down employees’ throats — even though most of them (in their own words) fail and (in their own words) it is “very hard” to do a successful program.
And as long as they continue to do try to protect their revenue streams on the backs of corporations and employees, we will continue to protect them from the “pry, poke, prod and punish” jihad that is increasingly part of our corporate culture.
A special shout-out to Professor Matthew Woessner of Penn State, who made the trip down to DC, and was able to ask very pointed questions about Ron’s/Highmark’s program, the worst in wellness history. Ron disavowed any part of the “awful” Penn State program (he must have gotten lost and wandered into that conference room mentioned above) A question was also raised to the point of, that’s only one university. So the others are all fine. Matthew then got up and said Ohio State, which was the only other one he was closely familiar with, also hated their program. Quite a timely put-down and along with the questions from actual wellness program participants, highlighted the disregard in which most employees hold these programs.
Prediction: Wellsteps-Boise School District wins 2015 Koop Recognition
We are going to make a prediction. We might be wrong, though, because in the immortal words of the great philosopher Yogi Berra, “It’s tough to make predictions, especially about the future.” We predict that the Boise School District, a Wellsteps customer, is going to win the 2015 Koop Award. At a minimum, they will get an honorable mention.
We base this prediction on three insights. First, as our previous posting shows, the award tends to go to the program that spews the most nonsense. Specifically, to the one that ignores both biostatistics and fifth-grade math most creatively. Obviously, Wellsteps misunderstands the statistical concept of regression to the mean. Misunderstanding biostatistics is a requirement for being a wellness vendor. What’s more surprising is that they were absent that day in third grade when the teacher explained the law of math that numbers can’t increase and decrease at the same time. Laws of math tend to be strictly enforced.
In all fairness, it is possible that both Wellsteps’ claims are true: total costs may very well have declined even as cost/person increased. The Boise School District might simply employ or insure fewer people in 2014 than in 2011. Or maybe the Wellsteps program was so unpopular and worthless that employees opted to get insurance through their spouses. But even the most dishonest wellness vendor with the most clueless customer wouldn’t claim credit for a reduction in costs due to fewer people being insured. And even the ethically challenged Koop Committee isn’t dishonest enough to endorse a claim that blatantly specious.
Second, the award almost always goes to a client or customer of a Koop Award Committee member, or to a client or customer of a sponsor of the Committee. Wellsteps’ Steve Aldana sits on the Committee. All the other vendors and sponsors on this Committee have already been graced with an award for one of their customers. So now it’s Wellsteps’ turn, as they have yet to win one for a customer of any size. (This partly reflects their lack of customers of any size.)
After all, why even bother being on this C.Everett Koop Award committee if you can’t give a C. Everett Koop Award to yourself? Isn’t that what Dr. C. Everett Koop was all about — self-dealing, cronyism and corruption? (not)
Third, the timing of the “White Paper” Wellsteps just published is quite fortuitous. Sort of like in World War I, when one side knew an infantry attack was coming because it was preceded by an artillery bombardment by the other side, Wellsteps is preparing us for more “over the top” claims of success in a program that — by their own admission — was a total failure at controlling costs through 2013, and only did OK in 2014 because the cost of non-participants declined precipitously.
Fourth, if the Committee was at all on the fence, our posting last month would have helped them decide in favor of Wellsteps. One thing this Committee enjoys doing is showing us that facts and math doesn’t matter because their customers don’t read our material. The more outrageous their claims, the more they like to rub our faces in the reality that very few people in human resources care what we have to say.
This isn’t because they have, to use Mr. Aldana’s hilariously misinformed term, I-don’t-care-itis. Instead it’s because most HR executives don’t hear what we have to say, as we are blocked from most linked-in groups run by members of the wellness ignorati.
We are actually quite proud of the enemies we’ve made…but even so would appreciate if you could re-post this.
Update: it is also possible that Wellsteps didn’t get their act together in time to apply for this award–applications were due in May and their White Paper just came out last month. In that case, we’ll look forward to revisiting this post next year.