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National Bureau of Economic Research has bad news and good news for the wellness industry

Not to be confused with those immortal words often attributed to the great philosopher Yogi Berra, a big joke among economists is: “An economist is someone who upon learning how something works in practice, wonders how it will work in theory.”

That joke morphed into reality last month — though it was a controlled study testing a theory, rather than the theory itself. The “theory” would be that inactive unmotivated non-participants can be used as a control for active motivated participants. Ironically, this study design has never been proposed as legitimate, even in theory. Wellness “researchers” like it because it always show savings, even when nothing happens. For example, even when there was no program for the participants to participate in.

Obviously if this were a legitimate design, the FDA would approve it for clinical trials, saving a ton of time and money vs. having to do controlled trials.

To wit, the National Bureau of Economic Research (NBER) just published a study showing that the participants-vs-non-participants (“par-vs.-nonpar”) study design, used extensively by the very stable geniuses in the wellness industry to do their alt-research to fabricate their alt-findings, is completely invalid.

No surprise. This NBER study validates what we’ve all observed in practice — as the three examples in this article amply demonstrate.  The somewhat more amusing TSW version is here.


Highlights of NBER study for the wellness industry: bad news first

First the bad news. Fasten your seat belts and be shocked, shocked to learn that the researchers could identify:

  1. No noticeable change in health behaviors due to the wellness program
  2. No noticeable change in health outcomes due to the wellness program
  3. Clear self-selection bias among participants opting into the wellness program

Lest anyone think we are taking this out of context, here are their exact words:

We do not find any significant effects of treatment on total medical expenditures, employee productivity, health behaviors, or self-reported health measures in the first year following random assignment.  We further investigate the effect of our intervention on medical expenditures in greater detail, but fail to find significant effects on different quantiles of the spending distribution or on any major subcategory of medical expenditures (pharmaceutical, office, or hospital). We also do not find any effect of treatment on the number of visits to campus gym facilities or on the probability of participating in a popular annual community running event, two health behaviors that are relatively simple for a motivated employee to change over the course of one year.

This of course merely confirms what we observe in outcomes reports published by wellness vendors, including the two most recent proud recipients of the Deplorables Awards.  Actually, in the case of Wellsteps there was indeed a noticeable change in health outcomes among program participants — they got worse.

Also, the authors — no doubt anticipating the objection from the very stable geniuses at the Health Enhancement Research Organization — specifically note that nothing in Year One’s results presage any step-function improvement in Year Two. So the specious “Wait ’til next year” argument is off the table.

You might be thinking, “Another nail in the wellness industry coffin.” True, except that there almost isn’t room for any more nails. Soon the coffin will have enough nails to create its own gravitational field.


Next, the good news

Here are the two pieces of good news for the wellness industry. One finding was:

Our 95% confidence intervals rule out 78 percent of previous estimates on medical spending and absenteeism.

That means that it is possible that 22% of previous estimates may conceivably not be completely invalid. This is not to say that 22% are valid, just that they aren’t automatically invalid. That is great news for the wellness industry, where clearing the bar for not being automatically invalid is cause for celebration.  As Dave Chase says, the bar for wellness is so low a snake could jump over it.

However, the 78%-totally-invalid figure specifically invalidates Katherine Baicker,  author of the so-called “Harvard Study.” Depending on whether you are a wellness vendor or an oppressed employee, she is either the Johnny Appleseed or the Typhoid Mary of wellness.  Her famous 3.27-to-1 ROI was tallied entirely from par-vs.-nonpar studies, exactly the methodology that the NBER just invalidated, citing exactly the studies she cited. (The three examples in my study referenced above were also part of her meta-analysis.)

So perhaps she might now make a formal statement regarding par-vs-non-par as a study design?  Either a retraction or a defense. Just something that clarifies her previous statements, which seem to be neither retractions nor defenses but rather more like excuses:

  1. It’s too early to tell (um, after 30 years of workplace wellness?)
  2. She has no interest in wellness any more
  3. People aren’t reading her paper right (we’re only reading the headline, the data, the findings and the conclusion, apparently)
  4. “There are few studies with reliable data on the costs and the benefits” (um, then how were you able to reach a conclusion with two significant digits?)

The irony is that Kate Baicker has otherwise done outstanding research. Her study on Oregon Medicaid is a classic. In Oregon at the time, Medicaid eligibility was determined by lottery amongst applicants. That meant that — quite the opposite of wellness control groups  — the control group of people not picked in the lottery had equal motivation to seek insurance coverage as people who were picked.  After following both groups going forward, her finding was that obtaining insurance to access basic medical care did not change outcomes. (Having insurance did bring peace of mind, though.)

And yet somehow in “Workplace Wellness Can Generate Savings,” she was quite comfortable reaching a conclusion that was completely inconsistent with her Oregon finding, not to mention the Law of Diminishing Returns: throwing additional unrequested, generally unwanted, and largely misdirected medical interventions and advice at employees who already have insurance — and recall that most insured Americans are drowning in medical care — could dramatically improve their outcomes enough to calculate not just a massive ROI, but an ROI precise to two significant digits.

What she will hopefully learn through the NBER study is something that I learned 11 years ago: when the data proves you wrong, fess up.  Then people like me have to find someone else to blog about. Fortunately, in wellness, that is not a heavy lift.


The second piece of good news for the wellness industry

To quote the study:

 …wellness incentives may shift costs onto unhealthy or lower-income employees if these groups are less likely to participate in wellness programs. Furthermore, wellness programs may act as a screening device by encouraging employees who benefit most from these programs to join or remain at the firm

To be clear, this calculation does not imply that adoption of workplace wellness programs is socially beneficial. But, it does provide a profit-maximizing rationale for firms to adopt wellness programs, even in the absence of any direct effects on health, productivity, or medical spending. [emphasis theirs]

In other words, employers can use wellness programs to subtly discriminate against unhealthy — read, older and poorer — workers.  Many of the very stable geniuses in the wellness industry will be happy to hear this. The exceptionally stable genius who will be most thrilled to hear this is Michael O’Donnell.  Mr. O’Donnell is the former Prevaricator-in-Chief of the wellness industry trade publication and a current member of the Koop Award cabal.  These are excerpts from one of his editorials:

First, he says prospective new hires should be subjected to an intrusive physical exam [editor’s note: notwithstanding the fact that this is totally illegal], and hired only if they are in good shape.  OK, not every single prospective new hire needs to be in good shape — only those applying for “blue collar jobs or jobs that require excessive walking, standing, or even sitting.”   Hence he would waive the physical exam requirement for mattress-tester, prostitute, or Koop Award Committee member, because those jobs require only excessive lying.

Second, he would fine people for not meeting “outcomes standards.” In an accompanying document, he defines those “outcomes standards.” He specifies fining people who have high BMIs, blood pressure, glucose, or cholesterol.

In other words, Mr. O’Donnell wants to charge for insurance by the pound, as that accompanying document says. Actually, by BMI, which of course is of dubious value as a measure of weight, let alone health.

Here is his actuarial formula:

Although having read his very stable arithmetic elsewhere in this same document, I’d worry about the accreditation status of any actuarial school, or for that matter any school of any kind within the 50 states, that would accept him:

Thirty-one states have no laws that prohibit employers from using smoking status as the reason for not hiring… In the remaining 29 states…smoking status cannot be used as the reason for not hiring.

I’m not waiting around for a retraction from this genius either.

2015 Koop Award Winner McKesson Stock Plummets in 2016

They say being on the cover of Sports Illustrated jinxes you. I wouldn’t know.  There is no chance of that for me, unless they run a feature story about 60-year-olds playing Ultimate Frisbee on Christmas night, when they should be playing canasta with their aunts.

That jinx may be an urban legend, but here’s a real jinx: winning a C. Everett Koop Award.  The 2016 vendor got humiliated in STATNews, of course — we’ve already covered that. The 2012 awardee was embarrassed in the media as well. The vendor ended up losing their gig.

Neither of their customers (Boise or Nebraska) are public companies, though, and that’s what this article is about, because it’s the customer’s performance we are most interested in, not the vendor’s. The latter do quite well for themselves, snookering unsuspecting employers.

The most recent public company to win an award was the 2015 winner, McKesson. McKesson got clobbered in the stock market in 2016, the 14th worst performance among the S&P 500, as investors learned that only the dumbest bunch of managers would pay a cabal of vendors (that themselves are among the industry’s most clueless, like Vitality) to harass their employees. Employee Benefit News took notice of the McKesson wellness program, and pilloried them, thus triggering the sell-off.


You might say: “Wait a minute. Yes, that was a failed, hilariously mismeasured, program whose award was due to the cronyism of having 5 of their vendors and consultants connected with the Awards Committee, but how could something as trivial as a wellness program be responsible for their stock price collapse?”

The answer, of course, is that it doesn’t. Based on the amount of money these programs lose, McKesson’s wellness program was probably only responsible for 1% or so of the 27% stock price decline.  And that’s precisely the point. Ron Goetzel claimed that winning a Koop Award caused a dramatic increase in stock prices.  I noted that, like most of Ron’s defenses of wellness, that analysis didn’t hold water, and any observer with a calculator and access to stock price histories could see that wellness causes a dramatic decrease in stock prices.

While I won that face-off (a year later, you would have been way ahead of the game shorting Koop Award stocks and hedging with index and sector funds), neither conclusion is really valid. Both analyses have a ridiculously low signal-to-noise ratio. Many things happen in the market that overwhelm wellness. For instance, I don’t think any of the analyses of Citibank’s 2008 crash would blame their Koop Award-winning wellness program.

Instead, the negative impact on stock valuations can be shown to be pretty trivial.  Let’s start out with some favorable assumptions. Assume the typical program is more successful both than the allegedly successful one most recently measured in Health Affairs and also than the award-winning so-called best-in-the-country Wellsteps program for Boise, in that it neither loses money nor harms employees. Instead, it is only worthless. So even though Ron Goetzel and Michael O’Donnell say most programs fail, let’s assume yours neither causes health spending to increase or employees to get worse.

If you pay vendors to “manage” 10,000 employees @$150, that’s $1.5 million lost. With a typical pretax P/E of 10, you reduce your market value by $15,000,000. A company with 10,000 employees might have (for example) a market value of $1.5-billion. That makes the negative impact of wellness on stock price only 1%, hardly enough to cost a CEO his job.

So the good news is that McKesson’s collapse is the exception. Screening the stuffing out of employees, lying about outcomes, winning a Koop Award, and hiring a cabal of clueless vendors will not cause your stock price to plunge. In a year in which the media gave the wellness industry little reason to cheer, costing your shareholders only 1% of their investment in your company is great news. Worthy of a celebration. Or at least a couple rounds of canasta.

So many candidates for the Deplorables Award countdown, so few numbers between 1 and 10

Having covered the also-rans last week, here are the first runners-up, as we inch ever closer to the coveted top spot. (To read the original postings, click on the numbered headers.)

Today we are highlighting more people and organizations who’ve made the wellness industry what it is. Wednesday we will complete the listing of the Stars of Wellness, the people and organizations who are making the industry what it should be.


#5 Interactive Health

Interactive Health conducted what may be the head-scratchingest screen in wellness industry, a difficult feat given all the competition. For starters, they tested me for calf tightness. It turns out my calves are tight–and right on-site they loosened them. I could feel my productivity soaring…until the left one went into spasm that night and I couldn’t get back to sleep. Still, I can see their point — loose calves are a useful trait for many common jobs.

first-baseman

Next, Interactive Health shattered the record, previously shared by Total Wellness and Star Wellness, for most USPSTF non-recommended blood tests. I don’t know what half these things are, which means neither does Interactive Health.

interactivehealth

 


#4 Koop Award Committee

Where would a Deplorables Greatest Hits List be without the Koop Award Committee?

Every year, like clockwork, the industry’s biggest liars select the industry’s biggest lies.  2016 started with last year’s winning program, McKesson’s, being exposed as a joke in Employee Benefit News, and ended with this year’s winner, Wellsteps, being exposed as a joke in STATNews.

When bestowing this year’s award to their fellow Committee member, Wellsteps, they didn’t even pretend not to lie. And what lies they were! Not just regular-sized lies. Not even supersized lies. We’re talking lies that would make a thesaurus-writer blush.

To put their lies in perspective, I may not even know you, but if a Koop Committee member told me the sky was blue, and you told me the sky was green, I’d at least go look out the window.

PS  Not everyone on the Committee is a liar. One person is quite honest and can’t believe what goes on every year. I don’t want to name my source because in Koop-land, honesty is grounds for termination. As is getting validation. Or adopting the Code of Conduct. Basically ethical behavior is off-limits. An executive of one group, Altarum, published a blog critical of wellness and <poof> the Committee disappeared them.


#3 Michael O’Donnell

Michael O’Donnell seems to crave my attention. When he managed to go three whole months without being featured in a TSW posting, he came up with these irresistible nuggets:

  • “Wellness is indeed the best thing since sliced bread, up there with vaccines, sanitation and antibiotics.”
  • “[Wellness] can prevent 80% of all diseases.”
  • “The ROI from wellness is very strong.”
  • “Workplace health promotion may play a critical role in preserving civilization as we know it.”

If nothing else, Mr. O’Donnell presents the best argument for requiring educational standards, or at least a GED, in this field — by demonstrating his total lack of understanding not just of wellness, but also of vaccines, sanitation, antibiotics, percentages, diseases, ROIs, and preserving civilization as we know it.

Oh, yes, and multiplication as well. His article on how to increase productivity with wellness used an example demonstrating a productivity decrease. In 2016, he also went on an anti-employee jihad that should be read in its entirety. (Translation: some of my best work…)  Highlights:

  • Prospective new hires should be subjected to an intrusive physical exam, and hired only if they are in good shape.  OK, not every single prospective new hire — only those applying for “blue collar jobs or jobs that require excessive walking, standing, or even sitting.”   Hence he would waive the physical exam requirement for mattress-tester, prostitute, or Koop Committee member–because those jobs require only excessive lying.
  • He would “set the standard for BMI at the level where medical costs are lowest.”  Since people with very low BMIs incur higher costs than people with middling BMIs, Mr. O’Donnell would fine not only people who weigh more than his ideal, but also employees with anorexia.

If employees didn’t already have an eating disorder, what better way of giving them one — and hence extracting more penalties from them — than to levy fines based on their weight?  Employees above his ideal weight would pay per pound, sort of like if they were ordering lobster or mailing packages.


#2: Ron Goetzel, Seth Serxner, and Paul Terry (Health Enhancement Research Organization)

These three characters — naturally also on the Koop Committee — managed to pile more lies, sardine-like, into a single page than anyone else in this industry, in the “poison pen” about me they circulated to the media.

A good starting question would be, why on earth would anyone think that they can send a “confidential” letter to the media?  The media are in the business of disseminating information. You see, that’s why they call them “the media.”  Am I going too fast for you, Mr. Goetzel?

The funny thing about these Einsteins? Their defense to my observation that their very own numbers show wellness loses money was that their very own numbers were made up. Imagine being so dishonest that the way you defend yourselves is by claiming you fabricated your own report.

That’s not even the punchline.  It turns out that this allegedly fabricated report is in truth an actual non-fabricated report. So, in the immortal words of the great philosopher LL Cool J, they lied about the lies that they lied about.

How did I learn this? That will be the subject of a post early year.


Watch this space…soon we will be naming the industry’s #1 Deplorable of 2016.

The Great Goetzel-Lewis Debate, Part 2: The Debate Ends Almost Before It Begins

This is Part 2, my opening remarks. These and all future annotations will be synched to the main debate tape, which is downloadable from the Population Health Alliance website. “Synched” meaning that the exchanges being annotated below can be found at the points in the tape noted in bold.

Click here if you haven’t already listened to/read Part 1.


20:40

I got a chuckle for my opening line but Ron clearly won the style points on opening lines.

You’ll note my opening statement contains no unsupported claims, whereas his entire opening statement was nothing but unsupported claims. I am all about proof and examples — all of which are in the public domain, easily sourceable, and on this site. Many come right from him and his cronies, in their multitudinous gaffes.  Ron isn’t debating me as much as he is “debating” against his own industry. The walk-backs, disavowals, concessions etc. make my presence almost superfluous.


22:00

I review Penn State’s ill-fated wellness program. This is a layup. Worst program ever, and Ron’s fingerprints are all over it. I get some laughs for my riff on testicles, which were a major focus of the Penn State program, along with a disproportionate number of questions about ladyparts.


23:00

Ron interrupts (with my permission) to say: “I had absolutely nothing to do with Penn State.” I observed that he was in the room defending it, and gave chapter and verse , referring to the screenshot below and quoting the title.  He must have assumed I didn’t see that article. But at the time many journalists contacted me, dumbfounded that Ron, Highmark’s Don Fischer and Penn State’s Susan Basso were still defending it.

goetzel penn state

The exact quote from that article, in which he was in the room, on the call:

An independent researcher involved in that study, Ron Z. Goetzel, director of the Institute for Health and Productivity Studies at the Rollins School of Public Health at Emory University, said the study offered sophisticated controls and was published in a peer-reviewed journal. It’s backed up by additional independent studies, he said.


23:40

I review Nebraska. Because I did not anticipate the pants-on-fire Wellsteps-Boise Koop Award in 2016 — the type of lying that gives lying a bad name — I call Nebraska “the most dishonest program ever” …and yet Ron gave them a Koop Award and steadfastly refused to rescind it (since the vendor was a sponsor of the award) even after they admitted lying following my expose of their lies. [Postscript: Ron has now completed the rewrite of the history of this program. Fortunately we took screenshots along the way, documenting each time he tampered with the original application.]


24:10

I quote Ron’s co-authored HERO guidebook — which of course, in a major gaffe (gaffe is defined as “accidentally telling the truth”) — admitted wellness loses money. If this debate were in a court of law, the case wouldn’t even get to the jury. It’s called estoppel. If you have said something on the record, you can’t turn around and say the opposite. So the debate is technically over, legally speaking.

His response (actually the moderator jumped in to defend him) was, that was just one data set. No, that data set was quite representative of the decline in events that takes place regardless of a program, and in any case, who deliberately plants an invalidating data set in their own propaganda? No, these people just didn’t notice that the costs on Page 15 exceeded the savings on Page 23. And they are the self-professed experts in measuring outcomes.

Costs ($1.50 PMPM):

HERO list of costs

Savings ($0.99 PMPM):

hero p 23 99 cents with red bar


25:00

I reference two proofs. First, the one that says wellness can’t work. Next, my proof that the official government database shows quite literally no impact of workplace wellness on cardiometabolic inpatient admissions this century.  Ron accepts this proof. He is caught. His own employer, Truven, holds the contract for managing this database. If he claims the data is flawed (it isn’t), he disses his own employer. So the debate is technically over, mathematically speaking.  He just admitted wellness has been completely ineffective. Game, set and match to me. However, wellness apologists don’t understand fifth-grade math (hence this site), so few people in the room understood that the debate had ended.


25:45

I reference the million-dollar reward that we’ve offered to anyone who can show that wellness has broken even.  Of course, Ron hasn’t claimed it.  I offered the reward because even people who don’t understand mathematical proofs understand that someone who backs his claims with $1-million must believe them. By declining to collect the $1-million (the reward has rules and is a legally binding contract), Ron is admitting he and his cronies are lying about the effectiveness of wellness.


26:14

I point out that RAND and the New York Times are both on my side.  The Times, I noted, “was laughing at you folks for how bad your analysis was.”  I continue with many more examples of both the left wing and right wing media skewering wellness. “You guys are running out of wings.” Ron attempts no rebuttal even though I had offered to let him interrupt me if I said something inaccurate. But there’s nothing inaccurate about my portrayal of the mainstream media’s position on workplace “pry, poke and prod” wellness. It’s all here. They hate it.

[Postscript: You can now add Slate, STATNews, and many others to list of publications which have skewered wellness, all linked from here.]


27:25

I point out the many instances in which Ron’s own cronies have gone rogue. Altarum, Debra Lerner, and Michael O’Donnell (three times) are all examples of Koop Committee members who deliberately or accidentally dissed wellness. And I reiterate that the HERO Report, that Ron co-authored, admits wellness loses money.  This report was signed by 60 wellness apologists. Basically the entire industry admitted failure, in the industry’s biggest-ever gaffe.  See our 8-part critique of that ill-fated venture.


Thus ended the two prepared opening statements. By the way, a shout-out for Fred Goldstein, the moderator. In reviewing this tape I had clocked Ron’s “5-minute” opening speech at 9 minutes, but I was allotted the same length.  The next installments will cover the rebuttals.

Why do employee wellness industry leaders hate employees so much?

I would like to express my gratitude to the editor of the American Journal of Health Promotion, Michael O’Donnell.  He recently decreed that “despite common lore, I am not an idiot.”  Coming from a man brilliant enough to singlehandedly create entire alternative universes of arithmetic and statistics, “not an idiot” is mighty praise indeed.

michael-odonnell-not-an-idiot-quote

I’m unsure exactly what “common lore” he is disputing, unless he means that the Phi Beta Kappa committee at Harvard also thinks I am an idiot, relatively speaking, because they snubbed me until I was a senior.

I will return the compliment.  Michael O’Donnell is not an idiot either.  Quite the contrary, he and his Koop Committee buddies knew exactly what they are doing when they gave their friends at Wellsteps awards for harming employees.  Bottom line is, these people simply hate employees, and happily throw them under the bus whenever it’s profitable to do so. While Boise is a great example, Penn State still reigns supreme.

While we could write a post about almost any member of that Committee, this post focuses only on one member, Mr. O’Donnell.  Still, it’s hard to dislike the man given all the kudos he throws my way. For instance, in addition to not being an idiot, I am also praised above as: “close to being accurate.” Since we disagree on everything, he is therefore acknowledging that he himself is many light-years from accurate — as Wellsteps and every other Koop award demonstrates.


Michael O’Donnell’s Anti-Employee Jihad

Michael O’Donnell also said, as you can see above, that I am not a “misanthrope.”  However, in this case, I can’t return the compliment.  His new editorial is a misanthropic anti-employee jihad.  First, he says prospective new hires should be subjected to an intrusive physical exam, and hired only if they are in good shape.  OK, not every single prospective new hire — only those applying for “blue collar jobs or jobs that require excessive walking, standing, or even sitting.”   Hence he would waive the physical exam requirement for mattress-tester, prostitute, or Koop Committee member, because those jobs require only excessive lying.

Second, he would fine people for not meeting “outcomes standards.” In an accompanying document, he defines those “outcomes standards.” He specifies fining people who have high BMIs, blood pressure, glucose, or cholesterol.

Finally, he wouldn’t hire smokers at all, because they are so unworthy and untalented. Meaning Humphrey Bogart never should have been cast in Casablanca.  Ernest Hemingway and George Orwell should have piled up rejection letters. Roger Maris should get his asterisk back.*  Rihanna, Simon Cowell, Adele, Brad Pitt, Obama, Churchill, Einstein. Sinatra, Twain, Kidman.  Sheesh!  I agree with you, Michael. What a bunch of losers.

And thank goodness Watson didn’t smoke or Moriarty would likely still be at large.

sherlock-holmes


A Unique Way to Charge Employees for Health Insurance: By the Pound

Almost every nonsmoker would be caught in his dragnet too, as he would “set the standard for BMI at the level where medical costs are lowest.”  Since people with very low BMIs incur higher costs than people with middling BMIs, Mr. O’Donnell would fine not only people who weigh more than his ideal, but also employees with anorexia.

If employees didn’t already have an eating disorder, what better way of giving them one — and hence extracting more penalties from them — than to levy fines based on their weight?  Hopefully, he would allow people with wasting diseases like cancer to appeal their fines.

Employees above his ideal weight would pay per pound, sort of like they were ordering lobster or mailing packages.

Yes, I have a hard time believing anyone would disdain employees that much too, so here is the screenshot:

odonnell-bmi

He claims that all these fines will “enhance morale” for employees, whether they like it or not.


How would Michael defend his anti-employee jihad?

The Wellness Ignorati don’t engage with me, for obvious reasons given their self-immolating comments when they do. So I’ll provide his rebuttal. It would be, as he said in the first screenshot above, that I am once again “creating controversy where it does not exist.”  Clearly, his editorial and white paper are mainstream, and I’m just causing trouble again for no reason.

Michael wonders why, in his own words (echoed by Ron Goetzel), 90% to 95% of wellness programs fail.  He says it’s because employers don’t spend remotely enough money on them. He recommends up to $300/employee/year…and what better way to reach that spending target than to make them go to the doctor, and set up expensive weigh-ins, inspections and fining procedures?

While Michael O’Donnell may not be an idiot, I’m not sure I could say the same about any CEO who takes his advice.



*Maris should get his asterisk back because, as a smoker, he still holds the record for “Most home runs by a player who never should have made the team.”

Hey, How Come Wellness Needs an ROI But Real Healthcare Doesn’t?

Now that the myth that there is any ROI in wellness is thoroughly both debunked and also even acknowledged by the wellness industry, vendors often fall back on the “argument” that nothing else in healthcare needs an ROI.  Why should workplace wellness be singled out?  The editor of the American Journal of Health Promotion, Michael O’Donnell, even asked: “Who cares about an ROI anyway?”

The answer to Michael’s question?  Everyone should care. And everyone should insist on an ROI from wellness, for three distinct reasons.  Each reason is sufficient on its own.  So even if there were a fallacy in two of the reasons (and there isn’t), the remaining reason would still be definitive.

First, consider an employee with appendicitis. You don’t calculate an ROI. You call an ambulance. But suppose a vendor says to you: “If an employee’s appendix bursts, the cost could be $100,000.  So we propose taking out everyone’s appendix preventively.”

You’d ask:  “What’s the rate of burst appendixes and how much do appendectomies cost?”  While that’s an extreme example (and we didn’t mean to give these people any ideas), this is basically the calculation you should make when vendors propose screens. Here’s how to do the calculation. You’ll be shocked at how much it costs to avoid even one event by screening everyone.

Second, wellness is the only thing in healthcare that employees are forced to do, subject to a financial forfeiture of penalties or lost incentives.  Other activities which people are penalized for not doing include: wearing helmets/life jackets/seat belts and getting kids vaccinated.  In each case, the clinical evidence/science overwhelms considerations of personal choice.  (Even then, in some states personal choice still rules.)

By contrast, the only thing that’s overwhelming about wellness evidence/science is how overwhelmingly the evidence eviscerates wellness, which of course is what this site is all about.  Unfortunately, wellness vendors don’t understand evidence — or for that matter healthcare itself. Many vendors have no knowledge of basics like clinical guidelines, or even arithmetic.  One wonders how they can do their jobs as wellness vendors without understanding healthcare. And that brings us to the third reason that wellness (unlike healthcare) needs an ROI, which is…

Wellness isn’t healthcare.  Quite literally every other provider of physical healthcare–from heart surgeons to  acupuncturists–needs to train, pass a test, get a license, take continuing education, and be subject to review by an oversight board.  Not wellness vendors.  You can become a wellness vendor for $67,000. “Up to” eight days of classroom and on-the-job-training are also included in that $67,000.  (To put that in perspective, Four Seasons housekeepers get ten days of training.) The vendor that offers these franchises, Star Wellness, brags about how no healthcare background is needed to be a wellness vendor. A background in “sales or municipal administration” is perfectly sufficient.

So if you’re wondering why wellness vendors know so little about wellness, there’s your answer:  they aren’t required to know anything about wellness. Knowing just a little exceeds the minimum requirement.

Quizzify Q in B and W

Quizzify does have an ROI…and it’s guaranteed.

To conclude, here is our advice to workplace wellness vendors trying to justify what popular healthcare blogger Paul Levy calls the “wellness tax“: shut up and just be happy you still get to collect it, and that the authorities haven’t shut you down. (A doctor doing all this overscreening and billing for it would have been shut down.)

Don’t try to justify your hyperdiagnostic jihad on the basis of ROI or any other purpose other than enriching your bank accounts. Every time you try, you provide yet another reason why whatever college gave you a degree in anything other than advanced idiocy should lose its accreditation.

American Journal of Health Promotion Admits Massive Wellness Losses

RAND’s Soeren Mattke said it best:

The industry went in with promises of 3-to-1 and 6-to-1 ROIs based on health care savings alone.  Then research came out that said that’s not true.  They said, “Fine, we are cost-neutral.” Now research says:  “Maybe not even cost-neutral.”  So they say:  “It’s really about productivity, which we can’t really measure, but it’s an enormous return.”

In other words, whenever you invalidate one metric, they come up with another one. We then have to shoot that one down, and the cycle repeats.  It’s invalidity-meets-Whack-A-Mole.  After the healthcare spending ROI fiction imploded, Michael O’Donnell, editor of the wellness industry trade journal, asked dismissively: “Who cares about ROI anyway?”

Since ROI wasn’t working, they then tried value-on-investment (VOI), which turned out to show even greater losses than a straight ROI calculation.

Continuing that tradition, Michael O’Donnell of the American Journal of Health Promotion presents: Return on Allocated Resources, or ROAR.  ROAR counts everything, including productivity. By counting everything, ROAR shows far greater losses than VOI.

Michael says that a 1% increase in productivity is worth $1933:

ajhp productivity 1

However, a much greater 3.75% (90 minutes of a 40-hour workweek) reduction in productivity only costs $2184:

ajhp productivity 2

How did he accomplish this sleight-of-hand, where a 1% increase in productivity practically offsets a 3.75% decrease?  Simple: by putting both thumbs and every other appendage on the scale. He accounts for lost work time at an employee’s hourly rate. So far so good. However, he then applies a magic multiplier to the hourly rate to calculate increases in productivity based on hypothetically enhanced corporate revenues due to the productivity increase.  So if payroll is 30% of revenues, and productivity climbs 1%, then revenues would also automatically climb 1%. That means in dollar terms revenues climb more than three times faster than productivity.

Had he used the same revenue multiplier for the certain 3.75% productivity decrease due to wellness-induced lost work time that he used for his speculative 1% productivity increase, his time-off-for-wellness scheme would cost a whopping $7143/employee/year.

And wellness vendors wonder why line managers are so reluctant to allow employees to work out on company time.

So while per-employee losses from wellness based purely on added healthcare spending and program expense are “only” in the three figures, the net reduction in productivity from a (speculative) 1% increase less a (certain) 3.75% decrease due to lost work time amount to a mind-boggling $5210/year.

And that is probably an understatement.  The 3.75% lost work time due to wellness doesn’t include the time employees spend changing clothes after their workouts, lying on HRAs, standing in line to be screened and “coached,” complaining to HR that they haven’t received their incentive checks yet, and hanging out at the water cooler dissing the program.

If you’re keeping score at home, this is the third time Michael O’Donnell has strayed off message.  Just like some people are convinced that Donald Trump is a closet Democrat trying to torpedo the GOP, you would be excused for thinking that Michael O’Donnell is a member of our Welligentsia group, trying to sow chaos amongst the Wellness Ignorati.

He isn’t, but nonetheless I count him among our greatest assets.  First, he admitted that up to 95% of wellness programs don’t work.  Then he admitted that studies done using randomized control trials lose money.  And now this one, detailing — using his own math — by far the greatest losses that a wellness metric has ever shown.

Quizzify Q in B and W

Quizzify’s guarantee numbers add up (source: Intel-GE Validation Institute)

Ron Goetzel is probably tearing his hair out over his crony’s unforced errors on the eve of our debate.  Or, in the immortal words of the great philosopher Warren G. Harding: “I can handle my enemies.  It’s my friends who have me pacing the floor at night.”

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