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Is your wellness vendor snookering you? Take this quiz to find out.
Is your wellness vendor snookering you? There are certain facts that vendors are not exactly forthcoming about. This is because facts represent an existential threat to the “pry, poke and prod” industry. See how many facts you know — and how many they’ve suppressed — by taking this quiz.
You’ll earn more points, the closer you are. You don’t have to be exact — and honestly I’d worry about you if you got the exact answers to every question. I’d love you for it, but I’d still worry about you.
- Wellness vendors claim they can save significant money by reducing hospital admissions for diabetes and heart attacks, because those admissions are very common. How many admissions per 1000 covered lives does the average employer incur in a typical year?
The Health Enhancement Research Organization claims a certain savings figure for wellness PEPM. But that’s before taking into account vendor fees, extra doctor visits, tests, and prescriptions, compliance issues, employee time needed, overhead and basically anything else. In other words, what is the PEPM savings figure that at Bain & Company we used to refer to as “profit before cost”? Answer to the nearest one dollar. Hint: the answer is somewhere in this quiz.
To eventually save money someday, you first need to improve/reduce the risk profile of your population. According to eternal optimist and wellness promoter-in-chief Ron Goetzel, what is the maximum percent improvement in a risk profile that a company can expect after 2 to 3 years of wellness programming @$150 PEPY?
Speaking of Ron Goetzel, he said “thousands of wellness programs” fail to get good outcomes. What round number did he claim have succeeded?
And speaking of Ron Goetzel again, he finally admitted it was “hard” to force employees to change behavior. How many “very’s” did he put in front of the word “hard” in that admission?
The Wishful Thinking Factor, totally coincidentally abbreviated as WTF, is defined as: Total claimed cost reduction/total number of risk factors reduced. What is the average WTF for the last six Koop Award-winning programs, on average? (Hint: the real ratio of savings to risk reduction is about 0.05x, since even if savings does not lag risk reduction, a maximum of 5% of spending is wellness-sensitive.)
Speaking of risk reduction, employees in the most recent Koop Award-winning program, Wellsteps/Boise, originally tallied 5293 risk factors. Approximately how many risk factors did those same employees tally after participating, excluding dropouts?
In a participants-vs-non-participants study design, what percent of the perceived savings is due to the invalidity introduced by the study design itself in which unmotivated employees are used as the control for motivated employees, rather than health improvements attributable to the actual program itself, according to all four studies conducted on this topic, including three by wellness promoters?
If you use Interactive Health as a vendor hyperdiagnosing the stuffing out of your workforce, what is the annual percentage of employees that will likely be told they have “newly discovered conditions” that “require” a doctor’s intervention?
Of 1000+ wellness vendors, how many are validated by the Validation Institute?
- 2. Yes, only 2. All this wellness fuss is about 2 admissions per 1000 employees. Derivation: the roughly 150,000,000 employees and dependents covered by commercial insurance (mostly from employers) generate roughly 150,000 heart attacks and 120,000 diabetes events. See the HCUP database and enter “410” for heart attacks and 250 for diabetes admissions for the ICD9 for the most recent full year (2014). Scoring: Give yourself 1 point for guessing 4 to 10 and 2 points for guessing fewer than 4.
- One dollar. $0.99 PEPY. As is well-known, they tried to walk this figure back once they realized they had told the truth. Scoring: Give yourself 1 points for guessing $1.00, since the answer in the hint was on that very same line.
- 2%. That’s a few dollars PEPY in savings. (Looks like the HERO report was pretty close, its own protestations notwithstanding.) And you paid $450/employee over 3 years to achieve it. Actually it was 1% to 2%, but we asked for the maximum. Scoring: Give yourself 2 points for 2% or less, 1 point for 4% or less.
- Only 100. Besides Johnson & Johnson, Mr. Goetzel has never disclosed any of the other 99 without others making the observation that they self-invalidate according to their own data. Scoring: 2 points for 200 or fewer, 1 point for 400 or fewer.
- 4. In The Healthy Workplace Nudge, Rex Miller gets Ron Goetzel to admit that “changing behavior is very very very very hard.” Gosh, Ron, do you suppose this might explain why an employer population’s risk factors never noticeably decline? Scoring: 2 points for 4, 1 point for 3 or 5.
- Infinity. That’s because of the next question. The 21% risk factor increase for Wellsteps more than offset the trivial risk reductions achieved by the previous years’ winners. The actual WTFs for the previous years will be the subject of a future posting. Scoring: give yourself a point if you guessed that the WTF was 5 or higher. That would be 100 times the actual figure and still way below the wellness fantasy-league figure.
- 6397. Risk factors rose 21%. And yet somehow, even though the risk profile was deteriorating sharply, the risk profile of the population was also improving enough for Wellsteps to claim that healthcare costs declined 30%. 30% is enough to wipe out wellness-sensitive medical events for the entire Boise teacher population and about 30,000 of their closest friends. (Wellsteps originally admitted that costs increased, but took that slide down when it occurred to them that telling the truth would be inconsistent with their marketing strategy.) Scoring: 1 points for 5500 to 6000 or 6600 to 7000, 2 points for 6001 to 6599.
- 100%. It turns out that the participant-vs-non-participant study design is responsible for all the perceived savings that wellness vendors claim for programs. The New York Times just explained how, in the landmark University of Illinois study, both the “gold standard” RCT methodology and the invalid par-vs-non-par methodology were used and had completely different results. This also happened three other times (summarized here) — with Newtopia, Health Fitness Corporation, and a study done by the chairperson of the Koop Committee showing how feeding diabetics more carbs would reduce their costs by improving their health. Literally, 4 studies — all of which were run by people trying to show savings — showed exactly the same thing. Scoring: all or nothing — 1 points for 100%.
- 45%. This is because running 40 inappropriate tests on every employee makes it inevitable that at least 1 or 2 of those tests reveal a false positive. Scoring: Give yourself 2 points for guessing between 40% and 50%, 1 point for 30% to 39% or 51% to 60%.
- Four. All four are honest and make modest claims they can defend or valid contractual representations. AND, they actually screen according to guidelines! (In the wellness industry, doing something appropriate merits an exclamation point.) They are: It Starts With Me, Splashlight, Sustainable Health Index, and US Preventive Medicine. That’s <1% of all wellness vendors. Scoring: give yourself 1 points for 8 or fewer.
0-2 points. Has your wellness vendor sold you a bridge too?
3-5 points: Your wellness vendor is blocking your internet connection
6-9 points: Nice work!
>9 points: Send your fifth-grade math teacher a thank-you note for doing a better job than the wellness vendors’ teachers did.
More Media Coverage Slamming New Genetic-Screening Wellness Bill
This afternoon STATNews followed up with more criticism of HR 1313, the Preserving Employee Wellness Programs Act. As measured by comments to their previous article and the Washington Post’s article, public opinion is running about 999-to-1 against it. That’s a lot even for wellness.
Ryan Picarella, of WELCOA, jumped on this and got way ahead of HERO, which is not opposing it. They can’t. Aetna is a major dues-paying supporter, and Aetna loves genetically screening employees for defects. Naturally they fabricate their outcomes. This time we mean it literally when we say: “Lying is part of wellness vendor DNA.” Aetna even invested in a company to further their dystopian vision, a company ironically named Newtopia.
By contrast, this is the kind of leadership we’ve come to expect from WELCOA, filling the ethical vacuum created by HERO.
But, more importantly, this article is the first media mention of Ethical Wellness, our new website dedicated to putting the wellness back in wellness. You might recall the original Workplace Wellness Code of Conduct. Ethical Wellness has updated it. You can sign on to the website, join and endorse, all at no cost. You can also contribute, separately, and be highlighted as a contributor. Scott Life and Dan Keith have both pitched in $500, as compared by to my $10 (to test the donating mechanism — that’s my story and I’m sticking to it). I’ll be putting in the other $490 shortly. Really. There is also a linkedin group. No mass postings — a true discussion group.
We’ll be talking more about Ethical Wellness in the coming days. for now, it’s about not fining employees for refusing to have their children genetically screened for defects.
Announcing the Wellness Industry 2016 Deplorables Awards
For this year’s Deplorables Awards, I think we’re gonna need a bigger basket. As a result, this will be a two-part series.
Why? Because we need to accommodate all the bad hombres and nasty women who have subverted the perfect elegant philosophy of wellness into nothing more than a profit machine, with no regard for integrity, customers, or employees.
Yes, 2016 was a year in which a record number self-anointed industry leaders gave lying and cheating a bad name. In that sense it was no different from any other year, though 2016 offered even more good news and bad news:
- The bad news: not content with merely lying and cheating, this cabal branched out into harming employees, fat-shaming, and pure misanthropy;
- The good news: wellness did succeed in one way, as a “natural experiment” showing what happens in healthcare if being a provider requires no credentials beyond a GED, a driver’s license, and a pulse.
Indeed, whatever mathematician first postulated that everyone can’t be worse than average had apparently never experienced the wellness industry. (Exceptions of course, being the few that, like Quizzify, are validated by the Validation Institute or have accepted the Employee Health Program Code of Conduct.)
#10 Optum and Wellsteps (Runners-Up);
What do you do when you need to defend your blatant disregard of the US Preventive Services Task Force guidelines? Simple — you blame your customers. Optum’s Seth Serxner said: “Customers make us” do this. Optum’s PR hack said I was making Optum “look bad.”
I said: “Sure, I’ll apologize. Just name one account that will admit to insisting on paying a higher price than you wanted to charge, in order to screen the stuffing out of their employees.” Never heard from them again.
Wellsteps got caught by ace reporter Sharon Begley of STATNews, and their CEO was forced to admit Wellsteps was violating USPSTF guidelines.
#9 The Johnson & Johnson Fat Tax gives misanthropy a bad name. (Honorable mentions to Vitality and Ron Goetzel.)
Misanthropy, greed, and weight-shaming provided the wellness industry with its key “talking points” in 2016. And nothing combined the three like the Johnson & Johnson Fat Tax fiasco. The point of the (apparently stillborn) Fat Tax was to stigmatize overweight employees, by “pressuring” (their word) companies into disclosing to shareholders how many fat employees they had. That in turn would somehow pressure these employers into spending more money on wellness vendors.
It’s not altogether clear what that disclosure would do for the actual overweight/obese employees, but somehow this disclosure was supposed to allegedly benefit shareholders. Indeed, the Fat Tax cabal is right about that in one respect: this disclosure would benefit shareholders — it would indicate to shareholders that they ought to unload their shares in a hurry, because management just disclosed it is stupid.
Vitality was a co-conspirator in hatching this scheme, which is ironic because they admitted they couldn’t even get their own employees to lose weight. And where you hear the word “stupid,” can the name “Goetzel” be far behind? This whole thing was his idea, based on the notion that “playing doctor” with employees makes stock prices increase. However, his claim that companies with Koop Award-winning wellness programs outperformed the market can easily be invalidated by anyone with a calculator and a triple-digit IQ.
#8 IBISWorld: How is wellness different from King Midas and Gold?
Here are links to the postings on the most hilarious report we’ve ever read about the wellness industry:
- New wellness industry report costs $5400 (but that includes shipping)
- New report raises the bar for cluelessness in wellness
- How is wellness different from King Midas and gold?
The answer to the question in the header? Everyone who touches wellness turns to stupid. Not just garden-variety stupid. More like fifty shades of stupid.
Mind you, most wellness industry leaders don’t need to touch anything first before reaching that endpoint, but occasionally a company like IBIS, with no prior experience in wellness, ventures into this field — and that’s where the fun starts. These IBISWorld Young Turks (literally–the writer is named “Turk”) are so excited about this industry, they practically speak in tongues:
Wellness firms may offer employers stress management courses and sessions that offer music therapy, aromatherapy, Tai Chi, and post disaster stress reduction through coaching.
Government-funded initiatives that promote wellness to cut costs related to chronic ailments (e.g., obesity and diabetes) has further exacerbated many businesses movement toward purchasing corporate wellness services.
And my own personal favorite:
The industry provides wellness programs to businesses across the United States, including small, medium and large businesses in the private sector and businesses in the public sector.
“Businesses in the public sector”? I knew that many of our legislators are for sale but I didn’t realize they had incorporated.
#7 Healthfairs USA Raises the Bar for Misbehavior
Healthfairs USA doubled down in 2016 on lying and cheating with an elegant new strategy: insurance fraud. They not only harm employees, but bill insurance companies directly for the privilege of paying for those harms. They offer cancer tests that are “99% accurate” (hence their multiple Nobel Prizes), and over-the-counter nutritional supplements…all of which are covered by most insurance companies because they get a doctor to sign a claim form.
Disclosure: we aren’t entirely sure that billing insurance companies for USPSTF D-rated screens and worthless, possibly harmful, pills constitutes insurance fraud. Our opinion is probably no more accurate than their cancer tests.
#6 Aetna’s DNA wellness program combines junk science, junk math, and junk integrity
In 2014, Aetna decided to “play doctor” with obese members of self-insured customers by telemarketing their employees to pitch very controversial high-priced drugs whose sales are “flailing” because almost no patients seem to want to take them. Among other things, Aetna said these drugs increase productivity even though right on the label, the drugs warn that they could reduce productivity (attention span and language facility).
Not content with the warm welcome that scheme brought them, in 2015 they introduced a DNA-based wellness program and claimed a whopping $1464/participant in savings. What put the whop in that whopper were these two tidbits. These savings were achieved:
- in the first year alone;
- on participants who were not actually sick to begin with. (You couldn’t qualify for this study if you were already sick.)
The reason Aetna needed to fabricate such a high savings figure is that the wellness field requires ROIs greater than 2-to-1, and this DNA test sells for $500/employee. So you need to show savings between $1000 and $1500.
Also, in 2015, we were able to show the program was completely ineffective, a convincing enough demonstration that one of the board members of the journal that published the study with the $1464 claim publicly apologized.
What do you do when it turns out your science is all wrong (news flash: being told you have a gene for obesity doesn’t motivate you to lose weight) and your math is all wrong? Of course, you apologize and retract the study, and offer to return the money to the lucky few companies that signed up for your program.
Haha, good one, Al. Obviously, like all the other Deplorable Award-winners on this list, you sell your snake oil harder than ever, and that’s what gets them on the 2016 list. Whereas in 2015, they could use the dumb-and-dumber defense, this year they know the numbers don’t add up and yet they are still flogging it.
Don’t miss the slam-bang conclusion as we count down to #1. Will Ron Goetzel retain his crown, or will he be unseated as the wellness industry’s #1 Deplorable?
Yes, we realize he has already appeared on this list at #9, but many lists feature the same entities making multiple entries. For instance, the Beatles once held positions #1 through #5 in Billboard’s Top 40, so it can be done.
Not that I want to put any ideas in his head.
Aetna’s Employee DNA Collection Obsession Combines Junk Science, Junk Arithmetic, and Junk Integrity
It seems like most of my columns should or do start with a line like: “Just when you thought it couldn’t get any worse…”
Well, this time it really can’t get any worse. Aetna’s obsession with collecting employee DNA has truly reached the pinnacle of junk science, junk arithmetic, and junk integrity. (Not to mention junk privacy, as our guest-posting privacy expert noted.)
Junk Science and Junk Arithmetic
By way of background, we have already chronicled not just the junk science of using employee DNA to predict and prevent diabetes, but also the inability of their partner organization, Newtopia, to understand fifth-grade math. Nonetheless Newtopia wants us to trust their understanding of PhD-level science — and also trust them to store our DNA. (Like many vendors who were absent the day the teach taught arithmetic, they took their fuzzy math off their website following our instructional posting. We never received a thank-you note for this free consult, in case you were wondering.)
That same posting covered their reference site-from-hell, in which only a small fraction of employees participated, and the customer complained about the price tag, which is the wellness industry’s highest, @$500 per employee.
That price tag means claiming an ROI at the industry standard level of 3-to-1 requires fabricating far greater savings than wellness vendors usually fabricate. For instance, Ron Goetzel says programs should cost $150 and save $450. (Note: in all fairness he doesn’t say that any more. After our initial exposes, he retreated to a 1-to-1 ROI, as he admitted during our debate. Most recently he’s even backed off that. Now he says most programs fail.)
But showing that industry-standard ROI on a $500 program requires concocting savings approaching $1500/employee in the first year alone, an industry record. And did we mention that ROI was achieved on employees who were specifically selected for having nothing wrong with them to begin with, other than the possibility of getting metabolic syndrome at some point later in their lives? (Or as we originally wrote, these employees were “at risk for being at risk”.)
Oh, yes, and there was no clinically or statistically significant improvement in the set of health indicators that Aetna measured? And that Aetna was a co-author of the HERO study showing wellness loses money?
We said all this — posted it right on The Health Care Blog. Then the most amazing thing happened. One of the members of the editorial advisory board of the Journal of Occupational and Environmental Medicine (JOEM) –a trade journal with a long and glorious history of publishing suspect claims about the wondrous world of workplace wellness — essentially apologized in the comments. Specifically, he agreed the study never should have gotten past peer review. This wasn’t just any member of their board. This was the only member, Nortin Hadler, who has an actual national reputation in population health, having written many successful, influential and well-reviewed books on screening, overtreatment, and the harms of pushing people into the medical system.
So far, all we have noted is that Aetna has combined junk science with junk math. Next is where the junk integrity comes in. Just to set the stage by recapping the points above:
- Aetna must have already known their outcomes are made up because no one in population health –and very few people not in population health — could possibly think you could save $1400/person on healthy people in 12 months without doing anything other than assigning an “inspirator” to tell them to eat more broccoli, DNA or no DNA;
- They did already know wellness loses money because they co-authored the HERO report saying wellness loses money;
- If they genuinely had no idea their outcomes were made up, they would have learned that when they read my proof — a mathematical proof, not open to dispute like a scientific proof;
- And if they still doubted it, they could have read the comment by Nortin Hadler.
What does a wellness vendor do in these situations? Simple. It recalls the words of the French General Ferdinand Foch: “My left is collapsing. My right is in retreat. I shall attack.”
Their PR department called Bloomberg, had them assign a reporter completely new to the wellness beat, and then wheedled a complete puff piece out of her, crossing their fingers that the reporter wouldn’t google this thing, which would have created a front-page story.
In the Bloomberg paean, Aetna’s thesis is that best way to motivate people to lose weight is to tell them their genes make it very difficult to lose weight. If that logic doesn’t resonate with you, you have company. Here is a quote from that article — one single quote — that basically invalidates the entire remainder of the story, puff piece or not:
George Annas, a bioethics professor at Boston University, cautions against reading too much into DNA tests. “The chance that they have a genetic test that can determine if you’re prone to be fatter than other people is very, very unlikely,” he said. “What [Newtopia] really seems to be saying is that if you tell people that you have a genetic condition that may predispose you to be overweight, that may motivate people.” For some, he said, DNA testing could have the opposite effect: If someone is predisposed to gaining weight, then why bother dieting or exercising?
Speaking of things which have almost no chance of happening, here are two more. First, we’ve asked JOEM for a formal retraction, given that the study was admitted by Dr. Hadler (who hadn’t seen it pre-publication) to be blatantly wrong. Second, Aetna isn’t likely to apologize either, any more than they did for their last foray into wellness, which involved pitching some of the most controversial drugs on the marketplace to patients who weren’t even sick and didn’t ask for them. Instead, they will probably double down on DNA.
The behavior of both JOEM and Aetna can be explained with an old Chinese proverb: “When you are riding a tiger, the hardest thing is getting off.”
Forbes’ Shaywitz Takes On Aetna’s DNA Collection Program
Whoever concluded that more is learned from one bridge that falls down than 100 that stay up did not included Aetna’s data in their calculations: 2 major bridge collapses, nothing learned.
Aetna first gained notoriety in these pages — and in our book, Surviving Workplace Wellness, and on The Health Care Blog — for being the first health plan to pitch expensive name-brand drugs to its members. Not just any members, but members who weren’t sick — and that someone else was insuring, since there wouldn’t be any savings.
And not members who requested them, but members who Aetna pitched them to, members who mostly didn’t want them. And not just any drugs, but drugs that were/are so controversial that they became the subject of an essay in the Journal of the American Medical Association concluding they never should have been approved. (As a sidebar, while all of wellness is claimed, mostly falsely, to increase productivity, one of these drugs says right on its label that it reduces productivity, specifically impacting memory, attention and language. And yet Aetna insisted productivity would increase. Using a drug that reduces productivity to increase productivity truly puts the “off” in “off-label” use.)
So what did they learn from a failed wellness program that was expensive, intrusive, ineffective, and incredibly unpopular using a third-party that doesn’t seem to know what it’s doing? Their takeaway was: “Let’s come up with a program that’s even more expensive, intrusive, ineffective, and incredibly unpopular using another third-party that doesn’t seem to know what it’s doing…and, for added measure, let’s lie about the outcomes.”
And thus they hatched their scheme to bring DNA surveillance into the workplace. Not to identify possibly useful mutations, but to estimate the risk of diabetes and heart attacks. And not: “We’ll cover this testing if you go to the doctor and together decide whether to order it.” Rather: “You’ll forfeit money if you don’t agree to this, and our partner gets to keep your DNA and re-sell it.”
We’ve already covered the intrusiveness, and fact that their partner, Newtopia, seems unable to understand basic arithmetic and science. We’ve also covered their reference-site-from-hell, which didn’t exactly embrace this program.
Most recently, we’ve covered the lying-about-outcomes angle. Because the program is going to sell for up to $700, Aetna had no choice but lying– they needed to “show” $1400 in savings to achieve a 2-to-1 ROI. Scroll down to the comments — the most respected member of the editorial board of the journal that published their outcomes now says they never should have published the study. (He himself hadn’t reviewed it.)
But all of our exposes are trumped by David Shaywitz. Writing in Forbes, he points out that the entire idea of using genetics to predict and manage obesity-related illness is, to use a technical genomics term, stupid.
We’d urge reading the whole posting (though he doesn’t get into Aetna/Newtopia until page 2), but here are the takeaways:
(1) “The three variants examined by Aetna/Newtopia explain a very very small fraction of genetic risk;”
(2) “Even if you carry the harmful genes, there is no obvious course of action” different from standard diet-and-exercise.
Shaywitz — who may have done more research before writing this column than Aetna did before starting this program — also clearly distinguishes this type of genetic information from identifying (for example) the BCRA1 mutation, which might actually be useful. “Useful” is not a term found often in wellness programs so you won’t be surprised to hear that Aetna doesn’t include BCRA1 mutations in theirs.
What are the takeaways?
First, Aetna’s wellness programs need some adult supervision. Programs like these should never be allowed out the door. Of course, not offering wellness is not an option. It is way too profitable, and if they don’t, someone else will. However, there are plenty of other ways to rip off employers and humiliate employees that are less expensive and less intrusive than the two Aetna has come up with.
Second, Quizzify is making a bet that — especially because Aetna is not hiring any of them — there are a lot of smart people still out there, people who would prefer to pay a low price for an employee health program that is non-intrusive, fun, guaranteed to save money, Intel-GE Validation Institute-validated, and carries a Harvard Medical School imprimatur than pay a high price for programs that don’t work and employees don’t like.
Yes, we know it’s not always about us, but we appreciate Aetna’s efforts to make us look good by comparison.
Aetna Accidentally Invalidates the Wellness Industry’s “Savings” Model
If engineers learn more from one bridge that falls down than from 100 that stay up, this new Aetna-Newtopia study is the Tacoma Narrows of wellness industry study design. No article anywhere — including our most recent in Harvard Business Review — has more effectively eviscerated the fiction that wellness saves money than Aetna just did in a self-financed self-immolation published in the Journal of Occupational and Environmental Medicine. Hopefully the people who give out Koop Awards to their customers and clients will read this article, and finally learn that massive reductions in the cost of participants associated with trivial improvements in risk are due to self-selection by participants, not wellness programs. And certainly not wellness programs centered around DNA collection.
Aetna studied Aetna employees who, by Aetna’s own admission, didn’t have anything wrong with them, other than being at risk for developing metabolic syndrome, defined as “a cluster of conditions that increase your risk for heart attack, stroke and diabetes.”
In other words, taking the wellness industry’s obsession with hyperdiagnosis to its extreme, the subjects’ “diagnosis” was being at risk for being at risk. Not only did they not have diabetes or heart disease, but they didn’t even have a syndrome that put them at risk for developing diabetes or heart disease. You and I should be so healthy.
As this table shows, after one year, the changes in health indicators between the control and study groups were trivial (like a difference in waist measurement under 3/10 of an inch), and only triglycerides was barely statistically significant (p=0.05). Additionally, the control group actually outperformed the study group in 3 of the 6 measured variables, as would be predicted by random chance. Bottom line: nothing happened.
And yet, Aetna reported savings of $1464/participant in the first year. This savings figure is more than 20 times higher than what Aetna’s co-authored HERO Report says gets spent in total on wellness-sensitive medical events. It’s also far higher than Katherine Baicker’s thoroughly discredited 3.27-to-1 ROI, that she has basically retracted, published six years ago–that, yes, in keeping with wellness industry tradition, their article cited. (Only now, because the study is now six years old, Aetna feels compelled to insist that it is “recent.”)
How did they achieve such a high savings figure in a legitimate RCT? Simple. That savings was not the result of the legitimate RCT. Having gone through the trouble of setting up an RCT, they then proceeded to largely ignore that study design, since as their own table above shows, nothing happened.
Spending was a bit lower for the invited group, but obviously there couldn’t have been attribution to the program. A responsible and unbiased researcher might have said: “While there is a slight positive variance between the spending on the control group and the spending on the invitee group that wouldn’t begin to cover the cost of our DNA testing, we can’t attribute that variance to this program anyway. The subjects were healthy to begin with, there was no change in clinical indicators, and we didn’t measure wellness-sensitive medical events even though we know from our own HERO report both that those represent only a tiny fraction of total spending, and that those are the only thing that a wellness program can influence.”
Instead, they coaxed about 14% of the invitees to give up their DNA, and measured savings on them. More than coincidentally, that decidedly uninspiring 14% participation rate was about the same as the Aetna-Newtopia debacle at their Jackson Labs reference site-from-hell. Basically, employees don’t want their DNA collected, and DNA turns out to be quite controversial as a tool to predict heart disease down the road, let alone during the next 12 months. Further, Newtopia admits they store employee DNA, lots of people have access to it, and they could lose it.
The DNA also seems to have had precious little to do with the actual wellness program itself–and for good reason given the links above. This seems like a classic wellness intervention of exactly the type that has never been shown to work, with the DNA being only an entertaining sidebar. The subjects themselves exhibited no interest in hearing about their DNA-based predictions.
This is the first time a study has compared the result of an RCT to the result of a participants-only subset of the same population. The result: a mathematically and clinically impossible savings figure on the subset of active participants, and an admission of no separation in actual health status between the control and invitee groups by the end of the program period.
So Aetna — in this one article — accidentally proved what we’ve been saying for years about the fundamental bias in wellness study design that creates the illusion of savings:
Participants will always massively outperform non-participants, period — even when the program doesn’t change health status or even when there was no program for the “participants” to participate in.
Newtopia Wants Your DNA
We often say on this site that “lying is part of wellness vendor DNA.” However, we didn’t mean that literally–until Newtopia came along. You see, Newtopia, like most vendors, lies — but they also actually collect employee DNA.
In all fairness to Newtopia, many of what could be termed “lies” could charitably be characterized as “very misleading but technically accurate statements,” So ironically it would be us who would be lying if we said these were all lies. Hence we will call them “gaffes,” a category which includes lies but also includes situations in which the truth shocks the conscience as much or more than a lie would.
Gaffe #1: Engagement:
To Newtopia’s credit (not unlike HERO, which did the same thing in its report), they put the invalidating information about their engagement right on their website. This again proves our mantra from Surviving Workplace Wellness that: “In wellness, you don’t have the challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
Specifically, for some reason Newtopia provided a link to an Associated Press story, which they called a “profile,” but obviously we wouldn’t be linking to a puff piece “profiling” them. They Said What? only links to real reporting, which is invariably unflattering to wellness vendors and which would never be considered “profiles.” Puff piece or real reporting? You make the call — We can’t both be right.
Among other things (and there are plenty of other things, which we will get to) the AP reported that of 130 employees of the profiled customer organization, Jackson Laboratory, invited into the program, only 15% remain one year later,
However, the website itself proclaims:
Maybe “unheard of engagement” technically isn’t a lie. Maybe they meant: “unheard of” in that an engagement rate as low as 15% would be unheard-of. We doubt that because elsewhere they cite their use of “engagement science,” whatever that is. (Funny thing, Quizzify, the only company to literally financially guarantee increased engagement, doesn’t use “engagement science.” Instead Quizzify simply offers employees a tool they will want to use.)
Gaffe #2: Success
On its website, Newtopia’s case study for this customer, Jackson Labs, states:
However, the AP’s Tom Murphy borrowed a trick from Reuters’ Sharon Begley—and actually did reporting. They asked Jackson Labs itself for some statistics. They learned that of the 28 employees who submitted to Newtopia, only 19 remain. So even if every single one of those 19 lost weight, only 68% — not 92% — would report weight loss. (Newtopia might respond that their website’s 92% statistic was after six months whereas the 68% was after a year, thus begging the question of why they decided not to update the statistic on their website. It’s also a window on the truism that the longer the measurement period, the more people regain the weight.)
Whether 68% or 92%, Newtopia credits its results to “science.” Indeed their website loudly proclaims:
Gaffe #3: Made-Up Facts
One of the darnedest things about science is, it is a fact-based discipline. You can’t “drive” your own facts. For instance, their website proclaims:
Productivity is defined as “output per man-hour.” Therefore in a company that is “3x more productive,” each employee gets 3x more work done.
If Newtopia’s statement is accurate, and if Walmart promoted health, their cashiers could ring up 3x more customers. Doctors could see 3x more patients. Pilots could fly planes three times faster. Teachers could teach three times more classes. The recorded messages on hold would tell us that customer service thinks our calls are three times more important to them…
Another made-up fact:
Quite the opposite of “failing to control the incidence,” current approaches have in fact dramatically reduced the rate of heart attacks and strokes. Don’t take our word for it. Here are the federal government’s statistics for heart attacks:
During most recent available period, in which the population over 50 grew close to 20%, the number of heart attacks fell 19%. Not bad for “failing to control the incidence.” The wellness industry, of course, had nothing to do with that decline, which encompassed all age categories and payers.
Strokes also declined quite a bit. Curiously, strokes increased significantly in the age categories in which wellness programs were supposed to prevent them, paralleling the dramatic growth of the wellness industry from 2001 to 2012. They declined dramatically in the >65 population, which doesn’t have access to workplace wellness and which grew close to 20% over this period. So it looks like the only industry that “failed to control the incidence” was: the wellness industry.
Gaffe #4: Unsupported Statements
Another thing about science? Credible scientists don’t make statements that aren’t “driven” by evidence. Note this statement:
Besides being uncited and disputed by its largest customer (Aetna, which “collaborated” on the HERO report admitting wellness loses money), note the wording. It makes it sound like the more you spend on wellness, the more your costs fall. The implication is that spending an extra $500 on Newtopia’s genetic testing (over and above the cost of a regular wellness program) will then save even more.
If only this were a lie!
Newtopia also admits they could make a mistake with it. OK, they don’t exactly admit it. They imply it. They say your DNA could be used in “error management,” and by definition there is no need for error management unless you make errors. And with the full list of people who have access to it — eight categories of occupation including “naturopathic doctors” plus unspecified “other persons” — errors are inevitable.
People sometimes complain that all we do is criticize wellness vendors. Newtopia is Exhibit A in why that’s often not such a bad idea. Even Newtopia doesn’t seem to mind–we gave them the opportunity to fact-check, rebut or comment on this, and they didn’t.