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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.
Ron Goetzel seems to have memory problems. How do we know this? He has taken completely contradictory positions on 14 occasions, having apparently forgotten the second time what he said the first time.
I know what you’re thinking: “Only on 14 occasions?”
Of course not, silly. I’m talking about 14 occasions during a single 90-minute period.
That 90 minutes was the so-called “Great Debate” between him and me a couple of years ago. Who won? Well, you don’t see him posting this debate on his website, do you? I didn’t post this until now because only recently has transcription software become sufficiently accurate. You can read/listen by clicking through on the time stamps in each section, any one of which also give you access to the entire thing.
These 14 snippets feature two sets of statements that would seem to be at complete variance with each other. While I’m not calling anyone a liar, it does seem that Ron is forgetful. Very very forgetful.
On his own willingness to correct his own mistakes
Minute 08:28 “Anytime we hear about things that are wrong, we look into them and try to correct them.”
Except when he forgets to do so, as in when he gives out awards to his friends who have publicly admitted lying and harming employees.
On the Penn State wellness program debacle
Minute 13:03 “I had nothing to do with Penn State.”
He might have forgotten that he participated in their press conference “taking the offensive in the wellness controversy.”
On his concerns for informing the wellness debate with facts
Minute 29:54 “And by the way, in doing research, we look for limitations. We look for critiques….I welcome public peer review.”
Except when he forgets to welcome critiques and public peer review, as when he circulates letters to the media telling them not to publish my critiques.
On my misdeeds and lack of qualifications to do peer review
Minute 30:38 “Some of the stuff that Al talks about and points out is right on the money and I agree and I said so in the Health Affairs blog that I’ve written, but some of the stuff is really out there. It’s outlandish.”
Except that he can’t seem to recall even a single “outlandish” example.
Al: “Ron, I appreciate your giving me credit for being qualified to do peer review. Would you say that I’m the most qualified person, in terms of number of mistakes found, to do peer review?”
Except when he is about to admit that I am…
Al: “Well, who has found more mistakes than I have?”
This might explain why he and his cronies always “forget” to ask me to peer review. Though for his most recent Health Affairs article, he did remember to list me as someone who he did not want to peer review his article. I reviewed it anyway — after publication…and, like most of his stuff, it spontaneously combusts upon exposure to any possessor of a triple-digit IQ.
On throwing his Wellsteps friend, Steve Aldana (proud recipient of the 2016 Deplorables Award), under the bus
Minute 34:03: “I’m not gonna answer for Steve Aldana.”
Hmm… he seems to have forgotten this bold statement when he “answered for” Steve Aldana after I blew the whistle on Mr. Aldana’s Wellsteps debacle in Boise. Ron defended him even though it meant acknowledging that Wellsteps is arguably the worst vendor in wellness history, as measured by self-admitted harms to employees, lies about outcomes, and misapplication of clinical guidelines.
On applying for the million-dollar reward
Minute 34:33 A million dollars is a lot of money and I’ll take it.
Except he forgot to apply. Even when I raised the reward to $3 million.
On his failure to observe that his own guidebook showed wellness loses money
Minute 45:14 “I was not involved in the chapter that looks at healthcare costs.”
Oops! He forgot that he and the other HERO board members and other collaborators spent “two years and countless hours of research and discussions” on this, as the first paragraph of the guidebook claims, and as the chapter’s author gratefully acknowledged. Also, Ron is considered HERO’s resident expert on study design and outcomes. He claims to have published 171 articles, mostly involving study design and outcomes. And yet, he says he simply passed on reviewing a chapter on study design and outcomes in his own organization’s seminal guidebook on this topic, because over two years he couldn’t find the time. Or maybe he just forgot.
On walking back his own guidebook
Minute 45:26 “Those numbers [in his guidebook] are wildly off…Every number in that chapter has nothing to do with reality.”
He must have forgotten this when he claimed the same thing in the Chicago Tribune: that wellness could achieve a 1-2% reduction in risk in 2-3 years. That works out, optimistically, to achieve almost the same $1 per employee per month gross savings “in reality” (before vendor and screening fees, of course) that his very same guidebook claims.
On the Nebraska scandal
Minute 53:54 “Yes, state of Nebraska did win the Koop award. They won the award because they had solid evidence. They improved the health risk profile of the population following a cohort population over time.”
His memory is playing tricks on him again. Their “solid evidence” quite conclusively demonstrates the opposite. Of 20,000 state employees, only 161 more reduced risk than increased it.
On his ability to evaluate the Nebraska outcomes
Minute 53:59 “They also use excellent methods in doing economic evaluation.”
He forgot that these “excellent methods” contained so many rookie mistakes that the Validation Institute uses this “economic evaluation” as the issue-spotter for their Advanced Critical Outcomes Report Analysis Certification. The entirety of Chapter 8 of Surviving Workplace Wellness is devoted to all the hilarity in this program’s design and outcomes. Indeed this program would save a ton of money if laughter were the best medicine. Here is the Omaha World-Herald’s write-up.
On programs that penalize employees with surcharges
Minute 01:00:55 “Health promotion programs that are evidence-based and that work are not surcharge programs that you [a questioner in the audience] described, and I agree.”
He forgot that he disagrees, and defends punitive surcharge programs (or at least to tries to)
On how programs don’t need to save money
Minute 01:15:57 “An ROI of one to one is good enough for me.”
He might have forgotten he told people to “expect a 3-to-1 ROI.”
On his commitment to improving population health
Minute 01:15:57 “You give me a dollar, you get a dollar back, but you have to document that you’ve improved population health… You have to show that you’ve improved population health. Not just one or two people, the entire population.”
On Medicare’s wellness program
Minute 01:25:43 “Randomized clinical trials show population participated in the program versus control had significantly improved health outcomes, did not cost Medicare a dime, cost neutral.”
He might have forgotten that the actual conclusion was: “Utilization and expenditures actually increased among participants, mirroring the experience in the corporate world.”
I’ve often recommended that Ron have his statements reviewed by a smart person before publishing them. I would now add, a smart person taking notes.
Special Bonus Feature: Ron “endorses” Quizzify…until he doesn’t.
Minute [42:57] “Did go on the [Quizzify] website. It was a lot of fun, very clever.”
See the punchline in the comments. Glad to know he thinks employee health literacy is worthless.
The most comprehensive expose of the “pry, poke and prod” industry is likely to have broken the 1000-download threshold by the time you read this.
Published by the leading law-medicine journal, it is their second-most-popular paper of all time. Curiously, while this is the oldest law-medicine journal in the country and has covered a multitude of topics over many decades, the most popular paper of all time is also a smackdown of pry, poke and prod programs.
Because TSW doesn’t lie (that’s part of the reason we are so unpopular amongst the HERO crowd and its sycophants), I would acknowledge that the methodology they use to measure popularity favors more recently published articles, and ours is “only” a year old. Even so it is quite a feat because, while we are close on the feels of #1, there is a big gap between us and the #3 article.
In the structured world of law, as opposed to the “Wild West” of wellness, there are rules. That’s why I chose the leading law-medicine venue for this expose.
One rule of evidence is that some of the best evidence — one of the few exceptions to the hearsay exclusion — is what’s known as an “admission against interest.” An admission against interest is “a statement by a party that, when uttered, is against the party’s pecuniary, proprietary, or penal interest.” It’s even more compelling if it is captured electronically, as on a live mic, or in print.
The best example is Robert Durst accidentally admitting that he killed his wife during a bathroom break while being interviewed for a documentary, when he was still miked. You’d have to be, as Larry David might say, pretty pretty pretty pretty stupid to make admissions against interest when you are miked or in print.
One would think.
And yet the wellness industry’s entire modus operandi is to do exactly that. All that remains is for someone like me to point these things out, take a screen shot (the equivalent of Durst being miked), and then sit back, make some popcorn, and watch them react. Reacting is also a form of evidence. Reacting the way a guilty person would react is prima facie evidence of guilt. (To use the examples from the TSW landing page, think OJ and the white Bronco or Lance Armstrong and just about anything he said or did after being accused.)
Needless to say, the wellness industry’s very stable geniuses never step out of character when it comes to guilty reactions. This runs the gamut. Sometimes, as with Bravo, they pull down the incriminating screenshot immediately after being outed. Or, as with Interactive Health, they simply excise the incriminating data from their “research report” and call it a “research summary.” (And also they try to bribe me not to talk about them any more. I’m just sayin’…)
Or, as with Wellsteps, they act out with unsupported and creatively spelled recriminations.
Or sometimes simply trying to erase history. This is the specialty of Ron “The Pretzel” Goetzel, twisting and turning his words to do exactly that, not realizing that we keep screenshots. Here is the “before” and “after” picture of him erasing the smoking-gun evidence that a program’s “impact” was due entirely to separation into participants-vs-non-participants rather than pry, poke and prod. Note that from 2004 to 2006, separation between participants and non-participants increased almost 20% — before there was even a program to participate in.
Before (what really happened):
In order to maintain the fiction that participants-vs-non-participants is a valid study design, Ron simply removed the labels from the x-axis:
Lest anyone domiciled in a state where marijuana is now legal think the first one was a mistake and was corrected as soon as they noticed, they actually repeatedly reprinted and reused the original in many forums, like this one:
Sometimes, and this was my favorite of Ron “The Pretzel” Goetzel’s twists and turns, he literally rewrote history, in the form of forging a letter from the Governor of Nebraska, once he admitted the initial claim of saving the lives of 514 cancer victims was exposed as a fraud:
Here is your assignment: pass this along to everyone you know and ask them to read the article. Then hopefully it will be time to write the history of wellness the way it should be written. And keep a screenshot in case Goetzel tries to rewrite it.
Note that this personal blog post does not necessarily represent the views of any organization with which I am affiliated, other than the one with which I co-founded. I am referring, of course, to the Needham Frisbee Club, where everyone is welcome to join and play and become fitter — since fitness at any size, not corporate crash-dieting contests, is the key to health.
By now, many facts are well-known about weight and weight loss programs:
- Variations in body size do not correlate with variations in willpower
- No one really knows why the country has gotten fatter since 1986, reversing the trend through 1985, and without understanding the causes of this fairly sudden reversal, it’s not possible to address it. (We do know that the lowering of cutoffs in 1989 created an additional 30 million “overweight” people in the U.S. overnight. http://www.cnn.com/HEALTH/9806/17/weight.guidelines/)
- It is much better to be “fit and fat” than to try to diet your way to health
- The vast majority of people who lose weight gain it back
- 1/3 to 2/3 gain back more than they lose
- No wellness vendor has discovered the secret to weight loss that has eluded researchers for decades
- The often quoted 90-95% failure rate of programs is likely underestimated.
Further, while perhaps not proven, there is growing evidence, also here, and here, that weight cycling may be hazardous to health. (This would likely be particularly true when an employer ties incentives to gaining weight for the first weigh-in in order to lose it by the second weigh-in.)
And, yet, a number of the workplace wellness industry’s very stable geniuses have chosen to body-shame employees. The individuals and companies listed below are the wellness industry’s leading body-shamers, charter members of the Body-Shaming Hall of Shame. No surprise that wellness luminaries are leading the charge towards body-shaming, as their industry has repeatedly been called words like “sham” and “scam” by Pulitzer Prize-winning media outlets not otherwise known for name-calling.
Where possible, we have provided contact information, that you can use to let the appropriate people know how you feel about endorsing body-shaming in the workplace. Obviously, one can never eliminate discrimination based on body type, but hopefully this exposé, and creating the Body Shaming Hall of Fame, will reverse the trend towards employer support of weight discrimination in wellness programs.
Troy Adams, Wellsteps
Wellsteps is known in general for harming employees, and won a Deplorables Award in 2016 for harassing Boise School District employees. Mr. Adams cemented his and Wellsteps’ candidacy for this list by declaring: “It’s fun to get fat. It’s fun to be lazy.” After receiving many complaints, he took that article down. But he never apologized and Wellsteps continues to pitch “wellness or else” programs in which employees are fined if they can’t lose weight.
Ignorance of physiology (fines and incentives have never cured any disease known to mankind) is quite consistent with the rest of Wellsteps’ philosophy. They also have no understanding of arithmetic (costs can’t increase and decrease at the same time), drinking (it is OK to have wine with dinner or a beer at a ballgame), smoking (smokers don’t take their first steps to quitting by smoking only on weekdays), nutrition (“one more bite of a banana” will not improve your health), and arithmetic again.
You can let Wellsteps’ largest client know how you feel about this by writing to the Boise School Committee at Jeannette.email@example.com and copying the editor of the local newspaper, Rhonda Prast, at firstname.lastname@example.org.
Michael O’Donnell, American Journal of Health Promotion
Michael O’Donnell served, until recently, as the prevaricator-in-chief of the industry trade publication, the American Journal of Health Promotion, which might as well be called the American Journal of Self- Promotion, for the simple reason that – despite the overwhelmingly poor economics of “pry, poke and prod” programs and their strong likelihood of harming employees – they have published only one single sentence critical of wellness…and when that was discovered to have slipped through pre-publication review by their thought police, they walked it back in the next issue.
Mr. O’Donnell was voted into the Hall of Shame thanks to his proposal to charge employees for insurance based on BMIs, a “pay what you weigh” approach, like ordering lobsters or sending a package.
- 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 outcomes analyst for a wellness company – because those jobs require only excessive lying.
- Employees above his ideal weight would pay per pound.
- 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?
We aren’t making this up. Here is an excerpt:
He claims that all these weigh-ins and fines will create an “insanely great program” for employees, whether they like it or not.
Vitality Group, Johnson & Johnson – and Ron Goetzel
Where would a wellness-related Hall of Shame be without Ron Goetzel? Name a debacle or scandal in wellness, and his fingerprints are on it. Penn State, Nebraska, McKesson, Bravo/Graco, and of course Wellsteps come immediately to mind.
He was also the very stable genius behind the Johnson & Johnson Fat Tax. The Fat Tax was supposed to be a game-changer, ostracizing overweight folks with the misfortune of working for publicly traded corporations. In this scheme, companies would weigh their employees and then disclose those weights to shareholders. The shareholders would presumably reward those companies doing the best job of reducing employee weight, creating more profit for the wellness vendors, like Vitality or Johnson & Johnson, who would help employees lose weight. Ultimately it would be a tax, in that every employer that did not hire a wellness company and/or fire fat employees would see its stock price tumble, making wellness a mandatory fee.
While this “fat tax” would go a long way towards achieving the Wellness Ignorati’s goal of monetizing body-shaming, bringing financial disclosure into the picture raises all sorts of regulatory issues. Could you force employees to be weighed in order to meet SEC disclosure rules? What if employees cheated on the weigh-in, as employees are wont to do? Would that create a Sarbanes-Oxley violation?
There are three ironies here. It turns out that companies that are obsessed with prying, poking and prodding their employees, like McKesson, watch their stock prices tumble. And companies specifically obsessed with goading their employees into crash-dieting contests, like Schlumberger’s chart below, have the worst stock performance of all.
Second, it turns out that Vitality can’t get its own employees to lose weight, and yet they want you to hire them to get your employees to lose weight.
Finally – and this shouldn’t come as a surprise to anyone – there is zero correlation between employee weight and corporate performance.
Mr. Goetzel works for Johns Hopkins and often places their name on his essays. If you have an opinion on whether Johns Hopkins should be supporting institutionalized body-shaming, you can express your opinion by writing to Dean Ellen MacKenzie at email@example.com .
Dr. Delos “Toby” Cosgrove, president of the Cleveland Clinic. After commenting that he would not hire smokers at the Clinic, he added that he would not hire obese people if he could legally deny them jobs.
So he doesn’t want to work with obese people, except if they happen to be president.
Dr. David Katz coined the term “oblivobesity” because apparently, he feels we have not yet made larger people feel bad enough about themselves to force them to do something about their weight – the difficulty of which has apparently been overstated because, according to Katz writing in the Huffington Post:
“There are rare cases of extreme weight loss resistance and such, but by and large, we can lose weight and find health by eating well and being active. Really.”
He deftly rebuts 30-plus years of consistent and conclusive research to the contrary by adding “really” to the end. Because everyone knows that makes a statement true. Really.
He also continues to illustrate his postings with pictures of headless fat people. And then there is his defense of Dr. Oz.
Please feel free to contact us about additional “shamers” you would like to add to the list along with the reasons why.
Rarely does a book come along where you can see the author changing his mind about the conclusion as he goes along. The Healthy Workplace Nudge, by Rex Miller (with Philip Williams, and Dr. Michael O’Neill) is such a book. (For politicos, here is another such book.) Don’t skim the first few chapters — enjoy watching his journey to enlightenment. Like him, I myself took the same journey. Until about 2007, I didn’t just drink the Kool-Aid. I also mixed it up and sold it…until I did a little fifth-grade math, reaching a conclusion summarized in an observer’s blog post entitled Founding Father of Disease Management Astonishingly Declares “My Kid is Ugly.”
Like virtually everybody including myself (and every member of Congress in 2010), upon first hearing the wellness industry elevator pitch, Rex starts out by assuming that wellness must save money — it seems so obvious. But the more he learns, through his extensive research, the more he realizes that the “pry, poke and prod” industry is a fraud. “My [initial] unfamiliarity with workplace wellness was a benefit,” he observed. As a tabula rasa, the more he looked, the more he saw: “A few studies have become major pillars of misinformation that have been repeated for more than a decade.”
Welcome to my world, Rex.
After that, the more he learned, the more he learned. Trying to get to the root of the ubiquitous $3-in-savings-for-$1-in-investment meme that permeates the field and predated Katherine Baicker’s subsequently retracted 3.27-to-1 ROI, here’s what he discovered:
When I reached the global health and wellness director for the most cited case study, he admitted he did not know where the numbers came from or even who had actually created the report. So the result seemed to be a very high profile…urban legend.
Meanwhile, back in the company of my new castaway friends, the misfit provocateurs [Tom Emerick, Soeren Mattke and me], I kept hearing simple declarative sentences and sourced data.
He is spot-on regarding the distinction. Here is how one of the Wellness Ignorati explains Koop Award-winner (and notorious opioid distributor) McKesson’s seemingly self-contradictory award-winning program results:
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… Lewis’s conclusion essentially compares apples and oranges by mingling overall summary statistics with an interpretive analysis section that’s descriptive. The latter is based on repeated cross-sections of McKesson employees.
By contrast, here is “Lewis’s conclusion” after observing the self-contradiction in the Koop Award application that prompted this Employee Benefit News smackdown, presented in a simple declarative sentence:
The average weight of McKesson’s employees can’t rise and fall at the same time.
As if Rex needed more data points, another red flag was being disinvited from speaking at one of the Wellness Ignorati-fests. This happens whenever a speaker subsequently admits to critical thinking after being “confirmed” to speak. Critical thinking is right up there with data, math, integrity, facts, analysis, grammar, wellness and me in the rogue’s gallery of damned spots the Wellness Ignorati attempt to wash out, out — or at a minimum pretend to ignore (hence their moniker).
That’s why allowing the noses of the Rex Millers of the world (among whose unforgivable misdeeds are quoting the Al Lewises of the world in their books) into their tents might nudge their bright-eyed and bushy-tailed, painstakingly sequestered, acolytes to use the internet, perhaps searching on keywords like “Koop Award.” If they do, they might learn that in 2016, the year after the Ignorati disinformed their flock that Koop Award-winning companies dramatically outperformed the stock market, the 2015 winner became 2016’s 14th-worst performer in the S&P 500.
Mr. Miller refers to the Ignorati as harboring “deep anger” about being exposed for “fabricating the data.” Rex says he “doesn’t know the intent of using false data,” but I can clue him in: false data is quite useful if you are selling a scam (the LA Times‘ word, not mine).
Mr. Miller’s expert interviewing style even enticed Ron Goetzel to come tantalizingly close to admitting what we’ve spent four years in TSW demonstrating: that his whole career — claiming huge amounts of money can be saved by coercing lots of employees into claiming to eat more broccoli — is one giant fabrication. Mr. Miller quotes Mr. Goetzel as saying: “Changing behavior is very very very very hard.”
Yes, Ron, your cordially-welcomed-but-ever-so-slightly-overdue Eureka Moment is very very very very accurate. I imagine you’ll retract it soon, because on the other occasion when you were accurate — when your guidebook accidentally admitted wellness loses money — you immediately tried to disown your findings as soon as I congratulated you on their (apparently unintentional) accuracy.
The Nudge…and the Real Estate
The essence of Mr. Miller’s thesis is that hammering people with forced behavior change is very very very very pointless.
Having concluded that prying, poking and prodding employees does likely more harm than good, Rex moves on to a totally different way of doing wellness, which is to say, passively rather than actively. Clearly Rex put a lot of time and shoe leather into researching this book, and it shows. Many examples are offered of how little steps — simply moving different snacks to different places or making stairways more appealing than elevators — nudge behavior.
Way beyond that, the most notable advances in this book concern the built environment. He observes we spend 90% of our lives indoors, and yet little attention is paid to the effect of indoor space on health, wellness and productivity. I suspect more attention is paid to it than he gives credit for, but certainly we have all worked in or visited stultifying workplaces, workplaces where you can’t imagine wanting to hang out in any longer than necessary.
He proposes taking the built environment to the next level. Upgrading a typical building to the WELL Certification standard costs between $150 and $500/employee, all-in. Contrast that to the math provided to him by Tom Emerick that Walmart estimated for a wellness program: accounting for all the administrative costs, false positives, and lost productivity from health fairs and “workshops” totals thousands of dollars per employee. On the “credit” side of the ledger, every pound an employee lost cost Walmart shareholders $50,000.
By contrast, what goes into that $150 to $500 spent on the built environment get you? Suddenly every employee is “participating” in your wellness program, with no penalties or incentives needed. Not just the food in the cafeteria, but everything down to the air that circulates can be optimized for health and performance. “At their best,” he concludes, “buildings can be inspiring and invigorating–with little additional expense.” For instance, office and factory interiors tend to be dry, which facilitates the spread of disease. They also often allow in little natural light, the lack of which can disrupt circadian rhythms. Both can be easily remedied, with humidification, and with lighting that mimics our circadian rhythms.
The beauty of his proposal on the built environment is that, unlike traditional wellness programs where even the promoters say you need to do everything right to get them to work (“Only 100 or so programs succeed, while thousands of programs fail,” according to Mr. Goetzel), you can solve this problem by throwing money at it…and not much at that. Mr. Miller does go on to point out the value of leadership, but I prefer solutions that anyone can implement, as opposed to solutions that require CEO behavior change, which is very very very very hard.
The built environment is one of several chapters he proposes on solutions, and all are worthy reading, but this section is my favorite because it was new ground at least to me, and because it is so accessible to the average company. Even in existing space as opposed to new construction, a large chunk of what he is proposing can be accomplished for the price of a few years of a “pry, poke and prod” program. As one CEO who made this investment observes: “Hardly a week goes by when I don’t get a thank-you.”
In conclusion, go to Amazon and buy this book. Do it very very very very soon. Plus, the more copies he sells, the more Ron Goetzel will get very very very very mad.
In the immortal words of the great philosopher Soeren Mattke of RAND:
“The industry went in with promises of 3 to 1 and 6 to 1 based on health care savings alone – then research came out that said that’s not true – then they said ok we are cost neutral – and now as research says maybe not even cost neutral they say but is really about productivity which we can’t really measure but it’s an enormous return.”
That’s two moles whacked in just one paragraph.
Then when the productivity thing didn’t pan out, they invented something called value-on-investment, which (even though they invented it specifically to show savings) turned out to show massive losses on even the most cursory examination. Third mole.
Bottom line: all their studies that do actually exist self-invalidate no matter what they claim because — get ready — wellness loses money. Now it looks like there is a fourth mole to whack — Mr. Goetzel’s latest charade is, yeah, maybe virtually all studies in existence reveal losses upon examination, but that studies that don’t actually exist show massive savings. Perhaps he was inspired by Wellnet, which shows massive savings in “undetected claims cost,” which also don’t exist. Google on “undetected claims costs.” The only hits you get are Wellnet and me making fun of Wellnet.
I was recently forwarded an email containing Ron’s latest musings. I’ve never met the originator of the email, so he could have fabricated the entire thing for all I know. But in terms of credibility, if Ron Goetzel tells me the sky is blue and someone I’ve never met tells me the sky is green, I’d at least go look out the window.
Ron “the Pretzel” Goetzel’s latest twist — since he can’t find fault with my work — is that all the studies I invalidate are published studies, which he acknowledges in this email to be of generally poor quality. He now claims there is a parallel universe of unpublished studies showing savings that are of high quality. For some reason, this special reserve collection of buried treasure is stashed in a secret hideaway drawer under lock and key in a safe room. (He says his clients don’t want competitors finding out how well they are doing, but could it be they simply prefer not to be publicly humiliated, like most of his other clients?)
The claim that unpublished studies show the greatest savings is ironic. Why? Because Ron previously stated: “Many unsuccessful programs are not reported.”
Where Ron and I would agree is that the published studies I have invalidated — like this one and this one and this one and this one and this one and this one and this one and this one and this one and this one — are definitely of low quality. Maybe that’s because Ron himself:
- wrote them;
- gave them an award; or
- both, since conflict of interest is his modus operandi, or
- in the case of Penn State, goaded them into creating a wellness program that became a national punchline.
He did name the three companies that:
- produce these alleged secret studies, and
- “pay Truven $250,000 to analyze their numbers.”
The latter would be quite impressive if they do — except that they don’t. I’m not naming them to protect their privacy, but suffice it to say I sent them both the snippet of that email with their names in it, and they got a kick out of it. (“I never, ever, thought this nonsense worked.”) I added that if Ron Goetzel went around bragging that I paid him $250,000 to analyze my numbers, I’d sue for defamation.
On the flip side, he is also telling people (privately, so that I don’t find out about it like this) that I am [blushing] “the least credible person in the industry,” perhaps having forgotten that he had already accidentally admitted that I am the most credible person in the industry. I’m in good company — he also disses the second-most-credible evaluator in the field, for the simple transgression of publishing a high-quality study that showed losses that Ron inadvertently validated, before trying to pretzel his way back from with a series of lies that would make a White House press secretary blush.
He would also have to explain why, if I am so non-credible, he begged to be on the advisory board of the Validation Institute (which I started with Intel-GE Care Innovations). We couldn’t have him on the board because the whole point of the Validation Institute was to be credible, which it is. It is now the official validator for the World Health Care Congress.
He even got David Nash to try to strongarm us. We could have just said no, but what fun would that have been? We said: “Sure, you just have to be certified in Advanced Critical Outcomes Report Analysis first.” The test at the time consisted of finding all the errors in his Nebraska analysis, so he couldn’t earn the CORA certification without admitting that all the claims in the study were fabricated, impossible, or represented industry-leading ignorance of the way prevention works. For example, the very stable Nebraska geniuses “waive[d] all age-related screening guidelines” so that young people could get screens intended only for older people, which would be like “waiving” the minimum age for getting a driver’s license to get more young drivers on the road.
How many errors were there? Eventually, with the help of people getting validated (we had missed a few errors ourselves because there were so many of them), we dedicated an entire chapter of Surviving Workplace Wellness to Nebraska, a chapter which opens as follows:
It’s time for the 2017 Deplorables Awards, lovingly bestowed on those vendors who do the best job making other vendors look good.
The good news is that you don’t have to actually win the Deplorables Award to sue me. Runners-up are eligible too. Here is my address for hand-service delivery most of the year:
890 Winter Street #208, Waltham MA 02451
In case you decide to sue me between June 22 and August 8, use:
8 Paddock Circle, Chilmark, MA 02535
And don’t leave out my attorney:
Josh Gardner, GARDNER & ROSENBERG P.C., 33 Mount Vernon Street, Boston, Massachusetts 02108
I don’t know how much more I can do for you, other than lick the envelope. So go for it. Don’t make me beg.
But, remember, unlike your usual business model, in court you are required to actually tell the truth (I would be happy to explain to you how that works), meaning there is no chance of your winning — or likely even avoiding summary judgment, since none of the evidence is in dispute. It’s all your own writings. Oh, and I do my own cross, which means you won’t be able to find an expert witness. Anyone who knows enough about wellness to be an expert witness also knows enough about wellness to know that attempting to defend you would be a humiliating, on-the-record experience.
And there is always the chance that some annoying jerk might blog about it…
The 2017 Runners-Up
Imagine a four-square matrix with competence on one axis and integrity on the other. The people and organizations we’ll be highlighting today would intersect with the companies mentioned in Monday’s posting at only one single point.
Springbuk and Fitbit
As many of you recall, earlier in the year we analyzed the study done by Springbuk that secretly financed by Fitbit. Or maybe I need new glasses, because I just couldn’t find the disclosure in the Springbuk report that this paean to Fitbit was financed by Fitbit, the way Nero used to have the judges award him Olympic medals.
Coincidentally, the study showed Fitbit saving gobs of money because employees taking more than 100 steps a day spend less money than those taking fewer. However, a simple tally of one’s own footsteps shows that it is impossible not to take 100 steps a day unless you are both:
- in a hospital bed; and also
- on dialysis.
This 100 steps-a-day threshold was repeated many times in the study, with no explanation of how that number came to be. However, it turns out we owe these two outfits an apology. Fitbit and Springbuk have told a number of people privately (not publicly, in order to avoid an embarrassing news cycle) that they didn’t really mean to say that 100 steps a day constituted activity. They meant to say that taking 100 steps a day implied you had your Fitbit on. My apologies for failing to read their minds that their conclusions were based on reading people’s minds to determine whether they wore the Fitbit deliberately, or simply forgot/remembered/cared to put their Fitbit on.
They never did explain — privately or publicly or to anyone — how employees who took an average number steps during the baseline year could show huge savings by taking an average number of steps in the study year too.
They also never explained how these two statements didn’t completely contradict each other, even though I specifically asked them to in a personal letter, excerpted here:
Third, can you reconcile this statement…:
“The materials in this document represent the opinion of the authors and not representative of the views of Springbuk, Inc. Springbuk does not certify the information, nor does it guarantee the accuracy and completeness of such information.”
“This demonstration of impact achieved by integrating Fitbit technology into an employee wellness program reinforces our belief in the power of health data and measurement in demonstrating ROI,” said Rod Reasen, co-founder and CEO of Springbuk.
National Business Group on Health
Next up is the National Business Group on Health. Last year they made the list for criticizing the US Preventive Services Task Force for not demanding enough screenings, in a country that is drowning in them. Not content to rest on those laurels, this year they earned an Honorable Mention for inviting Dr. Oz to keynote on the role of quackery in corporate wellness, and perhaps tell us about his latest lose-weight-by-eating-chocolate miracle diet.
HERO of course also earns a runner-up award. 2017 will be remembered as the year they finally came to grips with the realization that a business model based on fabricating outcomes requires that perpetrators possess that critical third IQ digit. Without that extra “1”, an organization trafficking in math that can at best be considered fuzzy is going to be outed.
This year’s set of lies? By way of background, their 2016 poison-pen letter insisted they had fabricated that data set showing that wellness loses money without disclosing that it was fabricated — and also never reviewed their fabricated data before publication. Early in the year, I had the insight that, wow, this “fabricated” Chapter in their guidebook is so much better than the other chapters that something is amiss. No one at HERO can analyze data competently…and yet, here it was, a competent data analysis.
I did something I had never thought to do before, which was look up the actual author of that chapter. It was Iver Juster MD. He was a great analyst even before he read all my books, took all my courses, and achieved all my certifications in Critical Outcomes Report Analysis.
- Whereas Paul Terry and Ron Goetzel had insisted that Iver fabricated the data, Iver said, of course he didn’t — whatever made me think that? (“If it wasn’t real, I would have disclosed that,” he observed. Of course he would have. Iver has tremendous integrity.)
- The Board discussed and reviewed his chapter at length, and made helpful suggestions, for which he was quite grateful. This review process required “countless hours,” just as the HERO document says:
The number of transparent lies HERO tells could make a president blush. In the immortal words of the great philosopher LL Cool J, they lied about the lies they lied about.
Even though 2017 was an off-year for them in terms of the number of lies, they still told enough to be named a runner-up.
Wellness Corporate Solutions
Next is Wellness Corporate Solutions, famous for its crash-dieting contests. WCS now offers a water-drinking contest. The idea is to set up a “challenge” for your team to drink more water than other teams. They call this a “healthy competition.” I guess they didn’t get the memo that forcing yourself to drink when you don’t want to drink, just to make more money, is anything but healthy. Here is a novel idea: drink when you are thirsty. Evolution 1, WCS 0.
Perhaps as an encore, WCS, Dr. Oz and the National Business Group on Health could team up to offer a chocolate-eating contest.
I looked into this outfit to see where they get their ideas. The CEO previously ran something called the Washington Document Service. That qualifies her to run a wellness company. As Star Wellness says, to run a wellness company successfully, your background needs to be in sales, or “municipality administration.” After all, what is more central to administering a municipality than documents?
What fun would a list of runners-up be without Wellsteps, the proud recipient of the 2016 Deplorables Award? While their streams of consciousness weren’t as memorable in 2017 as in 2016 (“It’s fun to get fat. It’s fun to be lazy“), they get credit for trying. Their 2017 weight-loss campaign was headlined: “This campaign is not really about weight loss, it is about helping you apply the behavioral secrets of those who have lost weight.”
So if your kids ever want you to teach them how to ride a bike, say: “It’s not really about riding a bike. It’s about helping you apply the secrets of people who have ridden bikes.”
And what secrets are we talking about? What person who has lost weight doesn’t brag to everyone or even write a book? If there is a secret to weight loss, like eating chocolate, Wellsteps owes it to the country to tell them. Don’t make us beg.
Odds and Ends
No Koop Award winner this year, but an honorable mention to past winners and runners up for their commitment to wellness:
Sounds like in 2018 the logical winners would be Philip Morris, or maybe The Asbestos Corporation of America.
Veering briefly into the public sector, kudos to Representative Virginia Foxx, (R-NC5) for introducing the Required Employee DNA Disclosure Act. Even HERO thought it was a dumb idea…and their threshold for thinking something that increases wellness industry revenues is a dumb idea is quite high, having all rallied behind the Johnson & Johnson Fat Tax, in which companies would be required to disclose the weight of their employees.
Next up…the winner of the 2017 Deplorables Award