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Rocky, Bullwinkle, Wellness, and the American Journal of Managed Care

Some of you might remember the closing credits of Rocky and Bullwinkle.  Due to copyright restrictions, we can display only a “fair use” snippet. (“Fair use” means you could use one question from Quizzify as an example without special permission as long as you cite the source, but if you tried to copy the whole thing, we’d get elected president, hire a special prosecutor, and throw you in jail.)

Rocky asks: “You got the credits, Bullwinkle?”

Bullwinkle replies: “All on this itty-bitty card…oops” and then it folds out:

bullwinkle

(Source: Jay Ward Productions.)


So what does this have to do with wellness, besides nothing?

Simple –I just consolidated all the lies and harms of the Wellsteps/Koop Award into one itty-bitty posting for the American Journal of Managed Care blog.  And it also folds out — with links to all the other “smoking guns” in this scandal.  If you just want to forward one article around, that’s the one.

Kudos to American Journal of Managed Care for going where Health Affairs fears to tread, by posting the entire, unbowdlerized expose in all its sordid glory.  Indeed one would think the latter publication would show some contrition for having started this “pry, poke and prod” mess, by publishing the original Baicker propaganda — with no disclosure of the authors’ conflicts of interest or funding sources…and apparently also no peer review. This thing has been cited 250 times.  And that was after it was shown to have been made up. It has 549 citations in total.

Sadly, in addition to not being subject to any other regulations, wellness is not subject to Pottery Barn Rules. Health Affairs created this mess, but they don’t need to pay for it. Quite the contrary, the Health Affairs “impact factor” has probably been boosted more by this article’s 549 citations than almost any other article they’ve ever published.  And guess who has to clean up after them?

peabody

(Source–you guessed it–Jay Ward productions.  These are the closing credits to Mr. Peabody.)


Kudos also, by the way, to the perpetrators of the Wellsteps fraud — Steve Aldana, Ron Goetzel, Seth Serxner. They have the good sense not to take my bait by actually attempting to rebut. The one time they did, in Sharon Begley’s article, their “rebuttal” took the form of basically admitting they had made the whole thing up.

Abe Lincoln seems to be in the news a lot this week, and he put it best: “Better to be thought a fool and say nothing than to speak out and remove all doubt.”  Words the Wellness Ignorati should live by.  You’d think they would have learned that by now.

 

 

If Wellsteps and the Koop Committee can show they aren’t lying, they can collect the $1-million reward

Those of you with long memories may recall our standing offer of a $1-million reward to anyone who can show that the wellness industry has broken even during this century.  You need a long memory because no one ever claimed the reward. For all the bluster of Ron Goetzel and his cronies, apparently none of them actually believe what they say…or they would be $1-million richer.

Oh, wait, in the case of both Ron Goetzel and his cronies, maybe they haven’t claimed the reward because they do believe what they say.

The offer is legally binding.  There are clear rules. There is an entry fee, but it is refundable to the claimant if they win.


We would now extend that offer specifically to Wellsteps and/or the Koop Award Committee, and we’ll throw in HERO too, since it’s all the same inbred crowd.  All they have to show is what they have already claimed: that Wellsteps made Boise School District employees so much healthier — perhaps by reciting their mantra that “it’s fun to get fat and it’s fun to be lazy” —  that the School District could, as a direct result of this enhanced employee health, reduce their healthcare benefit spending by roughly one-third after three years.

To make it extra easy for the these people, I’ll relax the requirements:

  1. They can submit the existing “This Is How You Win a Koop Award” self-congratulatory paean.  That means both that they don’t have to do any extra work (besides adding to up 20 links at their option, as the rules allow), and that the word limit on the reward application is waived to accommodate the size of that posting.
  2. Any or all Koop Committee members can participate with you in the oral arguments, but I myself am not allowed to bring a second. This means they can gang up on me, by crowdsourcing their IQs.

And of course they already know what arguments I am going to make because I posted them. That’s like having the debate questions in advance.

They would have to file the entry fee, or formally request a month’s extension, by November 1.  The only reason for the deadline is that when they ignore this offer, as they inevitably will,  I can start saying they are admitting they’re lying as early as November 2.

As with the regular award, I am perfectly happy to offer it the other way around, where I pay the entry fee, and I have to prove they’re lying, as opposed to them proving they are telling the truth. That way they can’t say the game is rigged, since I’m willing to play either hand.


Since the Koop Committee members are all such civic-minded citizens, they need not personally collect the windfall if they win.  I am perfectly willing to — indeed, would prefer to — donate a million dollars to the Boise School District, either as an unrestricted gift or to set up a fund to update, enhance, and increase employee (and student) access to their fitness facilities and equipment.

Surely, Mr. Aldana and Mr. Goetzel, if you truly care about the health and well-being of those employees, you will make the small effort required to secure this million-dollar contribution on their behalf.


And, Mr. Aldana, please don’t pretend you aren’t applying for the award because you are unaware of my work. For instance, you view my Linkedin profile with a regularity roughly halfway between obsessive and man-crush.*

*As recently as…

aldana-linkedin-profile-check

 

 

 

How the 2016 Koop Award Raises Lying to an Art Form

If you were at the HERO conference, you witnessed a surreal experience.  Executives from Johns Hopkins, Mercer, United Healthcare and elsewhere willing to risk their jobs by perpetuating what has now been exposed as a bald-faced, presidential candidate-level lie: that Wellsteps deserves an award for a program allegedly benefiting Boise teachers so dramatically that costs fell by a third. They will not mention the article in STATNews that came out yesterday showing that school district employee health deteriorated.

You read the article, so you know they are lying.  And they know you know they are lying. And yet the whole thing just continues as though it is somehow all OK because no one is admitting it publicly.

Here is some more detail on the lies in question.


Sharon Begley’s article Wellness Award Goes to Workplace Where Many Health Indicators Got Worse does not lose anything in the re-reading. Quite the contrary, almost every quote in it is either a lie, or exposes the Wellsteps application as a lie. In each case, Wellsteps’ Steve Aldana, Johns Hopkins’ Ron Goetzel, United Health Care’s Seth Serxner, and all the other committee members know it’s a lie, because of the aforementioned article.

“Lie” might seem like a harsh term, but the alternative is to assume that Ron and his cronies have absolutely no idea how to read an outcomes report, even though I have already showed them how to read this report in particular.

True, one could argue that Ron has been known to use the “dumb and dumber defense” when giving his friends their awards, but in this case he can’t pretend he doesn’t know any better because he was quoted in the article.  Another argument that these are lies: no one — not even a member of the Koop Committee — can possibly be this stupid accidentally.


Let’s go lie by lie. Let’s start with the last quote from Ron “the Pretzel” Goetzel, because it sets the stage for the others. He got his moniker because he has a way of twisting and turning words to make himself sound like he isn’t lying.  In this case, he said if “an application said everything went exactly right,” it would certainly “raise eyebrows” on the Committee.

“Went exactly right”???  Ron, isn’t the entire point of wellness to make employees healthier?  So if a program makes employees unhealthier, we say it didn’t go “exactly right”?

Using this definition, here are a few other things that did not “go exactly right”: New Coke, Yugos, the 1962 Mets, Vietnam, subprime loans, Yahoo, and the 2016 presidential nominating process. And for that matter, Begley’s article points out that McKesson’s 2015 award also wasn’t “exactly right,” in that the program didn’t do anything and the data self-contradicted. It’s not just McKesson. I have been tracking these Koop Award-winners for years, and they all self-invalidate. Each is more hilariously not “exactly right” than the other.

Yessirree, if there is one thing that shouldn’t keep Koop Committee members up at night, it’s the fear that one of their award applications might be exactly right. So the good news is that no Committee member has to worry about contracting an acute case of over-raised eyebrows.


Another lie exposed: It turns out the Koop Estate licenses the name to this cabal in order to make money, just like Dr. Koop licensed his name to make videotapes. The award is now admitted to be “industry sponsored.” This is the first time this provenance has been disclosed in print. It is basically a marketing scheme for the committee members and sponsors. They had claimed to be a “private-public” organization. That Orwellian Pretzel-speak is a lot different from being admittedly industry sponsored.


Next, Dr. James Fries — whose major wellness expert credential is writing an article finding massive population-wide savings against a phony control group by getting a few diabetics to eat less fat — called this “an exemplary program” that “showed improvements in health behavior” leading to cost reduction. Yes, a few self-reported behaviors improved. We suspect the Boise teachers lied, because they clearly lied when they self-reported their smoking (only 2.5% admitted it) and drinking (only 20%).

But let’s assume they didn’t lie–meaning somehow they are different from everyone else when they complete workplace health assessments. Exercising three more minutes a day and eating 0.11 more fruits and vegetables/day cannot reduce health care costs at all, let alone by a third, especially when the employees became unhealthier overall.

This statement would therefore qualify as a mistake, assuming Dr. Fries is not bright enough to already realize it is wrong. If Dr Fries doesn’t retract it now that he knows it’s wrong, it becomes a lie.


That brings us to Steve Aldana.  He has been caught lying many times, including this example where he accidentally told the truth before retracting it.  (He and his friends burn a lot of time trying to explain away instances in which have to explain why they accidentally told the truth but didn’t really mean it.)

His biggest lie is his discussion of regression to the mean. Compare his quote to his application. First, the quote, which shows he is actually familiar with the concept:

“In just one year, many employees will move from one [risk] group to the other,” he explained, “even though they did not participate in any wellness programs or any intervention whatsoever.” That movement, he continued, “reflects changes in health risks that occur naturally,” making it possible that some high-risk people become low risk “even though your program didn’t do anything.”

Contrast that to his application, in which he pretends he has never heard of regression to the mean, and instead attributes the “dramatic improvements” in the highest-risk Boise employees to the “program impact”:

wellsteps-worst-health-behaviors

He also contributed my favorite line of the article: even “one more bite of a banana” can make a difference in people’s health. This is true, of course, for the segment of the population that is starving to death. Otherwise, how dumb is this claim?  Let’s just say that if a college taught him this, it could lose its accreditation.

And that brings us to his biggest lie of all: He says I didn’t understand the program benefits because I didn’t read the data.  I did, of course. I even actually added up the datapoints, which no one on the Koop Committee did. I’ll give Committee members the benefit of the doubt and assume they failed to add the datapoints not because they didn’t want to expose the truth that Boise employees got worse in their friend’s program, but because calculators are not yet available in their cave.

Adding the data would have revealed to them — as it did to me — that they harmed employees. 6397 biometric indicators deteriorated, while only 5293 improved.  This conclusion shared by both Ms. Begley and the Boise consultant, Kellie Wirth, who helped set up the program. Apparently, the law of averages caught up with the perpetrators of this Boise scheme, because Kellie Wirth is honest. She calls the biometric results “very disappointing” and says my concerns “are valid.”


The biggest lie of all: that these extra banana bites and trivial improvements in self-reported health behaviors — combined with statistically significant deteriorations in self-rated health and risk scores — could have any effect, let alone an effect of mind-boggling magnitude, on overall spending:

wellsteps-cost-savings

Funny thing, Ron Goetzel insists that “most programs fail” because they aren’t done right, and that getting to a 1-to-1 ROI is a heroic accomplishment, only achievable when employee health is improved:

goetzel-roi-quote

And yet when it comes to giving his friends awards, failed programs harming employees but generating massive phony ROIs don’t seem to bother him at all.  Let’s see him Pretzel his way out of this one.


One thing vendors love to do is play blame-the-victim. The Pretzel pioneered this approach by saying he had “absolutely nothing to do with Penn State,” when in fact he was in the room when they defended their program to the media.

Seth Serxner stood up, on camera, and basically declared United Health Care/Optum hates it when employees spend too much money on their screening programs, and typically begs to do less. United Healthcare complained that I was making them look bad, but then couldn’t produce a single name of a single employer who would admit to deciding to spend more money for the express purpose of screening inappropriately.

And now here comes Steve Aldana, blaming the Boise school administrators for insisting on throwing taxpayer money away and harming their employees, by flouting US Preventive Services Task Force guidelines. My suspicion is that their Boise customers have an alternative view, but — despite the presumably obvious pride they must be taking in this award — they are refusing to comment on it.  One can only imagine the conversations taking place in Boise right now…and this is before the Idaho Statesman gets hold of this debacle.


And Ron wonders why the number of applications for the Koop Award was down by two-thirds this year…which brings us to yet another lie told by Mr. Goetzel in this article.  He attributes the decline to the following:

the application process, including the requirement that wellness programs submit statistics and rigorous data analysis, has become so strict that fewer programs want to go through the process.

However, if you actually look at the application form, it is exactly the same now as it has been every year this century. And indeed the data submitted, if anything, was more comprehensive then. For instance, the 2000 winner, Fannie Mae, clearly documented all the prostate, pulmonary function and other USPSTF D-rated tests they forced employees to submit to.

Are you smarter than a Koop Award Committee member? Take this quiz to find out

Last week we asked if you were smarter than a wellness vendor. (SPOILER ALERT:  you are — assuming you can read this posting without moving your lips.)  I suggested taking the Interactive Health IQ test, just to be sure.

Now, see if you are smarter than a Koop Committee member. They all reviewed this Wellsteps application and decided it was award-worthy.*

Do you agree that this application is award-worthy? If not, see how many self-invalidators you can find. I don’t mean “challenges” to the data. I mean self-immolations. Remember the mantra: “In wellness you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”

After you’ve finished, review the answers to see what you got right and what you missed.  You may have read it before since it’s been getting lots of views for six weeks, but I’ve added several observations since the original posting.

You may even find things I missed, so let me know. The reason is that — aside from possibly the first Sunday in November — there aren’t enough hours in a day to identify everything that Koop Committee members “overlook” in their friends’ applications.

If this type of analysis interests you, I might recommend applying for Critical Outcomes Report Analysis certification. This program is run by the Validation Institute, the gold standard in all things analytical regarding population health and employee health. (Disclosure: while I am not an employee, they occasionally subcontract to me.)

There is nothing highly technical in the answer posting. In order to make it possible for a Koop Committee member to understand and hence decide to rescind the award, I used only fifth-grade math, simple declarative sentences, short words, and lots of pictures.


*Speaking of disclosures that don’t appear in the award application, the Wellsteps CEO also served on the awards committee itself until very recently. Indeed, until so very recently that he still says he is on it.

aldana-resume

Wellsteps Apologizes, Returns Koop Award, and Endorses Code of Conduct

Wellsteps has profusely apologized for harming Boise’s employees, according to objective and subjective health indicators, for overscreening the employees, for demonizing even the slightest consumption of alcohol, for suppressing their earlier acknowledgement that costs increased, and for mis-attributing the allegedly massive savings figures.

Not!

They’ve recognized that these smoking guns exist, of course — that much we’ve learned from other sources.  But obviously they haven’t apologized.  In case you haven’t noticed, these days refusing to apologizing is a thing. Indeed it’s more than a thing. It’s a Major Lifestyle Trend, potentially even bigger than quinoa, bidet toilets, and the Kardashians combined.

They (Wellsteps, not the Kardashians) aren’t going to give up their Koop Award voluntarily.  To paraphrase the immortal words of the great philosopher S.I. Hayakawa, they stole it fair and square. (Helps that Wellsteps’ CEO is on the award committee, of course, though you wouldn’t guess it from their announcement.)

And they (Wellsteps again, but probably also the Kardashians) certainly aren’t going to endorse the Code of Conduct.  They can’t, because they and their whole Koop Award cabal would be in immediate violation of its call for no harms to employees and no lying about outcomes.


However, the Code of Conduct is getting great reviews everywhere else, which is actually what this column is all about.

First, honest, well-intentioned, and competent vendors, brokers and consultants — none of which are connected with the Koop Committee or the Health Enhancement Research Organization — have shown their support in large numbers. The Code has garnered tons of “likes” and very supportive comments.  If you see your consultant or vendor on this list of “likers” and commenters, give them the kudos they deserve. And add your own too.

Quizzify

Second, Quizzify on Friday became the first vendor to endorse the Code, and will be incorporating it in every contract going forward.  Read the Quizzify statement, and urge other vendors to follow suit. Embracing the code should be easy for others like it was for Quizzify. Any honest, competent vendor should find the principles self-evident.

ConscienHealth

Third is a pleasant surprise twist, the one referred to in the Linkedin “tease” for this column.  On Sunday, I was delighted to see http://www.ConscienHealth.org pick it up.  By way of background, ConscienHealth is an advocacy group for the evidence-based treatment and prevention of obesity. In their own words:

We develop strategies that are based on sound science [and] public policy, and a deep understanding of consumer needs.”

Here is a summary of what they said, but we’d urge you to read the whole shebang, because they stated it better than we did. Alone among websites with an interest in wellness, ConscienHealth speaks specifically for the overweight employees who are victimized by crash-dieting schemes and other corporate fat-shaming activities:

We now have enough regulations on the subject of employer wellness programs to make your head spin…but the most encouraging development is a code of conduct based on a simple premise: act purely to improve health and do no harm.

The folks who developed this code – Ryan Picarella, Al Lewis, Rosie Ward, and Jon Robison – applied deep knowledge of the good and the harm that employer wellness programs can do. While others fight over the fine points, this code brings us back to the big picture with a few key principles:

  1. Wellness programs should work for the benefit of employees.
  2. Programs should not single out, fine, or embarrass employees for their health status.
  3. Employers should respect and protect employee privacy.
  4. Employers should measure and report program outcomes honestly.

If those considerations seem obvious, it’s because they are. And yet we have examples of “wellness” that have disrespected, humiliated, and financially exploited employees. Sometimes it’s been done out of ignorance. Sometimes it’s a subterfuge for cost shifting to people with chronic diseases – health problems that nobody wants to have.

We here at They Said What would urge Wellsteps and other “pry, poke and prod” vendors to develop programs that satisfy those same four criteria. Unfortunately, they aren’t quite there yet. Indeed a beam of light leaving criteria #1, and #4 wouldn’t reach them for several seconds.


Disclosure: Al Lewis, who co-maintains this site, is also a principal in Quizzify, which endorsed the Code.  Attention to Wellsteps: See how conflict-of-interest disclosures work?  It’s not that hard. Next time you win a Koop Award — and based on the number of consultants and vendors on the award committee (plus sponsors) who need to be win one too, it should be your turn again in about 6 years — try disclosing your presence on the award committee in your breathless announcement of how brilliant you are.

Or, as Mark Twain said: “Always tell the truth. This will delight some people and astonish others.” We will be both, if it ever happens.

We called it! We predicted the combination of invalidity and cronyism would win Wellsteps a Koop Award!

We cannot, cannot make this stuff up.

Wellsteps, which could take lessons in integrity from the presidential candidates, was obviously fabricating the outcomes for its Boise School District. How do we know this? Simple. Costs can’t rise and fall at the same time, even using wellness industry math. And yet Wellsteps claimed they did.

As soon as we saw how obviously, hilariously invalid their result was, we predicted that Wellsteps would win a Koop Award for the Boise School District.  We based this prediction on the combination of data fabrication, cronyism, nonsense, and cluelessness which are the DNA of both that award and of Wellsteps’ phony outcomes. Our only mistake was thinking they would win in 2015, but you’ll see at the end, we said that if they didn’t win in 2015, it was because they were late, and would win in 2016, which is what they just did.

Note when you compare Wellsteps Stumbles Onward: Costs Rise and Fall at the Same Time to their current press release, you’ll see there is something missing from the latter.  They removed the “smoking gun,” which invalidates the entire program.  In both documents, they said costs absolutely declined across the whole population, including non-participants…

wellsteps overall trend

…but on a per capita basis the costs of both participants and non-participants increased, at least in their initial writeup. This slide below has now been conveniently disappeared from their press release. I suspect this is not an accident. Here it is:

wellsteps cost per person

Participants’ cost rose just a little while non-participants’ cost rose a lot.  This separation is due to the proven fallacy of the participants-vs-non-participants methodology.  Even so, the line graph says the whole enchilada at Boise declined, not just the participants.

The only way per capita costs could increase AND total costs decline is if the program is so bad that employees prefer to join their spouse’s health plan, or if the number of employees declines.  But even the most dishonest wellness vendor wouldn’t credit either of those changes to their wellness program, and no member of the Koop Award Committee could “overlook” that impossibility.

Or would they?


Be sure to read the second installment, where we dive even deeper into the Wellsteps doodoo.

 

 

Albert Einstein Meets the C. Everett Koop Wellness Award

Quizzify Q in B and W

Quizzify’s unified theory of healthcare: smarter employees use less

One of Albert Einstein’s great regrets was never having developed a “unified theory,” a consistent set of calculations that could explain the universe. That’s the bad news. The good news is that he did give us the word “Einstein” as in: “Ron Goetzel’s Koop Committee members are the biggest bunch of Einsteins in all of wellness, no easy feat considering the competition from WELCOA, HERO and others.”

Past postings have easily invalidated all the Koop awards since 2010.  This did not require breaking a sweat.  Rather, as Surviving Workplace Wellness observes: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data.  It will invalidate itself.”

Previously, we’ve had to content ourselves with pointing out the plethora of individual rookie mistakes in each award. Now, however, we have a Unified Theory of Koop Award Ludicrous Impossibility. It reveals a remarkably consistent set of ludicrously mathematically impossible outcomes across all this decade’s award-winners.  Not just any old ludicrously mathematically impossible outcomes but — and this is what excites my Inner Nerd — the same ludicrous mathematical impossibility pervades every award-winning outcome.  

In each case the award winner has documented a small risk reduction among active participants.  (They have also shown that willingness to participate, rather than the actual program, is what generates the savings, of course, but choose to ignore their own findings.)  And in each case that small risk reduction generates what we thought were fairly random claims of savings.  But it turns out that in 5 of the last 6 awards, the claims savings weren’t random at all but rather were essentially the same, using the same simple formula comparing risk reduction to claims savings.  (The missing year is 2013. We can’t do Dell because we don’t want to embarrass them due to our relationships.)

The Unified Theory of Koop Award Ludicrous Impossibility Revealed

In the real world, trivial reductions in risk among participants — excluding non-participants because they increase in risk — have no impact on spending discernible in the white noise of random claims variation. And if we could discern an impact, it would be even more trivial than the risk reduction, because risk-sensitive medical events are a small percentage of total events.  For instance, if risk-sensitive medical events comprise the typical 5% of total spending, and risk declines by 1%, the reduction in total spending would be 1% of 5%, or 0.05%.  And that’s before subtracting fees.

However, on Ron Goetzel’s planet — also inhabited by fellow Einsteins like Optum’s Seth Serxner, Wellsteps’ Steve Aldana, and Staywell’s David Anderson, and obviously Mercer and Milliman — the opposite is true: a trivial reduction in risk generates massive cost savings. For example, McKesson saved $13 million via a 1% overall risk reduction. At that rate of savings and their rate of spending, their entire health spend could be wiped out if risk factors fell 14%.   Not just their spending on wellness(risk)-sensitive medical events, but their total spending spending on healthcare.  Wiped out. Gone. Obliterated.

A simple example can demonstrate how the Unified Theory works.  Suppose the Koop Award goes to an outfit that claims to have achieved a 10% cost savings by reducing risks 2%.  Then it follows that a 100% cost savings (10 times the claimed amount) could be achieved if risks fell 10 times the claimed 2%, or 20% in total.

To give credit where credit is due, we shall call this resulting figure — 20% in this hypothetical — the Goetzel Factor. The Goetzel Factor is specifically defined as: “The percentage decline in risk factors projected to wipe out spending according to the Koop Award Committee validations of risk and cost savings.”

The Evidence

Let’s review the last five awards (leaving out 2013) using this formula to estimate a Goetzel Factor. Note that the risk reduction is cross-sectional, meaning it is averaged across the entire population, not just participants.  So if the stated or calculated risk reduction is 2%, as with McKesson, and half the employees participate (ditto), the figure in the table below for McKesson would be 1% (half of 2%).goetzel factor

Conclusion: the range of Goetzel Factors is remarkably tight–13% to 16%.  Given the ludicrous impossibility of wiping out spending by reducing a small minority of risk factors, the consistency of the result is amazing:  the Goetzel Factor reveals almost exactly the same ludicrous impossibility every time!

There are a few asterisks in this Unified Theory. In some cases, the award application itself wasn’t specific on some things, like total spending.  So we made assumptions and “showed our work” as they say in fifth-grade math. Or, in the case of British Petroleum, we defaulted to their article in JOEM, which had much more detail.  In any case, the spreadsheet calculations and sources are available to all legitimately qualified researchers, meaning those excluded from the Koop Award Committee because they aren’t Einsteins.

Wellness phooey!

Koop Award Shmoop Award!

 

Ron Goetzel’s “Dumb and Dumber” Defense Deflects Latest Koop Award Ethical Scandal

By Al and Vik

Oh, the twists and turns as Ron “The Pretzel” Goetzel tries to wriggle out of all his ethical stumbles.

This time around, we thought we had nailed both him and his cabal handing out the ironically named C. Everett Koop Award to themselves and their friends based on made-up outcomes.  Specifically, this time they gave their sponsor (Health Fitness Corporation, or HFC) an award based on data that was obviously made up, that no non-sponsor could have gotten away with submitting.  This was the third such instance we’ve uncovered of a pattern of giving awards to sponsors for submitting invalid data while making sure that the award announcement contains no reference to the sponsorship.  (There are probably others; we’ve only examined 3, which might explain why we’ve only found 3.)

How obviously was the data made up?  Well, take a looksee at this slide, comparing participants to non-participants.  This is the classic wellness ignorati ruse:  pretending that non-motivated inactive non-participants can be used as a valid control for comparison to active, motivated participants.  The wellness ignorati would have us believe that any healthcare spending “separation” between the two groups can be attributed to wellness programs, not to inherent differences in motivation between the two groups.   Unfortunately for the ignorati, their own slide invalidates their own argument:  in 2005, the label “Baseline Year” shows there was no program to participate in, and yet – as their own slide shows – participants (in blue) significantly underspent non-participants (in red) nonetheless.  In Surviving Workplace Wellness, we call this “Wellness Meets Superman,” because the only way this could happen is for the earth to spin backwards.

total savings chart

Given that the 2005 baseline label was in plain view, we just assumed that HFC did not indeed have a program in place for this customer (Eastman Chemical) in 2005, which is why they called 2005 a “Baseline Year” instead of a “Treatment Year.”  Not actually having a program would logically explain why they said that didn’t have a program, and why they used that display or variations of it like the one below for 4 years with the exact same label.  Presumably if they had had a program in 2005, someone at HFC would have noticed during those 4 years and relabeled it accordingly.

Originally we thought the Koop Award Committee let this invalidating mistake slide because HFC — and for that matter, Eastman Chemical — sponsor the awards they somehow usually win.  But while trying to throw a bone to HFC, the Koop Award luminaries overlooked the profound implication that the year 2005 separation of would-be participants and non-participants self-invalidated essentially the entire wellness industry, meaning that is is an admission of guilt that the industry-standard methodology is made up.

Slide1 (1)Goetzel the Pretzel to the rescue.  He painstakingly explains away this prima facie invalidation.   Apparently the year 2005 was “unfortunately mislabeled.”  Note the pretzelesque use of the passive voice, like “the ballgame was rained out,” seemingly attributing this mislabeling to an act of either God or Kim-Jung-Un.  He is claiming that instead of noticing this invalidator and letting this analysis slide by with a wink-and-a-nod to their sponsor, none of the alleged analytical luminaries on the Koop Committee noticed that the most important slide in the winning application was mislabeled — even though this slide is in plain view.  We didn’t need Edward Snowden to hack into their system to blow up their scam.  They once again proved our mantra that “in wellness you don’t need to challenge the data to invalidate it. You merely need to read the data.  It will invalidate itself.”

We call this the “Dumb and Dumber” defense.  Given two choices, Goetzel the Pretzel would much prefer claiming sheer stupidity on the part of himself, his fellow Koop Award committee members like Staywell’s David Anderson and Wellsteps’ Steve Aldana, and his sponsor HFC, rather than admit the industry’s methodology is a scam and that they’ve been lying to us all these years to protect their incomes.

Still, the Dumb-and-Dumber defense is a tough sell.  You don’t need Sherlock Holmes, Hercule Poirot or even Inspector Clouseau to detect a few holes in the Pretzel’s twisted logic:

  • How could no one – no member of the Koop Award Committee or employee of Health Fitness Corporation (which used this as its “money slide” for years) – have noticed this until we pointed it out for the third time (the first two times not being as visible to the public)?
  • In early 2012, this slide was reproduced–with the permission of Health Fitness Corporation–right on p. 85 of Why Nobody Believes the Numbers, with the entire explanation of its hilarious impossibility. We know Mr. Goetzel read this book, because he copied material out of it before the publisher, John Wiley & Sons, made him stop.  So we are curious as to why it has taken until now for him to notice this “unfortunate mislabeling.”  Hmm…would the fact that it was just exposed to the world in Health Affairs have anything to do with this sudden epiphany?  We’re just sayin’…
  • If indeed it was just an “unfortunate mislabeling,” how come HFC has now expunged all references to this previously highlighted slide from their website, rather than simply change the label?

As regards the third point, we would recommend that next time Mr. Goetzel invokes the Dumb-and-Dumber defense, he coordinate his spin with his sponsor.

But let’s not overlook the biggest point:  the entire Koop Committee – including “numbers guys” like Milliman’s Bruce Pyenson and Mercer’s Dan Gold — is apparently incapable of reading a simple outcomes slide, as they’ve proven over and over.

So, as a goodwill gesture, we will offer a 50% discount to all Koop Committee members for the Critical Outcomes Report Analysis course and certification. This course will help these committee members learn how to avoid the embarrassing mistakes they consistently otherwise make and (assuming they institute conflict-of-interest rules as well to require disclosure of sponsorships in award announcements) perhaps increase the odds that worthy candidates win their awards for a change.

Goetzel, Koop Committee, Staywell, Mercer, BP America meet Groundhog Day

Perhaps the strategy of the leaders of the wellness ignorati (who constitute the Koop Committee) is to overwhelm us with so many lies that we don’t have time to expose every one and still get home in time for dinner.

No sooner have we finished pointing out the numerous (and unrebutted) implausibilities and internal inconsistencies in Ron Goetzel’s posting on the value of workplace wellness, than the Koop Committee (Mr. Goetzel and his cabal) feeds us even more red meat:  They gave the 2014 Koop Award to British Petroleum.  However, apparently only British Petroleum wants to tell the world about it. The Koop Committee hasn’t even updated its own website to list 2014 award winners.

Recall that we’ve spent months excoriating Goetzel and his sidekicks (Wellsteps’ Steve Aldana, Milliman’s Bruce Pyenson, Mercer’s Dan Gold and the rest of them) for doing three things in the Nebraska award, for a program that prima facie seems to be in violation of Nebraska’s state contractor anti-fraud regulations:

(1)   Gave it to a program where the numbers were obviously fabricated and later admitted to be

(2)   Gave it to a program whose vendor sponsors the Committee

(3)   Forgot to disclose in the announcement that the vendor sponsors the Committee

Perhaps what you are about to read isn’t their fault.  Perhaps their mothers simply failed to play enough Mozart while the Committee members were in their respective wombs, but here’s how they applied the learning from the Nebraska embarrassment to their decision to award British Petroleum.  This time they:

(1)   Gave it to a program where the numbers had already been shown to be fabricated

(2)   Gave it to a program whose vendor sponsors the Committee

(3)   Forgot to disclose in the announcement that the vendor (Staywell) sponsors the Committee

(4)   Forgot to disclose in the announcement that the vendor sits on the Committee

(5)   Forgot to disclose in the announcement that the consulting firm (Mercer) sponsors the Committee

(6)   Forgot to disclose in the announcement that the consulting firm sits on the Committee

 

mercer staywell sponsorship

I suspect we will be writing a similar analysis again next year, when once again, the Committee will attempt to demonstrate the value of sponsoring a C. Everett Koop Award.

Health Fitness Corp wins a Koop award for curing non-existent cancers in Nebraska

C. Everett Koop National Health Award Committee,


Wellness Council of America and Health Fitness Corp.


Short Summary of Award:

The C. Everett Koop award committee’s mission is:

“…to seek out, evaluate, promote and distribute programs with demonstrated effectiveness in influencing personal health habits and the cost effective use of health care services. These programs have the objectives of

  • Providing appropriate quality care
  • Sharply reducing the alarming rate of health care inflation, by holding down unnecessary expenditures.”

Materials Being Reviewed:

The brochure in question describing the Nebraska program is downloadable from the WELCOA website.

Case Study of Award Winner for 2012: Health Fitness Corporation and Nebraska

Summary of key figures and outcomes:

Alleged cancer outcomes include the following:

cost-saving catches

Risk reduction outcomes include the following:

change in risk factors

Questions for C. Everett Koop Award Committee:

I: Alleged Cancer Outcomes

Were you troubled by the program sponsors’ decision to waive all age-related colon cancer screening guidelines established by the government, and send out 140,000 flyers, at taxpayer expense, featuring a beautiful woman much too young to have a screening colonoscopy?

age related colon cancer screenings

ANS: Refused to answer

How come, when the program reported that 514 of the 5000 (or fewer) people screened had colon cancer (in addition to the ones who would have been screened anyway), none of the Committee members with health informatics backgrounds from Truven Health Analytics and Mercer and Milliman (and from Wellsteps and Staywell, both of whose programs are also highlighted) were concerned that this alleged 11% colon cancer rate was at least 100 times greater than Love Canal’s?

ANS: Refused to answer

When Health Fitness Corporation admitted lying and reversed their story from making “life saving, cost-saving catches” of “early stage [colon] cancer” to revealing that those 514 people didn’t have cancer, why did the Koop Committee re-endorse what would appear to be outright data falsification, instead of rescinding the award?

ANS: Refused to answer

Even if the committee is allowing Health Fitness Corporation to keep its award and not even apologize, why does this claim of “life-saving, cost-saving catches” still appear on the WELCOA website even though the lie has been admitted?

ANS: Refused to answer

Wouldn’t the fact that the perpetrator of this acknowledged lie is also a sponsor of this Koop award that its own customers have won three times (including this incident) create the perception of a conflict of interest?

conflict of interest?

ANS: Refused to answer

Does anyone on the Committee think if Dr. Koop were still alive that he would endorse your position on data falsification of cancer victims?

ANS: Refused to answer

WELCOA’s website said it was founded by someone who appears to be the inventor of the self-serve all-you-can-eat restaurant. Despite his well-deserved reputation for integrity, did he endorse data falsification of cancer victims even after the perpetrators admitted it?

Warren Buffet?

ANS: Refused to answer (but did change the spelling)

II: Risk Reduction Outcomes

How do you reconcile the claimed savings figure exceeding $4-million with your own chart above showing that only 161 active participants (3.1%) reduced a risk factor? (That chart of course doesn’t include dropouts and non-participants, whose risk factors may have increased.)

ANS: Refused to answer

Dividing the total savings by 161 yields more than $20,000/person in savings. Wouldn’t that $20,000+ for each risk factor avoided imply that all 161 would have had a heart attack even though the entire eligible population only had about 30 heart attacks the previous year, while the participating population would have had about 7?

ANS: Refused to answer

How do you reconcile your statement that 40% of the population had previously undiagnosed high blood pressure or high cholesterol with your other statement that “the total number of prescription scripts [sic] filled within the Wellness Plan reduced [sic] 3% last year,” despite your reducing or waiving the copays? Shouldn’t prescriptions have gone up, if indeed 40% more people were at risk?

ANS: Refused to answer

How can you attribute the 3% reduction in prescriptions to “improved lifestyles” with the fact that your own graph shows only 161 people improved their lifestyles enough to reduce a risk factor? What happened to the thousands who were diagnosed but were neither medicated nor improved their lifestyles?

ANS: Refused to answer

How do you reconcile that same finding – that 40% had high blood pressure or cholesterol — with that same graph, showing that almost three-quarters of the population was low-risk?

ANS: Refused to answer

How do you reconcile the brochure’s claim that the “majority of employees touted how the program has improved their lives” with the brochure’s own admission that only a minority of employees (42%) even bothered to be screened once and only 25% twice despite the four-figure financial incentive?

ANS: Refused to answer


Follow-up response

Not-for-attribution response received August 1, stating that the reason the Committee let them keep their award was not because were a sponsor but rather because they did not make the life-saving claim on their application.  (They did make all the other invalid claims.)  Because they didn’t make the claim on the application, they are not in violation of the Committee’s ethical standards by making it in other venues.

Our reaction:

So it is OK if a ballplayer admits using steroids as long as he didn’t happen to test positive?


Follow-Up Response

September 2014: Nebraska listed as a “best practice program” by Ron Goetzel

Our Reaction:

Doesn’t this listing contradict your initial excuse — that you forgot to ask them about whether they made up their cancer statistics during your due diligence — because now you know about that lie and all the other lies in their outcomes measurement…and yet you still call them a best-practice program?

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