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Wellness War Is Over; Wellness Lost

armisticeActually, proponents surrendered in the wellness war, producing a report that debunks their own claims of return on investment.

Quizzify 4

When the war’s over, make sure you are on the winning side

via Wellness War Is Over; Wellness Lost.

HERO (Health Enhancement Research Organization) Crowdsources Arithmetic

This is the third in a series deconstructing the Health Enhancement Research Organization’s (HERO) attempt to replace the basic outcomes measurement concepts presented to the human resources community in Why Nobody Believes the Numbers with a crowdsourced consensus version of math.  The first installment covered Pages 1 to 10 of their outcomes measurement report, where HERO shockingly admitted wellness hurts morale and corporate reputations.  The second installment jumped ahead to page 15, where HERO shockingly admitted wellness loses money. This report covers pages 11-13.  Next week we shall be covering Page 14. 

4 out of 5 wellness vendors don't get this

4 out of 5 wellness vendors don’t get this

Spoiler Alert:  The wellness industry believes that math is a popularity contest.   (We have a million-dollar reward if they can show that’s true.  More on that later.)

All the luminaries in the wellness industry got together to crowdsource arithmetic, and put their consensus (a word they use 50 times) in an 88-page report.  Unfortunately, math is not a consensus-based discipline, like democracy.  It is not even an evidence-based discipline, like science.  It is a proof-based discipline.  A methodology that doesn’t work in hypothetical mathematical circumstances is proven wrong no matter how many votes it gets.

The pages in question list 7 “methodologies” for measuring outcomes.  To begin with, consider the absurdity of having 7 different ways to measure.  Imagine if you asked your stockbroker how much money you made last year, and were told:  “Well, that all depends.  You could measure that seven different ways.  And by the way, six of those ways will overstate your earnings.”   Math either works or it doesn’t.  There is only one right answer.

Methodology #1: “Cost Trend Compared with Industry Peers”

This methodology “may require consulting expertise.”

As a sidebar, one of the many ironies of this HERO report is that most of these methodologies emphasize the need for actuarial or consulting “inputs” or “analytic expertise”…and yet no mention was made on Page 10 of the cost of this expertise when all the elements of cost were listed.  While not mentioned as a cost element, consulting firms are very expensive  And even if consulting were free, we generally recommend hiring only consultants to do outcomes report analysis who are certified in Critical Outcomes Report Analysis by the Validation Institute.

By contrast, Staywell and Mercer offer an example of what happens when you as a buyer use non-certified “consulting expertise” to evaluate a vendor.  Here’s what happens:  the vendor wins.  Needless to say, Staywell showing savings 100x  greater than what Staywell itself said was possible simply by reducing a few employees’ risks raises a lot of questions.  But despite repeated requests and offers of honoraria to answer these questions, Mercer wouldn’t answer and the only response Staywell gave us was to accuse us of bullying them.  Staywell and Mercer held firm to the Ignorati strategy of not commenting—even though Mercer was representing the buyer (British Petroleum), not the vendor.  Oh, yes—both Staywell and Mercer are represented on the HERO Steering Committee.

To HERO’s credit, they do admit the obvious for Methodology #1: If all your peers are using the same vendors, who recommend the same worthless annual checkups, the same overscreening/overdiagnosis, the same lowfat(!) diets, and the same consultants to evaluate all the phony savings attributable to these checkups, diets, and biggest-loser contests, obviously you’ll get the same results.  And since trend is going down everywhere (including Medicare and Medcaid, which have no wellness), everyone gets to “show savings.”

Methodology #2:  “Inflection on expected cost trend.”

Mercer has been a big proponent of this methodology, as in the previous Staywell example.  At one point they used “projected trend” to find mathematically impossible savings for the state of Georgia’s program even though the FBI(!) later found the program vendor, APS, hadn’t done anything. In North Carolina, they projected a trend that allowed them to show massive savings in the state’s patient-centered medical home largely generated, as luck would have it, by a cohort that wasn’t even eligible for the state’s patient-centered medical home.

Comparing to an “expected” trend is one of the most effective sleight-of-hand techniques in the wellness industry arsenal.  Every single published study in a wellness promotional journal comparing results to “expected trend” has found savings.   And have you ever hired a consultant or vendor to compare your results to “expected trend” who hasn’t found “savings”?  We didn’t think so.


Methodology #3: “Chronic vs. non-chronic cost trend.”

The funny things about this methodology are twofold.

First, the HERO Committee already knows this methodology is invalid because it was disproven in Why Nobody Believes the Numbers (and I offered an unclaimed $10,000 reward for finding a mistake in the proof).   We know that people on the Committee have read my book because at least one of them – Ron Goetzel – used to copy selected pages from it until the publisher, John Wiley & Sons, made him stop.  Methodology #3 was the fallacy on which the entire disease management industry was based.   I myself made a lot of money measuring outcomes this way, until I myself proved I was wrong.  At that point, integrity being more important to me than money, I changed course abruptly, as memorably captured by Vince Kuraitis’ headline: Founding Father of Disease Management Astonishingly Declares: “My Kid Is Ugly“.  (Naturally the benefits consulting industry filled the vacuum created by my withdrawal from this market, and plied their clients with worthless outsourced programs that more than coincidentally generated a lot of consulting fees.)

If you had perfect information and knew who had chronic disease (before the employees themselves did) and everyone stayed put in either the non-chronic or chronic categories, you could indeed use non-chronic trend as a benchmark, mathematically (though the epidemiology is still very squirrelly).  The numbers would add up, at least in a hypothetical case.

But we can’t identify anywhere near 100% of the employees who have chronic disease.  Absent that perfect information, any fifth grader could understand the proof that this methodology is fabricated, as follows.  Assume that 10 people with a chronic disease cost $10,000 apiece both in the baseline and in the study period.  Their costs are therefore flat.  The program did not reduce costs between periods.

Now add in 10 people with undetected chronic disease as the “non-chronic benchmark.”  Maybe they are ignoring their disease, maybe they don’t know they have it, maybe they are misdiagnosed, maybe the screen was wrong (vendor finger-pricks are very unreliable).  Assume these 10 people cost $5000 in the baseline…but they have events in the study period so their costs become $10,000.

That makes the “non-chronic trend” 100%!  Suddenly, the program vendor looks much better because they kept the costs of the chronically ill cohort constant even though the “benchmark” inflation was 100%.

Quizzify 3

At Quizzify, wellness results always add up.

Second, Why Nobody Believes the Numbers has already shown how to make this methodology valid mathematically (though the epidemiology applied to that math might still be squirrelly, and there could still be random error in non-hypothetical populations).  You simply apply a “dummy year analysis” to the above example.  So do exactly what is described above, but for a year-pairing before the program.   Then you’ll know what the regression-to-the-mean bias is, and apply that bias to the study years.  So If in fact the “non-chronic trend” is always 100% due to the people with unrecognized chronic disease, you would take this trend out of the benchmark non-chronic population before applying that trend to the chronic population.  In this case, as in every case, the bias is eliminated.  This is called the Dummy Year Adjustment.  (Chapter 1 of Why Nobody Believes the Numbers offers several examples of the DYA.)

Proofs are best understood to be proofs if accompanied by rewards, since only an idiot would monetarily back a proof that wasn’t a proof.   So here’s what we propose for this one:  I’ll up my $10,000 reward to $1,000,000.  A panel of Harvard mathematicians can decide who is mathematically right.  The HERO Committee escrows a $100,000 nuisance fee for wasting my time and paying for the panel if they are wrong.  (We’ll pay if we lose.) They present Methodology #3.  We lose the $1,000,000 if the panel votes that this HERO methodology is valid without our “Dummy Year Adjustment.”

My challenge: Either collect your $1,000,000, or publicly apologize for proposing a methodology which you know to be made up.  Or is offering you a million dollars “bullying,” a word defined very non-traditionally in this field?   Our bad.

Yes, we know this sounds like a big risk but you might remember the old joke:

Science teacher:  “If I drop this silver dollar into this vat of acid, will it dissolve?”

Student: “No, because if it would, you wouldn’t do it.”

Methodologies 4 and 5:  The Comparison of Participants to Non-Participants

Besides not making any intuitive sense that active motivated engaged participants are somehow equivalent to inactive unmotivated non-participants, Ron Goetzel already admitted this methodology is invalid.  Health Fitness Corporation, accidentally proved that on the slide below.

HFC full color

Note that they “matched” the participant (blue) and reference (red) groups in the 2004 “baseline year” but didn’t start the “treatment” until 2006.  However, in 2005, they already achieved 9% savings vs. the “reference group” even without a program.  This “mistake” was in plain view, and was pointed out to them many times, politely at first.  Page 85 of Why Nobody Believes the Numbers showed it, but as the screenshot below shows, I was too polite to mention names or even to call it a lie, figuring that as soon as Health Fitness Corporation or Ron Goetzel saw it, they/he would be honest enough to withdraw it.

hfc unnamed

Not knowing the players well, I naively attributed the fact that HFC used this display to a rookie mistake, rather than dishonesty.  That was plausible because rookie mistakes are the rule rather than the exception in this field.  (As we say in Surviving Workplace Wellness, the good news about wellness vendors is that NASA employees don’t need to worry about their job security because these people aren’t rocket scientists.)

On the advice of colleagues more familiar with the integrity of the wellness industry true believers, I also tried a test of the rookie-mistake hypothesis: I strategically placed the page with this display next to the page that I knew Ron Goetzel would be reading (and copying), a page whereon I complimented him on his abilities.  I might the the world’s only bully who publicly compliments his victims and offers to pay them money:



That way, I would know that if Mr. Goetzel and his Koop Committee and their sponsors HFC didn’t remove this display, it was due to a deliberate intentiion to mislead people, not an oversight or rookie mistake.

Sure enough, that display continued to be used for years.  Finally, a few months ago, faced with the bright light of being “bullied” in Health Affairs, HFC withdrew the slide.  Ron “the Pretzel” Goetzel earned his moniker, twisting and turning his way around how to spin the fact that this “mistake” was ignored for so long despite all the times it had been pointed out.  He ending up declaring the slide “was unfortunately mislabeled.”  He gave no hint as to who did the unfortunate mislabeling, despite being repeatedly asked.  We suspect the North Koreans.  The whole story is here.

Summary and Next Steps

The first five of these methodologies in Pages 13-14 have several things in common:

  • They all contradict the 6th methodology;
  • They contradict the statement on page 15 that the only significant savings is in reducing admissions. Of course, self-contradiction is embedded in Wellness Ignorati DNA.  To paraphrase the immortal words of the great philosopher Ned Flanders, the Wellness Ignorati  “believe all the stuff in wellness is true.  Even the stuff that contradicts the other stuff.”
  • They call for megadoses of consulting and analytic expertise, contradicting the list on Page 10 that omits the cost of outside expertise.

Speaking of Methodology #6, our next installment will cover it.  It’s called event-rate based plausibiltiy testing.  I would know a little something about that methodology, since I invented it.  I am flattered that the Wellness Ignorati, seven years later, are finally embracing it.  I am even more flattered that they aren’t attributing authorship to me.  No surprise.  That’s how the Wellness Ignorati got their name – by ignoring inconvenient facts.  Ignoring facts means they cross their fingers that their customers don’t have internet access.  Customers who do can simply google on “plausibiltiy test” and “disease management” and see whose name pops up.

Achieving wellness should not mean sacrificing personal privacy and security

Al and I are very pleased to present our first guest post. This insightful essay, by privacy expert Anna Slomovic, explores a vital issue that, like so many important and complex things in wellness, gets ignored or dismissed. Our thanks to Anna for allowing us to post her work.

data-backup-571157_1280Most American companies, particularly large employers, now have wellness programs. These programs can have many different components, including detailed health risk assessments (HRAs) and biometric screenings, wearable fitness devices that count steps, and mobile apps that track what food employees buy or eat. When employees ask about the rules that govern use and disclosure of wellness data, the typical response is that the data is “kept private” and is “safe and secure.” Unfortunately, such general reassurances hide the complexity of the privacy rules for data in wellness programs.  In fact, the data may travel more widely than wellness proponents may want us to know, and employees are unlikely to understand all the allowable uses and disclosures of the data.

One complication comes because wellness programs may be part of a health plan or may be separate from a health plan. Different rules apply, depending on a program’s structure. Another complication is that wellness data exists in different databases controlled by different companies. The privacy rules that apply depend on who holds the data.  The same data may be under different protections in different places.

Let’s start with HRAs and biometric screenings for cholesterol or blood sugar, blood pressure, and weight. These wellness initiatives are most likely part of a health plan because they meet the definition of “medical care” in federal law. When data is part of a health plan, it is subject to the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA), the main health privacy law in the United States. HIPAA permits many uses and disclosures for health-related purposes without requiring individual consent, including data analysis for health plan sponsors, outcomes evaluation, and development of treatment guidelines. Nevertheless, the HIPAA Privacy Rule imposes some meaningful use and disclosure protections for individuals. Among the most important in the employment context is the requirement that an employee must specifically authorize use of HIPAA-covered data for employment-related decisions. Employers comply with HIPAA requirements by hiring vendors to collect and analyze individual-level data and by having the vendors deliver only aggregate or statistical results.

Not all wellness initiatives meet the definition of “medical care,” and these initiatives can be offered inside or outside a health plan. For example, many employers have programs that offer employees discounts on wearable fitness devices, or points and rewards for taking a specific number of steps, using an app that tracks what food they buy or eat, or working out at a gym. These activities are not “medical care,” and can be offered as part of benefits unrelated to health, where HIPAA does not apply.

For non-HIPAA data collected through wellness programs, the only privacy rules that apply are what participating companies and employers devise.  The privacy framework is even less robust for many fitness-related devices and apps.  Many do not have privacy policies. Several studies show that even in cases where privacy policies exist, they often permit broad uses and disclosures, including operations, personalization, improvements to apps, devices and services, research, and marketing and promotion, all performed by the companies themselves or their partners.

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Quizzify is the ONLY wellness program that does ask employees for personal health information

Of course, the story does not end with data collected by individual companies. Data from apps and devices can be combined with other public or private data, and many device and app features depend on this. The other data might come from gyms (to verify attendance and workouts), supermarkets (to verify food purchases), vendors of rewards catalogs where rewards points can be redeemed for merchandise, or from companies that have historical weather data or list locations of restaurants and other types of businesses. By combining data from various sources, the device or app maker might be able to give feedback to the user about their monitored eating and exercise patterns, or notify the user about rewards for which she qualifies. Although all these companies collect, use and disclose data related to a wellness program, none is subject to the HIPAA Privacy Rule or probably to any other privacy law.

Privacy regulations in the US apply to specific sectors of the economy like healthcare or finance. When data is disclosed, the recipient gets a copy while the disclosing company keeps its copy. Therefore, if data legally moves between sectors, different rules (or no rules) apply to different copies of the data, depending on who has them. For example, several companies would have data from a fitness tracker or app linked to a wellness program. One copy would remain with the device or app manufacturer, who could use and disclose the data in accordance with its privacy policy. A copy passed to a wellness vendor might be subject to the HIPAA Privacy Rule if the wellness vendor is acting on behalf of the health plan, or may be subject only to commercial rules if it is not.

Robust wellness programs can build a detailed picture of an individual life by combining data collected via HRAs, biometric screenings, devices, apps, activity on health portals, health claims, attendance records provided by employers, and public data.  Employees will rarely know who has the data, what privacy rules apply, or what rights, if any, the employer has.

Simple reassurances that the data is “kept private” and is “safe and secure” are not nearly enough. Wellness programs need much greater transparency about their structure, participating companies, and data flows, policies, and practices. Only then can employees understand the true stakes of seemingly innocuous wellness programs. Employees also need the right to opt out of any wellness program, without penalty, on the grounds that they refuse to give up their privacy.

Anna Slomovic is a privacy consultant and scholar. She was formerly a Chief Privacy Officer of several companies in health and financial services. You can learn more about her at


Beware: ‘Wellness’ May Be Hazardous to Your Health | Judith Feder

radioactive-147921_1280We are very pleased to have Judy Feder of Georgetown and Sam Bagenstos of Michigan join us in questioning the validity, integrity, logic, and privacy invasion behind workplace wellness programs.

Wellness programs that actually help people improve their health are a good thing. But privacy and protecting workers from job-based discrimination are good things too. Corporations and politicians should take care not to invoke ‘wellness’ in ways that weaken important civil rights protections and give employers license to snoop around in our medical records and our private lives. That would most definitely be bad for our health.

via Beware: ‘Wellness’ May Be Hazardous to Your Health | Judith Feder.

We Concede the HERO Report is right–wellness does lose money

The HERO Report concludes that wellness loses money.  We agree.  We also think it loses much more money than they will admit to, but the news here is not about us.  The news is that more than 3 dozen self-described experts and industry leaders representing more than 2 dozen companies have reached consensus that their industry loses moneySlide1

Count us more shocked now than we were by the report’s admission that wellness adversely impacts morale, (This is covered in Installment 1.)

Together, the HERO findings — and our broad consensus with those findings — have serious Affordable Care Act policy implications.  The entire basis for the ACA “Safeway Amendment” allowing large fines for (among other things) failure to lose weight is that the cost savings from skinnier employees merits invading their privacy, dignity and automony through medicalizing the workplace (“companies playing doctor” as some have called it).  Senate committee hearings, proposed new legislation, and EEOC lawsuits around this provision have all been based on the assumption that wellness saves money.  The Senate committee never even lobbed a softball question about that assumption, and even the more hostile witnesses didn’t challenge it.

Recently there was even an eyeball-to-eyeball encounter between the Business Roundtable’s (BRT) Gary Loveman and President Obama.  Even though his company (Caesar’s) went bankrupt while embracing wellness as essential to their profitability, Mr. Loveman argued that corporations should be allowed to fine workers who don’t lose weight because the benefit to corporate bottom lines would trump both privacy concerns and the substantial health hazards of these programs.

gary loveman

Gary Loveman, Business Roundtable


Apparently, though, Mr. Loveman’s company went bankrupt slightly faster because of wellness.  Yes, along with employees, employers would be better off without forced (highly penalized or incentivized) workplace medicalization.  If you fire your wellness vendor, everyone benefits.

Everyone, that is, except the wellness industry denizens who make their money off this.  That’s why we think HERO spoke the truth unintentionally.  Very few people (I was one of them, having switched sides in 2007 when I saw that data failed to support wellness/disease management) willingly undermine their own incomes for integrity’s sake.  So this posting will proceed on the basis that is was a gaffe on their part.

Curiously, this is the second time in recent months wellness industry leaders have accidentally admitted wellness loses money, and the third time they’ve accidentally told the truth and had to walk it back.

Equally curiously, wellness economics information disseminates very slowly if at all — testament in large part to the absolutely brilliant and flawlessly executed strategy by the Wellness Ignorati of ensuring that facts get ignored (hence their name).  So even as the vendors are admitting that wellness loses money, benefits consultants and HR executives have once again pushed participation incentives/penalties to new highs, a whopping $693/employee/year, according to a new report.

As for the figures themselves, we are also attaching a spreadsheet so that you—as an employer—can figure this out on your own in your own population, rather than just take HERO’s word for it that wellness loses money.

The costs, according to the HERO report’s own screenshots

First, review the screenshot from the first installment, showing the costs of wellness.   The list of cost elements is fairly exhaustive –down to the level of a space allocation for a health fair — though the Committee conveniently left out consulting fees.   No surprise there, given that Mercer consultants sit on the committee.

HERO list of costs

Then, compare the list of costs in that screenshot to costs in this second screenshot, from Page 15 of the HERO Report.  That comparison won’t take long because only one program cost is listed:  “$1.50 — Cost of EHM [Employee Health Management] PMPM fees.”

HERO list of costs

The two lists of costs are totally inconsistent.  Suddenly, when it comes time to measure ROI on page 15, most of the costs on Page 10 have disappeared…

The reason for that?  The savings from wellness – in the HERO committee’s own words below – are so trivial that in order for wellness to produce savings, the second screenshot has to ignore most of the costs listed on the first one.  Whereas the first screenshot listed three categories of costs covering 12 different line items (13 if you count the AWOL consulting expenses), the second screenshot says you should only count one item:  vendor fees.

And by the way, the vendor fees themselves self-invalidate.  At about $40 per employee per year, biometric screening fees alone cost more than the stated $1.50 per person per month, or $18/year.  Yet $18/year is the total they list for all fees combined, including the $40 screenings.

Rather than point out the many cost elements on the first screenshot missing from the second, we’ll invite you to use our spreadsheet and enter your own data instead of theirs.  Simply fill in your own direct costs of wellness.

Whatever number you get will dramatically understate your true costs because there are three elements of cost that we aren’t counting on this spreadsheet:

  • What their spreadsheet call the “indirect” costs, which we have listed as “$0”,
  • What their spreadsheet calls the “tangential” costs of damaged reputations and employee morale—ask Honeywell whether they brag about their wellness fines and lawsuit in their recruiting (and, ironically, I just returned from a consult for Penn State itself, where the adverse morale impact still overhangs employee relations);
  • The massive costs of overscreening, overdiagnosis, and overtreatment generated by biometric screens – all of which are conducted far more often than the USPSTF recommends and most of which (as in the examples we occasionally post on this site) include screens that no one other than a wellness vendor or consultant would ever propose.

The financial benefits

Against those costs are the benefits. Page 15 lists some alleged benefits of wellness that leave us scratching our heads.

Generic substitution?  How does that have anything to do with wellness?  Quite the contrary, obsessing with wellness might take your eye off the generic substitution ball, and cause you to miss some tiering opportunities.  (The company that is best at tiering its pharmacy benefit, Procter & Gamble, is also known for its current employee-friendly wellness program, sort of the anti-Honeywell.)   And has anyone ever seen one health risk assessment (HRA) or participated in one health screen that even mentioned generic substitution?

Outpatient procedures?   Try to find one person in your organization whose outpatient procedure could have been prevented by eating more broccoli.

ER visits?  Maybe they decline.  But maybe they increase, due to sports injuries sustained by newly activated employees.  And someone who really is eating more broccoli might slice their finger chopping the crowns off the stalks.  (Anybody who voluntarily eats the crowns with the stalks still attached doesn’t need a wellness program.)

And then the catch-all:  savings through “overall wiser use of healthcare.”  Come again?  This is an industry that — as well documented by their own words captured on this website — makes its living telling employees to do exactly the opposite:  go get checkups you don’t need and won’t benefit from, submit to screens far in excess of USPSTF guidelines so that vendors can brag about how many sick people they find, yo-yo diet for “biggest loser contests” and weigh-ins, like ShapeUp’s get-thin-quick 8-week crash-diet programs, and avoid eating fat and cholesterol and load up on carbs instead.

cerner cholesterol

Perhaps what the HERO committee intends is that since employees largely don’t trust their employers, they will do the opposite of the recommendations.

The savings from wellness

Quizzify 4

When wellness doesn’t add up, Quizzify does

We are going to leave out respiratory savings.   To capture those, charge a smoking differential and make smoking cessation available.  Done.  You don’t need an intrusive and expensive wellness program for that.  (We are big believers in a “smoking differential” for employee-paid premiums.  It makes sense for all the reasons weight loss and other wellness programs don’t.)

Instead let’s focus on people who have cardiometabolic issues.  In order to lose weight and reduce their risk, they need to switch to a low-fat, low-cholesterol diet.

Oh, my bad!  That is sooo 2014!  While most of us not in the wellness business already knew the dangers of eating too many simple carbohydrates long before now, even the most ardent card-carrying member of the Wellness Ignorati learned in March that all their dietary advice has been wrong — to go along with their incorrect screening and checkup advice.  Yet recommending exactly the wrong things hasn’t stopped most vendors from claiming massive savings.  See “On the (Even) Lighter Side” and The Smoking Guns for examples.

Now let’s look at all the hospitalizations that can be avoided through wellness – heart attacks, angina, hypertension, and…um, hmm…did we mention heart attacks?   You’re thinking: “What about diabetes events?”  OK, we’ll add diabetes, only because the HERO report lists it and we want to be true to the report.  But diabetes complications admissions (like CHF, which they also list) are a disease management issue, not a wellness issue — you can’t prevent or manage diabetic neuropathy or left-ventricular heart failure by eating more broccoli. The $1.50 PMPM price would not be high enough to also include disease management, and in any event what one does in disease management for complex cases is much different from a typical “pry, poke, prod and punish” wellness program.

And “straight” diabetes admissions are usually the result of diabetic employees pushing their blood sugar too low by over-medicating themselves—often in a good-faith effort to hit Hba1c “targets” that your wellness program set, no doubt on the advice of your consultants.   Low blood sugar won’t do much for productivity either.  Without the advice of a company specializing in diabetes, you’re likely to get this result.  (And if this is the first you are hearing about the likely causes of “straight” diabetes ER visits and admissions, you should consider such an option.)

So we are now adding all ischemic and hypertensive heart events and diabetes as what they call “potentially preventable hospitalizations.”  How many of your hospitalizations are for those items?  Simply run the primary codes for those events, being careful not to double-count professional fees, to see how many you had.  Here’s what happens when you do it for the United States as a whole.

HCUP WSMEs non-respiratory

Next, divide the relevant figure (Private insurance, 432,065) by the total number of privately insured discharges in the US (7,360,684)

HCUP US as a whole

So—using the HERO Committee’s own acknowledgment of the undeniable fact that wellness can only impact wellness-sensitive medical events (WSMEs) and using the diseases that the report says to use — less than 6% of admissions are WSMEs.  If your non-birth-event admit rate is, as the report says, 45 per 1000, then you have 2.6 admissions per 1000 in non-smoking-related WSMEs.  Once again, don’t take our word for this.  Run this analysis on your own admissions.  You won’t be surprised by how few there are.  Do you even know anyone admitted to the hospital for these things, especially where the admissions could have been prevented with a few more screens, HRA and servings of broccoli?

Shameless plug:  We are happy to do this WSME analysis for you.  We do these all the time.  It’s $4000.  We can also tell you your savings, ROI, trend, comparison to others over time, and more.  We also adjust for the major secular decline in cardiac events that has been taking place anyway for decades that the Committee seems to be unaware of, sort of surprising given their alleged expertise in cardiac risk reduction.

Let’s say you run this analysis with or without our help, and a rate/1000 similar to the US average pops up.  The HERO report says you need to reduce this rate by “only 1 or 1.25 admissions.”  But that’s almost half of your total 2.6/1000 WSMEs!  And in any event, you’ve probably seen by now – if you downloaded the spreadsheet – that Page 15 seriously underestimates your wellness program expenses, meaning your breakeven reduction needs to be much higher than “only 1 or 1.25.”  It’s probably higher than the number of admissions you have available to be reduced.

You can enter both your admissions per 1000 and the reduction in that figure you achieved directly into the spreadsheet.

But for now let’s very generously assume their expenses are right, and you only need to reduce admissions by 1 to succeed. How hard would it be to go from 2.6 to 1.6 WSMEs per 1000, a reduction of 39%?  Here are five things to keep in mind:

  • Your true engagement rate itself is probably much lower than that aforementioned 39%, not including people who simply participate for the money, and the people who are engaged generally aren’t the ones who would crash anyway;
  • A big chunk of all heart attacks can’t be predicted at all, and certainly not now that law prohibits asking about family history;
  • Even events that can be generally predicted can’t necessarily be prevented (we all know people who are “walking heart attacks” and have been ignoring advice for years);
  • “Straight” diabetes admissions are more likely to be for over-control than under-control;
  • In 7 years of measuring this, we have never seen a reduction in WSMEs remotely approaching 39% after adjusting for secular declines in cardiac events that take place even without a wellness program (which the report overlooks)

See The Million Dollar Workplace Wellness Heart Attack Screen in Health Affairs for a more in-depth view of the math. But the entire committee writing this HERO report insists wellness saves money, right?  So, it’s us against them, right?  A he said-she said?  Wrong.  Here’s the denouement.  On Page 23, the report’s own example shows that wellness only saves $0.99 PMPM!   That figure, by the way, is grossly overstated for reasons we will get to when we deconstruct Page 23.  But for the time being, here it is.

hero page 23 99 cents  

So even their own comparison of their own overstated savings estimates to their own understated cost estimates reveal:  wellness is a loser financially.  They have already admitted it is a loser for employee relations.  Funny — if we had made these two arguments, they would attack us.  But they are making these two arguments themselves.

Once again, the Surviving Workplace Wellness mantra applies:  “In wellness, you don’t have to challenge the data to invalidate it.  You merely have to read the data.  It will invalidate itself.”

Where does this leave us?

To summarize, pages 10, 15 and 23 combined tell us:

  1. Even before adding page 10’s cost categories back to page 15, costs are $1.50 PMPM;
  2. Savings are only $0.99 PMPM, meaning wellness loses $0.51 PMPM;
  3. The first two points are not our estimates — they’re their estimates and are far more optimistic than ours;
  4. Adding back the cost elements on page 10 to page 15, and then on Page 23 removing the respiratory savings, adjusting for secular decline in WSMEs, and adding in all the extra doctor visits would create a much larger loss from wellness;
  5. And they have already admitted that “pry, poke, prod and punish” programs are bad for morale.

Now you see why RAND’s PepsiCo study showed a negative ROI from wellness:  It’s because there is a negative ROI from wellness, which no one disputes any more.

And you see the reason we asked the question in the last installment:  Why would any company “do wellness” if the biggest proponents of wellness – people who make their living off it – admit that it’s a waste of money that adversely impacts morale?

Likewise, now you see why wellness vendors and consultants get “outed” all the time on this site, advocate savings methodologies designed to obfuscate rather than enlighten, and try to prevent you from learning that we exist.  We are not saying they are sociopaths.  Sociopaths lie for no reason.  Conversely, wellness vendors and consultants are just trying to keep their jobs.  Bleeding customers or clients dry is only a good job security plan if indeed the customers or clients never find out about it.

But now customers know how their own vendors and consultants really feel.  And we can all work together to dismantle these programs and start doing wellness for employees instead of to them.

Poll: Cue the Wellness Industry Response…  

We have a little dispute with RAND’s Soeren Mattke.  He says the wellness industry modus operandi is, whenever one claim is disproven, to switch to another claim.

We say the reason they are known as the Wellness Ignorati is, their strategy is to ignore facts, including ones they admit, and they will simply just ignore this posting so as not to create a news cycle, rather than switch claims.

There is also the chance that they admit that their own financial model is accurate. This would demonstrate integrity, a quality historically in short supply in this field.

So vote early (but not often)…



While we aren’t deconstructing this as a sales tool for Quizzify.  But as it happens, Quizzify is literally the only wellness program that does pay for itself.  Don’t take our word for it.  Quizzify is 100% guaranteed to save money and improve morale/engagement–exactly the opposite of what the HERO report says usually happens.  No other wellness program is either, let alone both.

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Quizzify: the antidote to poke-prod-pry-punish wellness

Obama Is Smack In The Middle Of A Brewing Fight Over Workplace Wellness

Shakespeare_Cobbe_portrait_detailThe President is hoisted by his own petard.

“The best evidence suggests that workplace wellness programs based on financial incentives probably don’t work as intended,”

via Obama Is Smack In The Middle Of A Brewing Fight Over Workplace Wellness.

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Healthcare sanity, wherefore art thou?

Employers Should Disband Employee Weight Control Programs | AJMC

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What’s the most common mistake your employees make during doctor visits?

tape-403586_1280From our newly published paper in the American Journal of Managed Care:

There is no published evidence that large-scale corporate attempts to control employee body weight through financial incentives and penalties have generated savings from long-term weight loss, or a reduction in inpatient admissions associated with obesity or even long-term weight loss itself. Other evidence contradicts the hypothesis that population obesity rates meaningfully retard economic growth or manufacturing productivity.

via Employers Should Disband Employee Weight Control Programs | Page.

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