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A vendor’s guide to snookering self-insured employers

Dear Wellness, Diabetes, Clinic, Price Transparency, and Medication Therapy Management Vendors,

While most of you already know the majority of these tricks, there might be a few you haven’t deployed yet. So take good notes.

Sincerely,

Al Lewis

PS If you are an employer, just pass this along to your vendors…and watch your savings skyrocket. Or use “An Employer’s Guide to NOT being snookered” to see your savings become realistic.


Best practices for every vendor

Compare participants to non-participants. Using non-participants as a control for participants allows you to show massive savings without doing anything. This is not an overstatement. Here is a program — which naturally won an award for its brilliance from Ron Goetzel and his friends before I observed that they were a fraud according to their own data– that did just that. They separated participants from non-participants but didn’t bother to implement a program for two years—by which point the participants had already improved by 20% vs. the non-participants — without even having a program to participate in. (Note on this slide that the control and study group were set up in 2004 but the program didn’t start until 2006, when the cost separation had already reached the aforementioned 20%.)

Two other observational trials support this conclusion. Most recently, the National Bureau of Economic Research ran a controlled trial to test exactly this hypothesis. Sure enough, like the three observational trials, they found that virtually the entire outcome in wellness can be explained by that popular study design itself, rather than the intervention.

In any participation-based program, ignore dropouts. Assume that employees who drop out do so randomly, not because they are discouraged by their lack of progress or interest.

Draw a line upwards and then claim credit for the “savings” between the actual upward spending and the “trend” you drew. As Optum’s Seth Serxner stated so succinctly: “We can conclude that the choice of trend has a large impact on estimates of financial savings.”

Start with the ridiculously high utilizers, high-risk people, or people taking lots of drugs. Let the group regress to the mean, and then claim that as savings.

Never admit, like Wellsteps did, that you are familiar with regression to the mean, since most employers are not aware of it.  The higher the costs/risks of the original users, the more savings you can claim. Here are two verbatim claims:

  • A heavy equipment manufacturer found high use of the ER was a becoming a cost concern, so it send mailings that showed appropriate care settings to the homes of members with two or more visits to the ER in the past year. As a result, ER visits were down 59 percent those who got the mailing.
  • A pharmaceutical company saw a spike in ER claims was coming from repeated use by the same people, so two mailers were sent: one to households with one ER visit in the past year; another for those with two or more visits. Following the mailings, there was a 63 percent drop in ER visits.

Pretend not to notice that low utilizers can show an increase in utilization — or especially that low-risk people can increase in risk. Focus the mark (I mean, the customer) on the high-risk people who decline in risk. Never draw graphs to scale, or your customer might notice that 2/3 of their employees are low-risk in the first place.

Cigna chart

It doesn’t matter what your intervention is. Claim credit for the entire difference in trend. For instance, in this example, Community Care of North Carolina claimed credit for a huge reduction in PMPM costs for babies for their medical home program…but babies weren’t even included in the program. (Neonatal expenses didn’t decline either.)

Or do what Safeway did, launching the wellness craze: change to a high-deductible plan, and transfer a large chunk of costs to employees. Don’t even bother to institute a wellness program, but attribute all the savings (from the transferred deductible spending) to wellness anyway, so that you get invited to the White House.  And after that blows up on you, demonstrate that your very stable genius investment in wellness was not a fluke by investing your company’s money in Theranos.


Special Instructions for transparency tool vendors

Assume that every employee who uses your tool is looking to save their bosses some money, rather than (for instance) to find the closest MRI…and that none of them would have used a lower-cost venue absent your tool.

If only 10% of employees use your transparency tool, and only 10% of events are shoppable, nonetheless take credit for the entire difference in trend across the board, and ignore the literature showing online price-comparison tools don’t work.

If people who haven’t met their deductible shop more than people who have, attribute the former’s lower cost to use of the tool, rather than to the fact that by definition people who don’t meet their deductible spend less than people who blow through it.

Special instructions for wellness and diabetes vendors

If you are a wellness or diabetes prevention/management vendor, never ever let employers know that every year since statistics have been kept, fewer than 1 in 1000 employees/dependents end up in the hospital with diabetes.  (And another 1 in 1000 with a heart attack.) Always tell them how many employees are at risk and how many “newly discovered conditions” they have, and how they will all end up in the hospital, even though hospitalizations for heart attacks and diabetes in the employer-insured population have been declining for years.

Wellness vendors should always put the trivial percentage reduction in risk (for participants only, of course – and ignoring dropouts) on one page and the massive savings on another page. Most employers won’t bother to do the math to notice, for example, that Interactive Health claimed $50,000 in savings for every employee who reduced one risk factor, while the state of Nebraska won an award for claiming to save $20,000+ for every risk factor reduced, as did Staywell for British Petroleum.

If you didn’t reduce risk factors, present your outcomes in a format no one can make heads or tails of, like this one, from Wellsteps. If Wellsteps was able to snooker an entire committee of self-anointed outcomes experts to win an award for program excellence, surely you can snooker a few customers.

Claiming people lose weight is a big part of your outcome reporting, so make sure to do the following:

  1. Never count nonparticipants, and ignore dropouts.
  2. Don’t do any long-term follow-up to see who regained the weight (most participants)
  3. Give them time to binge before the initial weigh-in

Special instructions for diabetes vendors

In addition to measuring on active participants only, raise the bar for Hb A1c so that only people with high Hb A1c’s can be included. That belt-and-suspenders approach will ensure that you can’t fail to show savings, even if (as is likely the case) you don’t change anyone’s behavior other than the employees who were going to change anyway, which you might as well count.

Next — most diabetes vendors and a few wellness vendors have already figured this out — you can charge much more if you can submit claims, rather than just be an admin expense line item. You see, most employers focus much more on the 10% admin expense than they do the 90% medical expense, which they consider to be beyond their control.  Your claims expense – which would draw attention to itself as an admin cost — won’t get noticed in the 90% of medical losses, sort of like the dirt from the tunnel sprinkled around the Stalag in The Great Escape.

Special instructions for medication therapy management vendor

Only mention “gaps in care” that you close, not the ones that open up. And, as noted in the chart below, always use percentages. So in this chart (provided by one of the major PBMs), they claimed that twice as many gaps were closed (37%) vs opened (18%), and yet, as is almost always the case with MTM vendors, nothing happened to the total number of gaps, which remained at exactly 820:

 

Tally all the employees who were on large numbers of meds and now take fewer. But don’t mention all the employers who were on fewer meds and now take more.


What to do if you’re asked why you aren’t validated by the Validation Institute

Here are the most popular answers to that question:

  1. No one has asked us to. (Quizzify didn’t need to be asked.)
  2. We hired our own outside actuarial firm to validate us, and they concluded we save a lot of money.
  3. Sure, we’ll get validated as soon as you sign the contract.

 

Wellsteps stumbles into the truth

Seems like half our postings involve three vendors. These three very stable vendors — Interactive Health, Bravo and Wellsteps — constitute the wellness industry’s “Axis of Genius.”


 

In a recent video that we urge everyone to watch, Steve Aldana of Wellsteps (proud recipient of the 2016 Deplorables Award) recently admitted that “wellness is the most researched topic in healthcare.”

He is absolutely right about that. There are dozens of studies showing that wellness loses money and often harms employees.

And he would know because he has produced a ream of research showing that Wellsteps’ very own program is arguably the worst program on the planet. I say “arguably” because Wellsteps’ Boise program may not be the worst program on the planet. It is only the worst program on the planet according to its own documented findings.  I never thought I would say this, but I applaud Mr. Aldana! His willingness to tell the truth is admirable.

Funny thing about the wellness industry. Every other industry’s “research” always make their product look good. For years, cigarettes were safe–according to the tobacco industry. The oil and gas industry often publishes research showing there is no global warming.  And Monsanto executives are probably the only people on earth who think Agent Orange is harmless.

Sure, critics can and do “challenge the data” those other trade groups publish, but to the credit of those organizations, at least they don’t accidentally disprove their own message in their own “findings.”

Quite the opposite in wellness. About 40 seconds in, Mr. Aldana says: “Critics of the wellness industry say that the studies are flawed.” No, Mr. Aldana, we are not accusing you of being “flawed,” or even of lying. We are accusing you of telling the truth, for once. The wellness industry is unique in that its own data is its own worst enemy.  Remember the saying: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”

While he showed great integrity by reporting the Boise outcomes accurately (and even exposed his results to a wider audience, albeit under duress), that display of integrity turns out to be out of character. Alternative fact-tellers need to have long memories, and his is apparently quite short. When he first reported the financial results, he made the impossible claim that Boise’s healthcare costs fell by a third, due to his forced wellness program even though flouting clinical guidelines and giving out questionable advice also caused a 20% increase in risk factors:

But his report was so long that by the time he got to the end of it, he had completely forgotten this alleged savings claim…and accidentally admitted costs actually increased. (He later suppressed the latter finding, but I always anticipate cover-ups by wellness vendors so I take screenshots before posting anything. It’s been said that the beginning of the end of “pry, poke and prod” was the day a millennial taught me how to capture a screenshot.)


Yes, you might note, the participants did marginally better than the non-participants (though the latter seem to have the momentum). And that brings us to his next claim in the video, where he laments the lack of randomized clinical trials. Actually, there have been two, the most recent one highlighted in the New York Times recently.  And, yes, of course, they show “pry, poke and prod” has no impact. The NYT article specifically demonstrated that participants-vs-non-participants is an invalid methodology that will always show savings even if nothing happens.  A vendor called Newtopia also did an RCT…and showed the same thing. 100% of savings was caused by the act of separating the two groups based on motivation…and when you re-combined them, there was no savings.

The wellness trade magazine had also previously admitted this, though as noted Mr. Aldana has a short memory.

Mr. Aldana closes by claiming that if I am right about wellness losing money, then all these CEOs and CFOs who still think it saves money are “idiots.”  Well, if he says so. And this is not the first time he has dissed his own clients. When he was caught flouting clinical guidelines, he claimed his customer made him do it.

This statement — that “we must be right or else we would have been outed before” — is akin to Paul Manafort’s original defense to tax fraud charges: “If he was committing such large-scale fraud, why didn’t the IRS audit him?” Manafort’s attorney quickly backed off that defense. Like Paul Manafort and the IRS, the only thing that a company still using one of these vendors in the “Axis of Genius” proves is that the wellness industry excels in snookering them.

Please feel free to email a colleague about Mr Aldana. Not because we are asking you to, but because he is:

 

Wellsteps Presents a Confederacy of Wellness Vendors

When a true genius appears, you can know him by this sign: that all the dunces are in a confederacy against him.

–Jonathan Swift


If this list looks familiar, it’s likely because it largely coincides with finalists for the Deplorables Awards.  One exception would be Keas, though. They’re on Wellsteps’ best vendor list even though they no longer exist, likely victims of their own stupidity.  I will miss them though — if laughter were the best medicine, they would be the best vendor. You would, however, be better off contracting with a vendor that didn’t exist than with Wellsteps — at least your employees wouldn’t get worse.

Likewise, Provant is no longer with us. They drank themselves to death. (Water, that is — they insisted every employee drink 8 glasses a day.)

The law of averages did catch up with Wellsteps, though. They listed US Preventive Medicine, whose outcomes, almost uniquely in the wellness industry, are validated by the Validation Institute.

A couple of other quality vendors are listed too. I asked one how they got mixed up with these people, and he replied that he had no idea how they got on that list. Another vendor thinks the point of the list is to help Wellsteps with SEO, on the theory that these vendors, to show off this award, will link to Wellsteps, thus raising Wellsteps’ Google ranking. Let’s see how that’s working out for ’em:

Likely Google ends up this way because no self-respecting, honest, vendor would deliberately link to Wellsteps. If they put Quizzify on this awards list, Quizzify would send a cease-and-desist letter. It would be a worse stain on Quizzify’s reputation than winning a Koop Award.

Another thing the Koop Award has in common with Wellsteps: Channeling Nero, they both bestow awards upon themselves. Look closely at that list: one of the best vendors named by Wellsteps is: Wellsteps.

One other observation: the very stable geniuses on the Koop Award Committee — which loves to give its board members and sponsors awards — are largely also mixed up with the Health Enhancement Research Organization, known as HERO. HERO rhymes with Nero. Coincidence? I think not.

This is the second time Wellsteps has published this list. Since the list is unchanged, our write-up can be unchanged too. Below is the write-up from the first time they pulled this caper, the first Sunday in November of last year.



Wellsteps’ Steve Aldana has “endorsed” a confederacy of 25 wellness vendors, including his own company, Wellsteps.  Alas, in the world of the Welligentsia, in which an increasing number of employers reside, an endorsement from Mr. Aldana earns about as many points in a vendor selection process as neat handwriting.

There are usually not enough hours in a week to both do my Day Job running a fast-growing company (Quizzifywhich plenty of thought leaders have endorsed, so we don’t have to endorse ourselves), and also play wellness-meets-whack-a-mole with the Wellness Ignorati. Fortunately, this week does have enough hours, thanks to the time change.  (The wellness industry is lucky that “falling back” is not a regular occurrence.)

wellsteps-confederacy

I haven’t heard of many members of this confederacy, but I’ve heard more than enough about the ones below. Each link takes you to our own “endorsements.”


Keas Meets Lake Wobegon: All Employees Are Above Average (in Stress).  This is the best argument for requiring that wellness vendors attain a GED.

Provant: “In the Belly of the Beast” A nine-part series that one line can’t do justice to. We would simply note that you do not have to drink eight glasses of water a day. Indeed, you probably shouldn’t if you expect to get anything else done.

Staywell’s Wellness Program for British Petroleum is Spewing Invalidity.  It wasn’t just that their savings claim was mathematically impossible. That’s just the threshold for wellness savings claims. Staywell also somehow saved BP 100x as much as Staywell’s own website says is possible. And because they have a “special relationship” with Mercer (meaning they pay them), Mercer “validated” this fiction for BP, at BP’s expense…

Staywell and British Petroleum Meet Groundhog Day.  They won a Koop Award. Since Staywell and Mercer are both on the Koop Committee and their results are completely invalid and they are obviously lying, they satisfy all the award criteria.

Total Wellness’s Total Package of Totally Inappropriate Tests.  They could lose their license for subjecting employees to this panoply of US Preventive Services Task Force D-rated quackery, except that in wellness the only license you need is a license to steal from unsuspecting HR directors. This leads to…

Total Wellness: The Best Argument for Regulating the Wellness Industry.  Total Wellness isn’t about to lose this Race to the Bottom without a fight. Watch as they try to out-stupid Star Wellness in their quest for that prize.

US Corporate Wellness Saves Money on People Who Don’t Cost Money.  We call this Seinfeld-meets-wellness, because it’s about nothing: even if you have absolutely no risk factors, these very stable geniuses will still save you a fortune. And someone should also tell them you can’t reduce a number by more than 100% no matter how hard you try.

Virgin Pulse. This outfit acquired ShapeUp, which gives harmful crash-dieting programs a bad name. Don’t take our word for it. It’s in the Pittsburgh Post-Gazette.

Vitality’s Glass House:  Their Own Program Fails Their Own Employees.  These people might have more luck selling you a crash-dieting program if they could get their own employees to lose weight.

Wellness Corporate Solutions Gives Us a Dose of Much-Needed Criticism.  We don’t want to spoil the punchline.


And that brings us to Wellsteps itself, which earns its “endorsement” from its own CEO by making so many appearances on this list that there is barely enough room for the rest of the confederacy. If you only have time for the Executive Summary, this is the one to read. But squeezing it all into one place requires sacrificing the laugh lines, and if there is one thing Wellsteps excels at, it’s providing laugh lines.

Wellsteps ROI Calculator Doesn’t Calculate an ROI…and That’s the Good News.  Watch what happens when Wellsteps meets Fischer-Price. No matter what variables you enter in this model, you get the same result.

Wellsteps Stumbles Onward: Costs Go Up and Down at the Same Time. This isn’t possible even using wellness arithmetic. Eventually Wellsteps solved this problem by simply deleting one of the slides. But because we long ago learned that doctoring/suppressing data is one of the wellness industry’s signature moves, we took a screenshot before we did our expose.

Prediction: Wellsteps Wins Koop Award.  In 2015, I went out on a limb to make this prediction, noting Wellsteps’ perfect Koop Award storm of invalidity, incompetence, and cronyism.

Wellsteps: “It’s Fun to Get Fat. It’s Fun to Be Lazy.” This one was penned by Dr. Aldana’s waterboy, Troy Adams, who apparently during his self-proclaimed “11 years of college” never learned that “fat” and “lazy” aren’t synonyms.  Paraphrasing the immortal words of the great philosopher Bluto Blutarski, 11 years of college down the drain.

Does Wellsteps Understand Wellness?  They are demonizing even the slightest consumption of alcohol, among many other misunderstandings. Shame on me for enjoying a glass of wine on a Saturday night!

The Back Story of the Scathing STATNews Smackdown of Wellsteps and the Koop Committee. This one leads to several other links.

The Koop Committee Raises Lying to an Art Form.  It turns out Steve Aldana is not stupid: he apparently has heard of regression to the mean, but just pretended he hadn’t so he could take credit for it with the Boise Schools, who were not familiar with the concept.

if Wellsteps Isn’t Lying, I’ll Pay Them $1 Million but let’s just say I’m not taking out a second mortgage just yet.


An Honorable Mention goes to another vendor on Wellsteps’ list, in the form of the Don Draper Award, for this advertising gem, aimed at ensuring that even the most stable genius HERO Board member can catch their name:

wellnation


To quote the immortal words of the great philosopher Rick Perry, even a stopped clock is right once a day.* And, yes, on that Wellsteps list there is one standout vendor, US Preventive Medicine. It has validation from the Validation Institute.  As you read their validation, note that while they show an enviable reduction in wellness-sensitive medical events, they don’t claim an ROI. This is testament to the integrity of both USPM and the Validation Institute.


*If you are a regular reader and didn’t find this quote amusing, read it again. If you are a wellness vendor, find a smart person to explain it to you.

 

Wellness as seen by a wellness coach

We’ve posted many times on the subject of wellness as seen through the eyes of employees who have been harmed or just really annoyed. And Slate carried a number of comments from other employees, who said things along the lines of: “I’d like to punch them in the face.”  We also often write about employees who “out” vendors whose advice is truly bad.

Of course, we have also posted on the viewpoints of wellness promoters, our favorite lines coming from the very stable genius Michael O’Donnell, the former Prevaricator-in-Chief of the wellness trade association’s magazine, who contributed the following nuggets:

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

This, on the other hand,  is the first time we’ve posted from the viewpoint of a wellness coach, Barb Ryan Tessari.

Here is her take:

I’ve had an upfront and personal vantage point, but I don’t get an opportunity to share much of what I have learned from the people that I have served. In the wellness industry, the goal is to be able to show a CFO hard dollar proof that the employer’s investment is working, mostly in the form of impersonalized analytical data. The intrinsic value of the work I do with the employees gets watered down to a tick in biometric screening improvements (which doesn’t always translate into an improvement in a population’s overall health) and a summary of what I did last year for their people in two paragraphs or less.

She adds:
I keep up with the trends in the wellness world, but I often don’t relate to the conversation. Sometimes I chuckle -sometimes I just scratch my head. Whether you call it wellness, wellbeing, engagement or whatever, not much of it touches on what I see as the reason people aren’t responding to change and what needs to happen to change it. I find that the strategies for change do not focus on what people need – in the real world. Human connection.

And this is why wellness can be such an epic fail:

Wellness strategies mostly focus on external factors to change behaviors. Of importance is the ability to capture tangible evidence and to automate the process so it is cost efficient and can be sold to large employers. The thing is, the external factors, the “hows and whats,” are the easy part. The reality is, for a large part of the population, the challenges in changing lifestyle behaviors stem mostly from internal factors. It’s the age-old problem of knowing what to do, but not being able to get yourself to do it. But it is so much more complicated than that.

A few observations about what makes it much more complicated and nuanced than wellness vendors would have us believe:

Day-to-day demands of life, technology and environmental influencers are constantly attacking even in absence of a major event going on in an employee’s life. The reality is, too many Americans are exhausted, distracted and their needs and wants for themselves come last. If, on top of everything else their work environment is stressful, unsupportive or they don’t feel important, it exacerbates their situations. There is no escape.

Hmm…So much for Wellsteps claim that employees “are suffering from I-don’t-care-itis.”  It’s just the opposite — employees care about too many things, so sometimes their own needs come last.  (As an aside, I always listen to my father’s stock market advice because in the stock market, the only person whose advice is as valuable as the person who is always right is the person who is always wrong.  So when planning your wellness strategy, listen to Wellsteps!.)


My personal favorite part of Barb’s blog is about sending employees to the doctor. Here are her observations, which closely mirror mine (meaning, of course, they are exactly the opposite of what most wellness vendors would have us believe):
  • ER and doctor visits often lead to expensive testing for chest pains, stomach issues, breathing problems or generalized aches and pains when the underlying cause is extreme stress/anxiety. I know their story. I know their stress. Many doctors don’t even ask the question.
  • Newly diagnosed diabetics (or pre-diabetics) are not sent to nutritional counseling, but instead the doctor prescribes metformin and merely instructs them to stop eating carbs.
  • Some doctors, whether intentionally or unintentionally “fat shame” their patients. I have heard the employees’ stories often, which delays care and certainly doesn’t empower a patient to make changes in self care
  • It seems many primary care doctors specialize in sending patients to specialists. And specialists don’t talk to each other. The focus seems to be to figure out what is wrong within the scope of their practice. There is little “connecting of the dots” to see if one problem could be connected to another. Patients are passed from one specialist to another and the employer and employee are paying the bill – not to mention the loss in productivity.

This is one of the reasons we frequently highlight Interactive Health in these postings — their whole business model is to brag about how many patients they send to the doctor for more tests for “newly discovered conditions.”


There is some good news in all of this — ways that coaches can make a difference and advice for companies currently throwing money away on mass screens and automating results, since one size does not fit all. I’ll let Barb finish telling you the stories.

We interrupt this program…

I have several new posts ready to go — the usual suspects acting out in their usual hilarious fashion — but this is a serious post.

It is time for wellness vendors to stop harassing employees about their weight.

A new article summarizing the voluminous data on the futility and harms of weight-shaming just appeared. It doesn’t contain new data, but rather presents the existing evidence in a clear and compelling format.

This article finds fault in the physician community, but the wellness industry (the outcomes-based companies and their enablers at the Health Enhancement Research Organization (and their enabler-in-chief, Ron Goetzel) is even worse because they tie money to weight loss. They give employees a financial reason to binge before the first weigh-in and then dehydrate themselves and crash-diet before the last one.

This does nobody any good, except of course the outcomes-based wellness vendors — like Interactive Health, Wellsteps, Wellness Corporate Solutions, Staywell, Bravo, Total Wellness, Star Wellness, Health Fitness Corporation and probably a host of others.  And there is a special dishonorable mention for HealthyWage, whose entire business model is corporate crash-dieting contests.

They aren’t going to agree to stop on their own, any more than Monsanto stopped making DDT on its own volition. They need to have it made clear that this behavior won’t be tolerated any more.

Action Steps

A starting point is this linkedin post.  Like it, comment on it, share it.  Once we get to 100 likes and comments, and we’re already more than halfway, I can probably generate media attention.

 

 

https://www.linkedin.com/feed/update/urn:li:activity:6448329478551719936/

 

Is your wellness vendor snookering you? Take this quiz to find out.

Is your wellness vendor snookering you? There are certain facts that vendors are not exactly forthcoming about. This is because facts represent an existential threat to the “pry, poke and prod” industry. See how many facts you know — and how many they’ve suppressed — by taking this quiz.

You’ll earn more points, the closer you are. You don’t have to be exact — and honestly I’d worry about you if you got the exact answers to every question. I’d love you for it, but I’d still worry about you.


  1. 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?

  2. 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.


  3. 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?


  4. Speaking of Ron Goetzel, he said “thousands of wellness programs” fail to get good outcomes. What round number did he claim have succeeded?


  5. 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?


  6. 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.)


  7. 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?


  8. 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?


  9. 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?


  10. Of 1000+ wellness vendors, how many are validated by the Validation Institute?


Answers:

  1. 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.  

  2. 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.

  3. 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. 

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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%.

  9. 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%.

  10. 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.


 

Scoring:

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.

 

Extensive Wellness Industry Expose Reaches Popularity Milestone

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:

Original:

nebraska cancer koop award

Doctored:

nebraska polyps


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.

 

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