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In this hyperpartisan era, conservatives and liberals agree on only one thing: forcing employees into outcomes-based wellness programs is one of the worst ideas in the history of ideas. If you scroll down our feature In The News, you’ll see wellness gets equal treatment by right-wing publications like Newsmax and The Federalist as well as left-wing publications like Slate and Mother Jones.
Opposing forced wellness has already propelled one candidate into elective office: Matthew Woessner, whose leadership in Penn State’s faculty revolt against the punitive “pry, poke and prod” plan proposed by Highmark and Ron Goetzel, was elected President of the university’s faculty senate. Matthew is a self-described Republican libertarian.
In keeping with the bipartisan nature of wellness, it is fitting that the first Congressional candidate to take on the wellness industry is, conversely, a Democrat, Jenny Marshall. Jenny (as she likes to be called) is running against Virginia Foxx (R-NC5), who chairs the House Committee on Education and the Workforce. A powerful combination of this lucrative committee chairmanship, lack of ethics and a gerrymandered “safe” district (at least until voters find out about this bill), allows Foxx to “represent” the American Benefits Council rather than voters in her district. Indeed, I suspect she has nary a single constituent who supports employees being pried, poked and prodded into submission. It is not at all clear how this bill would benefit her district.
Any controversy over whether forced wellness saves a nickel or even improves health has long since been laid to rest. Hence, the American Benefits Council’s enthusiasm for forced wellness is all about making programs so onerous and unappealing that employees prefer to pay the $1000 fines rather than be subjected to the indignity and potential harms of being pried, poked and prodded by unlicensed, unregulated wellness vendors.
On the other hand, these programs can be very lucrative for employers, who can claw back large chunks of their insurance premiums forfeited by non-compliant employees. Vendors have already figured out how to offer “immediate savings” for employers through collecting these fines from employees.
Unless Foxx’s bill becomes law, this lucrative, misanthropic, anti-employee loophole will be closed December 31, thanks to the ruling in AARP v. EEOC, which will prevent employers from forcing employees into “voluntary” wellness programs.
Foxx’s HR1313, known colloquially as the Employee DNA Full Disclosure Act, would override this common-sense federal court decision. Worse, it would allow employers to force not only employees but their children into these programs. And not just prying, poking and prodding them, but collecting their DNA as well. Yep, your children’s DNA is fair game if this bill passes. It is so onerous that even much of the wellness industry opposes it, though they stand to benefit from it.
It is headed for a floor vote sometime this spring, having been voted out of her committee on — get ready — a straight party-line vote. (So much for the GOP standing for individual rights.)
Jenny Marshall fights back
Jenny has posted a summary of this bill right on her campaign website. Asked for a comment, she replied: “Foxx’s bill could very well be the worst proposed legislation in the history of Congress. Its intrusiveness would make Orwell blush. I can’t figure out why she would want to invade the privacy of her constituents like this, other than raking in big dollars from lobbyists. For too long now, Foxx has turned a deaf ear to the wants and needs of the people of our district, and for that betrayal should be voted out of her seat.”
If this bill passes, the very stable geniuses at “outcomes-based” wellness vendors like Bravo, Interactive Health, Wellsteps, Corporate Wellness Solutions, and Staywell will be able to trample employee rights to privacy, fine them and harm them — for no reason other than to enrich their own coffers, and those of their corporate overlords. Absent this legislation, millions will be thrilled to be freed from their anti-employee jihads on December 31 — and employers can find kinder, gentler conventional programs, a la Redbrick or unconventional ones like Limeade (and/or Quizzify, of course) instead.
The way to keep this bill from passing? Vote Foxx out of office. Shed no tears for her. She will get a lucrative job, possibly representing the American Benefits Council in their quest to collect fines from employees — just like she does now.
Only starting in 2019 her paycheck will come directly from them, as opposed to indirectly, as it does now.
Often I don’t have time to write a full blog in my own words, but fortunately I usually don’t need to. It’s enough to quote the words of the very stable geniuses in the wellness industry verbatim. Being quoted verbatim, of course, is one of these geniuses’ worst nightmares.
Among the most stable of the wellness industry geniuses is Steve Aldana, CEO of Wellsteps, winner of the 2016 Koop Award as well as the 2016 Deplorables Award. How does he report the National Bureau of Economic Research’s complete evisceration of wellness industry research methods? Let’s take a looksee at the highlights of his posting.
First, it appears that two opposing studies, “one for and one against wellness,” came out “at the same time.”
One the one hand, someone — apparently he doesn’t know who — seems to say that there “wasn’t much improvement” at the University of Illinois. And something must have been wrong with this result, because “these results contradict over 90% of publish [sic] studies.”
“At the same time,” a publication no one has heard of found the opposite: health behaviors improved for “over 2 full years” in — get ready — one of Wellsteps’ very own accounts.
This is a textbook example of a false equivalence, the wellness version of: “You also had some people that were very fine people on both sides.”
To begin with, the researchers in the first group weren’t just any old researchers. This was the National Bureau of Economic Research (NBER). And the NBER didn’t say “they didn’t see much improvement.” Their specific words were that the causal effects were — get ready — nearly indistinguishable from zero for nearly every outcome.
Further to say this conclusion “contradicts over 90% of published studies about wellness,” would be like saying Galileo’s findings “contradicted” over 90% of published studies about astronomy.
The study’s actual conclusion used a slightly different verb:
Our 95% confidence intervals rule out 78 percent of previous estimates [of the effect of wellness] on medical spending and absenteeism from the prior literature. [Let me translate that, in case the words are too long for the very stable geniuses at Wellsteps to understand: you and all your very stable friends have been geniusing about savings for decades now.]
The reason the NBER was able to be so conclusive is that, to quote one of our Alert Readers, Robert Dawkins: “They foolishly included a valid control group.” Kudos to Mr. Dawkins for that very unstable moronic observation. (In any event, far from contradicting other research, the study is quite consistent with most articles on wellness not written by someone feeding at the employer wellness trough.)
The other journal, which published an article “at the same time,” found an improvement in healthy behaviors. That journal is called Health Promotion Practice. And if you haven’t heard of it, you’ve got company. Their “impact factor” is the lowest in an industry whose journals are notable for low impact factors. I googled quite extensively, and it appears — get ready — that no article from this journal has ever been cited, excerpted or even had the fact of its very existence even grudgingly acknowledged in the lay or scholarly media.
By contrast, the NBER article has been picked up everywhere — except of course by the wellness industry. See if you can find any reference to this article — or AARP v. EEOC, which was also national news — on the Health Enhancement Research Organization website.
Turns out there’s a reason no one cites this journal. It’s because it’s so genius. Exhibit A is this very same article, a rehash of the Boise School District findings that somehow overlooked the key finding, which is that the employees got unhealthier during Wellsteps’ program. Instead, the author — displaying not the slightest intellectual curiosity as to how this could possibly be true — reports the most genius findings we’ve ever seen in a journal:
- only 3% of Boise School District employees smoke, and…
- …they smoke only 4 days a week.
Perhaps — just playing devil’s advocate here — the other 17% of Boise employees who smoke (Idaho has a 20% smoking rate) might have lied on their health risk assessment? The “tell” is that everybody knows smokers don’t smoke only 4 days a week. Obviously, they smoke 5 days a week, with time off for weekends, major holidays and Beethoven’s Birthday.
Very stable genius that he is, the author (both a friend of Wellsteps’ Mr. Aldana, according to the disclosure statement, and also a genius who has already been profiled on this site for his previous insights) also admits that with a high non-participation rate and a 20% dropout rate:
There exists the possibility of selection or dropout bias that could have influenced the results reported.
Ya think? Maybe just a tiny bit?
But wait…there’s more
We’ve highlighted Mr. Aldana’s phrase “at the same time” describing how these articles were simultaneously published. We repeated the phrase in three separate places above for emphasis because — get ready — these two results were not published at anything like the same time.
To begin with, Mr. Aldana has been very stably geniusing about his Boise results for more than two years now. (See my article from September 2015 accurately forecasting that, thanks to the number of obvious errors and self-immolating contradictions, this study would win a Koop Award. And of course the Boise employees got harmed.)
This article, using that same data set, was published last July, whereas the NBER article just came out a few weeks ago. Perhaps in some geologic sense July 2017 and January 2018 are “the same time,” but imagine if the rest of the world defined “at the same time” as “six months apart.” For instance, let’s join Sherman and Mr. Peabody in the Wayback Machine and set the dial for June 1944:
Eisenhower: “OK, we’ll storm Omaha and Utah Beaches, and you guys can storm Juno and Sword Beaches at the same time, and then we’ll hook up and say…”
Churchill: “…Merry Christmas, chaps.”
For a good time, try googling on Wellsteps.
NY Times’ economists and Pulitzer Prizewinning LA Times columnist skewer “voluntary” wellness incentives
In the immortal words of the great philosopher Dizzy Dean, don’t fail to miss it.
Ever since Ron Goetzel’s Penn State debacle, the news cycle has been the Health Enhancement Research Organization’s (HERO) kryptonite.
To be sure, they have other enemies too — transparency, integrity, math, data, facts, employees, smart people — but those bullets just bounce off them. How do we know this? We think we’re making an impact with our exposes and whistleblowing — and yet forced, incompetent and sometimes harmful prying, poking and prodding continues unabated. When we prove that none of the wellness numbers add up and back that proof with a monster reward for disproving us, they retreat rather than fight — but then they pop up again, whack-a-mole style with yet another claim: “Oh, well, numbers don’t have to add up. It’s all about the value.” Yada yada yada.
That’s why they never respond to anything we ever write, or for that matter anything anyone else ever writes. STATNews, for example, wanted to host a point-counterpoint, but couldn’t find anybody to oppose me. Health News Review posted a podcast with no opposing views.
The one wellness executive who failed to understand the news-cycle-as-kryptonite dynamic was Wellsteps’ Steve Aldana, not exactly a rocket scientist even by the standards of the wellness industry. In an attempt to get his name in the paper, he accidentally admitted that all of Boise’s Koop Award-winning numbers were fabricated. Yes, he humiliated himself, yes, he admitted he lied, yes, he could easily have been charged with defrauding the city…and yet Boise is still Wellsteps’ account.
If they had any lingering doubt, that lesson taught the rest of these people to stay out of the media even if it means taking a few punches.
That brings us to today. I’ve been scouring Google to find someone — anyone — to take the side of the EEOC in what is likely to become an extended news cycle over the definition of “voluntary” for wellness programs. So far, no one has stepped forward to support the EEOC’s and HERO’s argument that “voluntary” can mean “we’ll fine you up to $2000 if you don’t.” Instead, both The Incidental Economist (the NY Times‘ economics bloggers) and the LA Times‘ Pulitzer Prize-winning business columnist, Michael Hiltzik, come down strongly on the side of AARP, Merriam-Webster, Funk & Wagnalls and Dictionary.com.
- In 2015, the EEOC proposed a rule treating wellness programs as “voluntary” if they involved premium differences of no more than 30% of the full cost of a health plan. Worker advocates were aghast — 30% of a full-price premium could amount to thousands of dollars, and since the workers’ share of their health plan premiums often was only 30% or so, the penalty could double their annual costs. For many families, that made voluntary programs effectively mandatory.
- [The judge] observed that the 30% incentive “is the equivalent of several months’ food for the average family, two months of child care in most states, and roughly two months’ rent.” He recognized that a fee of that magnitude could be especially coercive to lower-income employees
- The biggest problem with wellness programs is there’s no evidence that they work. The most frequently cited statistic in their favor came from Safeway, whose claim to have saved on per capita healthcare costs after implementing a wellness program prompted drafters of the Affordable Care Act to liberalize the incentive rules. But Safeway’s story was soon debunked. Other supposed success stories came from wellness program promoters themselves, who were engaged in selling their wares to big employers.
- The rule allowed employers to impose huge penalties on employees who refused to participate in wellness programs, even though the Americans with Disabilities Act says those programs must be “voluntary.”
- In the court’s view, the EEOC had basically ignored the problem in its rulemaking, asserting without explanation that wellness programs backed by enormous penalties were somehow voluntary. I applauded the decision: I’ve been railing against the EEOC for two years now for blessing mandatory wellness programs over the ADA’s express prohibition.
Once again, I’d urge everyone to sign up for the January 18 webinar. There will be more clarity, you can ask questions, and you’ll hear questions from others too. What you won’t hear is a peep out of HERO. Not because we censor or blacklist adversaries (that’s their signature move, not ours — one person reports that HERO took him off the program because he admitted to respecting my work) but because they know better than to, in the immortal words of the great philosopher John Cusack, say anything.
It’s time for the 2017 Deplorables Awards, lovingly bestowed on those vendors who do the best job making other vendors look good.
The good news is that you don’t have to actually win the Deplorables Award to sue me. Runners-up are eligible too. Here is my address for hand-service delivery most of the year:
890 Winter Street #208, Waltham MA 02451
In case you decide to sue me between June 22 and August 8, use:
8 Paddock Circle, Chilmark, MA 02535
And don’t leave out my attorney:
Josh Gardner, GARDNER & ROSENBERG P.C., 33 Mount Vernon Street, Boston, Massachusetts 02108
I don’t know how much more I can do for you, other than lick the envelope. So go for it. Don’t make me beg.
But, remember, unlike your usual business model, in court you are required to actually tell the truth (I would be happy to explain to you how that works), meaning there is no chance of your winning — or likely even avoiding summary judgment, since none of the evidence is in dispute. It’s all your own writings. Oh, and I do my own cross, which means you won’t be able to find an expert witness. Anyone who knows enough about wellness to be an expert witness also knows enough about wellness to know that attempting to defend you would be a humiliating, on-the-record experience.
And there is always the chance that some annoying jerk might blog about it…
The 2017 Runners-Up
Imagine a four-square matrix with competence on one axis and integrity on the other. The people and organizations we’ll be highlighting today would intersect with the companies mentioned in Monday’s posting at only one single point.
Springbuk and Fitbit
As many of you recall, earlier in the year we analyzed the study done by Springbuk that secretly financed by Fitbit. Or maybe I need new glasses, because I just couldn’t find the disclosure in the Springbuk report that this paean to Fitbit was financed by Fitbit, the way Nero used to have the judges award him Olympic medals.
Coincidentally, the study showed Fitbit saving gobs of money because employees taking more than 100 steps a day spend less money than those taking fewer. However, a simple tally of one’s own footsteps shows that it is impossible not to take 100 steps a day unless you are both:
- in a hospital bed; and also
- on dialysis.
This 100 steps-a-day threshold was repeated many times in the study, with no explanation of how that number came to be. However, it turns out we owe these two outfits an apology. Fitbit and Springbuk have told a number of people privately (not publicly, in order to avoid an embarrassing news cycle) that they didn’t really mean to say that 100 steps a day constituted activity. They meant to say that taking 100 steps a day implied you had your Fitbit on. My apologies for failing to read their minds that their conclusions were based on reading people’s minds to determine whether they wore the Fitbit deliberately, or simply forgot/remembered/cared to put their Fitbit on.
They never did explain — privately or publicly or to anyone — how employees who took an average number steps during the baseline year could show huge savings by taking an average number of steps in the study year too.
They also never explained how these two statements didn’t completely contradict each other, even though I specifically asked them to in a personal letter, excerpted here:
Third, can you reconcile this statement…:
“The materials in this document represent the opinion of the authors and not representative of the views of Springbuk, Inc. Springbuk does not certify the information, nor does it guarantee the accuracy and completeness of such information.”
“This demonstration of impact achieved by integrating Fitbit technology into an employee wellness program reinforces our belief in the power of health data and measurement in demonstrating ROI,” said Rod Reasen, co-founder and CEO of Springbuk.
National Business Group on Health
Next up is the National Business Group on Health. Last year they made the list for criticizing the US Preventive Services Task Force for not demanding enough screenings, in a country that is drowning in them. Not content to rest on those laurels, this year they earned an Honorable Mention for inviting Dr. Oz to keynote on the role of quackery in corporate wellness, and perhaps tell us about his latest lose-weight-by-eating-chocolate miracle diet.
HERO of course also earns a runner-up award. 2017 will be remembered as the year they finally came to grips with the realization that a business model based on fabricating outcomes requires that perpetrators possess that critical third IQ digit. Without that extra “1”, an organization trafficking in math that can at best be considered fuzzy is going to be outed.
This year’s set of lies? By way of background, their 2016 poison-pen letter insisted they had fabricated that data set showing that wellness loses money without disclosing that it was fabricated — and also never reviewed their fabricated data before publication. Early in the year, I had the insight that, wow, this “fabricated” Chapter in their guidebook is so much better than the other chapters that something is amiss. No one at HERO can analyze data competently…and yet, here it was, a competent data analysis.
I did something I had never thought to do before, which was look up the actual author of that chapter. It was Iver Juster MD. He was a great analyst even before he read all my books, took all my courses, and achieved all my certifications in Critical Outcomes Report Analysis.
- Whereas Paul Terry and Ron Goetzel had insisted that Iver fabricated the data, Iver said, of course he didn’t — whatever made me think that? (“If it wasn’t real, I would have disclosed that,” he observed. Of course he would have. Iver has tremendous integrity.)
- The Board discussed and reviewed his chapter at length, and made helpful suggestions, for which he was quite grateful. This review process required “countless hours,” just as the HERO document says:
The number of transparent lies HERO tells could make a president blush. In the immortal words of the great philosopher LL Cool J, they lied about the lies they lied about.
Even though 2017 was an off-year for them in terms of the number of lies, they still told enough to be named a runner-up.
Wellness Corporate Solutions
Next is Wellness Corporate Solutions, famous for its crash-dieting contests. WCS now offers a water-drinking contest. The idea is to set up a “challenge” for your team to drink more water than other teams. They call this a “healthy competition.” I guess they didn’t get the memo that forcing yourself to drink when you don’t want to drink, just to make more money, is anything but healthy. Here is a novel idea: drink when you are thirsty. Evolution 1, WCS 0.
Perhaps as an encore, WCS, Dr. Oz and the National Business Group on Health could team up to offer a chocolate-eating contest.
I looked into this outfit to see where they get their ideas. The CEO previously ran something called the Washington Document Service. That qualifies her to run a wellness company. As Star Wellness says, to run a wellness company successfully, your background needs to be in sales, or “municipality administration.” After all, what is more central to administering a municipality than documents?
What fun would a list of runners-up be without Wellsteps, the proud recipient of the 2016 Deplorables Award? While their streams of consciousness weren’t as memorable in 2017 as in 2016 (“It’s fun to get fat. It’s fun to be lazy“), they get credit for trying. Their 2017 weight-loss campaign was headlined: “This campaign is not really about weight loss, it is about helping you apply the behavioral secrets of those who have lost weight.”
So if your kids ever want you to teach them how to ride a bike, say: “It’s not really about riding a bike. It’s about helping you apply the secrets of people who have ridden bikes.”
And what secrets are we talking about? What person who has lost weight doesn’t brag to everyone or even write a book? If there is a secret to weight loss, like eating chocolate, Wellsteps owes it to the country to tell them. Don’t make us beg.
Odds and Ends
No Koop Award winner this year, but an honorable mention to past winners and runners up for their commitment to wellness:
Sounds like in 2018 the logical winners would be Philip Morris, or maybe The Asbestos Corporation of America.
Veering briefly into the public sector, kudos to Representative Virginia Foxx, (R-NC5) for introducing the Required Employee DNA Disclosure Act. Even HERO thought it was a dumb idea…and their threshold for thinking something that increases wellness industry revenues is a dumb idea is quite high, having all rallied behind the Johnson & Johnson Fat Tax, in which companies would be required to disclose the weight of their employees.
Next up…the winner of the 2017 Deplorables Award
As almost everyone in the wellness industry knows, we have offered a $2 million reward to anyone who can show that conventional annual “pry, poke and prod” wellness saves money. I’m feeling very generous today, what with the holidays upon us, so let’s make the reward $3 million.
Even more importantly, let’s loosen the rules — a lot — to encourage applicants. You’ll find the $3 million reward is not just more generous, but also far easier to claim than the previous $2 million reward.
Loosening the Rules
Except as indicated below, the rules stay the same as in the previous posting, but with the following relaxed standards. Most importantly, I’ll now accept the burden of persuasion. It is my job to convince the panel of judges, using the standard civil level of proof, that you are wrong, as opposed to you having to convince them that I am wrong.
Next, let’s expand the pool from which the judges can be drawn. It wasn’t very nice of me to allow you to choose from only the 300 people on Peter Grant’s exclusive healthcare policy listserve, since obviously no one invited into a legitimate healthcare policy listserve thinks wellness saves money.
In addition, you can also choose among the 150+ people on Dave Chase’s email list and the 70 people on the Ethical Wellness email list. (www.ethicalwellness.org) And to make it totally objective, we will add as judges whatever two bloggers happen to be the leading dedicated lay US healthcare economic policy bloggers at the time of the application for the award, as measured by the ratio of Twitter followers-to-Twitter-following, with a minimum of 15,000 followers.
So judges are chosen as follows: two bloggers chosen by objective formula, plus we each choose six people from among the other 520, with the other party having veto rights for 5 of them. That gives a total of 4 judges, who will choose a fifth from among those roughly 500 people.
This means I only name one of the five judges, so I can’t “stack the deck,” not that I would need to.
The original rules included the requirement of defending Wellsteps’ Koop Award. After all, the best vendor should be exemplary, right? A beacon for others to follow? A benchmark to show what’s possible when the best and brightest make employees happy and healthy?
However, now you have another option. You could instead just publicly acknowledge that the Koop Award committee is corrupt/incompetent, since that possibility cannot be ruled out as a logical explanation for Wellsteps winning that award. Your choice, but, one way or the other, the Wellsteps award must be addressed in your entry.
Next, you may bring as many experts with you to address the adjudication forum (a Washington, DC venue to be chosen later) as you wish to bring. I, on the other hand, will be limited to myself.
Further, you no longer have to defend the proposition that wellness as a whole has saved money. You can, if you prefer, simply acknowledge that most of it has failed…except you. Meaning that, if you are a vendor that has been “profiled” on this site in the last 2 years, you can limit your defense to your own specific results. You don’t have to defend the swamp.
That new loophole allows companies like Interactive Health, Fitbit, Wellness Corporate Solutions, etc. — and especially Wellsteps — to get rich…if what I have said specifically about them is wrong. I have $3 million that says it isn’t.
Special Offer for HERO
Ah, yes, the Health Enhancement Research Organization (HERO). The belly of the beast.
Let me make them a special offer. Paul Terry, the current HERO Prevaricator-in-Chief, has accused me of the following (if you link, you’ll see they had enough sense not to use my name, likely on advice of counsel, given that I already almost sued them after they circulated their poison pen letter to the media):
I’m convinced responding to bloggers who show disdain for our field is an utter waste of time. I’ve rarely been persuaded to respond to bloggers [Editors note, in HERO-speak, “rarely” means “never” — except for that intercepted Zimmerman Telegram-like missive], and each time I did it affirmed my worry that, more than a waste, it’s counter-productive. That’s because they’ll not only incessantly recycle their original misstatements, but worse, they’ll misrepresent your response and use it as fodder for more disinformation.*
Tell ya what, Paul. let’s debate disinformation, including your letter. Aside from the standard 10% entry fee (used to pay the judges honoraria, reserve the venue, and compensate me for wasting my time with your THC-infused quixotry), all the economic burden falls on me.
The only catch: I have asked you on multiple occasions to clue me in as to what my alleged disinformation actually is, if any. That way I can publicly apologize and fix it, should I choose to do so. Before applying for this award, you need to disclose this alleged disinformation. You can’t just go around saying my information is made up etc. without specifying what it is.
By definition, “disinformation” is deliberate misrepresentation. To my knowledge, as a member of the “integrity segment” of the wellness industry, I have never, and would never, spread disinformation.
On the other hand, if I did spread inadvertently incorrect information by mistake, it seems only fair to let me fix it — especially given that I have been totally transparent and generous with my time in explaining to you what yours is, and how to correct it. (I might have missed some. Keeping up with yours is a challenge of Whack a Mole-meets-White House press correspondent proportions.)
So perhaps it is time to man up, Mr. Terry. You and your cronies claim to have been collecting my “disinformation” for years, without disclosing any of it. I’m offering you a public forum and $3-million to present it…with only one of 5 judges on “my” side.
Otherwise, perhaps you should, in the immortal word(s) of the great philosopher Moe Howard, shaddap.
A couple other mid-course corrections to the previous award offer. Someone wondered if this offer is legally binding, so if your attorney’s knowledge of contract law matches your knowledge of wellness economics, they can voice their likely spurious objection. I will publish the objection and address it if need be, to make the reward a binding offer.
And as mentioned, to close the original thread, Happy Holidays to one and all.
*As a side note, Mr. Terry writes: “We’re fortunate to work in an industry with a scant number of vociferous critics.” This “scant” number appears to include the entire media — left-wing, right-wing, centrist, and health policy. Apparently also most employees, according to Towers Watson. The good news about “pry, poke and prod” is that it truly bridges the partisan divide, in that everyone hates it.
Update February 20, 2018:
One of the very stable geniuses in the wellness industry has decided that the reason no one applies for this award isn’t that they know they’ll lose. It’s because a reward isn’t a valid offer. We would invite them to read this link.
Update March 19, 2018:
The new entry process is:
- Applicant puts $3000 into escrow (bank escrow fees to be 50-50 shared once escrow is completed), at which point an NDA is signed and I show tangible net worth (excluding primary and secondary residences — and any retirement accounts are accounted for net of tax penalty for early withdrawal) more than sufficient to pay the reward. Applicant may either go forward at this point, or forfeit the $3000 to me.
- Applicant adds $27,000, at which point a lien is placed on earning assets exceeding $3,000,000 as valued at at lower of cost or mark-to-market (and/or they are placed in escrow, and/or title is changed to the escrow agent). If I fail to provide that lien within 60 days, I pay a “liquidated damages” penalty of $100,000. The applicant is released from the NDA and may announce that I failed to deliver and they won by default. Assuming the $3,000,000 is sufficiently secured and the “liquidated damages” provision is not triggered, applicant may either go forward, or forfeit the $30,000 to me.
- Applicant adds $270,000 to the escrow, at which point the entry process is completed, and the reward process begins.
Included in this concluding batch is yet another wellness program debacle regarding eating disorders. The irony is, this one takes place at an addiction facility. I’ve always maintained that, along with facts, integrity, math, data, employees and me, another thing the wellness industry has no appreciation of is irony. Examples:
- The most recent Koop Award for the best wellness program went to Wellsteps, who according to their own data made employees worse;
- Vitality pitches its weight-loss program even though by their own admission they couldn’t get their own employees to lose weight;
- The wellness industry’s own trade association, whose job is to show wellness saves money and improves morale inadvertently admitted that wellness loses money and damages employee morale.
This final set of case studies concludes with a statement from an actual named, LCSW who specializes in the treatment of eating disorders.
Links to previous installments:
- Part 1: Recovering executive with anorexia nervosa begs not to be weighed…DENIED
- Part 2: Recovering technologist with bulimia told to “fit into his skinny jeans”
- Part 3: Recovering employee with anorexia nervosa told “nothing tastes as good as skinny feels” and advised to eat only half her lunch.
- Part 4: Recovering employee with bulimia and a severe grain allergy penalized for eating too many natural fats, as correctly prescribed by her dietitian…and begins purging again.
The school where I work recently instituted a wellness program. In order for our insurance premiums to not increase, we had to go through a series of tests: total cholesterol, blood pressure, BMI, LDL cholesterol and fasting glucose. If we did not “pass” 4 out of 5 of these biometric screenings, we had to go through six weeks of phone therapy and then have the screenings done again after that time.
If, after the six weeks of phone therapy, the results did not change, our insurance would go up about $50.00/month.
The whole experience was a nightmare. They conducted the screenings in the music room at school, with different tables and stations set up. About 10 or 12 teachers and staff members were in the room at one time, so there was little privacy.
We moved from one station to the next as each of our results was written down and passed to the next person.
When we got to the end, a wellness “counselor” went over our results. The lady saw my triglycerides number and immediately asked, “Does diabetes run in your family?” “Is obesity an issue in your family?” I asked why. She said that a high level of triglycerides means that the body has “too many fat cells” and that I am at an “increased risk.”
To someone who has struggled with an eating disorder, as I have, this was tantamount to saying “Because of your high triglycerides, you are fat. You are obese.”
Being weighed is always a humiliating and shameful experience for me, as it is for many people with eating disorders, and it can trigger exacerbations of my disorder (treating professionals familiar with eating disorders are well aware of this phenomenon and structure treatment accordingly). To have to be weighed in front of my peers made that experience even worse.
This biometric screening triggered my disorder. I was in tears by the time I got to the last “counselor” and had a very hard time controlling my feelings. Right after this, I needed to get into my classroom and be with my kids. I had to “suck it up,” until the end of the day.
It was horrible and it makes me wonder what is in our future in regard to all of this.
My workplace, an addiction treatment facility, has an employee “wellness” program.
If employees want to obtain the insurance “wellness rate” (the lower of two rates available to employees), we are required to start every year in January with a “health fair” and a “know your numbers screen” where they check weight, blood pressure, glucose levels and cholesterol. Then we are “advised” by a registered nurse to exercise more and eat less (as if that had never occurred to anyone previously).
This year, the medical assistant drawing my blood engaged in numerous behaviors that would trigger most people with an eating disorder. She informed me she “used to be as big as” I am until she “got bypass surgery.” Despite mentioning several times that I see a nutritionist who recommends that I not weigh myself or know my weight, I was asked to guess my weight before I stepped on the scale. I turned around when I stepped on the scale to avoid seeing my weight, but the assistant nonetheless chattered on about my weight.
I was reminded of embarrassing weigh-ins with school nurses and weight loss programs before I was exposed to eating disorder recovery.
This year we are also assigned to a “wellness team” where everyone is supposed to wear pedometers every day and log their steps weekly on a website. Everyone can see everyone else’s steps on the site and a competitive spirit is encouraged.
I am especially saddened and concerned that we have this potentially damaging environment that encourages obsession with weight and numbers in a facility that treats addiction, where one would hope we would be steered away from, rather than toward, the process of addiction to disordered eating.
I have worked with hundreds of patients over the 13 years during which I have worked with people with eating disorders. In the past two years, I have seen a number of patients who were quite negatively impacted by the wellness programs at their place of work.
In one instance, a patient with binge eating disorder reported that she would be financially penalized if she didn’t set weight loss as a goal and make progress toward this goal. However, this was in direct conflict with her treatment goals to stabilize eating and set any goals for weight loss aside. This patient could see how focusing on weight loss increased her binge eating; however, she felt shame and anxiety as a result of these pressures put on her by her employer. She did not feel that as a larger-sized person she could speak up about this injustice.
In another instance, a patient reported that her employer required her to complete a health screening or be charged $600.00, and when she didn’t meet the health targets she was given an opportunity to still get the monetary “rewards” by meeting with a dietician three times. She was also informed that she could get a “Healthy Weight Improvement Reward” by losing five pounds since her last health screening. Again, this is a patient with binge eating disorder whose condition is destabilized by focusing on weight loss. She too felt that as a larger-sized person she could not speak up about how this program could cause her harm.
Next week, and with the help of others, we will ask, what does this all mean? What can be done to prevent or discourage wellness vendors from harming employees?
And once again, kudos to the good guys, the vendors who are not implicated in this series at all, and indeed would never do such things to people:
American Institute of Preventive Medicine, Health Advocate, HealthCheck360, It Starts with Me, Limeade, Redbrick, SelfHelpWorks, Sterling, Sonic Boom, Sustainable Health Index, US Health Centers, US Preventive Medicine
You have to read this all the way through because, in breaking with long-established precedent (which needless to say is recounted in loving detail), in 2017 the Koop Award Committee — wait for it — did the right thing.
In 2017, 3 companies applied for a Koop Award. This is down from a peak of 21, and represents the belated recognition on the part of wellness vendors that it simply isn’t mathematically possible to satisfy the requirement of saving money. Thankfully, one of the best attributes of math is that it’s true whether you believe it or not.
Many an employer has won an award, only to learn later — via the media — that their vendor had fabricated the savings. This litany might explain the slight reticence of vendors to shine a light on their own programs:
- Wellsteps: “Top Wellness Award Goes to Workplace Where Many Health Measures Got Worse,” STATNews
- McKesson: “Wellness ROI Comes under Fire,” Employee Benefit News
- Health Fitness Corporation:”Nebraska’s Acclaimed Wellness Program Under Fire,” Omaha World-Herald
An example of what transpires when employers find out they’ve been snookered would be McKesson. If the name “McKesson” sounds familiar, it’s probably because you saw 60 Minutes the other night explaining how drug distributors including McKesson facilitated the opioid crisis.
The good news is, illegally trafficking in opioids doesn’t disqualify a company from winning a wellness award. Is this a great country or what?
Once McKesson got wind that Employee Benefit News was going to publish an expose on how they got snookered, they called in a consultant, not to investigate how they got snookered but rather to mount a coverup. The consultant “clarified” to Employee Benefit News — in lay terms that any fifth-grader could understand — how, among other things, employees’ weight could go down and up at the same time:
“Health indicators in 2013 and 2014 were adjusted in the analysis, while several sensitivity analyses of the ‘inter-individual’ impact that used a matching approach confirmed the results.”
Silly me! Of course weight can go up and down at the same time!
McKesson was not exactly copacetic about this coverage. Here is the reaction of McKesson’s wellness program champion to my analysis, as reported to me:
“I wish you could have been in the room when I questioned the architect of that whole program. I’ve never unintentionally pissed anyone off that much. Red faced and table pounding, it was a moment! He retired 3 days later. Coincidence?”
Next, consider last year’s award, bestowed upon their Wellsteps buddies. Wellsteps (motto: “It’s fun to get fat; it’s fun to be lazy”) is the kind of company that gives cronyism a bad name…but they were overdue for the award, never having won one despite their years of service on the Awards Committee.
Sure, Wellsteps harmed employees, but harming employees has never been a deal-killer for a wellness award. Ron Goetzel observed that employees en masse becoming sicker — both objectively and according to their own self-assessment — only meant that the program did not “[go] exactly right.” By that logic, the Vietnam War did not go exactly right either.
The 2017 Awards
No one won in 2017. The Committee deserves great credit for getting it right this year, finally albeit belatedly acknowledging that it is indeed impossible to get a positive ROI by screening the stuffing out of your employees. So kudos to them!
Instead, they gave “honorable mentions” to the three applicants: Delta Airlines, IDEXX Labs, and Pepsico. I’m sure all three deserved their —
Whoa! In the immortal words of the great philosopher Meat Loaf, stop right there! Come again? Pepsico? That Pepsico?
If one excludes the total debacles at Penn State, Nebraska and Boise — Pepsico runs the single most-pilloried wellness program in history. It was the subject of a Health Affairs article showing massive losses on its wellness program. These losses, massive as they appeared, were likely understated. I was the peer reviewer, and I passed it rather than make the author do more work, because I thought it was more important to get the word out there promptly than to make him recount every single stupid thing they did.
Pepsi’s Latest Innovation
In all fairness to Pepsico, maybe they do deserve at least a “most improved” award, because now you can buy Pepsi made with real sugar. This is a good thing, according to their announcement, even if the people who run their wellness program disagree. One can only imagine what a beleaguered Pepsico employee’s Outlook calendar looks like:
Perhaps McKesson’s consultant could explain this to us.
Delta and IDEXX
I can’t really comment on the other two because none of the four flight attendants I talked to at Delta had any familiarity with their program beyond the basics (“Yeah, I think if you fill out a form and go to the doctor, you get a discount on insurance or something like that”), while IDEXX doesn’t use vendors connected with the Awards Committee and doesn’t make up savings. To bestow an outright win in that situation would go against all precedent, so IDEXX should be happy with their honorable mention.
Theirs is a fitness-based program that deserves a closer look, as a model for what a wellness program should look like. I hope to do that someday.
And perhaps IDEXX is a harbinger of things to come, where wellness is done for employees and not to them, wellness vendors don’t lie about savings, and they endorse and agree to adhere to the Employee Health and Wellness Code of Conduct.
Otherwise, for the wellness industry, there might be trouble on the horizon.