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Final installment: 3 more stories of wellness shame and harms

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:

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.

Joan

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.


Katie

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.


Rhonda Lee Benner, LCSW

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.


What now?

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

What if they gave a Koop Award and nobody came?

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:

  1. Wellsteps: “Top Wellness Award Goes to Workplace Where Many Health Measures Got Worse,” STATNews
  2. McKesson: “Wellness ROI Comes under Fire,” Employee Benefit News
  3. 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.

 

 

 

 

 

 

 

 

The following is an unpaid apolitical announcement

We live in an era which can’t exactly be characterized as bipartisan, but every review shows — and as you can confirm by playing the game yourself — all members of every party agree on one thing: Quizzify.

Why? Because employee health literacy is a huge issue. You can’t achieve a culture of health without achieving a culture of health literacy.  And quite literally the only company that addresses it — in an engaging Jeopardy-meets-health education-meets-Comedy Central format, no less — is Quizzify. Literally, the only company of any note. Try googling on “employee health literacy” if you want to see for yourself.

Put another way, why wouldn’t you want to improve health literacy? Is there an argument for keeping employees in the dark, when for about $1 PEPM you could enlighten them? Wiser employees make healthier decisions…and it’s your money they’re making those decisions with.

Or, viewed yet another way, a three-part question:

  1. What is the only expense your employees are allowed to spend unlimited amounts of your money on?
  2. What is the only expense employees can spend your money on without training in how to spend it?
  3. How do your answers to those two questions make any sense in combination, or even individually?

The specific occasion for this posting is a terrific article in Workforce about Quizzify, featuring one of Quizzify’s many valued customers (and such a power-user that Quizzify routinely incorporates her edits into the main question database), Debbie Youngblood of the Hilliard City Board of Education.  While we encourage reading the article in its entirety, here are a couple of tidbits, starting with a quote from Debbie:

“I’ve always felt that there was a need to have more [information] available to people as they go through their stages of life,” she said. “It always surprises me that we expect people to know how to achieve overall well-being. We’ve given them very little opportunity to know, understand and practice the things that might be beneficial…”

She also believes it’s valuable to educate adults on health-related topics because it drives conversation. She sees employees discussing topics and questioning the information gained through their health literacy program.

To summarize…

Employees are talking about Quizzify.  About what they learned, what surprised them, and what they would do differently now. By contrast, employee comments about conventional wellness can’t be repeated in a family publication like TSW. Here are some of the more printable ones.  Oh, yeah, and don’t forget these.  (To be fair, occasionally an employee does benefit.)

Another tidbit in the article describes (in as many words) how Quizzify and Hilliard have morphed “cheating” into “learning.” Employees are encouraged to look up the answers in order to improve their scores. That’s how they learn — which of course is exactly what Ms. Youngblood and Quizzify want them to do. So employees brag about what they’ve learned, whereas in other wellness programs they brag about how they cheat.

Consequently, companies that think they’re creating a culture of health are instead creating a culture of deceit. Call us wacky idealists, but for $1 PEPY (in lieu of the likely much higher fee you are paying now), you could replace that culture of deceit with a culture of health literacy. Why wouldn’t you?


Disclosure
TSW principals, while not salaried by Quizzify, have an ownership interest in it. However, this site is not affiliated with Quizzify and opinions expressed in this blog are our own. Except this one, which seems to be shared by everyone.

Wellness program quote of the day

An uberfit Ultimate Frisbee teammate of mine reported that his company’s wellness vendor asked if his doctor had measured his waist size.

“No,” my friend replied. “He’s not a tailor.”

Is there ever a good reason to flout US Preventive Services Task Force guidelines?

This is the second part in the series on wellness vendors and the US Preventive Services Task Force (USPSTF).


Q: Why do vendors ignore or flout the USPSTF?

There are five reasons, three of which are unfortunate:

  1. Many vendors don’t understand the entire concept of screening, neither the science nor the arithmetic described in Part 1.   Healthcare is hard, and the USPSTF can’t be expected to dumb themselves down so that wellness vendors, for whom simple math is a challenge and who don’t have to meet any educational or licensing requirements other than eight days of training, can understand it.
  2. Obviously, the more vendors screen, the more money they make. Guidelines propose infrequent screening for fewer blood values than most vendors do. That means vendors who abide by guidelines can collect much less money from employers than those who charge what the market will bear. Examples of companies screening the stuffing out of employees include Total Wellness, Interactive Health, Star Wellness, Healthfair, and Healthfairs USA. Needless to say they make a lot of money. (Quizzify is very jealous! Doing the right thing and guaranteeing savings isn’t remotely as profitable as ripping off employers.)
  3. Many wellness vendors are dishonest. We’ve already pointed out that Wellsteps bragged about how they screen every Boise employee every year for everything, with no mention of USPSTF guidelines. But after they got caught, they admitted they knew that the guidelines say the opposite. And Optum’s Seth Serxner insisted — out loud, on tape, that they would be happy to screen according to guidelines, if only employers would let them.  And yet, here is Optum’s ad, saying exactly the opposite: if you want us not to raise your rates as much on insurance, it’s a “requirement” to pay us even more than you would save on insurance, to do annual screens.  (Naturally they are quoting two sources that they know to be false as well.)

united-healthcare-lies


Q; Those are three bad reasons. What are the two good reasons?

I would like to credit Pete Arens for bigly influencing my answer on this.  It’s rare that someone does that, and even rarer that I admit it. However, in this case, huge credit where credit is due. Pete’s the man.

USPSTF publishes guidelines, not requirements.  It is perfectly OK not to follow them — as long as you have a good reason. The reasons above — ignorance, dishonesty and greed — would clearly not qualify.  However, here are some excellent examples of reasons that would:

  1. You work in a high-stress environment, like a law firm. Making blood pressure screening available easily and much more frequently than once a year, even having some discreetly placed cuffs, might be a good idea. (Some maintain that stress doesn’t cause high blood pressure. Perhaps not, but to them I say, watch Episode 5 of The People vs. OJ Simpson.)
  2. Your workforce is largely outdoors. Skin cancer and Lyme Disease screens might be indicated.
  3. You have alternatives to screening (like Quizzify) for younger employees, but encourage and educate older employees and other employees at high risk to get screened. The USPSTF doesn’t say, “no screens.” It says screens should be age- and risk-appropriate. You offer both to everyone (that’s the law) but steer some employees one way and some the other.
  4. Your company is in the chemical dye or railroad industries. A bladder cancer screen or at least educational session to raise awareness might be advisable. (Bladder cancer can be identified and easily treated very early.)

Mr. Arens raised the question specifically of obesity screens. Are they appropriate at all, especially in a workplace? And that brings us to the other good reason to flout the guidelines: you think they’re wrong.  In that situation, make your case.  But it has to be a real case, and obesity screening could very well be such a case:

  • The Employee Health and Wellness Code of Conduct specifically says, don’t embarrass or single out employees. This would be a perfect example doing exactly that;
  • You are unable to find any meaningful literature or technique that is even remotely shown to successfully address obesity for more than a short, clinically meaningless period of time, so why screen for something you can’t address?
  • To the extent you, in a corporate setting, do want to make your workplace healthier, you don’t need screens to do that. Encouraging exercise and avoidance of sugary foods at work would have the same impact.

Read carefully: we aren’t saying specifically you have to pass on obesity screens for those reasons. We are saying that if you differ with USPSTF on any screen, disclose the reasons and/or cite the literature, so it looks like a thoughtful decision.  This is an example in which we would differ with guidelines.


Q: What would be a funny example of a vendor who tries to attack the USPSTF but falls on its sword?

Glad you asked. That would be Healthmine, whose credibility, um, collapsed as a result.  Rule of thumb: to attack USPSTF credibly, a good start would be spelling their name right.  We’re just sayin’…


Q: What would be a funny example of a vendor who flouts the USPSTF recommendations?

You’re asking all the right questions.  That would be Angioscreen. The only screen they offer, for carotid artery disease, is D-rated by USPSTF.

Carotid stenosis D


Q: I don’t see what’s so funny about that. Stupid, yes. Harmful, yes. Expensive, yes. But what makes them so funny?

They admit right on their website that employees shouldn’t get these screens.

angioscreen screenshot

Honestly, I’m not sure which of those two things is dumber — offering the screen or admitting working-age people shouldn’t get it. But at least no one can accuse them of lying.


Q: They also can’t spell “New England Journal of Medicine.”

Good point. I didn’t even notice that until you brought it up. Maybe their head of their advisory board can help them with spelling, since “quality control is extremely important” to them.

angioscreen quality control


Q: What does the USPSTF think of the wellness industry?

Their guidelines are intended for use by real doctors and medical practitioners. My guess is that they are horrified by the idea of an entire industry, unsupervised and uneducated, “playing doctor” with employees.  Meanwhile, the National Business Group on Health, a vendor-fest if ever there was one, lobbies against the USPSTF for not understanding the importance of screening the stuffing out of employees.


Q: Why do employers go along with overscreening?

That’s a great question. They need only look at their own hospitalization rates to see that hospitalizations from diseases they are trying to prevent by screening, like diabetes and heart attacks, are already ridiculously low. However, rather than look at their own data, they prefer to spout the “86% of illness is caused by chronic disease”  meme, which was already discredited when it was 75%, before the CDC decided to jump it up to 86%.

Anybody who reads that article can see that either is an impossibly stupid statistic.  Most hospitalizations at most employers have something to do with birth events, and most expense at most employers can be traced to one-time items not addressable through eating more broccoli (neonates, transplants, cancer) or employees who either have a rare disease or more likely have a dependent with a rare disease.


Q: Maybe This isn’t fair, and vendors screen more than guidelines because they don’t think cost should be an issue and that employees should get all the prevention they can possibly use regardless of price

Actually, the USPSTF specifically does not include cost in its analysis.  It balances harms and benefits, not costs and benefits.  Screening according to guidelines will therefore lose money, as Ron Goetzel just admitted, even if over the long run more employees may benefit from screens than are harmed.

Quite the opposite. Tons of vendors obsess with hyperprevention because they are totally ignorant of the science and math involved. Our favorite is one called: “HEALTHIER is WEALTHIER and ASSOCIATES.” Along with the usually assortment of wellness industry THC-infused folderol (“our program, if followed diligently for a year, will decrease your employee health cost by as much as $24 for every pound of weight loss, an amount quoted by Dr Michael Roisen [sic] MD, Chief Wellness Officer and Chairman, Cleveland Clinic Wellness Institute”), they want to screen employees every three months. Don’t believe us?

healthier-is-wealthier


Stay tuned for Part 3: Vendors who understand the USPSTF

Schlumberger’s program confirms that in wellness, harming employees is the new black.

Silly us. We thought Wellsteps’ wellness program was an outlier when it came to harming employees. But Wellsteps has nothing on Schlumberger.  Almost immediately after reading last year’s post on the harms of crash-dieting contests run by Healthywage, Schlumberger instituted  — hang on to your hats — a crash-dieting contest run by Healthywage.  They even included some decent-size prizes — $1000 per winning participant. How did they finance those prizes, with sales of their drilling equipment falling by about half from its peak? Simple. They canceled their employee gym membership subsidy.

Then, as some may remember, it turned out that Healthywage’s understanding of arithmetic rivaled their understanding of obesity. In their contest, somehow five teams lost exactly 16.59% of their body weight.  This is clearly alternative math, since the chances of that coincidence using real math are about 1 in 4 quadrillion, meaning that the odds of winning the lottery are about 1000 times better than the odds that Healthywage’s executives are not a bunch of idiots.

So Schlumberger harmed employees, wasted money, and got ripped off by alleged weight control experts who can’t read a scale. What does a company do in situations like this? Double down, of course. Literally. Yes, this year, they’re back partnering with Healthywage…with twice the prize money — $2000 apiece for the five members of the winning team.

schlumberger-contest

They gave employees a week’s advance notice, so that they could pack on some pounds that they can take off later.  Plus they could time their consumption of salt tablets, and concoct other ways to bloat up, before the contest began.  Basically they needed to figure out how to become as unhealthy as possible, before starting the unhealthy process of crash-dieting. (As an aside, several teams apparently tried to recruit pregnant women whose due dates fall during the contest period.)  And now that they contest is underway, who wouldn’t pop a few OTC diet pills to make $2000?


The difference is that this year, several concerned employees wrote to me and urged me to inform their benefits department of the indisputable facts that:

  1. Crash-dieting is a stupid idea;
  2. Offering prizes for crash-dieting is an even stupider idea.

I wrote the requested letter to Schlumberger, and explained all this to them, not that anyone with an internet connection should need an explanation of why crash dieting contests don’t work, or, more basically, why being stupid is a bad idea.

Their response?  The benefits department appears to have tried to determine who sent me the announcement, presumably in order to get them fired. It was actually multiple people since I have family in Texas in the oilfield services industry. I had anticipated this, so I un-linkedin with all of them before writing to Schlumberger. I’ve learned through experience that in wellness, you need to anticipate the most inappropriate and misanthropic reaction to any helpful offer, because that is the reaction you will get.  (For instance, rather than being concerned about Wellsteps harming their employees, the Boise School District wellness program coordinator told Wellsteps I was blowing the whistle on them for harming their employees.)


Update:  Healthywage presents alternative math, Volume 2. If the rule is (as stated) that you must sign up in teams of five, what is wrong with this picture?

schlumberger-703-people


And just as I was about to click “publish,” I noticed alternative math, Volume 3.  Apparently Healthywage thinks you can lose a high percentage of your total weight even if “you only have a little weight to lose”:

schlumberger-misunderstanding-percentages

And that brings us back to the main, decidedly unfunny, point: crash-dieting contests, especially with big prizes, are a very bad idea…and companies like Healthywage ought to be ashamed of themselves for making a business out of harming employees.

 

 

 

 

The 2016 Wellness Deplorables Award winner: Wellsteps

This completes our year-end series on the Goofuses and Gallants of the wellness industry. See:

goofusgallant



Are you smarter than an award-winning wellness vendor? Take this quiz and find out.

Q: How is the first unlike the second?

aldana-linkedin-profile-checkpopeye

The first, Wellsteps CEO Steve Aldana, claims that it’s bananas that provide magical powers.  And unlike Popeye and spinach, he doesn’t think we need to consume massive quantities. “Even one more bite of a banana” is all it takes to reduce overall costs by fully a third, despite their admission that costs for individual employees increase by about the same amount over the same period.

wellsteps-cost-savingswellsteps cost per person

Yes, you read that right, and, yes, is it mathematically impossible for a number to go up and down at the same time. I noted in Wellsteps Stumbles Onward that Wellsteps had accidentally told the truth on the second display showing increasing costs, thus totally contradicting the first. The second display subsequently disappeared.

Perhaps Wellsteps deliberately made up the first slide to fool people (in this case, the Boise School District).  The more charitable explanation, which shows Wellsteps in a better light, is that they didn’t deliberately lie when they said costs increased and decreased at the same time. Instead, they were simply confused by their own stupidity.


Lying is a Business Strategy

Wellsteps’ Linkedin group is called Wellness is a Business Strategy. I was banned from posting on it, accompanied by the following invocation of the First Amendment:

“It has come to our attention that an outspoken critic has entered false data into these calculators in order to make a point. We certainly support free speech; however, we wonder how valid the point can be when it is based on false data?” [Where “false data” is defined as “any data”]

Sounds like they support free speech…except when they don’t. Speaking of supporting free speech, they claimed in bright red letters — for no apparent reason other than they were probably suffering withdrawal symptoms from having gone a whole week without lying — that they had convinced Linkedin to ban us from posting.  And yet many of you clicked through from linkedin. So here we are, posting.

wellsteps-linkedin


Stupid is a Business Strategy

Wellsteps’ ROI model doesn’t generate an ROI.  It doesn’t even generate a savings projection. What does it “generate”?  One number: $1359.  Yes,  it always gives the same answer ($1359 savings per employee) if you zero out “annual cost increases” in their model to control for inflation. So anyone can see this model simply makes no sense, notwithstanding Wellsteps’ insistence that it is “based on every ROI study ever published.”

How stupid is Wellsteps’ model? Even Ron Goetzel refused to defend it. And when Ron Goetzel won’t defend stupid data fabricated by his friends, you know it’s bad.

groucho-marx


Harming Employees is a Business Strategy

To win the Deplorables Award, outlying and outstupiding other vendors is a dicey strategy due to all the competition trying to do the same thing. So Wellsteps decided to boldly go where no vendor has gone before: they acknowledged, even bragged about, harming employees. Sure, plenty of vendors harm employees–by enticing them into crash-dieting contests, flouting clinical guidelines or giving them worthless nutritional supplements and billing their insurers. But no one had ever documented the before-after harms of wellness as conscientiously as Wellsteps did, which I helpfully displayed in detail.


Insults are a Business Strategy

What the judges here at TSW especially liked about Wellsteps’ candidacy for the Deplorables Award was their track record of not just harms and deceit, but also insults. Very clever ones too.

For instance, Wellsteps’ rebutted my observation that all their data is fabricated by saying I’m full of “hot air.” Touche!

wellsteps troy adams

One would think that that this guy (Mr. Aldana’s crony) could have come up with a better counterargument, given that he claims to have spent “11 years in college.” If you’re keeping score at home, that’s four more years than Bluto Blutarski.

Here are a few more targets of their ripostes:

Such brilliant repartee, in an earlier generation, would have landed them a seat at the Algonquin Roundtable.


Bananas are a Business Strategy

So, congratulations to Wellsteps for winning their first Deplorables Award.  Darwin will take it from here, and maybe get them a new gig more appropriate to their capabilities.

aldana-banana

 

So many candidates for the Deplorables Award countdown, so few numbers between 1 and 10

Having covered the also-rans last week, here are the first runners-up, as we inch ever closer to the coveted top spot. (To read the original postings, click on the numbered headers.)

Today we are highlighting more people and organizations who’ve made the wellness industry what it is. Wednesday we will complete the listing of the Stars of Wellness, the people and organizations who are making the industry what it should be.


#5 Interactive Health

Interactive Health conducted what may be the head-scratchingest screen in wellness industry, a difficult feat given all the competition. For starters, they tested me for calf tightness. It turns out my calves are tight–and right on-site they loosened them. I could feel my productivity soaring…until the left one went into spasm that night and I couldn’t get back to sleep. Still, I can see their point — loose calves are a useful trait for many common jobs.

first-baseman

Next, Interactive Health shattered the record, previously shared by Total Wellness and Star Wellness, for most USPSTF non-recommended blood tests. I don’t know what half these things are, which means neither does Interactive Health.

interactivehealth

 


#4 Koop Award Committee

Where would a Deplorables Greatest Hits List be without the Koop Award Committee?

Every year, like clockwork, the industry’s biggest liars select the industry’s biggest lies.  2016 started with last year’s winning program, McKesson’s, being exposed as a joke in Employee Benefit News, and ended with this year’s winner, Wellsteps, being exposed as a joke in STATNews.

When bestowing this year’s award to their fellow Committee member, Wellsteps, they didn’t even pretend not to lie. And what lies they were! Not just regular-sized lies. Not even supersized lies. We’re talking lies that would make a thesaurus-writer blush.

To put their lies in perspective, I may not even know you, but if a Koop Committee member told me the sky was blue, and you told me the sky was green, I’d at least go look out the window.

PS  Not everyone on the Committee is a liar. One person is quite honest and can’t believe what goes on every year. I don’t want to name my source because in Koop-land, honesty is grounds for termination. As is getting validation. Or adopting the Code of Conduct. Basically ethical behavior is off-limits. An executive of one group, Altarum, published a blog critical of wellness and <poof> the Committee disappeared them.


#3 Michael O’Donnell

Michael O’Donnell seems to crave my attention. When he managed to go three whole months without being featured in a TSW posting, he came up with these irresistible nuggets:

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

If nothing else, Mr. O’Donnell presents the best argument for requiring educational standards, or at least a GED, in this field — by demonstrating his total lack of understanding not just of wellness, but also of vaccines, sanitation, antibiotics, percentages, diseases, ROIs, and preserving civilization as we know it.

Oh, yes, and multiplication as well. His article on how to increase productivity with wellness used an example demonstrating a productivity decrease. In 2016, he also went on an anti-employee jihad that should be read in its entirety. (Translation: some of my best work…)  Highlights:

  • Prospective new hires should be subjected to an intrusive physical exam, and hired only if they are in good shape.  OK, not every single prospective new hire — only those applying for “blue collar jobs or jobs that require excessive walking, standing, or even sitting.”   Hence he would waive the physical exam requirement for mattress-tester, prostitute, or Koop Committee member–because those jobs require only excessive lying.
  • He would “set the standard for BMI at the level where medical costs are lowest.”  Since people with very low BMIs incur higher costs than people with middling BMIs, Mr. O’Donnell would fine not only people who weigh more than his ideal, but also employees with anorexia.

If employees didn’t already have an eating disorder, what better way of giving them one — and hence extracting more penalties from them — than to levy fines based on their weight?  Employees above his ideal weight would pay per pound, sort of like if they were ordering lobster or mailing packages.


#2: Ron Goetzel, Seth Serxner, and Paul Terry (Health Enhancement Research Organization)

These three characters — naturally also on the Koop Committee — managed to pile more lies, sardine-like, into a single page than anyone else in this industry, in the “poison pen” about me they circulated to the media.

A good starting question would be, why on earth would anyone think that they can send a “confidential” letter to the media?  The media are in the business of disseminating information. You see, that’s why they call them “the media.”  Am I going too fast for you, Mr. Goetzel?

The funny thing about these Einsteins? Their defense to my observation that their very own numbers show wellness loses money was that their very own numbers were made up. Imagine being so dishonest that the way you defend yourselves is by claiming you fabricated your own report.

That’s not even the punchline.  It turns out that this allegedly fabricated report is in truth an actual non-fabricated report. So, in the immortal words of the great philosopher LL Cool J, they lied about the lies that they lied about.

How did I learn this? That will be the subject of a post early year.


Watch this space…soon we will be naming the industry’s #1 Deplorable of 2016.

Announcing the Wellness Industry 2016 Deplorables Awards

For this year’s Deplorables Awards, I think we’re gonna need a bigger basket. As a result, this will be a two-part series.

Why? Because we need to accommodate all the bad hombres and nasty women who have subverted the perfect elegant philosophy of wellness into nothing more than a profit machine, with no regard for integrity, customers, or employees.

Yes, 2016 was a year in which a record number self-anointed industry leaders gave lying and cheating a bad name.  In that sense it was no different from any other year, though 2016 offered even more good news and bad news:

  • The bad news: not content with merely lying and cheating, this cabal branched out into harming employees, fat-shaming, and pure misanthropy;
  • The good news: wellness did succeed in one way, as a “natural experiment” showing what happens in healthcare if being a provider requires no credentials beyond a GED, a driver’s license, and a pulse.

Indeed, whatever mathematician first postulated that everyone can’t be worse than average had apparently never experienced the wellness industry. (Exceptions of course, being the few that, like Quizzify, are validated by the Validation Institute or have accepted the Employee Health Program Code of Conduct.)


#10 Optum and Wellsteps (Runners-Up);  

What do you do when you need to defend your blatant disregard of the US Preventive Services Task Force guidelines?  Simple — you blame your customers. Optum’s Seth Serxner said: “Customers make us” do this. Optum’s PR hack said I was making Optum “look bad.”

I said: “Sure, I’ll apologize. Just name one account that will admit to insisting on paying a higher price than you wanted to charge, in order to screen the stuffing out of their employees.” Never heard from them again.

Wellsteps got caught by ace reporter Sharon Begley of STATNews, and their CEO was forced to admit Wellsteps was violating USPSTF guidelines.

 


#9 The Johnson & Johnson Fat Tax gives misanthropy a bad name. (Honorable mentions to Vitality and Ron Goetzel.)

Misanthropy, greed, and weight-shaming provided the wellness industry with its key “talking points” in 2016. And nothing combined the three like the Johnson & Johnson Fat Tax fiasco. The point of the (apparently stillborn) Fat Tax was to stigmatize overweight employees, by “pressuring” (their word) companies into disclosing to shareholders how many fat employees they had.  That in turn would somehow pressure these employers into spending more money on wellness vendors.

It’s not altogether clear what that disclosure would do for the actual overweight/obese employees, but somehow this disclosure was supposed to allegedly benefit shareholders. Indeed, the Fat Tax cabal is right about that in one respect: this disclosure would benefit shareholders — it would indicate to shareholders that they ought to unload their shares in a hurry, because management just disclosed it is stupid.

Vitality was a co-conspirator in hatching this scheme, which is ironic because they admitted they couldn’t even get their own employees to lose weight.  And where you hear the word “stupid,” can the name “Goetzel” be far behind?  This whole thing was his idea, based on the notion that “playing doctor” with employees makes stock prices increase. However, his claim that companies with Koop Award-winning wellness programs outperformed the market can easily be invalidated by anyone with a calculator and a triple-digit IQ.


#8  IBISWorld: How is wellness different from King Midas and Gold?

Here are links to the postings on the most hilarious report we’ve ever read about the wellness industry:

  1. New wellness industry report costs $5400 (but that includes shipping)
  2. New report raises the bar for cluelessness in wellness
  3. How is wellness different from King Midas and gold?

The answer to the question in the header? Everyone who touches wellness turns to stupid.  Not just garden-variety stupid. More like fifty shades of stupid.

Mind you, most wellness industry leaders don’t need to touch anything first before reaching that endpoint, but occasionally a company like IBIS, with no prior experience in wellness, ventures into this field — and that’s where the fun starts. These IBISWorld Young Turks (literally–the writer is named “Turk”) are so excited about this industry, they practically speak in tongues:

Wellness firms may offer employers stress management courses and sessions that offer music therapy, aromatherapy, Tai Chi, and post disaster stress reduction through coaching.

Government-funded initiatives that promote wellness to cut costs related to chronic ailments (e.g., obesity and diabetes) has further exacerbated many businesses movement toward purchasing corporate wellness services.

And my own personal favorite:

The industry provides wellness programs to businesses across the United States, including small, medium and large businesses in the private sector and businesses in the public sector.  

“Businesses in the public sector”? I knew that many of our legislators are for sale but I didn’t realize they had incorporated.


#7 Healthfairs USA Raises the Bar for Misbehavior

Healthfairs USA doubled down in 2016 on lying and cheating with an elegant new strategy: insurance fraud. They not only harm employees, but bill insurance companies directly for the privilege of paying for those harms. They offer cancer tests that are “99% accurate” (hence their multiple Nobel Prizes), and over-the-counter nutritional supplements…all of which are covered by most insurance companies because they get a doctor to sign a claim form.

Disclosure: we aren’t entirely sure that billing insurance companies for USPSTF D-rated screens and worthless, possibly harmful, pills constitutes insurance fraud. Our opinion is probably no more accurate than their cancer tests.


#6 Aetna’s DNA wellness program combines junk science, junk math, and junk integrity 

In 2014, Aetna decided to “play doctor” with obese members of self-insured customers by telemarketing their employees to pitch very controversial high-priced drugs whose sales are “flailing” because almost no patients seem to want to take them.  Among other things, Aetna said these drugs increase productivity even though right on the label, the drugs warn that they could reduce productivity (attention span and language facility).

Not content with the warm welcome that scheme brought them, in 2015 they introduced a DNA-based wellness program and claimed a whopping $1464/participant in savings. What put the whop in that whopper were these two tidbits. These savings were achieved:

  • in the first year alone;
  • on participants who were not actually sick to begin with. (You couldn’t qualify for this study if you were already sick.)

The reason Aetna needed to fabricate such a high savings figure is that the wellness field requires ROIs greater than 2-to-1, and this DNA test sells for $500/employee. So you need to show savings between $1000 and $1500.

Also, in 2015, we were able to show the program was completely ineffective, a convincing enough demonstration that one of the board members of the journal that published the study with the $1464 claim publicly apologized.

What do you do when it turns out your science is all wrong (news flash: being told you have a gene for obesity doesn’t motivate you to lose weight) and your math is all wrong?  Of course, you apologize and retract the study, and offer to return the money to the lucky few companies that signed up for your program.

Haha, good one, Al. Obviously, like all the other Deplorable Award-winners on this list, you sell your snake oil harder than ever, and that’s what gets them on the 2016 list. Whereas in 2015, they could use the dumb-and-dumber defense, this year they know the numbers don’t add up and yet they are still flogging it.


Don’t miss the slam-bang conclusion as we count down to #1. Will Ron Goetzel retain his crown, or will he be unseated as the wellness industry’s #1 Deplorable?

Yes, we realize he has already appeared on this list at #9, but many lists feature the same entities making multiple entries. For instance, the Beatles once held positions #1 through #5 in Billboard’s Top 40, so it can be done.

Not that I want to put any ideas in his head.

Oops, they did it again. Wellsteps stumbles on integrity one more time.

There are three ways to win a debate:

  1. Cite facts that support your position.
  2. Be smart enough to win a debate even though the facts go the other way.
  3. Break your opponent’s microphone.

Let’s consider each possibility in turn:

  1. Not a chance–Wellsteps won a Koop Award. When was the last time you saw a bona fide fact in a Koop Award application? Certainly STATNews doesn’t seem to have found any. And if Wellsteps had an actual fact in their favor — meaning if we were wrong about one single solitary thing — don’t you suppose they would have stumbled onto it by now?  Don’t you suppose that just one of their insults would be grounded in reality?  In the immortal words of the great philosopher Rick Perry, even a broken clock is right once a day, so the score is: Broken Clocks 1, Wellsteps 0.
  2. Smart? Hello! We’re talking Steve Aldana and Wellsteps here, not to mention Troy Adams, the originator of the Wellsteps tag line: “It’s fun to get fat. It’s fun to be lazy.
  3. Bingo. That’s what Wellsteps just tried to do. When all else fails, cheat.  They tried to get Linkedin to shut us down for “bullying” them by adding up their own numbers.  Here is their exact “update,” which they were kind enough to put in red so you can’t miss it.  To paraphrase the immortal words of the great philosopher Michelle Obama, when they go low, we go paste:

wellsteps-linkedin

 

And yet you may have just clicked through to this post from Linkedin, meaning that reports of our death (me and Jon Robison of Salveo Partners) are greatly exaggerated.


The irony is, Wellsteps doesn’t understand irony

The irony is, what greater form of bullying is there than to try to muzzle someone whose only crime was to agree with Wellsteps’ own data?

The other irony is, Wellsteps’ CEO recently wrote: “We certainly support free speech:”

It has come to our attention that an outspoken critic has entered false data into these calculators in order to make a point. We certainly support free speech; however, we wonder how valid the point can be when it is based on false data?”

I guess, to paraphrase the immortal words of the great philosopher John Kerry, Mr. Aldana was for free speech before he was against it. (Is “entering false data” like “bearing false witness”? If so, we yield to Wellsteps’ expertise.  And we did enter every combination of data imaginable into their “calculator.” It always gave the same answer. Try it. It’s like wellness savings measurement-meets-Fisher-Price. Just make sure to zero out inflation.)

 


Being in the “integrity segment” of this industry, we aren’t exactly big fans of Ron Goetzel, and the longer he lets his cronies at Wellsteps keep their Koop Award, despite it now being well-established that they harmed employees in multiple ways, the more his own sullied reputation suffers. However, we will acknowledge one thing that Ron Goetzel excels at, and that’s ignorance. He is great at ignoring facts, ignoring data…and, most strategically, ignoring us. Indeed, as the leader of the Koop and HERO cabals, he inspired the collective noun “the Wellness Ignorati.”  He knows better than to debate us, because the Wellness Ignorati always lose debates, even when they break our microphone.

 

 

An apology for my previous dismissive statements made publicly on Linkedin

Usually when I post an “apology” it is phony, like: “I apologize for calling Wellsteps’ arithmetic fabricated. I should have called Wellsteps’ arithmetic completely fabricated.

Here’s a similar apology, for Professor Baicker’s infamous “Workplace Wellness Can Generate Savings” meta-analysis claiming the 3.27-to-1 ROI from wellness that RAND also eviscerated:

I had been quite adamant in the previous post that this meta-analysis was likely just a gold-plated package of garbage case studies. I compared it to packaging subprime home loans into AAA-rated collateralized mortgage obligations (CMO).

That was before I looked at the individual studies comprising this meta-analysis. I realize now that comparing the Harvard Study to the CMO scam was unfair. So I owe an apology to Bear Stearns, Lehman Brothers, and Countrywide.

Next, I apologize for pointing out that Ron Goetzel, as recently as last week, is still quoting this very same thoroughly discredited 7-year-old study, as well as many other outdated analyses. For example, he insists on continuing to quote the New York Times economists’ September 2014 analysis that wellness programs “generally” don’t work, even though they subsequently made their conclusion much clearer: “We’ve said it before, many times and in many ways: workplace wellness programs don’t save money.” They then specifically criticized Mr. Goetzel’s own methodology (“industry studies based on study designs that cannot produce valid causal estimates”).

I apologize for thinking that this deliberately selective misinterpretation of these economists’ previous conclusions makes him sound deceitful.  And I apologize for being sure that the people who forwarded me this slide would agree with that assessment. And I apologize for once again making phony apologies.

goetzel-watson-health

goetzel-nyt-clipping


The real apology

Now that I’ve checked off the usual Wellsteps-and-Goetzel-integrity boxes, it’s time to step out of character and seriously apologize. Here’s what I did that I really do need to apologize for:  not cutting wellness professionals enough slack on giving them enough time to learn what took me several years to learn about wellness losing money.

I was once guilty myself of believing this 3-to-1 ROI nonsense, specifically about disease management (DM).  Why DM in particular? I had some ego wrapped up in it because I am actually credited with inventing DM. Really.  Just google on “invented disease management.” Whether or not I did (and plenty of others could share the credit), I was not just drinking the DM Kool-Aid. I was mixing it up and selling it to others.

Then, 10-12 years ago, a few people told me none of the DM savings numbers added up. I didn’t believe them. I thought it was sour grapes because they missed the boat.

True, I had enrolled a few of my own extended family members and friends into DM programs. Vendors were more than happy to offer me their best nurses, VIP treatment, you name it. Yet no one I referred thought these free programs were even worth a second free phone call.

Nonetheless, I was sure that somewhere there existed a whole lot of employees who did benefit from DM. Yes, in my fantasy world tons of people really appreciated these unsolicited calls from their health plan offering to help. After all, who among us doesn’t trust an unsolicited caller from their health plan offering to help?

In my worldview, the lucky recipients of these calls would respond: “You’re right. I should be taking my pills. Hey, thanks. I never would have thought of that on my own. And I was just about to have a heart attack, so you saved a ton of money.”

Yes, I realize this made no sense. Yet I never questioned my own findings. Basically, I ignored the warning signs about DM’s sketchy economics for years.  When I finally had the epiphany, it got quite the headline:

A Founding Father of Disease Management Astonishingly Declares: “My Kid Is Ugly.”

Once I questioned my own figures, the rest because immediately obvious to me — one after another after another, sets of numbers in this field simply did not add up. Wellness was a far worse offender than DM, which does appear to roughly break even or better.  No surprise about wellness. Screening costs about 10 times as much as DM and whereas people who qualify for DM are already well down the slope to infirmity, screens are performed mostly on healthy employees, who can’t generate any savings. (We of course support screenings according to guidelines, for the health of employees rather than an ROI. But most vendors ignore guidelines and screen the stuffing out of employees.)

Still, it had taken me years to have the initial epiphany…and yet now I was quite curt and dismissive with other people who didn’t immediately get it, and were defensive in support of their lifelong assumption.  I was basically saying to others in the field: “You know all those savings claims? Total malarkey.  Prying, poking and prodding doesn’t save any money.”  I’d expect everyone else to get this right away.  When they didn’t, I was not gracious with them in many cases.

Over time, a large number of folks have come around. They did it at their own speed, same as I did.  Take WELCOA, for example. They were among the worst (and God bless ’em, funniest) offenders…and yet now you won’t find an organization more committed to getting wellness right, helping employees, and being honest than WELCOA. (In their case, a night-and-day change of leadership helped.)  I’m not just saying this–I’m walking the walk. Quizzify is joining WELCOA’s Premier Provider Network for 2017, joining vendors I have a lot of respect for, like It Starts with Me, Populytics, and SelfHelpWorks. The first two, also like Quizzify, are validated by the Validation Institute.


Making good on the apology

A good apology comes with an offer to make it up. So if you feel like I dissed you prematurely, while you were learning wellness economics on your own, you can have one of:

  1. a free pdf of any of my books — Surviving Workplace Wellness, Cracking Health Costs, or Why Nobody Believes the Numbers
  2. half-price on a hardcopy of those books (order direct, not through Amazon, of course)
  3. a free analysis of any outcomes report
  4. a free month of Quizzify with no commitment (there is a minor asterisk on this one, please inquire)
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