It wasn’t even close. I offered a proof that wellness has not avoided a noticeable number of hospital admissions this century. Ron Goetzel accepted that the data was accurate and declined to claim the million-dollar reward for finding a mistake in it.
Here is the first post-debate coverage. Highly favorable. Quoted Ron as saying employees like wellness. Try telling that to an employee…
The exchange I will be dining out on for years will be when Ron admitted I am the best peer reviewed in the industry. After he accused me of not being qualified to do my job, the following transpired:
“Ron, will you admit I am the best peer reviewer in the industry?”
“Then who is?”
Silence, followed by laughter from the audience.
Ron’s biggest points are:
- Wellness works if you do it right
- Almost nobody does it right. Maybe Procter & Gamble did it right a quarter-century ago (yes, he cited a 25-year-old study) but unless you are Ron’s client or a few others, you’re doing it wrong
- You can only expect a 1-to-1 return, and he cited an example to that effect
Ron’s other points were (in no particular order):
(1) He had nothing whatsoever to do with the Penn State program even though he was one of four people in the conference room holding the press conference titled: Penn State Takes Offensive in Health Plan Controversy.
(2) Four people stood up to say how bad their program was. In each case, Ron’s answer was that it was their own fault or it was a lousy program. In one case when someone complained about the typically cliched advice given to them by a wellness coach, he said: “You should listen to them and then maybe you will change your behavior.” He and Michael O’Donnell agree that most programs (95% in Michael O’Donnell’s estimation) are done badly.
(3) I was castigated because Quizzify has a 100% guarantee of savings. In the wacky world of wellness, companies that don’t guarantee anything because they can’t achieve savings are better than companies that guarantee savings because they can achieve them.
(4) Companies do not screen according to guidelines, but that is their fault. Wellness vendors would be perfectly happy to cut their fees by 70% and just screen the people who the USPSTF says to screen.
(5) He said none of my stuff is peer-reviewed so I am not qualified to do peer review. That’s why I’ve been blacklisted. Never mind that my most recent peer-reviewed article is trending #1 for the year in a major journal. Never mind that all of their stuff is full of obvious rookie mistakes, and never mind that legitimate journals like Health Affairs ask me to peer-review. And never mind that Ron himself admitted I have found many mistakes in his stuff.
I also named all the household names (in healthcare, at least) who had reviewed our stuff–Stuart Altman, Tom Scully, Regina Herzlinger, Jim Prochaska, Bob Galvin, Leah Binder, Norton Hadler. Oh, yes–and Quizzify is the only company in population health whose content is reviewed and approved by doctors at Harvard Medical School. (Formal announcement forthcoming.) And then finally I observed that we weren’t standing up there today because of his peer-reviewed stuff. We were standing up there today because of my non-peer-reviewed whistleblowing.
(6) They will still be quoting Katherine Baicker’s “Harvard Study” with the 3.27-to-1 ROI for years to come. They claim the authors haven’t backed off it one iota, regardless of what Baicker has said. And since there are no other studies to cite other than their own (which accidentally found wellness loses money), they’re stuck with this one.
(8) Even though it appears that every employee in a “pry,poke, and prod” program thinks it’s a joke or worse (and that’s why the bribes and fines have to keep rising), employees really do love wellness and want more of it, according to Ron.
(9) He accused me of spreading lies and misformation but didn’t actually name any.
(10) He admitted to doctoring original applications in the Koop Award file after my exposes, but didn’t apologize either for doctoring them or for writing in Health Affairs that they weren’t doctored, but rather that the “original application is online and available for review.”
(11) He is still defending the lies told in the Nebraska program about saving the lives of cancer victims, and still thinks Health Fitness Corporation deserves their Koop award, even though only 161 state employees improved a risk factor and the state also lied about their savings.
(12) He says 80% of costs are due to preventable diseases like cancer. I have had cancer and it was not preventable. It is frustrating to see someone tell people that my disease was preventable, when it wasn’t. He is referring to the old urban legend, thoroughly debunked on this site, that 75% of cost is preventable…but, what the heck, why not add 5%? 75% or 80%, we had already shot this fallacy down anyway.
(13) Even thought the HERO Guidelines which he co-authored and which represent “countless hours of collaboration” say wellness loses money, he doesn’t believe that section. He didn’t write it or (I guess) read it during the “two years” of this guidebook’s development. And maybe the person who conducted the webinar defending it was a different Ron Z. Goetzel.
My points–none of which were rebutted except where noted–were:
(1) I proved (using the proofs on this site) that wellness loses money and that if he thought it made money he would claim his million-dollar reward. He accepted the proof (no choice — the database that the proof was based on is maintained by another part of his company) and didn’t rebut it. One of his cronies in the audience, Seth Serxner, tried to rebut the proof but we were fully prepared for that and already had the data. We apologize to Seth for making him look bad. So the proof that wellness has lost money for 14 years is established.
(2) I proved that his entire participants-vs-non-participants methodology is made up. This was not rebutted. So all the savings in all the Koop Awards are toast.
(3) There was no rebuttal to my observation that most programs don’t work according to their own data. The rebuttal was that their own data was only one case study.
(4) I showed that basically everybody who does not make their living off wellness is opposed to it, like the left wing media and the right wing media. (Wellness supporters are running out of wings.) See the In the News section.
(5) I also made the unrebutted point that his own allies on his own committee have strayed off the reservation too — Debra Lerner and Altarum and of course Michael “95% of programs don’t work and RCTs have negative ROIs” O’Donnell.
Conclusion: nothing will change. He and his cronies — even though they have now admitted my proof, and have all passed on claiming the $1-million award — will still attempt to shove programs down employees’ throats — even though most of them (in their own words) fail and (in their own words) it is “very hard” to do a successful program.
And as long as they continue to do try to protect their revenue streams on the backs of corporations and employees, we will continue to protect them from the “pry, poke, prod and punish” jihad that is increasingly part of our corporate culture.
A special shout-out to Professor Matthew Woessner of Penn State, who made the trip down to DC, and was able to ask very pointed questions about Ron’s/Highmark’s program, the worst in wellness history. Ron disavowed any part of the “awful” Penn State program (he must have gotten lost and wandered into that conference room mentioned above) A question was also raised to the point of, that’s only one university. So the others are all fine. Matthew then got up and said Ohio State, which was the only other one he was closely familiar with, also hated their program. Quite a timely put-down and along with the questions from actual wellness program participants, highlighted the disregard in which most employees hold these programs.
RAND’s Soeren Mattke said it best:
The industry went in with promises of 3-to-1 and 6-to-1 ROIs based on health care savings alone. Then research came out that said that’s not true. They said, “Fine, we are cost-neutral.” Now research says: “Maybe not even cost-neutral.” So they say: “It’s really about productivity, which we can’t really measure, but it’s an enormous return.”
In other words, whenever you invalidate one metric, they come up with another one. We then have to shoot that one down, and the cycle repeats. It’s invalidity-meets-Whack-A-Mole. After the healthcare spending ROI fiction imploded, Michael O’Donnell, editor of the wellness industry trade journal, asked dismissively: “Who cares about ROI anyway?”
Since ROI wasn’t working, they then tried value-on-investment (VOI), which turned out to show even greater losses than a straight ROI calculation.
Continuing that tradition, Michael O’Donnell of the American Journal of Health Promotion presents: Return on Allocated Resources, or ROAR. ROAR counts everything, including productivity. By counting everything, ROAR shows far greater losses than VOI.
Michael says that a 1% increase in productivity is worth $1933:
However, a much greater 3.75% (90 minutes of a 40-hour workweek) reduction in productivity only costs $2184:
How did he accomplish this sleight-of-hand, where a 1% increase in productivity practically offsets a 3.75% decrease? Simple: by putting both thumbs and every other appendage on the scale. He accounts for lost work time at an employee’s hourly rate. So far so good. However, he then applies a magic multiplier to the hourly rate to calculate increases in productivity based on hypothetically enhanced corporate revenues due to the productivity increase. So if payroll is 30% of revenues, and productivity climbs 1%, then revenues would also automatically climb 1%. That means in dollar terms revenues climb more than three times faster than productivity.
Had he used the same revenue multiplier for the certain 3.75% productivity decrease due to wellness-induced lost work time that he used for his speculative 1% productivity increase, his time-off-for-wellness scheme would cost a whopping $7143/employee/year.
And wellness vendors wonder why line managers are so reluctant to allow employees to work out on company time.
So while per-employee losses from wellness based purely on added healthcare spending and program expense are “only” in the three figures, the net reduction in productivity from a (speculative) 1% increase less a (certain) 3.75% decrease due to lost work time amount to a mind-boggling $5210/year.
And that is probably an understatement. The 3.75% lost work time due to wellness doesn’t include the time employees spend changing clothes after their workouts, lying on HRAs, standing in line to be screened and “coached,” complaining to HR that they haven’t received their incentive checks yet, and hanging out at the water cooler dissing the program.
If you’re keeping score at home, this is the third time Michael O’Donnell has strayed off message. Just like some people are convinced that Donald Trump is a closet Democrat trying to torpedo the GOP, you would be excused for thinking that Michael O’Donnell is a member of our Welligentsia group, trying to sow chaos amongst the Wellness Ignorati.
He isn’t, but nonetheless I count him among our greatest assets. First, he admitted that up to 95% of wellness programs don’t work. Then he admitted that studies done using randomized control trials lose money. And now this one, detailing — using his own math — by far the greatest losses that a wellness metric has ever shown.
Ron Goetzel is probably tearing his hair out over his crony’s unforced errors on the eve of our debate. Or, in the immortal words of the great philosopher Warren G. Harding: “I can handle my enemies. It’s my friends who have me pacing the floor at night.”