This is the eighth and final installment of the November 2015 “Great Debate” between Ron Goetzel and myself, at the Population Health Alliance Annual Leadership Forum. If you’d like to follow the entire thread, here is Part 1.
If you want to download the audio, be my guest. For some reason the progress bar on the audio doesn’t sync with the end of the debate, so if you want to jump to this section, drag the progress indicator to the far end of the bar, like this:
Hence unlike the previous sections, there are no timestamps on these liner notes. Still, it is the most dramatic part, as Optum’s Seth Serxner does that thing which gets wellness promoters in the most trouble (open their mouths) and Ron Goetzel tries to explain why, when wellness promoters accidentally tell the truth, they don’t really mean it.
Optum’s Seth Serxner, a wellness promoter who sits on the Koop award committee, stands up and makes a couple of comments defending wellness that advance my case more than any of the previous questions attacking wellness.
His first comment — that wellness-sensitive medical events (WSMEs) for employers would have gone way up without wellness — was one that I had hoped Ron would make, but Ron wasn’t stupid enough to take the bait. Ron knew full well that his company’s database showed exactly the same trend in WSME for the non-employed population (Medicare, Medicaid) as for the employed population, as the graph below indicates. This means, of course, that wellness is worthless. Here is a graphic representation of what I originally said–that wellness had not reduced WSMEs, according to the data produced for the government by Ron’s own company:
I of course pointed out that the data said exactly the opposite of Mr. Serxner’s fantasy, as shown below. I noted: “We didn’t post this data until this morning on the hopes that someone from the wellness industry would ask us that question so we could give that response.”
Here is the revised graph, proving definitively the worthless of “pry, poke and prod,” and making my $1-million reward (now $2-million) for showing wellness works a safe bet on my end.
Mr. Serxner, despite claiming to be an expert in wellness, apparently didn’t know this. Here is a guy who goes around telling clients that maybe their costs went up, but they would have gone up faster if Optum hadn’t saved the day with wellness. Of course, now that Mr. Serxner knows that he’s been dead wrong lo these many years, I’m sure he will go back to his clients and tell them he just learned that Optum never saved them anything. Not.
He figured out years ago that some human resources directors will actually fall for this sleight-of-hand. His specific mantra: “We can conclude that choice [emphasis TSW’s] of trend has a large impact on estimates of financial savings.” (Abstract is here. You’ll have to pay for the article to read his exact quote.)
In other words, in wellness you can make up savings by choosing a higher trendline for the comparison of actual costs. Is this a great industry or what?
In his second comment, Seth blames the victim. “Our clients won’t let us [screen]” appropriately. He says that many clients ignore guidelines deliberately. That would lead to the conclusion that clients want to spend more money on Optum’s services in order to screen inappropriately, but that Optum’s salespeople push back, insisting that they should send Optum less money…and the clients refuse.
In followup conversations with Optum, they were unable to name a single program in which Optum tried to insist on infrequent, clinically appropriate, inexpensive screening schedule, but where the account itself demanded the opposite. I can send the email thread to anyone who wants it. (The back story is that Optum’s mouthpiece contacted me to ask if I would stop embarrassing them by referencing Mr. Serxner’s comments. I said: “Sure, if you can name one account where Optum pushed back against the customer demanding higher-priced, inappropriate screening programs.” Never heard from them again.)
Another questioner points out that doing wellness for employees — serving carrots instead of donuts — hasn’t reduced costs. Ron says she’s reading the literature wrong. “A lot of programs reduce the rate of increase in costs, and that’s how savings are determined.” Um, Ron, were you listening a minute ago?
For someone who has proclaimed himself a “scientist” at multiple points, there is some irony (there’s that word again — being oblivious to irony is a prerequisite for being in the wellness industry) in not understanding how science works. An intervention is targeted at specific variables. Pain medications target pain, chemotherapy targets cancer, heartburn medications target stomach acid etc. Wellness targets WSMEs. So if WSMEs decline, that’s called a success. If, however, trauma or c-sections or joint replacements happen to decline while you’re running a wellness program, that’s called a coincidence. Those results are not at all attributable to a wellness vendor browbeating employees into eating more broccoli.
In response to a question, I say that as a former NASDAQ company CEO (and current Quizzify CEO) the greatest advantage I see in wellness is to convince my competitors to do as much of it as possible, so that they waste their time, lose their best people and increase their healthcare costs.
Ron says it’s silly to obsess with spending $100 or $200 on wellness when companies are spending $10,000/employee on “cancer, diabetes, heart disease and hypertension.”
This is nonsense. I’d invite Ron — remember, he says he’s a scientist, so he’s driven by data — to actually look at some data. Employers do not spend most of their money on preventable events in those categories.
Quite the contrary, birth events and musculoskeletal are their two biggest spending categories. Then there are some catastrophic events. The rest is comprised mainly of lots of drugs, tests, doctor visits etc. The actual preventable hospital events in the four categories Ron is referencing account for only a small percentage of all spending. (See the graphs above — about 6% of hospitalizations, meaning about 3% of all costs, or about $150 per covered person are preventable through wellness.)
Don’t take my word for that. Here are the top ten DRGs for commercially insured populations, according to Ron’s own company, Truven:
It took an hour and a half but finally, the infamous Kate Baicker study comes up. She’s walked it back multiple times, all in print, all cataloged here. But apparently neither she or David Cutler (her co-author) are giving up on it. Apparently there were a series of alleged private conversations I wasn’t privy to in which, notwithstanding their public comments, they are still not willing to retract it. It doesn’t matter because, in addition to RAND’s smackdowns, I pointed out that the studies comprising her meta-analysis were laughable, including one claiming that wellness caused a reduction in cat-scratch fever.
Add one more entry to the list of things Ron walking back: his claim that wellness gets an “expected” 3-to-1 ROI.
He is now perfectly fine with a 1-to-1 ROI. Having just said that Kate Baicker is standing by her 3.27-to-1 ROI, he refers to claims of a 3-to-1 ROI as “ridiculous.”
Which is it, Ron? Is the Kate Baicker 3.27-to-1 ROI correct as you said 60 seconds ago, or is a 3-to-1 ROI “ridiculous,” as you said just now?
I bring up Michael O’Donnell’s infamous statement that “randomized control trials” in wellness “show a negative ROI.” Yet another example of these wellness Einsteins accidentally admitting that wellness loses money and having to walk it back. Ron gets a point for being totally prepared for this exchange. He explains that, of course, like everything else I point out where they accidentally tell the truth in print (like the HERO guide earlier in the debate), it doesn’t really mean what it says in print. It means something completely different.
Ron excels at twisting and turning statements into their opposites. We have so much respect for his ability to do this, we call him Goetzel the Pretzel.
Like Mr. Goetzel was prepared to pretzel this gaffe, I am also prepared for Mr. Goetzel’s pretzel. This researcher, a graduate student at the University of Tasmania (that’s an island south of Australia), “averaged” low-quality studies showing positive ROIs with high-quality studies showing negative ROIs to find an overall slightly positive ROI. My reply: “That’s like averaging Ptolemy and Copernicus to conclude that the earth revolves halfway around the sun.”
Ron had said no one would do RCTs, but Aetna just did one and found no impact.
Ron, who spent about half the debate talking about how great peer review is, now admits the process is broken. Then he says “the peer review process works quite well.”
Which is it, Ron? Is peer review great or is it broken?
Then he says the editors of these journals are “not my friends” and then he says they are “close friends” of his.
Once again, which is it, Ron? Are they your close friends or not your friends?
The final question was emblematic of the entire debate, in which Ron makes statements that are obviously the opposite of the evidence. He alleges that 2/3 of employees want more wellness programs. I point out that if employees liked wellness you wouldn’t have to fine them to get them to participate. Indeed, they would pay for wellness, just like people are willing to pay for other things they like.
You only have to go to Slate or any other article to see that employees in this country don’t like wellness, any more than the employees in this audience do.
There you have it. Who won? You make the call. None of my work was challenged (except Quizzify –but with a 100% guarantee of savings that’s our problem if we’re wrong — and the reviews and case studies are very positive). Ron conceded the following:
- I am right a lot of the time (for anyone is keeping score at home, that would be 100%);
- I am the best peer reviewer in the field;
- most wellness programs don’t work;
- he can’t win my million-dollar reward; and
- he’s doctored a lot of material.
Here is a list of what he has said and done, that he just ran away from:
- his HERO Report;
- wellness industry “cheaters” like his colleague, Wellsteps’ Steve Aldana;
- his Penn State program;
- his 3-1 ROI claim.
The only program he defended was the indefensible Nebraska program.
I on the other hand lost on no exchange, and conceded nothing except that maybe Johnson & Johnson saved money on their wellness program. While blogging on this debate, I was finally moved to read the J&J outcomes report. Surprise! The whole thing is obviously fabricated and never should have passed peer review. I’ll blog on it another day.