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WTF! Introducing the wellness industry’s Wishful Thinking Factor

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Finally! A valid way to measure wellness outcomes that requires only a calculator, a triple-digit IQ, and complete suspension of disbelief! Introducing the Wishful Thinking Factor, or WTF. Those of you accustomed to reviewing wellness vendor outcomes may think those initials stand for something else…and we will indeed use those initials in their more common context at the end of this posting.

By contrast, this WTF is defined as:

Dollars claimed as savings/percent improvement in risk factors.

The elegance of the WTF is exceeded only by its widespread acceptance. WTF is already the wellness industry’s preferred analysis, so I am merely confirming that we agree. The only difference between my WTF calculation and theirs is they don’t actually put the numerator and denominator on the same page.

Meaning, they don’t actually announce: “Here’s our huge savings generated by our trivial risk reduction…wait…this is impossible…WTF???”

That’s because then it would be perfectly obvious that they are fabricating the savings. Instead they put “dollars saved” on one page and the improvement in risk factors on another page, way far away — and hope nobody compares them.  (Interactive Health is the most stable genius example of that, as we’ll see below.)


What is the real causal relationship between risk reduction and savings?

A distressingly relevant joke circulated among us rip-roaringly hilarious faculty back when I taught in the Harvard economics department. A chemist, physicist and economist are stranded on a desert island with only a can of beans. To open it, the physicist suggests dropping it off a cliff, so that it will open upon impact. The chemist points out that would splatter the contents, and suggests instead that they put the can in a fire, and once the can gets hot enough, it will melt. The physicist points out that the beans would all burn up in the fire.  At an impasse, they turn to the economist and ask what he would do.

The economist replies: “Assume a can opener.”

In keeping with that spirit, we will make six (count ’em, 6) equally generous assumptions for determining the true WTF:

  1. Every wellness-sensitive medical admission or ER visit is a direct function of the risk that the wellness vendor measures in a population. In other words, social determinants of health and genetics have nothing to do with the likelihood of a heart attack or diabetes event
  2. Even the dumbest wellness vendors know how to measure risk (following their five days of training in medicine)
  3. Employees never cheat to improve their biometric scores and never lie on their risk assessments
  4. Dropouts and non-participants would improve in risk at the same rate as participants do, so the fact that they don’t participate doesn’t change the overall risk reduction in the population
  5. No lag time between risk reduction and event avoidance
  6. No false positives, no added lab tests, drugs, doctor visits or anything else that might possibly increase utilization and cost of outpatient care in order to reduce inpatient utilization — which of course is the opposite of what the wellness trade association readily admits to:

Using those generous assumptions, measured wellness-sensitive medical admissions (WMSAs), and the total cost of those events, would decline at the same rate as measured risk declines. According to the Health Enhancement Research Organization, WSMAs comprise no more than $100 PEPY in a commercially insured population.  So every 1% decline in risk yields a spending decline of $1.

Relaxing the assumptions above would likely reveal that this WTF is also overstated, but it has the advantage of consensus among the 60+ experts who contributed to the HERO outcomes guidelines measurement tool, so we’ll call this the Gold Standard, to which other WTFs are compared.


Now let’s make a little list of the WTFs compiled by the industry’s very stable geniuses, in their great and unmatched wisdom. Naturally, in that category, the first to come to mind are Interactive Health and Ron Goetzel.

Let’s start with Interactive Health. Excluding dropouts and non-participants, they claimed a 5.3% risk reduction (20.3% reduced risk while 15% increased them). So they saved a maximum, assuming the six assumptions above, $5.30 PEPY:

The claimed savings was:

Averaging those claims yields $804, for a WTF of 151.

As a side note, allocating that $804 in savings across the 5.3% who actually did see a decline in risk factors yields over $15,000 per risk factor reduced. No mean feat when you figure that the average person only incurs about $6000 in employer spending. That was enough to get them in the Wall Street Journal


A second example (and there are many more) is the Koop Award given to Health Fitness Corporation for lying about saving the lives of cancer victims who never had cancer. The coverup of that fabrication was the lead story about Nebraska, along with whether Ron Goetzel had committed an actual crime, as opposed to simply snookering the rather gullible state, whose reaction when they found out is best described as Human Resources-meets-Stockholm Syndrome.

Mr. Goetzel defended his actions by saying that lying about saving the lives of cancer victims was overlooked by the awards committee, and what really earned Nebraska the award was saving $4.2 million by reducing 186 risk factors. Let’s calculate the WTF from that.

change in risk factors

the absolute reduction in risk was 0.17 (1.72 to 1.55) on a scale of 7, or roughly 2.4%. That represents about 180 people out of 5199 reducing a risk factor. (Of course, the remaining 15,000 of the 20,000+ state employees dropped out and/or wanted nothing to do with this program, but that’s a different story. So much winning!)

And yet somehow, despite only 180 people claiming to reduce a risk factor, the program saved $4.2-million, or $807 apiece for the total 5199 people. That yields a WTF of 336.


Speaking of Koop Awards, The Koop Award Committee is known for its embrace of WTF arithmetic, and it’s that time of year again during which they put their very good brains on full display. For instance, they once gave an award to Pfizer for saving $9 million, or roughly $300 per employee. How did Pfizer do that? With a 2% risk factor decline. Pfizer’s WTF worked out to about 150.

As a sidebar, Pfizer’s award application includes our all-time favorite displays:

Pfizer’s wellness team sent employees emails on weight control tips. Those who opened the messages lost about 3 ounces while those who did not open the messages gained 2 ounces. That could easily be accounted for by the number of calories required to open the emails.


The 2019 Koop Award

Most recently, the very stable geniuses just gave an award to Baylor Medical School, where, in keeping with tradition, risk factors declined by a whopping 1% — at least among the 25% of the workforce willing to be screened twice (!!!) a year to earn a 20% premium reduction. Let’s take a looksee at the biometric screening results:

On average, these five categories improved 1.04%, to be exact. This is actually quite an accomplishment for the vendor, Vitality, which typically gets no improvement or a deterioration.

The claimed savings — in keeping with Koop Award tradition, buried deep on another page — were $333/year, yielding a WTF of 320.


For any readers out there with the IQs of a Koop Award Committee member, let me spell out the pattern you’re seeing: the wellness industry’s own data yields WTFs 150 to 336 times greater than the wellness industry’s own guidebook estimates.

If anyone would like to reach me to review this arithmetic, or report their own vendor’s results, contact me directly. Schedule-wise, I’m not available today (Monday) or Tuesday. However I am available later this week, specifically WTF.


5 Comments

  1. Sam Lippe says:

    It’s called “attribution,” as you’ve pointed out. Biostatistics 101. If you reduce risk, you can only attribute reductions in spending on risk-related things, like heart attacks, to the risk reduction you achieved. You can’t say: “we did this one little thing and costs declined across the board.”

    Like

    • whynobodybelievesthenumbers says:

      I would say the perps on the Koop Committee know that, but then one must consider the saying: “Never attribute to malice that which can be adequately explained by stupidity.”

      Like

  2. Marissa says:

    This one is a keeper. Total smackdown of an entire industry in one simple division of their own numbers.

    Like

  3. Donald Ardell says:

    The article “WTF! Introducing the wellness industry’s Wishful Thinking Factor” is fascinating (and highly entertaining). It should be read, discussed and debated by corporate actors in the business of promoting services, programs and products (including books, journal articles, one-off presentations, seminars and conferences alleged to be about “wellness.” However, the most WTF-inducing reaction (here using the common meaning of the abbreviation) should be the failure of all parties to this debate to recognize that the word “wellness” is the ultimate WTF (wishful thinking factor).

    What the author, corporations and institutions, Interactive Health, the Koop Award folks and especially the unmentioned Global Wellness Institute (GWI) that claims “wellness” is a $4.2 trillion industry fail to appreciate or choose to ignore is that very little of what they offer, measure, promote or criticize at worksites and elsewhere is actually wellness. It is certainly not the wellness concept that as a philosophy, mindset and lifestyle that came into use in the mid-1970’s (sparked by a little known by influential physician named Halbert L. Dunn in the 60’s).

    Wellness is not a product, nor is it a service and it’s not what is measured by those who claim attractive ROIs on “wellness” initiatives and expenditures. It’s a positive lifestyle that can be abetted by products or services, but wellness is always a process of functioning that individuals shape, control and manage for themselves. Each person must be the sovereign of his or her own wellbeing.
    It is unlikely that it can be measured – can a philosophy be measured? Can the variables be controlled when assessing the true animators of lifestyle changes?

    Once again, wellness should mean and be promoted as a philosophy, a mindset, a set of ideas and principles consistent with embracing life in a positive manner. This is not complicated.

    Genuine wellness should encourage and guide people to think and function rationally, to live exuberantly, to maintain physical fitness, to dine wisely consistent with factual nutritional knowledge and to live as freely as possible. The latter means becoming liberated from cultural or circumstantial elements such as superstitions, irrational dogmas and other mental and social limitations that add constraints on personal liberties.

    The four dimensions of genuine or REAL wellness are reason, exuberance, athleticism (exercise and nutrition) and liberty.

    I hope this will be of some interest next time you read about wellness programs and such and think to yourself, WTF.

    Donald B. Ardell, Ph.D.
    http://www.donardell.com

    Like

    • whynobodybelievesthenumbers says:

      Thank you for your comment. Wellness is a perfect example — and I am summarizing what you said in a few words of what a political philosopher once said: “Every cause starts as a movement, becomes a business, and degenerates into a racket.”

      Like

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