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Search Results for: Aetna
Us. Bestselling author Nortin Hadler MD. And now RAND’s wellness uberguru, Soeren Mattke PhD.
What do we all have in common? Calling Aetna out on its phony savings from collecting its employees’ DNA to predict their future health. (Curiously, insured members who want a DNA consultation with a real doctor will find that it is not a covered benefit.)
Let’s make one thing clear: Aetna’s DNA program savings are invalid, period. It is not possible to save $1400/person (or any amount) in the first year (or any year) of a wellness program. And especially not if the people in the program were healthy to begin with, as these employees were. The cohort had a couple of risk factors for metabolic syndrome, which itself is a grouping of risk factors that might lead to a cardiometabolic disease. In other words, they were at risk for being at risk. You and I should be so healthy.
I suspect the reason Aetna picked $1400 as the fabricated first-year savings figure is that the program costs $500, and when HR people ask: “What’s your ROI?” you want to be able to respond: “Between 2-to-1 and 3-to-1” — and hope you are dealing with people who will actually believe whatever they are told. Where are these people? Trump rallies? I can’t find any. When we market Quizzify, even though our savings are 100% guaranteed, our prospects still make us demonstrate exactly where the savings will come from and how they will be measured. And the only thing guaranteed about this Aetna program is that it will lose money.
If you read the article carefully, as we did (unlike the peer reviewers), it actually self-invalidates, just like most other wellness vendor studies. There is no meaningful difference in health indicators between the control and study groups at the end of the period. Hence there can be no savings attributable to the program.
The logic is also rather twisted. Literally, they claim that if they tell you that you’ve got a gene for obesity, you’ll try harder to lose weight. Come again? When I was a kid, I saw a horserace on TV and told my mother I wanted to be a jockey. But my mother pointed out that at my growth trajectory I was likely to reach 6’5″. (I did.) So I immediately gave up that dream. Had I applied Aetna’s logic instead, I would have doubled down on riding, and maybe put a brick on my head.
Highlights of Dr. Mattke’s Criticism
Along the same themes as myself and Dr. Hadler, Dr. Mattke wrote a Letter to the Editor of the Journal of Occupational and Environmental Medicine (JOEM). Keeping in mind that because Dr. Mattke is employed by a nonprofit whose entire credibility depends on its reputation for neutrality and objectivity, it’s fair to infer that, however critical his comments, he is being very muted in his critique.
Also–though fairly discredited due to this and other obviously invalid articles — the JOEM is an “academic” journal, with standards for decorum that preclude calling people “losers” or accusing them of having small hands. So Dr. Mattke is doubly constrained in this letter. One can only imagine what he really thinks.
Four key points:
(1) He “congratulates” Aetna on designing a rigorous randomized control trial (RCT) to begin with (they did), but “wishes they actually applied that rigor to the analysis”;
(2) He points out that instead of following through on that design, they compared participants to non-participants. He says they need to look at “the eligible population, not the cohort of the eligible population that volunteered to join.”
(3) Only 11% of the invited employees joined (would you give your DNA to your employer?). “This highly selected group may differ in important observable and unobservable characteristics from the population, posing a substantial threat to validity.”
(4) “The study didn’t report the cost of the intervention.” Hey, if my wellness program cost $500 per participant, I wouldn’t either. ( I know it’s not always about us, but Quizzify costs $38 or less.)
He has other points as well, but with my 60-year-old eyes, they are hard to discern from the free online version of the letter, and I’m sure as heck not going to pay for it. Now that I’ve seen enough examples of what they use it for, the idea of sending money to these JOEM people is about as appealing to me as donating to Trump’s campaign.
Time for Aetna to Fess Up
Aetna is a fine organization in other ways. They do a lot of good things and have other excellent initiatives, in other divisions of the company. They should just call this DNA fiasco a mistake and move on. Instead they’ve been insisting that the figures are real. At some point a “mistake” becomes a lie, and Aetna is rapidly reaching that point.
Aetna’s Employee DNA Collection Obsession Combines Junk Science, Junk Arithmetic, and Junk Integrity
It seems like most of my columns should or do start with a line like: “Just when you thought it couldn’t get any worse…”
Well, this time it really can’t get any worse. Aetna’s obsession with collecting employee DNA has truly reached the pinnacle of junk science, junk arithmetic, and junk integrity. (Not to mention junk privacy, as our guest-posting privacy expert noted.)
Junk Science and Junk Arithmetic
By way of background, we have already chronicled not just the junk science of using employee DNA to predict and prevent diabetes, but also the inability of their partner organization, Newtopia, to understand fifth-grade math. Nonetheless Newtopia wants us to trust their understanding of PhD-level science — and also trust them to store our DNA. (Like many vendors who were absent the day the teach taught arithmetic, they took their fuzzy math off their website following our instructional posting. We never received a thank-you note for this free consult, in case you were wondering.)
That same posting covered their reference site-from-hell, in which only a small fraction of employees participated, and the customer complained about the price tag, which is the wellness industry’s highest, @$500 per employee.
That price tag means claiming an ROI at the industry standard level of 3-to-1 requires fabricating far greater savings than wellness vendors usually fabricate. For instance, Ron Goetzel says programs should cost $150 and save $450. (Note: in all fairness he doesn’t say that any more. After our initial exposes, he retreated to a 1-to-1 ROI, as he admitted during our debate. Most recently he’s even backed off that. Now he says most programs fail.)
But showing that industry-standard ROI on a $500 program requires concocting savings approaching $1500/employee in the first year alone, an industry record. And did we mention that ROI was achieved on employees who were specifically selected for having nothing wrong with them to begin with, other than the possibility of getting metabolic syndrome at some point later in their lives? (Or as we originally wrote, these employees were “at risk for being at risk”.)
Oh, yes, and there was no clinically or statistically significant improvement in the set of health indicators that Aetna measured? And that Aetna was a co-author of the HERO study showing wellness loses money?
We said all this — posted it right on The Health Care Blog. Then the most amazing thing happened. One of the members of the editorial advisory board of the Journal of Occupational and Environmental Medicine (JOEM) –a trade journal with a long and glorious history of publishing suspect claims about the wondrous world of workplace wellness — essentially apologized in the comments. Specifically, he agreed the study never should have gotten past peer review. This wasn’t just any member of their board. This was the only member, Nortin Hadler, who has an actual national reputation in population health, having written many successful, influential and well-reviewed books on screening, overtreatment, and the harms of pushing people into the medical system.
So far, all we have noted is that Aetna has combined junk science with junk math. Next is where the junk integrity comes in. Just to set the stage by recapping the points above:
- Aetna must have already known their outcomes are made up because no one in population health –and very few people not in population health — could possibly think you could save $1400/person on healthy people in 12 months without doing anything other than assigning an “inspirator” to tell them to eat more broccoli, DNA or no DNA;
- They did already know wellness loses money because they co-authored the HERO report saying wellness loses money;
- If they genuinely had no idea their outcomes were made up, they would have learned that when they read my proof — a mathematical proof, not open to dispute like a scientific proof;
- And if they still doubted it, they could have read the comment by Nortin Hadler.
What does a wellness vendor do in these situations? Simple. It recalls the words of the French General Ferdinand Foch: “My left is collapsing. My right is in retreat. I shall attack.”
Their PR department called Bloomberg, had them assign a reporter completely new to the wellness beat, and then wheedled a complete puff piece out of her, crossing their fingers that the reporter wouldn’t google this thing, which would have created a front-page story.
In the Bloomberg paean, Aetna’s thesis is that best way to motivate people to lose weight is to tell them their genes make it very difficult to lose weight. If that logic doesn’t resonate with you, you have company. Here is a quote from that article — one single quote — that basically invalidates the entire remainder of the story, puff piece or not:
George Annas, a bioethics professor at Boston University, cautions against reading too much into DNA tests. “The chance that they have a genetic test that can determine if you’re prone to be fatter than other people is very, very unlikely,” he said. “What [Newtopia] really seems to be saying is that if you tell people that you have a genetic condition that may predispose you to be overweight, that may motivate people.” For some, he said, DNA testing could have the opposite effect: If someone is predisposed to gaining weight, then why bother dieting or exercising?
Speaking of things which have almost no chance of happening, here are two more. First, we’ve asked JOEM for a formal retraction, given that the study was admitted by Dr. Hadler (who hadn’t seen it pre-publication) to be blatantly wrong. Second, Aetna isn’t likely to apologize either, any more than they did for their last foray into wellness, which involved pitching some of the most controversial drugs on the marketplace to patients who weren’t even sick and didn’t ask for them. Instead, they will probably double down on DNA.
The behavior of both JOEM and Aetna can be explained with an old Chinese proverb: “When you are riding a tiger, the hardest thing is getting off.”
Whoever concluded that more is learned from one bridge that falls down than 100 that stay up did not included Aetna’s data in their calculations: 2 major bridge collapses, nothing learned.
Aetna first gained notoriety in these pages — and in our book, Surviving Workplace Wellness, and on The Health Care Blog — for being the first health plan to pitch expensive name-brand drugs to its members. Not just any members, but members who weren’t sick — and that someone else was insuring, since there wouldn’t be any savings.
And not members who requested them, but members who Aetna pitched them to, members who mostly didn’t want them. And not just any drugs, but drugs that were/are so controversial that they became the subject of an essay in the Journal of the American Medical Association concluding they never should have been approved. (As a sidebar, while all of wellness is claimed, mostly falsely, to increase productivity, one of these drugs says right on its label that it reduces productivity, specifically impacting memory, attention and language. And yet Aetna insisted productivity would increase. Using a drug that reduces productivity to increase productivity truly puts the “off” in “off-label” use.)
So what did they learn from a failed wellness program that was expensive, intrusive, ineffective, and incredibly unpopular using a third-party that doesn’t seem to know what it’s doing? Their takeaway was: “Let’s come up with a program that’s even more expensive, intrusive, ineffective, and incredibly unpopular using another third-party that doesn’t seem to know what it’s doing…and, for added measure, let’s lie about the outcomes.”
And thus they hatched their scheme to bring DNA surveillance into the workplace. Not to identify possibly useful mutations, but to estimate the risk of diabetes and heart attacks. And not: “We’ll cover this testing if you go to the doctor and together decide whether to order it.” Rather: “You’ll forfeit money if you don’t agree to this, and our partner gets to keep your DNA and re-sell it.”
We’ve already covered the intrusiveness, and fact that their partner, Newtopia, seems unable to understand basic arithmetic and science. We’ve also covered their reference-site-from-hell, which didn’t exactly embrace this program.
Most recently, we’ve covered the lying-about-outcomes angle. Because the program is going to sell for up to $700, Aetna had no choice but lying– they needed to “show” $1400 in savings to achieve a 2-to-1 ROI. Scroll down to the comments — the most respected member of the editorial board of the journal that published their outcomes now says they never should have published the study. (He himself hadn’t reviewed it.)
But all of our exposes are trumped by David Shaywitz. Writing in Forbes, he points out that the entire idea of using genetics to predict and manage obesity-related illness is, to use a technical genomics term, stupid.
We’d urge reading the whole posting (though he doesn’t get into Aetna/Newtopia until page 2), but here are the takeaways:
(1) “The three variants examined by Aetna/Newtopia explain a very very small fraction of genetic risk;”
(2) “Even if you carry the harmful genes, there is no obvious course of action” different from standard diet-and-exercise.
Shaywitz — who may have done more research before writing this column than Aetna did before starting this program — also clearly distinguishes this type of genetic information from identifying (for example) the BCRA1 mutation, which might actually be useful. “Useful” is not a term found often in wellness programs so you won’t be surprised to hear that Aetna doesn’t include BCRA1 mutations in theirs.
What are the takeaways?
First, Aetna’s wellness programs need some adult supervision. Programs like these should never be allowed out the door. Of course, not offering wellness is not an option. It is way too profitable, and if they don’t, someone else will. However, there are plenty of other ways to rip off employers and humiliate employees that are less expensive and less intrusive than the two Aetna has come up with.
Second, Quizzify is making a bet that — especially because Aetna is not hiring any of them — there are a lot of smart people still out there, people who would prefer to pay a low price for an employee health program that is non-intrusive, fun, guaranteed to save money, Intel-GE Validation Institute-validated, and carries a Harvard Medical School imprimatur than pay a high price for programs that don’t work and employees don’t like.
Yes, we know it’s not always about us, but we appreciate Aetna’s efforts to make us look good by comparison.
If engineers learn more from one bridge that falls down than from 100 that stay up, this new Aetna-Newtopia study is the Tacoma Narrows of wellness industry study design. No article anywhere — including our most recent in Harvard Business Review — has more effectively eviscerated the fiction that wellness saves money than Aetna just did in a self-financed self-immolation published in the Journal of Occupational and Environmental Medicine. Hopefully the people who give out Koop Awards to their customers and clients will read this article, and finally learn that massive reductions in the cost of participants associated with trivial improvements in risk are due to self-selection by participants, not wellness programs. And certainly not wellness programs centered around DNA collection.
Aetna studied Aetna employees who, by Aetna’s own admission, didn’t have anything wrong with them, other than being at risk for developing metabolic syndrome, defined as “a cluster of conditions that increase your risk for heart attack, stroke and diabetes.”
In other words, taking the wellness industry’s obsession with hyperdiagnosis to its extreme, the subjects’ “diagnosis” was being at risk for being at risk. Not only did they not have diabetes or heart disease, but they didn’t even have a syndrome that put them at risk for developing diabetes or heart disease. You and I should be so healthy.
As this table shows, after one year, the changes in health indicators between the control and study groups were trivial (like a difference in waist measurement under 3/10 of an inch), and only triglycerides was barely statistically significant (p=0.05). Additionally, the control group actually outperformed the study group in 3 of the 6 measured variables, as would be predicted by random chance. Bottom line: nothing happened.
And yet, Aetna reported savings of $1464/participant in the first year. This savings figure is more than 20 times higher than what Aetna’s co-authored HERO Report says gets spent in total on wellness-sensitive medical events. It’s also far higher than Katherine Baicker’s thoroughly discredited 3.27-to-1 ROI, that she has basically retracted, published six years ago–that, yes, in keeping with wellness industry tradition, their article cited. (Only now, because the study is now six years old, Aetna feels compelled to insist that it is “recent.”)
How did they achieve such a high savings figure in a legitimate RCT? Simple. That savings was not the result of the legitimate RCT. Having gone through the trouble of setting up an RCT, they then proceeded to largely ignore that study design, since as their own table above shows, nothing happened.
Spending was a bit lower for the invited group, but obviously there couldn’t have been attribution to the program. A responsible and unbiased researcher might have said: “While there is a slight positive variance between the spending on the control group and the spending on the invitee group that wouldn’t begin to cover the cost of our DNA testing, we can’t attribute that variance to this program anyway. The subjects were healthy to begin with, there was no change in clinical indicators, and we didn’t measure wellness-sensitive medical events even though we know from our own HERO report both that those represent only a tiny fraction of total spending, and that those are the only thing that a wellness program can influence.”
Instead, they coaxed about 14% of the invitees to give up their DNA, and measured savings on them. More than coincidentally, that decidedly uninspiring 14% participation rate was about the same as the Aetna-Newtopia debacle at their Jackson Labs reference site-from-hell. Basically, employees don’t want their DNA collected, and DNA turns out to be quite controversial as a tool to predict heart disease down the road, let alone during the next 12 months. Further, Newtopia admits they store employee DNA, lots of people have access to it, and they could lose it.
The DNA also seems to have had precious little to do with the actual wellness program itself–and for good reason given the links above. This seems like a classic wellness intervention of exactly the type that has never been shown to work, with the DNA being only an entertaining sidebar. The subjects themselves exhibited no interest in hearing about their DNA-based predictions.
This is the first time a study has compared the result of an RCT to the result of a participants-only subset of the same population. The result: a mathematically and clinically impossible savings figure on the subset of active participants, and an admission of no separation in actual health status between the control and invitee groups by the end of the program period.
So Aetna — in this one article — accidentally proved what we’ve been saying for years about the fundamental bias in wellness study design that creates the illusion of savings:
Participants will always massively outperform non-participants, period — even when the program doesn’t change health status or even when there was no program for the “participants” to participate in.
Short Summary of Intervention:
“Aetna is launching a pilot program to test the benefits of new FDA-approved, prescription weight-loss drugs combined with lifestyle support. – See more in this news release.
- Aetna Press Release
- ”Special Communication” in JAMA Internal Medicine, published by the American Medical Association
- Aetna Presentation April 17
Summary of Aetna’s key points:
Self-insured employers can sign up for this program in which Aetna will outreach to obese employees and recommend use of the drugs Belviq and Qsymia
Questions for Aetna:
You are only offering this program to self-insured employers. If this is, as your title says: a “strategy to improve health status and reduce costs,” why are you denying this program to your own fully insured members, where the cost savings would accrue directly to your own shareholders while the health status improvements would benefit your own members?
ANS: Refused to answer
Does it concern you that neither drug in your pilot is approved in Europe and that JAMA Internal Medicine says the drugs have been associated with serious harms and that these well-respected JAMA physician editorialists state that these drugs should not have been approved for use in the United States?
ANS: Refused to answer
How does your description of these drugs on your sales slide as “safe and effective” square with the question above?
ANS: Refused to answer
Why, over the course of the 70-minute webinar (for which attendees were charged $300), didn’t you mention the JAMA essay or any other safety concerns?
ANS: Refused to answer
In addition to omitting mention of the potential harms in the JAMA article, none of your materials mention that the (many) known side effects include impacts on memory, attention and language. Wouldn’t those side effects be of concern to an employer who is interested in, as your materials say, increasing the productivity of the employees taking the drugs?
ANS: Refused to answer
Does it concern you that these drugs have been by and large rejected by patients and physicians, with sales for Belviq “well below even reduced Wall Street expectations” while Qsymia has been described as ”flailing” ?
ANS: Refused to answer
Does it concern you that, of any drug on the market, Belviq has the highest ratio of payments to doctors to overall sales?
ANS: Refused to answer
Suppose an employee’s doctor won’t prescribe these drugs. Many doctors refuse to prescribe these drugs because of the side effect profiles (hence the very low sales figures). In that case, will you pressure the doctor to prescribe the drugs, get a list from the manufacturers of doctors in the area willing to prescribe the drugs and encourage the employee to switch doctors, or pressure the employer to tell the employee to drop out of this program they were just recruited into at your request? In other words, if the doctor doesn’t comply, will Aetna play doctor?
ANS: Refused to answer
Are you aware of any other health plans that will recommend name-brand drugs to members who call and say that they have obesity or any other disease?
ANS: Refused to answer
Are you aware of any other health plans that, rather than wait for members to ask for drug recommendations, outreach to members who have a disease in order to recommend proprietary name-brand drugs?
ANS: Refused to answer
Are you aware of any other health plans that outreach to members who do not have a disease, but only a high BMI, to recommend proprietary prescription drugs, especially prescription drugs that “have been associated with serious harms”?
ANS: Refused to answer
You said on your webinar that people who go off these drugs will “gradually regain weight.” In that sense, other than the $2400/year cost and “potential for serious harm,” how would this result different from any other diet, in that people who stop adhering carefully will gradually regain their weight?
ANS: Refused to answer
Any responses, apologies, retractions, changes etc. by the vendor are listed here:
June 23, 2014: Note from Ed Pezalla at Aetna, Vice President for Pharmacy Policy and Strategy: “Thank you for reaching out and inviting additional dialogue. We have a new article about the program that addresses many of your questions. We expect to publish the article in the next week or so in Aetna’s Health Section. I can send you a link once it is posted.”
August 11, 2014: Ed Pezella sent an article that would “answer some of the questions“. I am having trouble locating the answers in that article but perhaps that’s because I can’t find my reading glasses.
October 2015: Qsymia sales still “flailing.” May be off the market by 2017. Belviq struggling as well. Aetna could have avoided this entire embarrassment in the first place if they had simply asked us if pitching obesity drugs to its customers was a good idea. Come to think of it, they didn’t have to ask us. They could have asked anyone with an IQ over 80.
May 2016: STATNews finds that obesity drugs — specifically these two — have been abject failures in the marketplace.
This afternoon STATNews followed up with more criticism of HR 1313, the Preserving Employee Wellness Programs Act. As measured by comments to their previous article and the Washington Post’s article, public opinion is running about 999-to-1 against it. That’s a lot even for wellness.
Ryan Picarella, of WELCOA, jumped on this and got way ahead of HERO, which is not opposing it. They can’t. Aetna is a major dues-paying supporter, and Aetna loves genetically screening employees for defects. Naturally they fabricate their outcomes. This time we mean it literally when we say: “Lying is part of wellness vendor DNA.” Aetna even invested in a company to further their dystopian vision, a company ironically named Newtopia.
By contrast, this is the kind of leadership we’ve come to expect from WELCOA, filling the ethical vacuum created by HERO.
But, more importantly, this article is the first media mention of Ethical Wellness, our new website dedicated to putting the wellness back in wellness. You might recall the original Workplace Wellness Code of Conduct. Ethical Wellness has updated it. You can sign on to the website, join and endorse, all at no cost. You can also contribute, separately, and be highlighted as a contributor. Scott Life and Dan Keith have both pitched in $500, as compared by to my $10 (to test the donating mechanism — that’s my story and I’m sticking to it). I’ll be putting in the other $490 shortly. Really. There is also a linkedin group. No mass postings — a true discussion group.
We’ll be talking more about Ethical Wellness in the coming days. for now, it’s about not fining employees for refusing to have their children genetically screened for defects.
We are still a few weeks shy of April Fool’s Day, but Congress is celebrating it early. Using all the fuss about real-and-replace as a smokescreen, the Business Roundtable has gotten its allies in Congress to sneak in a bill allowing employers to require genetic testing in their wellness programs. This will shock people, but genetic testing loses tons of money for employers, and vendors (in this case, specifically Aetna) lie about savings.
This article isn’t about the lies and the numbers, though. It’s about Congress giving employers basically unfettered rights to collect employee genetic information. You might recall there is a law that says employers can’t genetically test employees, or discriminate against employees on the basis of genes. The idea of this new legislation is that law wouldn’t apply in the case of voluntary wellness programs. As we learned last year, the Business Roundtable “convinced” the Equal Employment Opportunity Commission that “required” and “voluntary” are synonyms. Consequently, employers can simply demand that employees submit to this or get fined.
The article, by intrepid reporter Sharon Begley (who also exposed the Wellsteps debacle with Boise), can be accessed here. Add comments to that article, since it is likely to be passed around more than TSW is.
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.
#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:
- New wellness industry report costs $5400 (but that includes shipping)
- New report raises the bar for cluelessness in wellness
- 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.
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.
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.
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.
We are now in Ron’s wheelhouse, which is publishing peer-reviewed articles in third-tier wellness trade journals. Let’s see how he does.
For those who are new to this thread, Part 4 is here, and links to earlier installments. The recording is here. Time stamps roughly synch up.
Ron says he is a researcher, and publishes in peer-reviewed journals. He “applauds” me again for giving them the “opportunity” to correct their many errors, and says the comments I make are often “right on the money.”
It is indeed a creative use of the word “opportunity,” as in: “Last year the IRS gave me the opportunity to be subject to an audit.”
He says “that’s what the scientific method is all about, having peer reviewers critique your work and find problems.” And yet, I’ve never, ever been asked to peer review anything that he and his cronies have ever published. Go figure.
He would like “us” (meaning him and his cronies) to be able to review my work, even though I’m not allowed to peer-review theirs. He says he has “never seen an article by Al Lewis…to review.”
Hmmm…perhaps his internet is down?
Since all my work is right on this site (including links to other work, in “In the News” to Health Affairs, Harvard Business Review etc.) he is free to review it anytime, and we publish all comments. There isn’t really any need to for him to look at our material because mostly it’s his own and his cronies’ material. And you know the mantra from Surviving Workplace Wellness: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
As in his opening remarks and in his “secret” letter to the media, he once again criticizes my stuff as being “out there…outlandish,” but gives zero examples.
Ron, in the process of saying something he knows not to be true for a change, accidentally endorses me.
“Ron, would you say I am the most qualified person in peer review in terms of finding the most mistakes?”
“Well, who has found more mistakes than I have?”
[Silence and nervous laughter from the audience.]
I point out that — despite his tacit endorsement just now that I am the best peer reviewer — none of his friends’ wellness trade journals have ever asked me to peer review anything.
And he still refuses to say why he hasn’t claimed the million-dollar reward.
Peer reviewed or not, numbers need to add up, and Ron’s don’t. In one award-winning example, Eastman Chemical, $900/person in savings was shown — with risk factors changing by only 0.17 per person, excluding dropouts.
Ron did not rebut this. Eastman was one of the two Koop Award applications he had doctored when it turned out the applicant had accidentally told the truth but no one on the award committee noticed.
Ron has already run away from most of the industry’s claims, as earlier installments of this debate have observed. Now is he running away from Wellsteps’ Steve Aldana, whom he has co-presented and co-authored with and who naturally is on his Koop Award committee. Aldana recently wrote that I was “sick” because a colleague posted my Harvard Business Review article on his linkedin group and asked what people thought of it.
[2016 Update: Ron is now embracing Steve Aldana and Wellsteps, the first company to admit to harming employees.]
Ron is turning his blacklisting of me into my “plea” to do peer review in his trade journals. I have never “pled” to do peer review in his trade journals, which are mostly useful as punchlines. I merely observe that I’ve never been asked. “You’re very good at calling out mistakes, but you’re not very good at publishing your own research studies.”
He then cites the Johnson & Johnson study (that’s the same Johnson & Johnson that just proposed the Fat Tax). That is the only study he’s ever done that I’ve not been able to invalidate on its face, so he gets his first point of this round here. Not because the study is valid. There wasn’t enough data in it for me to automatically prove that it was invalid, which is a very high standard, but that’s my standard–“face invalidity.”
So there you have it: one company in the entire universe that might possibly have saved money on wellness. And as coincidence would have it, they also sell wellness services. No publication bias there…
November 4, 2016 Update: I just found this J&J study. It is even worse than the others. Employees lying on HRAs, trivial risk reductions…and of course massive savings. It appears that all they did was increase the deductible and then give employees $500 to do wellness, thus shifting the money out of the healthspend into the incentives account, which is not included in the “savings.”
I point out that even though I’m apparently not qualified enough to peer review for his friends who run low-impact journals, I do get called upon to peer review for Health Affairs and other high-impact journals. And most importantly, while I’ve done only two peer-reviewed articles, one led to the dismantling of the North Carolina Medicaid medical home. The other was #1 for 2015 in the American Journal of Managed Care and continues to be cited widely. My award-winning book was peer-reviewed by some of healthcare’s leading figures: Stuart Altman, James Prochaska, Tom Scully, Leah Binder, Bob Galvin, Regina Herzlinger, and Nortin Hadler (the same Nortin Hadler who apologized for poor peer review by one of Ron’s favorite trade journals).
Most importantly, speaking of peer review, Quizzify is the only population health company that may publicly say “our content is reviewed by doctors at Harvard Medical School.”
Ron — whose entire industry loses money and can’t even guarantee not losing money — is now lecturing me on Quizzify’s guarantee of savings and how it needs to be peer-reviewed. I was not expecting to be attacked for offering an incredible, unique, value proposition, so I didn’t have a good answer. Only in wellness is saving money for customers considered a bad idea.
He continues to harp on peer review by his friends-and-relations, but I won the round with one simple observation: “We are not here today because of Ron’s peer-reviewed articles. We are here today because of my non-peer-reviewed articles.”
I could fill a blog with all the nonsense that Ron’s friends who run so-called “peer-reviewed journals” have published. Come to think of it, I have. Examples:
AJHP’s proposal to tie insurance premiums to weight, like ordering lobster or mailing packages
JOEM’s Aetna debacle
AJHP’s “Randomized control trials show negative ROIs.” (I didn’t have to post anything here–this spoke for itself.)