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So I just got word of another of Ron Goetzel’s signature moves–spreading rumors among my business contacts. (How’s that worked out, Ron?)
Typically the “tell” is that a contact will ask me: “Hey, is it true that you eat your young?”
I’ll reply: “Lemme guess. Goetzel.”
“How’d you know?” would be the response.
Just for the record, because things I say have a way of being misquoted or misinterpreted, I do not eat my young, my old, my middle-aged or anyone else. Not for breakfast, lunch, or dinner. Or even between-meal snacks.
This happened again last week. My signature response to Ron’s signature move is, invariably, when-they-go-low-we-go-high. I simply shine a light on a wellness outcome, embarrassing him and his cronies. With the exception of US Preventive Medicine, which somehow manages to noticeably reduce risk in a population, these are quite predictably unfavorable. That’s on a good day. On a bad day, they actually harm employees.
Unfortunately, there hadn’t been a good wellness outcome to analyze in months.
And then, yesterday, a deus ex machina. The Journal of the American Medical Association just published the second year of the University of Illinois study showing, as usual, that:
Wellness. Doesn’t. Work.
This Seinfeld-like result showed no change in risk factors, after two years. The only “positive” was that more employees had PCPs, an outcome which could have just as easily been acheived by saying: “Hey, everyone, go get a PCP. We’ll give you the $100 we would have wasted by paying a wellness vendor.”
Cost savings? Haha, good one.
It will be interesting to hear the wellness industry’s excuse for this one. Because after the first year, the excuse from the vendor-infested National Business Group on Health was: “The lack of first-year cost savings should not be surprising.” For the second year, I guess they’ll just cross out the word “first,” and replace it with “second,” using a sharpie.
I know I’m late joining the discussion, but I nonetheless felt the need to contribute. I worked as an analyst for one of the corporate wellness providers on Al’s shit list, so I have an insider’s perspective. I ran some of our client’s ROIs. People love to quote them – including some of the commenters below [Michael O’Donnell, Ron Goetzel, etc.] and the sad thing is that we often base our arguments on what these ROIs are, as though they are fact. They are not.
Our models are based off poorly reviewed industry research, which would be laughed at in the econ graduate program I attended. That aside, I produced an ROI using their model – a model that I would have been embarassed to defend to anyone.
The result was a negative ROI, but when I emailed my supervisor the result, he called me into his office and told me verbatim: “We aren’t allowed to have a negative ROI. Go fix it.” I argued with him about how our already crappy model would be completely devoid of integrity and would render the results meaningless if I were to cherry pick variables to yield a favorable outcome, but that fell on deaf ears.
Additionally, our contracts often had a clause that penalized us if we did not “deliver” on a pre-agreed upon ROI. Talk about incentivizing us to cheat! During my tenure I never once witnessed a client question our methodology in any meaningful way.
So it’s back on you, the employer, to put the kibosh on these wellness people, since they are clearly not on the honor system.
While you do that, I am going to go have something to eat. Perhaps liver, with a nice chianti.
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:
- 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
- Even the dumbest wellness vendors know how to measure risk (following their five days of training in medicine)
- Employees never cheat to improve their biometric scores and never lie on their risk assessments
- 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
- No lag time between risk reduction and event avoidance
- 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.
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:
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.
All this time, I just thought that:
- employees got worse in wellness programs because
- wellness vendors, especially their CEOs, are stupid. (“In wellness, stupid is the new broccoli.”)
Here’s an example that would seem to fit the hypothesis like a glove:
- Wellsteps caused employee health to seriously deteriorate and
- their CEO needed to spend “11 years in college.” That’s four more than Bluto Blutarski (though I think Mr. Aldana did at least manage to graduate, possibly without even throwing up on the dean). Yet when he accused award-winning health writer Sharon Begley of dishonesty because she quoted Wellsteps’ outcomes report verbatim, he called her a “lier.”
So I put two and two together and thought: “stupid vendor equals program failure.” Turns out it’s much more complex than that.
A study published in Frontiers in Psychology examined the relationship between weight and wellness programs, with three studies, summarized here in their own words.
The present research focuses on a downside of workplace health promotion programs that to date has not been examined before, namely the possibility that they, due to a focus on individual responsibility for one’s health, inadvertently facilitate stigmatization and discrimination of people with overweight in the workplace.
- Study 1 shows that the presence of workplace health promotion programs is associated with increased attributions of weight controllability.
- Study 2 experimentally demonstrates that workplace health promotion programs emphasizing individual rather than organizational responsibility elicit weight stigma.
- Study 3, which was pre-registered, showed that workplace health promotion programs emphasizing individual responsibility induced weight-based discrimination in the context of promotion decisions in the workplace. Moreover, focusing on people with obesity who frequently experience weight stigma and discrimination,
- Study 3 also showed that workplace health promotion programs highlighting individual responsibility induced employees with obesity to feel individually responsible for their health, but at the same time made them perceive weight as less controllable.
Together, our research identifies workplace health promotion programs as potent catalysts of weight stigma and weight-based discrimination, especially when they emphasize individual responsibility for health outcomes.
This explains an awful lot. First and most obviously, why people gained weight in the award-winning Wellsteps, McKesson, and Vitality programs. In wellness, I observed three years ago, “fat-shaming is the new black.”
Second, it explains the futility of one of the two positive (albeit trivial) findings in the recent BJ’s Wholesale Club study — that more employees will “watch their weight.” Study 3 suggests that’s a bug, not a feature.
Third, it explains the harms being visited upon people who already have eating disorders. Especially because Ron says employees should weigh themselves daily, which naturally is the opposite of what the science says and is downright dangerous for people with eating disorders.
Finally, it explains why Ron Goetzel will be spending his entire life trying to turn lead into gold (or in his case, claiming he already has, by giving Koop Awards to a bunch of failed programs which he calls successes). Sustained weight loss as a result of wellness programs stigmatizing obesity has never happened in the past, and there is no possibility — none, zero — that workplaces trying to coax, cajole, bribe, fine, or shame employees into losing weight will ever be successful in the future.
In case you missed it, turns out that the last 11 wellness studies have all come to basically the same conclusion. This is the intro to Employee Benefit News listing them and linking to them.
And if anyone still thinks overscreening programs have merit, here is a complete expose from 2017 on “pry, poke and prod.” It’s pretty extensive so clear your calendar.
The highly-publicized, randomized control trial of the wellness program at BJ’s Wholesale Club published recently in the Journal of the American Medical Association found virtually no value in the program.
While most pundits applauded the study, wellness vendors — whose livelihoods, of course, depend on believing the opposite — attacked it. Two common threads among the attacks, including one right here in Employee Benefit News, were that the program was bad (“anachronistic” in this case) and that one can’t draw conclusions from one study. The specific argument: “Recent research has disappointingly focused on a single — typically anachronistic — program to make sweeping statements on wellness programs more broadly.”
Far from being anachronistic, the JAMA study was as mainstream as studies get — screenings, risk assessments, coaching, learning modules. This is what wellness has been all about. True, there are a few new things today — like employee health literacy education — which is my own business, but they are too early in the life cycle to be evaluated.
And far from being a one-off, this study’s finding of zero impact was completely consistent with the previous 11 (eleven) published studies for which data was provided. Let’s review those studies…
Note: someone might say: “that doesn’t add up to 11.” There are plenty of others. My favorite is the self-immolation published by the Health Enhancement Research Organization in 2015. Very stable geniuses that they are, they didn’t actually realize they showed wellness losing money until I pointed it out.
First, Mr. Goetzel claimed that he had never seen this study before (even though it was the centerpiece of his own organization’s guidebook) and that the data was fabricated (not sure how he knew that if he hadn’t seen it). When that defense was outed, he started vigorously defending the study, his principal defense being that HERO didn’t intend for costs to be compared with benefits.
Further, my suggestion that the costs should be compared to benefits was “mischievous,” according to Ron. That much I’ll gladly agree with…
We’ll go walking out
While others shout of war’s disaster
Oh, we won’t give in
Let’s go living in the past
A delegation from the Validation Institute attending the World Health Care Congress time-traveled over to the US Chamber of Commerce Monday to watch Ron Goetzel and a few acolytes try to re-create the shiny new wellness object from the 1980s. Just like in the 1980s, the theme was, and these are the exact words of one of the speakers: “Why aren’t more employers seeing the value in wellness?”
Um, because there isn’t any? 7 years after I first proved, and guaranteed, that none of this “pry, poke and prod” nonsense could possibly add up, the evidence has finally caught up with the conclusion.
Of course, there is value in wellness done for employees, rather than to employees. And far be it from me to discourage anyone from being screened according to guidelines. But that’s not what the US Chamber is all about. The US Chamber is about pressuring the EEOC into restoring the punitive “voluntary” wellness penalties that a federal judge put the kibosh on in December 2017, effective this year.
The irony is, the Chamber is its own worst enemy. If the EEOC ever got hold of a recording of that session, it would constitute an irrefutable argument for the EEOC not to change the rules. The speakers other than Ron were all about improving employee well-being through autonomy, independence, responsibility for projects from beginning to end, and creating a culture of health. All those are worthy goals. Goals which, more than coincidentally, have nothing to do with screening the stuffing out of the workforce and penalizing employees 30% for not losing weight. (Shame on Oprah Winfrey!) Quite the contrary, any organization trying to achieve those goals would never dream of manhandling their employees like that.
Ron Goetzel: Katherine Baicker is living in the past
If a fortune-teller had predicted the following as recently as three weeks ago, I would have demanded a refund: Ron Goetzel dissed Katherine Baicker., Specifically, he accused Professors Baicker and Song, along with BJ’s and their vendor, of “doing a program out of the 1980s,” saying that their outstanding study could safely be ignored. (These are the same 1980s in which wellness, according to its promoters, couldn’t fail.)
What horrible 1980s elements did the BJ’s program have? Coaching, screening, learning “modules” and HRAs. Of course, no one has included those things in a wellness program for at least 30 years. (not)
Curiously, Ron didn’t have any issue at all with Baicker’s original 2010 “Workplace Wellness Can Generate Savings” article, which was chock full of programs literally from the 1980s. Only 2 of the programs analyzed in that study were conducted in the 21st century.
If that fortune-teller had also predicted that Ron would start telling the truth someday, I would have demanded double my money back. But no fortune-teller would ever predict that. Fortune-telling industry malpractice insurers will no longer cover lawsuits arising out of that prediction.
And for good reason. It’s generally a safe bet, given Mr. Goetzel’s tenuous grasp on integrity, that he’s going to misrepresent something. Yesterday, as is his wont, he deliberately misrepresented the position of The Incidental Economist (TIE) on the subject of wellness. He quoted TIE as saying that wellness “usually” doesn’t save money. (As a sidebar, I’d note that it is a bit of a head-scratcher that even the misrepresented TIE position makes Goetzel’s position look bad.)
Perhaps I need new glasses, but I can’t seem to find the word “usually” in the most recent TIE article on wellness savings:
There’s another reason Ron doesn’t quote TIE, which is they completely dissed him and his Koop Award friends in that article. Totally worth a read.
What does a Goetzel program look like?
So how do you succeed? How do you avoid programs “from the 1980s”? Maybe you avoid that by using a vendor where Ron has a “strong working relationship,” like Vitality. And just to be on the safe side, maybe you report only the results from Vitality’s own program for Vitality’s own employees. That way you can’t fail…
…and yet fail they did…
Even with the investigator bias and self-selection and “home court advantage,” Vitality employees got 2% fatter and their eating habits got worse after being coached.
Although maybe that counts as a success in the wellness industry, because employees weren’t too badly harmed, as they are in a typical Koop-Award winning program. Congratulations to Mr. Goetzel!
Incredibly, events unfolded almost exactly this way at Penn State during their well-publicized wellness debacle 5 years ago. It was even funnier in real life because while exercise does of course promote wellness, faculty and staff were very restricted in their use of campus recreational facilities. Making those free to employees and dependents was not part of their wellness initiative.
No, instead employees were being forced into an outcomes-based wellness program, one that was supposed to save “millions of dollars.”
Coincidentally, while the Penn State HR department — ably assisted by Ron Goetzel, who later denied having anything to do with them despite being in their press conference – was trying to force employees into these programs, the Penn State bakery announced an expanded selection of pastries and desserts for the upcoming semester.
Penn State’s was, to paraphrase the immortal words of the great philosophers Gilbert & Sullivan, the very model of a modern forced wellness program. Sure, they violated clinical guidelines. That seems to be the price of entry for wellness. More head-scratchingly, women had to disclose whether they intended to become pregnant, or else pay a $1200 fine. This requirement was designed to, in the Highmark representative’s own words in a rather contentious faculty meeting — “help” them. That would be like offering to “help” the proverbial little old lady cross the street — but if she declines assistance, saying: “OK, then pay me $1200. The choice is yours.”
Full disclosure: Highmark has now abandoned their old outcomes-based wellness program on which Penn State’s was based in favor of a much lighter and more appropriate program, and we wish them the best at it. All indications are that it is going very well and is a model for others. A total turnaround.
Back to the storyline…
There is something about forced outcomes-based wellness programs that brings out employers’ inner stupid, and Penn State was no exception. Consider: almost by definition women who are planning to become pregnant have thought about it and have done the basic research. It’s the women who accidentally become pregnant who may possibly have the need for assistance. And even the dumbest HRA wouldn’t ask the question: “Are you going to accidentally become pregnant?”
So, using the very unlikely assumption that women completed the HRA honestly, Penn State’s forced disclosure requirement would have identified 100% of the people who did not need “help,” while missing 100% of the women who might. If you’re keeping score at home, that’s 100% false positives and 100% false negatives. That’s a lot even by wellness industry standards. Eat your heart out, Interactive Health.
And did I miss the memo where carriers were anointed the prime providers of medical “help”? Has anyone ever said to you: “You don’t look so good today. Better call your health plan”?
See https://theysaidwhat.net/2016/04/22/the-story-of-an-employee-who-benefited-from-wellness/ for the back story.
Do employees cheat in outcomes-based wellness programs? Of course not. Who would ever gain weight in order to be paid to lose it? That would be dishonest and unhealthy.
Haha, good one, Al.
Yes, obviously employees cheat in outcomes-based wellness programs and crash-dieting contests. But here are two things that aren’t so obvious:
- Cheating is far more widespread than employers would like to believe;
- This massive scale of cheating — two-thirds of all employees cheat in wellness — is well-known but suppressed by self-proclaimed “scientists” in the field, whose livelihoods would be in jeopardy if they acknowledged the scale of the cheating.
Cheating is widespread
How do we know this? Bloggers receive data from WordPress on hits for each post. Not just the number of hits, but the specific sources of the click-throughs — other bloggers or else “search engines.”
In any given week, the current posts and the home pages get the most hits. However, for the year as a whole, it’s a different picture. Take a looksee at our total hits for 2018:
Our typical blog post — not including home pages and related pages — gets about 2500 hits over the course of the year in which it is posted. But you’ll see that #3 on the 2018 list is: “How to cheat in a corporate weight-loss contest.” Almost every day that particular post racks up 15-25 hits, giving it 6388 for 2018. I used to assume that some other, more popular, blog was linking to it, but I can see linked blogs too on the Site Stats page, and there weren’t any.
Here are the 2019 stats through yesterday.. A new cycle of wellness programs and crash-dieting contests is about to start, so despite New Years week being a very slow week for TSW (like other HR blogs), that post is #1:
Further, even though these stats are 2018 and 2019, this blog was posted November 2016.`
What is driving this continuing popularity?
It turns out that the source of these click-throughs is indeed “search engines.” Seems that even though the target audience for this posting was the narrow HR/benefits community, employees themselves are googling on “cheating in wellness programs” and finding this post right on the first page of hits:
That also explains how we could get so many hits and yet so few comments and Facebook reposts. No one wants to be caught.
You might say: “That’s only 6,388 employees for a full year. The rest are honest.” Nice try, but consider:
- “Only 6,388 employees” clicked through despite noting from the first lines (as you can see) that this article really wasn’t a guide to cheating.
- This post is way down at the bottom of the front page.
- This was only a single year — 2018 — and the 2019 rate arithmetically projects to about 20,000 hits (though much of this posting’s hits are seasonal)
- The #2 source of click-throughs to this article is Slate’s masterful expose called Workplace Wellness Programs are a Sham, also on the first page of google hits above, which itself links to us–meaning that employees are also clicking through on that article in the same search.
- The 6,388 excludes the gazillion employees who don’t need to google anything in order to realize that the winning strategy in any outcomes-based wellness program or crash-dieting contest is to binge before the initial weigh-in and crash-diet before the final one — and of course lie on the risk assessment.
- The keywords that drive traffic to this site, according to Alexa? #3 — after Bravo and Wellsteps, two vendors who are “in the news” constantly — is “Healthywage Cheating.” Healthywage is the leading crash-dieting contest vendor.
The scale of cheating…and the suppression of the evidence by the wellness industry
Employees who don’t drink, smoke, use drugs, or occasionally indulge in foods other than broccoli and kelp have no need to cheat. They will also derive no benefit from wellness programs and employers will save no money on them, not even any make-believe savings that wellness vendors routinely claim. It is estimated that only 3% of people do everything right, health-wise. That mean the pool of potential cheaters is 97%.
How many of the potential cheaters are actually cheating? Review your own statistics yourself. 70% of employees drink, including 10% who drink more than 30 drinks a week. How many of your employees indicated on their HRA that they drink that much? Zero, you say? What a coincidence! That’s what all the other employer-administered HRAs conclude as well.
How many employees admitted drinking at all? If you said 20%, that would match the number claimed by Wellsteps for their award-winning program. That means slightly more than 2/3 of all drinkers — half your employees — are lying. Not because they’re inherently dishonest, but because you are basically asking them to lie in order to stay out of trouble. What kind of trouble? Wellsteps called consumption of any alcohol a “worst health behavior,” shaming employees who admitted to even occasional social drinking. Nonetheless they fully accepted as fact the 20% drinking rate statistic.
By encouraging all this lying, Wellsteps helped this employer, the Boise School District, create a culture of deceit instead of a culture of health. Kudos.
Now consider smoking. For that we turn to the industry’s leading source of alternative facts, Ron Goetzel. He “found” that for the years 2012-2014, 5.5% of his surveyed workers smoked, overlooking the statistical 12.3% of employees — roughly 2/3 of all smokers — who lied. Yet, like Wellsteps with the drinking, Mr. Goetzel presented this statistically impossible 5.5% as fact.
It’s not a coincidence that roughly the same proportion of smokers and drinkers lie. Nor is it a coincidence that these two “scientists,” as they call themselves, decided not to disclose the lies. Since they claim to be “among the most credible and conscientious scientists and practitioners working in corporate wellness today,” this is much more likely to be a deliberate omission than a rookie mistake, especially since I’ve informed them of this disparity and many other obvious misstatements many times and they usually just doubled down.
Admitting that their data is basically worthless means their entire conclusions are basically invalid, which in turn means that outcomes-based wellness itself is a fraud, which by the way it is
Lying to employers about personal behaviors is human nature. Most employees don’t want to disclose potentially damaging information, and think, quite justifiably, that if they give their employer 100% during working hours, their off-hours behavior is none of their employer’s business.
How can cheating in wellness be prevented?
For those two studies, Mr. Goetzel and Wellsteps were only encouraging employees to lie to their employers and cheat on the programs. The majority of employees responded predictably. By contrast, when you run an outcomes-based wellness program with large fines, or hold annual crash-dieting contests, you’re not just encouraging employees to lie and cheat. You’re practically begging your employees to lie and cheat. In crash-dieting contests, employees form teams, and strategize on how to binge and then crash-diet, allowing them to lose far more weight in 8-16 weeks than is healthy. Any team not intending to cheat wouldn’t even bother to compete. Teams that do want to compete will visit websites teaching them how to cheat, and which appetite suppressants and weight-loss pills to buy in order to win.
Wouldn’t it be great if there were a wellness vendor which, instead of denying human nature about cheating, channeled it? Instead of bragging about ferreting out “fraudulent participants,” made cheating part of the fun? There’s a word for that, and it’s not “impossible.” It’s “Quizzify.” Employees can rack up points for correct answers…and they are encouraged to look them up before selecting their response from the multiple-choice list. That way they are more likely to remember them.
And, unlike “how to cheat in wellness,” if you google on “How to cheat on Quizzify,” you won’t find any advice on cheating — other than Quizzify’s own rules urging employees to do exactly that.
For this year’s Deplorables Award, the winners were given a chance to fact-check in advance, and declined. No need for them to have wasted the effort — only one person, Keith McNeil, has ever found a material mistake in any They Said What posting
As in past years, we convened our panel of distinguished judges to address the age-old question about “pry, poke and prod” wellness programming: how is this stuff even legal?
After they get done contemplating that — and wondering why they’re the only people in the industry who seem to have ethics, an internet connection, and a triple-digit IQ — the judges reviewed the candidates for the coveted Deplorables Award. While any wellness vendor is eligible, they ruled out It Starts with Me, and US Preventive Medicine, since those vendors, whose claims are validated by the Validation Institute, apparently didn’t get the memo that you can’t succeed in this business without lying.
Ruling out those two dramatically narrowed the field down, to only about 1000. Narrowing the field even more, a few, like Provant, took themselves out of the running by going bankrupt. (Individuals are not eligible for the Deplorables Award, so we also need to rule out Ron Goetzel, despite his best efforts to make a late run at the trophy.)
This year, as in previous years, it boiled down to a battle between the very stable geniuses at Interactive Health vs. the people with very good brains at Wellsteps — more than coincidentally the 2017 and 2016 winners respectively. It was a close one. There are very fine people on both sides. Together with Mr. Goetzel, they constitute the wellness industry’s Axis of Genius.They both fabricate outcomes, flout guidelines, and harm employees, so it came down to a simple race to see who, in the wellness industry’s epidemic of very stable geniusitis, would be Patient Einstein.
The case for Wellsteps is compelling. To begin with, after a few proud possessors of high school diplomas observed that their fabricated ROI model will always return a “savings” of $1359 if you zero out inflation even if the smoking and obesity rates go from 0% to 99%, in 2018 they reprogrammed the model so that instead of always returning a “savings” of $1359 in the final program year regardless of what assumptions you input, an obvious rookie mistake that only an idiot wouldn’t notice when designing an Excel spreadsheet model, the model will always returns a “savings” of $1356 in the final program year, regardless of what assumptions you input.
Ah, much better, thank you.
Don’t take our word for it. Here it is. Note that for some reason the actual trendline on the graph doesn’t show up any more. You need to read the fine print instead. Here is what happens if you reduce smoking and obesity from 99% to 0%…
…and here’s what happens if your population already has 0 smokers and no obesity, so no improvement is possible:
If those columns of numbers at the bottom of each chart look identical, it’s because they are. This happens no matter what numbers you enter. (You are no longer allowed to enter increases in smoking or obesity like I used to do, so don’t even try. SPOILER ALERT: If you could, you would still get $1356 in savings.)
And, almost a decade after they first posted their ROI model, it still doesn’t calculate an ROI. Hello, do you see an actual ROI on this screenshot? At this point we’d settle for a phony one. (A real ROI estimation model can be found here.)
Their CEO has been featured on They Said What this year, with his take on the National Bureau of Economic Research’s invalidation of wellness outcomes. He accidentally admitted it was valid.
He claims to have spent “11 years in college.” Yet, even though that’s 4 years longer than Bluto Blutarski, he still can’t add the two columns of numbers he published that showed how badly his Koop-award-winning program for the Boise School District failed. Here are those two columns, a comparison of risk factors in the baseline year vs. one year into the Wellsteps program:
Here’s what happens when you actually add his two columns up — turns out there was a dramatic deterioration in Boise schoolteacher health status.
So it looks like that was, to paraphrase the immortal words of the aforementioned great philosopher Bluto Blutarski, 11 years of college down the drain.
The case for Interactive Health is equally compelling. After winning the Deplorables Award last year, they decided to double down on cluelessness, and so in 2018, they started a “smoking recession [sic] program.”
No one could figure out what they were talking about — apparently including the creators of their smoking recession program, who eventually took it off their website. My hunch was that they were trying to get smokers to switch to Parliament, which features a recessed filter, on the theory that the smoke would take longer to get into people’s lungs.
Later in the year they solidified their front-runner status with three more postings.
- A college intern was able to invalidate their claim that younger workers had more mental health issues than older workers, and that therefore you needed to pay Interactive Health to screen them;
- Next came Interactive Health-meets-Barbie, where they told someone whose HRA showed her to be severely anorexic that she was in a “healthy range.” We noted the irony that this is a company that wants to send almost half your employees to the doctor to treat “newly discovered conditions”…and yet here was someone who appeared to really have a condition that needed attention…and they missed it altogether;
- And just last week they cemented their candidacy by providing a cornucopia of misinformation about the EEOC.
That brings us back to the original question: how is it even legal to harm employees and completely disregard clinical guidelines, as these two companies are wont to do? Well, it turns out that, starting in 2019, it may very well no longer be. No, I’m not referring to the EEOC rule change. That will make companies liable to their employees for fining them, but it will still be legal to screen the stuffing out of them.
The good news is that apparently there will be a move afoot in the next session of Congress to prevent wellness companies from attaching penalties to screens that violate US Preventive Services Task Force guidelines — which is to say, most of Interactive Health’s and (according to Wellsteps’ CEO, Steve Aldana, himself), Wellsteps’.
If this bill were to pass, three things would likely happen:
- Employees would improve on health status;
- Employers would save money on wellness;
- Wellsteps and Interactive Health would throw up on Dean Wormer.
I would invite everyone to join tomorrow (Tuesday’s) webinar by Ron Goetzel. He will be attempting to undermine the National Bureau of Economic Research’s (NBER) outstanding University of Illinois study, which showed — surprise — that conventional wellness programs don’t come close to changing behavior, let alone saving money. I would love to attend, but I, of course, am not invited to his events any more than he is invited to mine. Oh, wait a sec, I invite him to all my events and alert him to all my postings on linkedin so that he can correct any errors I’ve made. Sorry, my memory failed me there for a second.
Speaking of failed memories, he is being joined on this webinar by Jessica Grossmeier. If that name rings a bill, it’s because she claimed her company, Staywell, saved $17,000 per risk factor reduced — about $3000/pound shed — for British Petroleum, having forgotten that she herself claimed it is only possible to save $105/avoided risk factor. See “British Petroleum Wellness Program is Spewing Invalidity.”
Despite this being the Gold Standard of randomized control trials, he will be accusing the NBER of many errors. (A cynic might note that being accused of making errors in a wellness study by Ron Goetzel is like being accused of cheating on your taxes by Paul Manafort. ) He will argue that:
- The study only covered the first year — he won’t mention that the authors also said the first year suggests nothing “is trending towards savings” in future years either;
- The study contradicts — you guessed it — Kate Baicker’s infamous 3.27-to-1 ROI, without mentioning that the NBER’s principal investigator, as coincidence would have it, reports to Kate Baicker, so it’s pretty unlikely he would diss her unless the data left him no choice;
- The study contradicts all the other findings out there — except for all the other studies testing the par-vs-non-par study design against a benchmark, all of which showed results quite literally identical to the University of Illinois result, in that the wellness program accomplished zero;*
- The participants outperformed the non-participants;
- They haven’t reported on the screening yet;
- It wasn’t a good program. To hear Ron tell it (literally hear him tell it — you can listen to the tape), anytime a program fails, it’s because it wasn’t done correctly. “100 employers [have] programs with really smart ingredients…but thousands of others still don’t do wellness right,” are his exact words in print. He is refusing to name any of them, other than the old Johnson & Johnson analysis. (J&J is a wellness vendor. Investigator bias, anyone?)
What else will he argue? Tough to say. One thing for certain: he won’t mention my name — any more than Bravo did when they wrongly predicted that the EEOC rules would be replaced in January while I predicted the opposite. Instead he uses a new vernacular for my postings: “Industry chatter.”
He probably picked up this idea from Bravo, which uses the phrase “industry noise” to describe me.
Where’s Waldo-meets-Ron Goetzel: Spot the errors and you may win a big prize
So let’s make this interesting. Whoever comes up with the best smackdown of the webinar’s obvious fallacies (and omissions) automatically gets entered in the contest to win the Martha’s Vineyard vacation, with the house, car and private (well, semi-private) beach. It is otherwise open only to people who have won various Quizzify trivia contests, but being able to identify five or ten pieces of “chatter” or “noise” in this self-anointed “expert webinar” clearly counts as being health-literate. To compete, send me an email with an attachment. I’ll pick a couple of finalists and put them on linkedin. (If you don’t want your name used — and Ron does bite back, so I don’t blame you — I will post on my own.)
*The result is also quite consistent with Ron’s observation that there is basically no change in behavior leading to risk reduction. If we are splitting hairs here, Ron found a 1-2% reduction, not 0%. Of course, that took three years.
Even by wellness industry standards, Provant Health’s business practices earned it our first multi-part series. It required nine parts to do them justice…
And now they are bankrupt too. Their remaining assets are being purchased by Quest Diagnostics, a reference lab company no doubt hoping to run additional lab tests on Provant’s dwindling employee base.
We knew this was coming because they had already started cutting back on spending, by dropping their internet connection, and hence didn’t realize that employees are not supposed to drink 8 glasses of water a day.
Here is a real-life example of what an employer can expect to achieve by spending a million bucks on these very stable geniuses:
BMI and glucose got worse. Somehow, blood pressure stayed the same — 120 over 75. Yes, despite the average employee being almost prediabetic, and sporting a 40-inch waist for males (and close to that for females), pretty much everyone in this company has ideal blood pressure. One explanation for this would be that Provant, whatever their shortcomings in weight control, are the world’s leading experts in all things cardio. (And that’s even before they started — when everyone in this company already had ideal blood pressure.)
That expertise might also explain how they were able to keep the cardiac ratio so low. An alternative explanation might be that there is no such thing as a “cardiac ratio.” (Google it.) I’ve heard of wellness vendors making up data, but this is a first–making up an entire metric to present its made-up data. Maybe the reason Quest Diagnostics purchased them was to develop a new lab test for cardiac ratios.
The good news is that, despite these underwhelming results, Provant was able to beat its targets, which is easy enough if you move the goalposts to the 50 yard line:
So much winning! Provant “wins” if the average employee is overweight but not quite obese yet, has glucose only 74 points higher than the threshold to be considered diabetic, and is only borderline hypertensive. No target is set for the cardiac ratio, of course, because it doesn’t exist.
In that sense the cardiac ratio is not unlike Provant itself.