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First, congratulations to Joe Andelin, who caught just about every fallacy, alternative fact and, if there were such a thing, alternative fallacy in yesterday’s presentation. I know he did because I was on the call.
Wait, Al, didn’t you say they blocked you?
Yes, but displaying the same level of competence that they routinely bring to their day jobs, they managed to block only my video, not my audio.
Here were our predictions we got on the nose. We predicted he would say:-
- 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;
- He said he study contradicts many of the other findings out there — except, of course, 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;
- 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?)
The last is his go-to excuse. He said the University of Illinois program, which consisted of screenings and incentives to use the gym, was a “throwback to the 1980s.” In reality, the program was a “throwback” to every single Koop Award-winning program, all of which feature “pry, poke and prod” programs and some kind of fitness incentive. The only thing missing from this program was the broccoli.
I was wondering where to go with the rest of this posting but then into my comments box popped my old friend Bob Merberg, who is perhaps the smartest person I have ever met on the subject of wellness outcomes measurement. His comments are better than anything I could have written (assuming I had been allowed to see the slides). Here they are in their entirety:
Al, I’m not usually one to comment on other people’s blog posts, and certainly not one to promote my own content, but I attended the webinar and found the conclusions drawn by the presenters to be egregious. One of the presenters correctly pointed out that subjects in the treatment group were, “More likely to report that the employer values worker health and safety.”
But then — bizarrely — he went on to say, “In other words, … people felt more engaged, and had better morale, and had better feelings of satisfaction working for the employer by being in the treatment group. In my mind, the headline ought to be ‘Wellness Program Increases Employee Engagement and Morale’ as opposed to ’37 Things We Didn’t Find Any Difference In.‘” Another presenter termed this the key finding.
But feeling like your health and safety are valued, while important, is by no means a the same as morale, engagement, or job satisfaction. In fact, the study did not measure morale or employee engagement. It did measure job satisfaction, self-reported “bad emotional health,” and changes in happiness at work, and found that the intervention group experienced no significant improvement compared to the control group.
If we were to jump to any conclusions from this study, they might be that feeling valued are NOT linked to job satisfaction and other psychosocial metrics.
To promulgate that the “key finding” was improved morale, improved employee engagement, and improved job satisfaction, is at best a sign of failure to understand the study, and at worst a deception. Under any circumstances, it’s a disservice to the study subjects who presumably consented to participate in good faith science, to the researchers — who were meticulous in their methodology and transparency — and to those of us in the wellness industry who are more interested in understanding what works rather than distorting facts to serve our own self-interest.
But wait…there’s more.
More in my blog post: https://www.linkedin.com/pulse/employee-wellness-truth-isnt-true-bob-merberg/
Mostly for fun, a time-lapsed video of my research and writing process on this subject: https://youtu.be/hQ6HqkN-VPw
Bob Merberg is moving on from Paychex, and in a lengthy (!) podcast with Jen Arnold, offers his “greatest hits” of the many ways in which his mind has been changed (“flip flops”) during his ten years in that position, and some advice for the future.
By way of background, Bob’s IntEWn blog has been a refreshing voice from the wellness trenches. Bob is quite literally the only corporate wellness manager willing to risk the wrath of various internal powers that be in order to report what really happens in wellness. By contrast, most other blogs are written by various outsiders reporting what they think should happen (or they think is happening) in wellness.
Here are the highlights of what he has learned (“flip flops”) in the decade he has been doing this:
- HRAs have very little value
- Screenings have even less value than HRAs (“I was railing against screenings a really long time ago”)
- Incentives have even less value than screenings (“the hallmark of a sh**ty program”) and Bob has de-emphasized them. We have a more nuanced view.
- CEO support is helpful is wellness even if they don’t walk 5000 steps. There are things only CEOs can do (such as employee-friendly building design).
- Culture is very difficult to change, and employees generally hate culture change for many good reasons…but it is much easier to found the company with the right culture to begin with (like we did at Quizzify). “Where are the success stories in culture change?”
- Outcomes-based incentives are “shameful,” and are little more than a cost-shift to employees who can least afford it. (“Given all of us a bad name”)
Here is the good news, his view of Total Worker Health (as described by the CDC), which is influenced by more basic factors than broccoli consumption:
- Living wages and other financial assistance, like 401K
- Work schedules and too much overtime, a huge source of stress, should be managed
- Things like quotas and goals set too high to meet (like at Wells Fargo) that create incredible stress. This Wells Fargo story alone merits the entire podcast. Ironically, they have a wellness program that includes stress management. “You as an employer are creating the conditions of stress.”
- The employer should start with creating healthier jobs, rather than helping employees cope with unhealthy jobs.
- It’s not about behavior and behavior change — it’s about the workplace itself.
I’ll leave the rest to you. Don’t want to steal his thunder.
We wish Bob the best in his new career as a consultant and look forward to working together.
Last week I highlighted the first cavalcade of Wellness Stars of 2016, deftly juxtaposed with the popular Wellness Deplorables Award annual countdown. (The actual countdown has to be done in three parts, with #1 still to come. So many candidates, so few numbers between 1 and 10.)
Today we again switch back from the Deplorables to the Stars, in nonprofits, government, and the private sector. We’ll end with shout-outs to some individuals.
Nonprofit Advocacy and Government Groups
A number of organizations have distinguished themselves in 2016. AARP is right out in front, advocating for employee rights. AARP is right out in front, advocating for employee rights. They see involuntary wellness poking and prodding as highly disproportionately discriminatory against older employees (which we would observe is just one of wellness’s many charming features). Since older people are more likely to weight more, have higher blood pressure, diabetes, and more trouble losing weight, etc., they are more likely to want to withhold health information from their employers for fear of discrimination, but instead will be penalized by these programs into surrendering it, with wellness promoters advocating even more penalties.
Next is NIOSH, the National Institute of Occupational Safety and Health. Withstanding the pressure from their CDC overlords who have gotten completely drunk on wellness Kool-Aid, NIOSH wrote an amazingly thoughtful vision for the next 10 years of “Total Worker Health“…without even mentioning the word wellness. Why? For the simple reason that hiring a vendor to pry, poke and prod employees in excess of US Preventive Services Task Force (USPSTF) guidelines has virtually nothing to do with real occupational health and safety — except, as in the case of crash-dieting contests and/or Wellsteps, to damage it.
And speaking of USPSTF, hats off to them. They have withstood the pressure from various specialty societies and the National Business Group on Health (NBGH is now the leading wellness vendor shill in Washington) demanding more screenings, and threatening to oppose their funding if they don’t deliver. The actual science always favors USPSTF in these debates, but the whiners have plenty of money to support their very specific agenda: overscreening today, overscreening tomorrow, overscreening forever. (Those with long memories recall when USPSTF revised its mammogram recommendations to be consistent with the evidence…and almost lost their funding as a result.)
Also on the nonprofit scene would be the former National Business Coalition on Health, now renamed the National Alliance of Healthcare Purchaser Coalitions, in order not to be confused with NBGH, and hence not be accidentally sullied by the latter’s reputation. The regional coalitions that comprise the national group also take their roles defending employers seriously.
In particular, the Midwest, Philadelphia, Northeast, Pittsburgh and South Carolina coalitions deserve extra plaudits. I’ve participated in each of those regional events and consistently have found them to be among the best of the employee health conference genre. The speakers are well-vetted, and it’s not a vendorfest. And the food is consistently good too. One was even covered by the local media.
And if there were an advocacy organization hall of fame, Leapfrog Group would be the first inductee. For years they’ve been getting hollered at by hospitals for ranking them objectively, and lobbying for more transparency in medical error reporting. Since “pry, poke and prod” overscreening is one humongous medical error, needless to say Leapfrog has been visibly opposed to it, and highly supportive of our efforts…and also can be as funny as we are on that subject.
The Private Sector
First is Medencentive. Whereas most employee health vendors generate tons of comments demanding the program’s removal (Penn State received about 2000 employee signatures demanding the removal of their Goetzel-inspired debacle before they finally caved), Medencentive generated over 3,000 users signatures in support of their program…out of only 21,000 eligible people, over a brief 45-day period. You might say: “Oh, well, their program must be tied to some huge incentive.” Actually, it’s only $15 per office visit.
A list of other companies worth of mention would include, as always, Quantum Health. When Cooperstown builds the Employee Health Program Hall of Fame, Quantum will be the first inductee. While what they do is most important, what they don’t do is also notable: they don’t chase down healthy employees to pry, poke and prod them. They focus only on employees who can benefit from their assistance. That shouldn’t be rocket science, and yet focusing only on employees in need who want help is the opposite of the typical wellness vendor “hyperdiagnosis” model.
I would also like to give a shout-out to Welltok, which received validation from the Validation Institute, for creating some of the best analysis I’ve ever seen to show noticeable and completely valid impact of their program.
Wellable, right here in Boston, publishes a newsletter that is a must-read, due to its sensible and literate takes on the wellness scene and speaking of sensible and literate, that brings us to…
…the industry’s drop-everything-and-read blog, when he actually gets around to writing it, is Bob Merberg’s In tEWn. To say Bob’s smackdown of Ron Goetzel’s Graco fiction was Al-worthy is an insult to Bob. He even found obvious lies missed by even the guy Mr. Goetzel calls “sharp-eyed Al Lewis.” (That explains it. All this time I thought Ron’s analysis was wrong all the time because he was dishonest. Turns out it’s only because he didn’t get LASIK and I did.)
To be sure, Mr. Goetzel’s reports in general — and Graco in particular — are a target-rich environment but even so, Bob’s was an impressive piece of peer review. Though to call this “peer review” is also an insult to Bob.
I am also a big fan of postings by Fred Goldstein, Bill McPeck and Dean Witherspoon even if I don’t always agree with them, and am pleased to add them to the Stars list despite the occasional disagreement. I am not interested in conformity but rather just in basing a debate on facts.
The up-and-comer on the scene among individuals? That would have to be Dave Chase. Dave is putting together The Big Heist, a documentary series on ripoffs in healthcare, naturally featuring wellness. You can look at his master list to find other “Good Guys.” Big Bang Health is such a Good Guy, also an up-and-comer. Phia Group, also a charter Good Guy, enjoys a well-deserved top-flight reputation in designing benefits plans incorporating state of the art cost and risk reduction techniques — and is also certain to be featured in Dave Chase’s magnum opus.
And three cheers for the industry’s #1 podcasters, James Kelley and Michael Prager. No one has ever found a material inaccuracy in this blog and I don’t want to start now so just for the record, Michael’s is on video. Speaking of which, Michael hasn’t found “inaccuracies” but he has made observations that helped me tighten or tweak my language, on two occasions, so thank you for that. Rachel Druckenmiller and Michelle Spehr have also contributed very insightful comments and postings and I look forward to highlighting them separately.
Meanwhile, more astute commenters on TSW worthy of mention: Dell Dorn and Doug Dame (I don’t think those are the same person, but then again, has anyone ever seen them in a room together?), and a big shout-out to Robert Dawkins for finding a fallacy in McKesson’s stillborn overvendored, underperforming, program that, as with Bob’s Graco analysis, even sharp-eyed Al Lewis missed. While McKesson’s program basically accomplished nothing, I did give them credit for a 1% reduction in tobacco use. Mr. Dawkins pointed out that over that same period, US tobacco use in general fell by that very same 1%. Frank Pennachio also has our backs and pushes out much of our material to the workers comp community.
Now that you are all done puking, rest assured that for my last post of the year, next week, I will step back into character and name the Winner of the 2016 Wellness Deplorables Award.
Until then, in the spirit of the season, we graciously offer all the Wellness Ignorati, Ron “the Pretzel” Goetzel, and all the Deplorables a very
Not all wellness vendors are as bad as Slate makes them out to be. Companies whose names begin with “Q” are doing quite splendidly.
Quizzify’s stack of stellar reviews and reviewers (see Employee Benefit News, Not Running a Hospital (Paul Levy), and Bob Merberg) now includes Tom Emerick, who just wrote an Insurance Thought Leadership review entitled: There May Be a Cure for Wellness.
Far be it from us to discourage anyone from reading the full review, but here are some excerpts:
“Quizzify…transforms the boring but long-overdue task of educating employees about health, healthcare and their health benefit into an entertaining trivia game.”
“Quizzify provides a plethora of shock-and-awe, ‘counter-detailing’ questions-and-answers (with full links to sources) that will educate even the savviest consumers of healthcare and entertain even the dourest CFO.”
“Scores and scores of people have told me they fudge answers on HRAs. Interestingly, they feel they are on the ethical high ground to do that because of the goofy, nosy and intrusive questions they are asked to answer, e.g., asking about your [future] pregnancy plans… Quizzify, on the other hand, encourages people to cheat. Quizzify wants you to look up the answers because that’s how you learn. So instead of denying human nature, Quizzify channels it.”
Tom also addresses the concern that employees might think Quizzify is all about trying to keep them from spending money on healthcare:
“On the other hand, there are instances where people should go to the doctor but don’t. Swollen ankles? Painless, perhaps, but you may have a circulation problem, possibly a serious one. Blood in your urine, but it goes away before you even make an appointment? That could be a bladder tumor tearing and then re-attaching itself, especially if you smoke. And show me one health risk assessment that correctly advises people over 55 or 60 to get a shingles vaccine if they had chicken pox as a kid.”
That last point is pretty emblematic of the difference between wellness and Quizzify. It’s a classic example of wellness vendors wasting opportunities to actually provide employees with useful information. Virtually no HRA advises shingles vaccines for the relevant subset of employees.
Conversely, to focus on one of the longstanding obsessions of wellness vendors, there are no questions in Quizzify where the answer is: “Buckle your seat belt.” We figure HRAs have that covered.
We would also observe that if your employees don’t realize they should buckle their seat belts, wellness is probably not your biggest problem.
Boring but Important Disclosure: While this blog is independent of Quizzify, I am a principal in Quizzify.