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Koop Award Committee-meets-Sergeant Schultz

Ever wonder why no one notices that wellness results are completely made up?

Wonder no longer.  it all starts with The Health Project, which gives out the C. Everett Koop Award.  This month is award season, meaning some of the award’s sponsors or committee members gets to ingratiate themselves with customers.  In honor of this month, let’s review previous years’ awards, and see the self-invalidating, but somehow unnoticed, details that call to mind the immortal words of the great philosopher Sergeant Wolfgang Schultz: “I know nothing.  I see nothing.  I hear nothing.”

To that iconic phrase, the Koop Committee adds: “I notice nothing.”

separated at birth

2014: British Petroleum (BP America)

Last year, the award went to British Petroleum.  BP’s candidacy wasn’t exactly a longshot, since both its vendor (Staywell) and its consultant (Mercer) are on the Committee AND are “sponsors” of this volunteer committee.    By the way, if you’re looking for any disclosure on the award announcement of those connections when you click through on the first sentence above, you’ll need x-ray vision, since there is none. No one seems to have noticed this omission.

Besides not understanding ethics, apparently Mercer and Staywell don’t understand arithmetic: their “rigorous analysis” claimed almost $20,000/person in savings for active participants who reduced a risk factor. Besides being mathematically impossible, clinically laughable, unchecked for plausibility in violation of their own HERO guidelines, and not adjusted for dropouts and non-participants, this figure, as the screen shot below shows, is  over 100 times more than Staywell itself says is possible.  Once again, no one seems to have noticed this glaring contradiction.

staywell grossmeier quote

2013–GRACO (honorable mention)

Ron Goetzel has written at length about Graco, as have we and others.  By starting the measurement in 2009, the year after the program started (as opposed to starting the measurement two years before the program started — see the 2011 award winner, Eastman Chemical), and “forgetting” to count revenues added by an acquisition. Mr. Goetzel was able to tie the growth in Graco’s revenues to the “bottom line performance” of its wellness program.  Of course, when you actually start measuring the year the program actually started (2008) — which coincidentally was also the year before the recession knocked 29% out of Graco’s revenues — and then adjust for the 2012 acquisition’s added revenues, Graco organically grew at about the same rate as everyone else.  Wellness had nothing to do with it.  Graco’s salespeople did not exceed their quotas because they ate more broccoli.

graco sales

Here’s what else didn’t happen due to its wellness program:  savings.  As our post showed, Mr. Goetzel didn’t notice that the cost trend for children (none of whom were in the wellness program) outperformed the cost trend for wellness participants. This means, of course, that the favorable trend among participants couldn’t be attributed to wellness, since the trend for a cohort without access to wellness was even more favorable.  It’s all right here.

Oh, yes, and it also turns out that Graco’s insistence on making its employees go to the doctor was more likely to harm them than benefit them. That’s not us–that’s the New England Journal of Medicine.

2012:  The State of Nebraska

We’ve already chronicled this one at length.  There were quite a number of glaringly obvious rookie mistakes that escaped the notice of the award committee, either due to incompetence or perhaps the fact that the state’s vendor, Health Fitness Corporation (HFC), was also a sponsor of the award.  See if you can find that sponsorship disclosure in their press release “congratulating” the State and LL Bean (the other winner, also a customer of HFC).  You’ll need an electron microscope to go with your x-ray vision.

HFC actually admitted lying about saving the lives of cancer victims who as it turned out didn’t have cancer, but still got the award because, according to Ron Goetzel at the 2014 Datapalooza conference, apparently this particular lie didn’t count because it wasn’t on their application, just everywhere else. It was impossible to miss, but Ron said he didn’t notice.  Is this a great country or what?

2011:  Eastman Chemical

Another HFC customer.  (HFC is really getting its money’s worth out of its sponsorship.) This was the one where — unlike 2013’s Graco, which started measuring outcomes the year after the program started in order to maximize the results — HFC started measuring outcomes two years before the program started in order to maximize the results.  They separated participants and non-participants in 2004 but didn’t start the program until 2006.  By 2005 the would-be “participants” were already 9% ahead…and by the time the program got underway in 2006, they were almost 20% lower-cost than the non-participants.

HFC full color

Once again, all this information was perfectly obvious at the time of the award submission, as well as highlighted in all of my books. It was also re-printed and re-presented multiple times, but somehow no one on the Koop Committee noticed until late 2014, when it was in Health Affairs.  At that point, the light being shined on him being too glaring to hide from, Mr. Goetzel had to respond.  Employing the passive voice to great advantage, Ron said the slide was “unfortunately mislabeled.”

hfc unfortunately mislabeled

Read that carefully.  If it’s hard to read, here is the source.  It’s towards the bottom.  He says this slide and other data “convinced” the Koop Committee to give them an award. That’s his story and he’s sticking to it.

Recently, for the second time, he went back into the Koop Award submissions and rewrote history. Compare the original Koop submission screen shot with the photoshopped version. Note the missing X-axis:

hfc rewritten

The original was:

HFC Eastman Chemical wellness data

His explanation didn’t indicate who mislabeled this slide, why he didn’t notice until now, why he snuck into the old files to relabel it, what the labels should have read — or why HFC never apologized, as others outside the wellness industry do when mistakes are made.

I can explain the last — just look at the wellness industry motto, on YouTube: “A Koop Award means never having to say you’re sorry.”

2010:  Pfizer

None of Pfizer’s outcomes figures stand up to even the slightest scrutiny, and Mercer did the analysis — making Pfizer a shoo-in for this award.  By their own admission only 4% of people moved out of high-risk status.  (Naturally this tally excludes non-participants and dropouts, who likely increased risk factors at a faster rate than participants reduced them.)  In other words out of 30,000 employees, 1200 reduced a risk factor.  And yet somehow Pfizer saved $9.4 million, almost $9000 per risk factor.  So if everyone at Pfizer reduced a risk factor, they’d easily wipe out all their healthcare spending.

They did some secure messaging, but only about a quarter of the at-risk population even opened their messages…and only about a quarter of them clicked through to the messaging.

Smokers self-reported at 6% before the program and 3% after it.  No one hazarded a guess that perhaps some employees were, oh, I dunno, lying?

However, no one can accuse Pfizer of lying about their weight loss results.  In particular check out this comparison, which was offered with a straight face, of employees who read their weight-loss messages vs. employees who didn’t.


Over the course of the study, people who didn’t read their messages gained 1.6 ounces while employees who did lost 2.9 ounces.  You could practically attribute that differential performance to the calories required to open the emails.

Congratulations to RAND’s Soeren Mattke on PepsiCo study award

8758572616_64ec78d961_bWe are proud (but also insanely jealous) of our friend Soeren Mattke, whose PepsiCo article  was named the #2 most-read for the year 2014 in Health Affairs.  We, as our avid albeit narrow fan base may recall, ranked only #12–and even then that was just for blog posts, not articles in print.

Yes, we know it’s not always about Ron “The Pretzel” Goetzel and his twisted interpretations, but he seems to have come up with what appears to be exactly the opposite interpretation of what the PepsiCo study said.  Don’t take our word for it — we’ve cut-and-pasted both what the study says about PepsiCo’s results and what he says about the study.

Here is what the article says about the financial impact of health promotion at Pepsico:  ROIs well below 1-to-1, meaning a net financial loser, for health promotion. (DM, though, was a winner.)

mattke ROI graph pepsico

As low as these ROIs are, several major elements of cost were not available for the calculation — probably enough extra cost to literally make the financial returns so meager that even if the program had been free, PepsiCo would have lost money.

mattke ROI omitting consultant fees etc Pepsico

Clear enough?  Negative returns from health promotion at PepsiCo, even without tallying many elements of cost.  Nonetheless, Mr. Goetzel pretzelized that finding in his recent wellness apologia.  Listed under “examples of health promotion programs that work” as a program that is a “best practice” is:  PepsiCo.  It stands proudly beside the transcendant programs at Eastman Chemical/Health Fitness and the State of Nebraska.

quote from goetzel article on pepsico

We look forward to a clarification from Mr. Goetzel about how a program that lost a great deal of money on health promotion can be an “example of a health promotion program that work(s),” which we will duly print…but don’t be sitting by your computer screens awaiting it.

HealthFitness takes credit for program savings without having a program


Short Summary of Intervention:

“When you partner with HealthFitness, we work collaboratively with you to develop a strategic plan for program implementation, which includes a cultural assessment and an operational plan. You can expect results-oriented programs and services delivered through a highly personalized strategy, matched to your employees and culture.”

Materials Being Reviewed:

Success at risk reduction and translation of that risk reduction into cost savings.  These excerpts are from the successful Koop Award application at

health fitness corp risk reduction form koop award

total savings chart

Summary of key figures and outcomes:

  • Reduction in risk factors from 3.20 to 3.03 — net change of 0.17 — over 5 years.  This success excludes dropouts.
  • 24% improvement in costs vs. non-participants, or $460/year at Eastman Chemical (currently up to >$500/year according to HFC website)

Questions for Health Fitness Corporation:

Since only about 20% of all inpatient events are wellness-sensitive, and you only reduced risk factors by 0.17 per person, and hospital expenses are at most 50% of total spending, how is it that you are able to reduce spending by 24%?

ANS: Refused to answer

Why did you take credit for savings in 2005, even though according to your own slide you didn’t have a program in 2005?

ANS: Refused to answer

Does starting the Y-axis at $1800 instead of $0 create the illusion of greater separation between the two cohorts?

ANS: Refused to answer

Your website says that comparing participants to non-participants “adheres to statistical rigor and current scientific standards for program evaluation” and “is recognized by the industry as the best method for measurement in a real-world corporate wellness program.”   Can you explain how non-motivated non-volunteers who decline financial incentives to improve their health are comparable to motivated volunteers, especially in light of the separation between the two groups that took place just on the basis of differential mindset in 2005, before you had a program?

ANS: Refused to answer

You and your customers have won three Koop Awards in the last 4 years. Do you think also being a sponsor of the Koop Award (along with Eastman, in this case) has helped you win these awards or is this just a coincidence?

wellness logos

ANS: Refused to answer

Why Nobody Believes the Numbers defines the “Wishful Thinking Multiplier” as “alleged cost saviings divided by alleged risk reduction.”  Your cost savings is $460 and your risk reduction in 0.17, for a Wishful Thinking Multiplier of 2700, the highest in the industry.  The book calculates that a risk reduction of your magnitude (even assuming dropouts also reduced risk by the same amount) could generate roughly a $8 reduction in annual spending.  To what do you attribute your ability to reduce spending by 50x what is mathematically possible?

ANS: Refused to answer

Help us with the arithmetic below, also from this Koop Award application.

eastman ROI

How is it mathematically possible to have a higher ROI ($3.62) when also including the cost of incentives in program expense than the ROI ($3.20) excluding the cost of paying incentives to employees to participate?

ANS: Refused to answer


Update December 2014:  Ron Goetzel admits HFC lied.  (See #5 and #6.)  The slide was “unfortunately mislabeled,” using the passive voice, as though it was an act of God (“the game was rained out” ) or else perhaps the North Koreans.  The geniuses at HFC apparently didn’t notice this “unfortunate mislabeling” for 4 years, despite it’s having been pointed out to them many times before this.

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