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As every wellness professional knows, saving money in wellness programs can only be accomplished — if at all — by getting employees to take more steps and eat more broccoli.
As far as the former is concerned, Fitbit has already undertaken initiatives to demonstrate that using its product to increase steps can play an integral role in wellness. In other words, they’ve mastered the art of blatantly fabricating outcomes.
Fitbit also offers employers significant discounts for bulk wearables purchase for wellness programs. These discounts have led to enough employer contracts for Fitbits that the Broccoli Growers Association of America (BGAA) has taken notice, and decided to follow their lead.
Specifically, the BGAA just announced a partnership with two leading organizations in wellness — the Health Enhancement Research Organization (HERO), and Safeway — to distribute 20% discount coupons for broccoli to wellness program enrollees at participating employers. Thought leaders in wellness, notably Schlumberger, have already announced they are signing up.
A spokesperson for the BGAA noted that “for years, wellness vendors have been urging employees to eat more broccoli, but until now that goal has been out of reach financially for many. We are pleased to do our part to relieve this financial hardship on employees, and help employers coax, fine, or bribe employees into adopting a more broccoli-intensive diet. This will definitely help them lose weight.”
Ron Goetzel, never one to miss out on a claim of wellness program impact, added that broccoli can be part of a smoking cessation program too. “Just keep some broccoli nearby,” he advises, “and every time you feel like a cigaret, eat a floret instead. It’s easy to do because they both end in ‘ret.’ My data shows that it’s easier to stop smoking if you remember to eat broccoli anytime the urge arises to smoke — and my data is always very well-sourced and consistent.”
The BGAA will also be providing recipes to give employees ways to vary their diet while still consuming sufficient amounts of broccoli to let wellness vendors claim savings. Broccoli can be steamed, sauteed, or eaten raw. Here is another suggestion for preparation.
Charley Blue, a frequent reader of these columns, is embracing this collaboration and wants to see it go farther. “I’d like the government to get behind this with some focused subsidies,” he proposed. “We could call it The New Green Deal”
Alice laughed: “There’s no use trying,” she said. “One can’t believe impossible things.”
“I daresay you haven’t had much practice,” said the Queen. “When I was younger, I always did it for half an hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast.”
Six impossible things before breakfast? The wellness industry would just be getting warmed up by believing six impossible things before breakfast. They believe enough impossible things all day long to support an entire restaurant chain:
Consider the article in the current issue of BenefitsPro — forwarded to me by many members of the Welligentsia — entitled: “Can the Wellness Industry Live Up to Its Promises?” BenefitsPro rounded up some of the leaders of the wellness industry alt-stupid segment. Specifically, they interviewed US Corporate Wellness, Fitbit, Staywell, and HERO. Each is a perennial candidate for the Deplorables Awards — except US Corporate Wellness, which already secured its place in the Deplorables Hall of Fame (and Why Nobody Believes the Numbers) several years ago with these three paeans to the gods of impossibility.
In case you can’t read the key statistic — the first bullet point — it says: “Wellness program participants are 230% less likely to utilize EIB (extended illness benefit) than non-participants.” Here is some news for the Einsteins at US Corporate Wellness: You can’t be 230% less likely to do anything than anybody. For instance, even you, despite your best efforts in these three examples, can’t be 230% less likely to have a triple-digit IQ than the rest of us. Here’s a rule of math for you: a number can only be reduced by 100%. Rules of math tend to be strictly enforced, even in wellness. So the good news is, even in the worst-case scenario, you’re only 100% less likely to have a triple-digit IQ than the rest of us.
And yet, if it were possible to be 230% dumber than the rest of us, you might be. For instance, US Corporate Wellness also brought us this estimate of the massive annual savings that can be obtained just by, Seinfeld-style, doing nothing:
So assume I spent about $3500/year in healthcare 12 years ago, which is probably accurate. My modifiable risk factors were zero then and they are still zero — no increase. So my healthcare spending should have fallen by $350/year for 12 years, or $4200 since then. But that would be impossible, since I could only reduce my spending by $3500. Do you see how that works now?
To his credit, US Corporate Wellness’s CEO, Brad Cooper, is quoted in this article as saying: “Unfortunately some in the industry have exaggerated the savings numbers.” You think?
I’m pretty sure this next one is impossible too. I say “pretty sure” because I’ve never been able to quite decipher it, English being right up there with math as two subjects which apparently frustrated many a wellness vendor’s fifth grade teacher:
400% of what? Is US Corporate Wellness saying that, as compared to employees with a chronic disease like hypertension, employees who take their blood pressure pills are 400% more productive? Meaning that if they controlled their blood pressure, waiters could serve 400% more tables, doctors could see 400% more patients, pilots could fly planes 400% faster? Teachers could teach 400% more kids? Customer service recordings could tell us our calls are 400% more important to them?
Or maybe wellness vendors could make 400% more impossible claims. That would explain this BenefitsPro article.
We have been completely unable to get Fitbit to speak, but BenefitsPro couldn’t get them to shut up. Here is Fitbit’s Amy McDonough: “Measurement of a wellness program is an important part of the planning process.” Indeed it is! It’s vitally important to plan on how to fabricate impossible outcomes to measure, when in reality your product may even lead to weight gain. Here is one thing we know is impossible: you can’t achieve a 58% reduction in healthcare expenses through behavior change — especially if (as in the 133 patients they tracked in one of their studies) behavior didn’t actually change.
You can read about that gem, and others, in our recent Fitbit series here:
- Springbuk wants employees to go to the bathroom
- Fitbit throws a bit of a fit, Part 1
- Fitbit throws a bit of a fit, Part 2
Health Enhancement Research Organization (HERO) and Staywell
I’ll consider these two outfits together because people seem to bounce back and forth between them. Jessica Grossmeier is one such person. Jessica became the Neil Armstrong of impossible wellness outcomes way back in 2013. Not just any old impossible wellness outcomes — those have been around for decades. She and Staywell pioneered the concept of claiming outcomes they already knew were impossible. While at Staywell, she and her co-conspirators told British Petroleum they had saved about $17,000 per risk factor reduced. So, yes, according to Staywell, anyone who temporarily lost a little weight saved BP $17,000 — enough to clean up about 1000 gallons of oil spilled from Deepwater Horizon.
See British Petroleum’s Wellness Program Is Spewing Invalidity for the details.
Leave aside both the obvious impossibility of this claim, and also the mathematical impossibility of this claim given that employers only actually spend about $6000/person on healthcare. Jessica’s breakthrough was to also ignore the fact that this $17,000/risk factor savings figure exceeds by 100 times what her very own article claims in savings. Not by 100 percent. By 100 times.
Fast-forward to her new role at HERO. In this article she says:
The conversation has thus shifted from a focus on ROI alone to a broader value proposition that includes both the tangible and intangible benefits of improved worker health and well-being.
Her memory may have failed her here too because HERO — in addition to admitting that wellness loses money (which explains its “shift” from the “focus on ROI alone”) — also listed the “broader value proposition” elements of their pry-poke-and-prod wellness programs. The problem is the elements of the broader value proposition of screening the stuffing out of employees aren’t “benefits.” They’re costs, and lots of them:
When she says: “The conversation has shifted from a focus on ROI alone,” she means: “We all got caught making up ROIs so we need to make up a new metric.” RAND’s Soeren Mattke predicted this new spin three years ago, observing that every time the wellness industry makes claims and they get debunked, they simply make a new set of claims, and then they get debunked, and then the whole process repeats with new claims, whack-a-mole fashion, ad infinitum. Here is his specific quote:
“The industry went in with promises of 3 to 1 and 6 to 1 based on health care savings alone – then research came out that said that’s not true. Then they said: “OK, we are cost neutral.” Now, research says maybe not even cost neutral. So now they say: “But is really about productivity, which we can’t really measure but it’s an enormous return.”
While other vendors, such as Wellsteps, harm plenty of employees, Interactive Health holds the distinction of being the only wellness vendor to actually harm me. I went to a screening of theirs. In order to increase my productivity, they stretched out my calves. Indeed, I could feel my productivity soaring — until one of them went into spasm. I doubt anyone has missed this story but in case anyone has…
They also hold the distinction of being the first vendor (actually their consultant) to try to bribe me to stop pointing out how impossible their outcomes were. They were upset because I profiled them in the Wall Street Journal . The article is behind a paywall, so you probably can’t see it. Here’s the spoiler: they allegedly saved a whopping $53,000 for every risk factor reduced. In your face, Staywell!
Here is the BenefitsPro article’s quote from Interactive Health’s Jared Smith:
“There are many wellness vendors out there that claim to show ROI,” he says. “However, many of their models and methodologies are complex, based upon assumptions that do not provide sufficient quantitative evidence to substantiate their claims.”
Finally, here is a news flash for Interactive Health: sitting is not the new smoking. If anything is the “new smoking,” it’s opioid addiction, which has reached epidemic proportions in the workforce while being totally, utterly, completely, negligently, mind-blowingly, Sergeant Shultz-ily, ignored by Interactive Health and the rest of the wellness industry.
There is nothing funny about opioid addiction and the wellness industry’s failure to address it, a topic for a future blog post. The only impossibility is that it is impossible to believe that an entire industry charged with what Jessica Grossmeier calls “worker health and well-being” could have allowed this to happen. Alas, happen it did.
And, as you can see from the time-stamp on this post, except at establishments favored by the Wellness Ignorati, breakfast hasn’t even been served yet.
This column originally appeared in the Corporate Health and Wellness Association blog but they were asked to remove it by Springbuk, which did the original analysis. Not because it is inaccurate — no inaccuracies have ever been pointed out despite multiple requests by me to do so — but because it was accurate.
So I’m re-posting it here.
This is a sequel to “Springbuk Wants Employees to Go to the Bathroom,” which should be read prior to reading this posting.
In wellness, it’s totally legal to lie to customers. Indeed, if you don’t, you’ll probably lose them, since your competitors are happy to do exactly that, and most customers aren’t going to notice anyway.
In securities, though, it is totally illegal to lie to shareholders or to pay someone to write a favorable but dishonest report on your product, with the intent of propping up the stock price.
This brings up to Fitbit, and a recent report on savings allegedly generated by their activity trackers, published by Springbuk. Let’s leave aside for a moment the value of activity trackers to users. I like mine enough to generally recommend they be offered and subsidized (not given away) as part of a corporate wellness program, but “like” is not the issue in this savings claim. The issue is whether the math works.
And it doesn’t.
The Springbuk report of savings and outcomes for Fitbit was impossible. Among the clinical issues is the study design itself: the report defines “active” as taking 100 steps a day. However, as the previous installment showed, it is impossible not to take 100 steps in a day without being so sick you can’t get out of bed. So rather than being the threshold for being counted as an “active” person, as the Springbuk study says, it should be the threshold for being a person who can get out of bed. And of course, people who can get out of bed will by definition have lower healthcare costs than people who can’t get out of bed, whether or not they wear a Fitbit.
Among the mathematical issues, it is not possible to reduce costs by 45.6% (one of the claims made) with a fitness device, because in the working-age population, only about 5% of hospital admissions are caused by lack of fitness.
Further, in addition to the apparent mathematical and clinical impossibility of Springbuk’s results, the author — and Fitbit — refused to respond to the following query.
Hi Mr. Daniels,
I have some questions about your report. Perhaps I’ve gotten some things wrong, so I’d love to hear from you in the next 3 business days, if I have.
First, isn’t it the case that anyone who is not in a wheelchair walks at least 100 steps a day, Fitbit or no Fitbit? Is that the threshold for “active” as opposed to “bedridden” ?
Second, Figure 2c indicates that the very fact of being in the “engaged” group, even if you never get out of bed, reduces costs by 30%+. How is this possible? A corollary: It would seem that all savings is being attributed to Fitbit, at least in the Fitbit interpretation. They also seem to be taking credit for this: “266 employees who used their Fitbit tracker for at least half the duration of the program decreased their healthcare costs by 45.6% on average.”
Third, can you reconcile this statement…:
“The materials in this document represent the opinion of the authors and not representative of the views of Springbuk, Inc. Springbuk does not certify the information, nor does it guarantee the accuracy and completeness of such information.”
“This demonstration of impact achieved by integrating Fitbit technology into an employee wellness program reinforces our belief in the power of health data and measurement in demonstrating ROI,” said Rod Reasen, co-founder and CEO of Springbuk.
Fourth, how is it possible to show basically no separation for 182 days of getting out of bed (taking 100 steps a day) from being bedridden, but massive separation for getting out of bed for 274 days? I can’t find the explanation of the exercise science that would lead to that result. It would seem that there is some huge physiological disadvantage to those extra 92 days of taking 100 steps.
Fifth, am I missing the disclosure that Fitbit paid you to do this study? I can’t find it anywhere. Or did you do this on a pro bono basis?
Sixth, would you have come up with this same result if you had been paid by a hedge fund that was shorting Fitbit stock and wanted to show no savings?
Seventh, since most wellness-related healthcare spending is unavoidable altogether by walking 100 steps a days or any other amount for 12 months, I’m wondering if you were able to determine approximately which elements of healthcare spending were reduced, in order to get a 45.6% reduction in costs? You would have to wipe out all hospitalizations, for example – and get roughly a 10% reduction in everything else.
Thanks very much. If you would like to reply, I’ll look forward to your reply by 5 PM EDT on Wednesday 5/24.
Assuming Fitbit paid Springbuk (that’s a big assumption — this obvious conflict of interest is not disclosed anywhere, so the reader has to decide whether Springbuk collected money, or whether they did this study out of the goodness of their heart), one of four outcomes is possible:
- Springbuk genuinely thinks, among other things, that walking 100 steps a day for 274 days reduces healthcare costs by 27% vs. walking 100 steps a day for only 182 days. No crime there, other than the one committed by the grade school that granted them a diploma. It’s unlikely they think this, because Springbuk says they are “obsessed with analytics” and that they sell “the leading health analytics software…[with] powerful insights.” So if Springbuk truly believes their own report, then congratulations are in order: they have accomplished more in this one analysis than most extremely stupid people accomplish in a lifetime. (Not an original line, as Veep fans know, but apropos nonetheless.)
- Springbuk wanted to show savings because they were being well-paid to do so, but Fitbit put no pressure on them when they gave them the check. Once again, doesn’t say much for Springbuk’s ethics, but Fitbit did not commit a crime.
- Fitbit paid Springbuk to lie for them, in order to impress prospects and customers. Once again, no crime. There wouldn’t be enough room in the prison system if lying in wellness were a crime. (See http://www.ethicalwellness.org for a list of wellness vendors that have agreed not to lie. It’s not very long.)
- Fitbit paid Springbuk to lie for them, in order to inter alia impress investors. This is not legal, any more than if Fitbit made up their own data for that reason. Since many Fitbit analyst reports make reference to savings of “up to $1500 per employee per year,” and since this study appears to be one of only two justifications for that statement (the other being equally suspect), there is a case to be made that Fitbit’s stock price would indeed be lower if they told the truth: that no disinterested researcher has ever found more than a trivial impact on employee health status or healthcare insurance cost.
We don’t know which of these four is the case. Is Springbuk dishonest, or just incompetent? Does Fitbit genuinely believe that wearing their device could magically reduce healthcare costs for US corporations by hundreds of billions of dollars, or are they willing to lie in order to boost revenues and their share price?
We look forward to hearing the answers to these questions once the financial media gets hold of this posting.
Header Photo – Copyright: dzejmsdin / 123RF Stock Photo
Opinions expressed in this column are those of Al Lewis individually. They do not necessarily represent the views of the Corporate Health and Wellness Association. Therefore all threats of lawsuits should be directed to the former, to which I say: “Go ahead. Make my day.”