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The question-and-answer period is now underway.
If you are just joining the thread, this is Part 6 of The Great Debate, a November 2015 exchange between Ron Goetzel and me, at the Population Health Alliance Annual Leadership Forum. Part 5 is here. You can download the audio here.
To the question: “What would you do to reduce healthcare costs?” Ron replies that he is “focused on prevention.” And that’s the issue. I point out that “too much of anything is bad for you, ours is already the most over-prevented society on earth, and these programs are all out of compliance with guidelines.” All these programs screen everybody far more than guidelines advise. Here are the guidelines. Find anything other than blood pressure where the wellness industry’s obsessive annual screens are recommended.
[Postscript: after the debate, the Connecticut study came out, showing that overprevention through wellness increases costs, as one would expect.]
The moderator asks how can Quizzify be the most effective company in employee health education. He challenges our 100% guarantee of savings. This is ironic. No wellness company offers any meaningful guarantee of savings, for the simple reason that it is mathematically impossible to save money in wellness.
Somehow in wellness, guaranteeing savings is a bad thing but losing money is a “good thing.” (Really, a direct quote — click on it.) It’s curious to challenge someone’s own willingness to guarantee their own results as part of their own business. Obviously, if my business judgment is wrong, Quizzify will fail. And what I didn’t say because I didn’t want to brag, is that people questioned my last business venture too, Matrix Medical. Fast forward: Matrix is now the most valuable population health company start-up of this millennium. (Before you ask me to lend you money, we mostly sold out on the “cheap” in 2013 to a private equity firm named Welsh Carson.)
Ron Goetzel endorses Quizzify. He went on the website and played the game. “It was a lot of fun. Very clever.” Then he asks — quite justifiably — how Quizzify can make problems like obesity and smoking go away. The answer, of course, is that Quizzify isn’t going to make obesity and smoking go away any more than wellness does. For example, consider McKesson’s Koop Award-winning program, where both weight and smoking went up. We can’t do worse than that. If we did, we could win a Koop Award.
Instead, Quizzify guarantees reductions in overall healthcare spending on “low value care.” As you can see from the demo on the website, we also educate people on hidden sources of sugar, of which there are more than you can count, but we don’t expect immediate savings from this and other nutrition/smoking education questions. Immediate savings are provided by our emphasis on avoiding low-value care.
Consistent with his theme of running away from his own work, Ron now runs away from his own HERO Report. Keep in mind two things as you listen to this section:
- Ron is disowning his own report. He is on the board of HERO, a tidbit which he overlooks in this hasty retreat;
- Within days of this debate, he was circulating his famous poison pen letter to the media completely owning it, and accusing me of reading it too carefully.
The moderator (who otherwise moderated fairly) for some reason jumped in and said the HERO Guidebook just used an allegedly hypothetical example to show losses. Since their “example” costs were $18/employee/year as opposed to the more typical $100 AND since the HERO example failed to control for the countrywide decline in wellness-sensitive medical events, the HERO example grossly underestimated losses from wellness.
Ron says “those numbers in [my HERO Guidebook] are wildly off,” and “have nothing to do with reality.” He says I “misrepresented and misinterpreted” these figures. But they are right there: A program costs $1.50 PEPM and saves $0.99. What’s to misinterpret? Ron apparently hadn’t noticed that his little Guidebook accidentally told the truth until I pointed it out — exactly like he hadn’t noticed that Eastman Chemical/Health Fitness self-invalidated. In both cases if fell upon me to point it out to these Einsteins.
Here is a posting showing what happens when you adjust those HERO figures for Mr. Goetzel’s alternative “reality” — losses skyrocket, just like Health Affairs showed in the Connecticut study.
Perhaps HERO would have more credibility telling us that wellness saves money if their own allegedly* “fabricated” example and any of the legitimate literature supported that claim. I’m just sayin’…
*The word “allegedly” is used because the example in the HERO guidebook is not a “fabricated” or “hypothetical” example. The words “fabricated” or “hypothetical” do not even appear in the chapter. Instead the example is an actual report. That’s why the Guidebook says it’s a report, and gives very specific details of the report–in the past tense, no less, as you would for a completed report. A “hypothetical” would use the present tense throughout, along with saying that it’s a hypothetical.
So Ron’s whole argument about this being somehow a hypothetical is shot, just like all his other arguments, by showing his own data.
To summarize Ron’s view so far in this debate: everyone who thinks wellness is a total waste of money — including RAND, basically all the media and every economist who has looked at it in the last six years — is wrong. Every time his own materials accidentally tell the truth and say wellness loses money, they’re wrong.
And as we’ll see in the next installment, every employee who hates their company’s wellness vendor is either in a bad program or they are a bad employee.
Basically everyone is out of step but Ronnie.
This is Part 2, my opening remarks. These and all future annotations will be synched to the main debate tape, which is downloadable from the Population Health Alliance website. “Synched” meaning that the exchanges being annotated below can be found at the points in the tape noted in bold.
I got a chuckle for my opening line but Ron clearly won the style points on opening lines.
You’ll note my opening statement contains no unsupported claims, whereas his entire opening statement was nothing but unsupported claims. I am all about proof and examples — all of which are in the public domain, easily sourceable, and on this site. Many come right from him and his cronies, in their multitudinous gaffes. Ron isn’t debating me as much as he is “debating” against his own industry. The walk-backs, disavowals, concessions etc. make my presence almost superfluous.
I review Penn State’s ill-fated wellness program. This is a layup. Worst program ever, and Ron’s fingerprints are all over it. I get some laughs for my riff on testicles, which were a major focus of the Penn State program, along with a disproportionate number of questions about ladyparts.
Ron interrupts (with my permission) to say: “I had absolutely nothing to do with Penn State.” I observed that he was in the room defending it, and gave chapter and verse , referring to the screenshot below and quoting the title. He must have assumed I didn’t see that article. But at the time many journalists contacted me, dumbfounded that Ron, Highmark’s Don Fischer and Penn State’s Susan Basso were still defending it.
The exact quote from that article, in which he was in the room, on the call:
I review Nebraska. Because I did not anticipate the pants-on-fire Wellsteps-Boise Koop Award in 2016 — the type of lying that gives lying a bad name — I call Nebraska “the most dishonest program ever” …and yet Ron gave them a Koop Award and steadfastly refused to rescind it (since the vendor was a sponsor of the award) even after they admitted lying following my expose of their lies. [Postscript: Ron has now completed the rewrite of the history of this program. Fortunately we took screenshots along the way, documenting each time he tampered with the original application.]
I quote Ron’s co-authored HERO guidebook — which of course, in a major gaffe (gaffe is defined as “accidentally telling the truth”) — admitted wellness loses money. If this debate were in a court of law, the case wouldn’t even get to the jury. It’s called estoppel. If you have said something on the record, you can’t turn around and say the opposite. So the debate is technically over, legally speaking.
His response (actually the moderator jumped in to defend him) was, that was just one data set. No, that data set was quite representative of the decline in events that takes place regardless of a program, and in any case, who deliberately plants an invalidating data set in their own propaganda? No, these people just didn’t notice that the costs on Page 15 exceeded the savings on Page 23. And they are the self-professed experts in measuring outcomes.
Costs ($1.50 PMPM):
Savings ($0.99 PMPM):
I reference two proofs. First, the one that says wellness can’t work. Next, my proof that the official government database shows quite literally no impact of workplace wellness on cardiometabolic inpatient admissions this century. Ron accepts this proof. He is caught. His own employer, Truven, holds the contract for managing this database. If he claims the data is flawed (it isn’t), he disses his own employer. So the debate is technically over, mathematically speaking. He just admitted wellness has been completely ineffective. Game, set and match to me. However, wellness apologists don’t understand fifth-grade math (hence this site), so few people in the room understood that the debate had ended.
I reference the million-dollar reward that we’ve offered to anyone who can show that wellness has broken even. Of course, Ron hasn’t claimed it. I offered the reward because even people who don’t understand mathematical proofs understand that someone who backs his claims with $1-million must believe them. By declining to collect the $1-million (the reward has rules and is a legally binding contract), Ron is admitting he and his cronies are lying about the effectiveness of wellness.
I point out that RAND and the New York Times are both on my side. The Times, I noted, “was laughing at you folks for how bad your analysis was.” I continue with many more examples of both the left wing and right wing media skewering wellness. “You guys are running out of wings.” Ron attempts no rebuttal even though I had offered to let him interrupt me if I said something inaccurate. But there’s nothing inaccurate about my portrayal of the mainstream media’s position on workplace “pry, poke and prod” wellness. It’s all here. They hate it.
[Postscript: You can now add Slate, STATNews, and many others to list of publications which have skewered wellness, all linked from here.]
I point out the many instances in which Ron’s own cronies have gone rogue. Altarum, Debra Lerner, and Michael O’Donnell (three times) are all examples of Koop Committee members who deliberately or accidentally dissed wellness. And I reiterate that the HERO Report, that Ron co-authored, admits wellness loses money. This report was signed by 60 wellness apologists. Basically the entire industry admitted failure, in the industry’s biggest-ever gaffe. See our 8-part critique of that ill-fated venture.
Thus ended the two prepared opening statements. By the way, a shout-out for Fred Goldstein, the moderator. In reviewing this tape I had clocked Ron’s “5-minute” opening speech at 9 minutes, but I was allotted the same length. The next installments will cover the rebuttals.
How this “study” gets published and why Johns Hopkins would allow its name to be used on it is anyone’s guess. In our last posting, we pointed out that in one place Graco’s employees cost $11,100 apiece to insure, just like other companies that offer competitive benefits. Yet later on in the story we see that employees only cost $2280. No mention of how these figures could be so inconsistent.
We let the rest of the study go, figuring we had already found the Macguffin. Ace reporter Bob Merberg, though, was not so easily convinced.
We’d urge reading his blog. Among the claims made by Mr. Goetzel was “revenues have doubled since 2009.” Well, yeah, but:
(1) it turns out Graco made a sizable acquisition in 2012, which might have had a teeny-weeny effect on revenues;
(2) revenues had plummeted in 2009, the year after the wellness program was introduced.
If you (a) measure from 2008, the year the wellness program was introduced, instead of cherrypicking the baseline year to give the best result, and (b) factor out the acquisition, revenues over the 2008-2014 period have pretty much tracked the economy as a whole. So nothing happened.
We can’t make this stuff up. Fortunately we don’t have to.
Talk about “burying the lead.”
Ron Goetzel just reported on a company called Graco, where employees were subjected to a “pry-poke-prod-and-punish” wellness program. These are line employees in an “old economy” company–exactly the type of company where healthcare spending would be high. And it is high. According to the article, Graco spent $29,000,000 on healthcare for 2600 employees. That’s about $11,100 apiece, roughly what you’d expect. This estimate is with or without a wellness program, since as Ron’s recent HERO report noted, wellness programs have no positive impact on spending.
Yet later on in the article he writes:
In the immortal words of the great philosopher Rick Perry, oops.
$190 per member per month (and we assume that he meant just for employees, not members) is $2280/year/employee. Here are the possibilities:
(1) Graco has the country’s mot expensive spouses, costing about $18,000/year (to bring the average spend to $11,000 per employee contractholder per year) but hasn’t noticed
(2) Graco has some magical special sauce that kept costs way below average even before the wellness program started that Ron failed to tell us about (hence “buried the lead”)
(3) Ron Goetzel made yet another rookie mistake in his math, thus invalidating the entire study, just like most of his Koop Awards.
You can rule out that this $190 had anything to do with the wellness program. Smoking rates (the only thing that really affects spending) remained unchanged, and obesity only fell a few points. And a company can’t save money by overscreening people, paying for their drugs, and making them get unnecessary checkups. In any event, it wasn’t $190/month. It was $11,100/year.
$2280 vs. $11,100… We look forward to Mr. Goetzel’s explanation of how both these figures could be true, since it appears they are completely at odds with each other. In the immortal words of the great philosophers Dire Straits, if two men say they’re Jesus, one of them must be wrong.
And once again, the mantra of Surviving Workplace Wellness holds true: In wellness, you don’t have to challenge the data to invalidate it. You simply have to read the data. It will invalidate itself.
We will no doubt be accused of “bullying” him for invalidating this study, which he obviously spent a lot of well-compensated time on. So just to show our good intentions, we will offer him our course and certification in Critical Outcomes Report Analysis gratis. It seems he could learn a lot from it and we look forward to announcing his successful completion.
Update: Ron apparently “forgot” to include the actual data in his writeup, which showed that, um, how to put this tactfully, his entire conclusion is wrong. Looks like kids (who had no access to wellness) trended better than the adults who did have access. We added this as the second installment.