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You have to read this all the way through because, in breaking with long-established precedent (which needless to say is recounted in loving detail), in 2017 the Koop Award Committee — wait for it — did the right thing.
In 2017, 3 companies applied for a Koop Award. This is down from a peak of 21, and represents the belated recognition on the part of wellness vendors that it simply isn’t mathematically possible to satisfy the requirement of saving money. Thankfully, one of the best attributes of math is that it’s true whether you believe it or not.
Many an employer has won an award, only to learn later — via the media — that their vendor had fabricated the savings. This litany might explain the slight reticence of vendors to shine a light on their own programs:
- Wellsteps: “Top Wellness Award Goes to Workplace Where Many Health Measures Got Worse,” STATNews
- McKesson: “Wellness ROI Comes under Fire,” Employee Benefit News
- Health Fitness Corporation:”Nebraska’s Acclaimed Wellness Program Under Fire,” Omaha World-Herald
An example of what transpires when employers find out they’ve been snookered would be McKesson. If the name “McKesson” sounds familiar, it’s probably because you saw 60 Minutes the other night explaining how drug distributors including McKesson facilitated the opioid crisis.
The good news is, illegally trafficking in opioids doesn’t disqualify a company from winning a wellness award. Is this a great country or what?
Once McKesson got wind that Employee Benefit News was going to publish an expose on how they got snookered, they called in a consultant, not to investigate how they got snookered but rather to mount a coverup. The consultant “clarified” to Employee Benefit News — in lay terms that any fifth-grader could understand — how, among other things, employees’ weight could go down and up at the same time:
“Health indicators in 2013 and 2014 were adjusted in the analysis, while several sensitivity analyses of the ‘inter-individual’ impact that used a matching approach confirmed the results.”
Silly me! Of course weight can go up and down at the same time!
McKesson was not exactly copacetic about this coverage. Here is the reaction of McKesson’s wellness program champion to my analysis, as reported to me:
“I wish you could have been in the room when I questioned the architect of that whole program. I’ve never unintentionally pissed anyone off that much. Red faced and table pounding, it was a moment! He retired 3 days later. Coincidence?”
Next, consider last year’s award, bestowed upon their Wellsteps buddies. Wellsteps (motto: “It’s fun to get fat; it’s fun to be lazy”) is the kind of company that gives cronyism a bad name…but they were overdue for the award, never having won one despite their years of service on the Awards Committee.
Sure, Wellsteps harmed employees, but harming employees has never been a deal-killer for a wellness award. Ron Goetzel observed that employees en masse becoming sicker — both objectively and according to their own self-assessment — only meant that the program did not “[go] exactly right.” By that logic, the Vietnam War did not go exactly right either.
The 2017 Awards
No one won in 2017. The Committee deserves great credit for getting it right this year, finally albeit belatedly acknowledging that it is indeed impossible to get a positive ROI by screening the stuffing out of your employees. So kudos to them!
Instead, they gave “honorable mentions” to the three applicants: Delta Airlines, IDEXX Labs, and Pepsico. I’m sure all three deserved their —
Whoa! In the immortal words of the great philosopher Meat Loaf, stop right there! Come again? Pepsico? That Pepsico?
If one excludes the total debacles at Penn State, Nebraska and Boise — Pepsico runs the single most-pilloried wellness program in history. It was the subject of a Health Affairs article showing massive losses on its wellness program. These losses, massive as they appeared, were likely understated. I was the peer reviewer, and I passed it rather than make the author do more work, because I thought it was more important to get the word out there promptly than to make him recount every single stupid thing they did.
Pepsi’s Latest Innovation
In all fairness to Pepsico, maybe they do deserve at least a “most improved” award, because now you can buy Pepsi made with real sugar. This is a good thing, according to their announcement, even if the people who run their wellness program disagree. One can only imagine what a beleaguered Pepsico employee’s Outlook calendar looks like:
Perhaps McKesson’s consultant could explain this to us.
Delta and IDEXX
I can’t really comment on the other two because none of the four flight attendants I talked to at Delta had any familiarity with their program beyond the basics (“Yeah, I think if you fill out a form and go to the doctor, you get a discount on insurance or something like that”), while IDEXX doesn’t use vendors connected with the Awards Committee and doesn’t make up savings. To bestow an outright win in that situation would go against all precedent, so IDEXX should be happy with their honorable mention.
Theirs is a fitness-based program that deserves a closer look, as a model for what a wellness program should look like. I hope to do that someday.
And perhaps IDEXX is a harbinger of things to come, where wellness is done for employees and not to them, wellness vendors don’t lie about savings, and they endorse and agree to adhere to the Employee Health and Wellness Code of Conduct.
Otherwise, for the wellness industry, there might be trouble on the horizon.
Rumor has it that within the next couple of days Health Affairs is going to release a paper in which Ron Goetzel admits that — even with his finger on the scale as it always is (along with the other nine and all his toes) — wellness loses money. This is total vindication for the years in which he has preferred to simply fabricate large savings, based on trivial risk impact, and then accuse me of “outrageous inaccuracies” and other such fanciful tales for observing — accurately, as it turns out — that all his savings are made up.
Yes, I know I’ve said he has admitted wellness loses money several times before, like in his HERO Guidebook, or in STATNews, or in the Chicago Tribune. But those were all gaffes. (A gaffe is defined as “accidentally telling the truth.”) The difference is, this time it’s deliberate.
And, no, he hasn’t sworn off lying. Lying is a thing these days. He was way ahead of the curve on that. Mind you, I have not seen the article, and I wasn’t allowed to peer review it. (Health Affairs allows authors to rule out certain peer reviewers, so he ruled me out — despite admitting not too long ago that I am the best peer reviewer in the field.) However, I anticipated that, given his level of integrity, he would use the completely invalid participants-vs-non-participants methodology, and so I invalidated it for him ahead of time, not that he didn’t already know.
Despite admitting losses, he still holds to the fiction that somehow risk factors decline, a claim which I intend to examine once I see the article. I suspect he didn’t plausibility-test the outcomes (even though his HERO guidebook says to do that) and/or he didn’t count dropouts and non-participants. But we’ll know soon enough.
However, by admitting wellness loses money even if risk factors improve, he just invalidated every single Koop Award he has ever bestowed on any of his buddies. The reason is that in those award-winning situations, risk factors either only improve a trifle (Staywell, 2014 and Nebraska, 2012), don’t decline at all (McKesson, 2015), or increase (Wellsteps and Boise, 2016). None of these non-improvements acknowledges dropouts, of course.
PS Remember my $2-million reward for showing wellness saves money? Let’s make it $3-million.
Having covered the also-rans last week, here are the first runners-up, as we inch ever closer to the coveted top spot. (To read the original postings, click on the numbered headers.)
Today we are highlighting more people and organizations who’ve made the wellness industry what it is. Wednesday we will complete the listing of the Stars of Wellness, the people and organizations who are making the industry what it should be.
Interactive Health conducted what may be the head-scratchingest screen in wellness industry, a difficult feat given all the competition. For starters, they tested me for calf tightness. It turns out my calves are tight–and right on-site they loosened them. I could feel my productivity soaring…until the left one went into spasm that night and I couldn’t get back to sleep. Still, I can see their point — loose calves are a useful trait for many common jobs.
Next, Interactive Health shattered the record, previously shared by Total Wellness and Star Wellness, for most USPSTF non-recommended blood tests. I don’t know what half these things are, which means neither does Interactive Health.
Where would a Deplorables Greatest Hits List be without the Koop Award Committee?
Every year, like clockwork, the industry’s biggest liars select the industry’s biggest lies. 2016 started with last year’s winning program, McKesson’s, being exposed as a joke in Employee Benefit News, and ended with this year’s winner, Wellsteps, being exposed as a joke in STATNews.
When bestowing this year’s award to their fellow Committee member, Wellsteps, they didn’t even pretend not to lie. And what lies they were! Not just regular-sized lies. Not even supersized lies. We’re talking lies that would make a thesaurus-writer blush.
To put their lies in perspective, I may not even know you, but if a Koop Committee member told me the sky was blue, and you told me the sky was green, I’d at least go look out the window.
PS Not everyone on the Committee is a liar. One person is quite honest and can’t believe what goes on every year. I don’t want to name my source because in Koop-land, honesty is grounds for termination. As is getting validation. Or adopting the Code of Conduct. Basically ethical behavior is off-limits. An executive of one group, Altarum, published a blog critical of wellness and <poof> the Committee disappeared them.
Michael O’Donnell seems to crave my attention. When he managed to go three whole months without being featured in a TSW posting, he came up with these irresistible nuggets:
- “Wellness is indeed the best thing since sliced bread, up there with vaccines, sanitation and antibiotics.”
- “[Wellness] can prevent 80% of all diseases.”
- “The ROI from wellness is very strong.”
- “Workplace health promotion may play a critical role in preserving civilization as we know it.”
If nothing else, Mr. O’Donnell presents the best argument for requiring educational standards, or at least a GED, in this field — by demonstrating his total lack of understanding not just of wellness, but also of vaccines, sanitation, antibiotics, percentages, diseases, ROIs, and preserving civilization as we know it.
Oh, yes, and multiplication as well. His article on how to increase productivity with wellness used an example demonstrating a productivity decrease. In 2016, he also went on an anti-employee jihad that should be read in its entirety. (Translation: some of my best work…) Highlights:
- Prospective new hires should be subjected to an intrusive physical exam, and hired only if they are in good shape. OK, not every single prospective new hire — only those applying for “blue collar jobs or jobs that require excessive walking, standing, or even sitting.” Hence he would waive the physical exam requirement for mattress-tester, prostitute, or Koop Committee member–because those jobs require only excessive lying.
- He would “set the standard for BMI at the level where medical costs are lowest.” Since people with very low BMIs incur higher costs than people with middling BMIs, Mr. O’Donnell would fine not only people who weigh more than his ideal, but also employees with anorexia.
If employees didn’t already have an eating disorder, what better way of giving them one — and hence extracting more penalties from them — than to levy fines based on their weight? Employees above his ideal weight would pay per pound, sort of like if they were ordering lobster or mailing packages.
These three characters — naturally also on the Koop Committee — managed to pile more lies, sardine-like, into a single page than anyone else in this industry, in the “poison pen” about me they circulated to the media.
A good starting question would be, why on earth would anyone think that they can send a “confidential” letter to the media? The media are in the business of disseminating information. You see, that’s why they call them “the media.” Am I going too fast for you, Mr. Goetzel?
The funny thing about these Einsteins? Their defense to my observation that their very own numbers show wellness loses money was that their very own numbers were made up. Imagine being so dishonest that the way you defend yourselves is by claiming you fabricated your own report.
That’s not even the punchline. It turns out that this allegedly fabricated report is in truth an actual non-fabricated report. So, in the immortal words of the great philosopher LL Cool J, they lied about the lies that they lied about.
How did I learn this? That will be the subject of a post early year.
Watch this space…soon we will be naming the industry’s #1 Deplorable of 2016.
When a true genius appears, you can know him by this sign: that all the dunces are in a confederacy against him.
Wellsteps’ Steve Aldana has “endorsed” a confederacy of 25 wellness vendors, including his own company, Wellsteps. Alas, in the world of the Welligentsia, in which an increasing number of employers reside, an endorsement from Mr. Aldana earns about as many points in a vendor selection process as neat handwriting.
There are usually not enough hours in a week to both do my Day Job running a fast-growing company (Quizzify, which plenty of thought leaders have endorsed, so they don’t have to endorse themselves), and also play wellness-meets-whack-a-mole with the Ignorati. Fortunately, this week does have enough hours, thanks to the time change. (The wellness industry is lucky that “falling back” is not a regular occurrence.)
I haven’t heard of many members of this confederacy, but I’ve heard more than enough about the ones below. Each link takes you to our own “endorsements.”
Keas Meets Lake Wobegon: All Employees Are Above Average (in Stress). This is the best argument for requiring that wellness vendors attain a GED.
Provant: “In the Belly of the Beast” A nine-part series that one line can’t do justice to. We would simply note that you do not have to drink eight glasses of water a day. Indeed, you probably shouldn’t if you expect to get anything else done.
Staywell’s Wellness Program for British Petroleum is Spewing Invalidity. It wasn’t just that their savings claim was mathematically impossible. That’s just the threshold for wellness savings claims. Staywell also somehow saved BP 100x as much as Staywell’s own website says is possible. And because they have a “special relationship” with Mercer (meaning they pay them), Mercer “validated” this fiction for BP, at BP’s expense…
Staywell, Mercer, and British Petroleum Meet Groundhog Day. They won a Koop Award. Since Staywell and Mercer are both on the Koop Committee and their results are completely invalid and they are obviously lying, they satisfy all the award criteria.
Total Wellness’s Total Package of Totally Inappropriate Tests. They could lose their license for subjecting employees to this panoply of US Preventive Services Task Force D-rated quackery, except that in wellness the only license you need is a license to steal from unsuspecting HR directors. This leads to…
…Total Wellness: The Best Argument for Regulating the Wellness Industry. Total Wellness isn’t about to lose this Race to the Bottom without a fight. Watch as they try to out-stupid Star Wellness in their quest for that prize.
US Corporate Wellness Saves Money on People Who Don’t Cost Money. We call this Seinfeld-meets-wellness, because it’s about nothing: even if you have absolutely no risk factors, these Einsteins will still save you a fortune. And someone should also tell them you can’t reduce a number by more than 100% no matter how hard you try.
Vitality’s Glass House: Their Own Program Fails Their Own Employees. These people might have more luck selling you a crash-dieting program if they could get their own employees to lose weight.
Wellness Corporate Solutions Gives Us a Dose of Much-Needed Criticism. We don’t want to spoil the punchline.
And that brings us to Wellsteps itself, which earns its “endorsement” from its own CEO by making so many appearances on this list that there is barely enough room for the rest of the confederacy. If you only have time for the Executive Summary, this is the one to read. But squeezing it all into one place requires sacrificing the laugh lines, and if there is one thing Wellsteps excels at, it’s providing laugh lines.
Wellsteps ROI Calculator Doesn’t Calculate an ROI…and That’s the Good News. Watch what happens when Wellsteps meets Fischer-Price. No matter what variables you enter in this model, you get the same result.
Wellsteps Stumbles Onward: Costs Go Up and Down at the Same Time. This isn’t possible even using wellness arithmetic. Eventually Wellsteps solved this problem by simply deleting one of the slides. But because we long ago learned that doctoring/suppressing data is one of the wellness industry’s signature moves, we took a screenshot before we did our expose.
Prediction: Wellsteps Wins Koop Award. In 2015, I went out on a limb to make this prediction, noting Wellsteps’ perfect Koop Award storm of invalidity, incompetence, and cronyism.
Wellsteps: “It’s Fun to Get Fat. It’s Fun to Be Lazy.” This one was penned by Dr. Aldana’s waterboy, Troy Adams, who apparently during his self-proclaimed “11 years of college” never learned that “fat” and “lazy” aren’t synonyms. Paraphrasing the immortal words of the great philosopher Bluto Blutarski, 11 years of college down the drain.
Does Wellsteps Understand Wellness? They are demonizing even the slightest consumption of alcohol, among many other misunderstandings. Shame on me for enjoying a glass of wine on a Saturday night!
The Back Story of the Scathing STATNews Smackdown of Wellsteps and the Koop Committee. This one leads to several other links.
The Koop Committee Raises Lying to an Art Form. It turns out Steve Aldana is not stupid: he apparently has heard of regression to the mean, but just pretended he hadn’t so he could take credit for it with the Boise Schools, who were not familiar with the concept.
if Wellsteps Isn’t Lying, I’ll Pay Them $1 Million but let’s just say I’m not taking out a second mortgage just yet.
An Honorable Mention goes to another vendor on this list, in the form of the Don Draper Award, for this advertising gem, aimed at ensuring that even the stupidest member of the Ignorati, and/or HERO Board members, can catch their name:
To quote the immortal words of the great philosopher Rick Perry, even a stopped clock is right once a day.* And, yes, on that Wellsteps list there is one standout vendor, US Preventive Medicine. It has validation from the Validation Institute. As you read their validation, note that while they show an enviable reduction in wellness-sensitive medical events, they don’t claim an ROI. This is testament to the integrity of both USPM and the Validation Institute.
*If you are a regular reader and didn’t find this quote amusing, read it again. If you are a wellness vendor, find a smart person to explain it to you.
Each of us delivers a rebuttal-cum-second statement. Ron uses his time to shore up his base — the “low information voters,” as they say in political science–with claims he knows to be inaccurate because he himself has said the reverse and/or the statements are invalid on their faces.
Ron says “A large proportion of the diseases we suffer from are preventable.” Actually, excluding smoking-related illness (where there has never been disagreement), “preventable” events consume far fewer employer dollars than birth events, musculoskeletal issues, and general “worried well” medical concerns.
Employers also spend money on rare diseases, infections, catastrophic issues, sports injuries, trauma, drugs, and doctor visits for various things. Are you seeing a pattern here? None of these are preventable by wellness. Where does he get his ideas?
Tallying all spending according to Ron’s own co-authored report — and the HCUP database compiled by Ron’s own employer, Truven — the rate of “potentially preventable hospitalizations” is 2.62 per 1000. Their report uses $22,500 as the average cost/hospitalization. Doing the math with the $22,500, that’s $59/per person per year, out of $6000/person or so spent on healthcare. Meaning about 1% of claims would be preventable through “pry, poke and prod” programs. And that assumes these programs worked perfectly. As years of Koop Awards of demonstrated, they don’t work at all. The most carefully studied program is Connecticut’s. Connecticut‘s pry, poke and prod program actually increased state spending on health care.
So Ron’s premise is utterly false. Let me put it another way: have you ever had a medical event that could have been prevented by completing a health risk assessment or eating more broccoli?
At this point his strategy emerges: argument-by-cliche. “Most diseases are preventable,” is his favorite. That would mean health-conscious folks would be blessed with eternal life.
Also, “80% of money is spent treating chronic diseases.” He is off by a factor of 80 from the relevant figure of 1%. He would arrive at that 1% figure if he asked the right question: “What percentage of cost can an employer save with a perfect wellness program?” He knows that because his co-authored guidebook says it. We also long since debunked this 80% myth.
As a public service, at the end of this posting we list the top hospitalizations. Remind us, Ron, which of these your wellness programs are going to prevent?
Someone needs to tell Ron that “stroke” is not a chronic diseases, nor are most cancers. A stroke is about as acute as you can get — each minute without treatment raises the odds of ending up like the Kardashians. And if cancer were a chronic disease, we wouldn’t run in “Races for the Cure.” We’d run in “Races for the Control and Management.”
I am personally infuriated that he thinks my recurring bladder tumors were/are preventable. I was involuntarily exposed to a carcinogen in 1984. He’s right about one thing, though: bladder cancer is usually chronic. However, most cancers aren’t, contrary to his claim. When was the last time someone said to you: “My doctor says I have lung cancer, but we’re staying on top of it” ?
He also, ironically, lists “depression” as something that can be addressed by wellness without explaining how employers forcing employees to do something they hate — “playing doctor” by taking their blood — is going to cure their depression.
“You can improve population health in the workplace if you apply evidence-based programs,” he says. And yet, his own Koop Awards, presumably given to the best programs, go to organizations that made essentially no impact on population health — 1%, 2% or 3% reductions in risk factors –-but then made up clinically and mathematically impossible savings figures. [Postscript: I wrote that in 2015. Little did I know that in 2016, the Koop Award committee would give an award to a company that increased risk factors and admitted flouting evidence-based guidelines.]
Following the debate, Health Affairs put the total kibosh on Ron’s idea. They published a study showing that you can’t get employees to lose clinically or statistically significant amounts of weight. Not that it would matter because weight has only the most trivial impact on health spending in the <65 population.
Another irony (there’s that word again): all the evidence — the US Preventive Services Task Force etc — says you shouldn’t screen all adults every year for anything other than blood pressure. And yet these Ron and his buddies advocate exactly that.
Ron’s business model is to write up studies showing his friends and clients save money on wellness, so he rattles some off. He notably leaves out Nebraska, because their program and his award for it were shown to be complete lies. However, leaving that program off this list (though it appears on most of his other “best practice” lists) is an excellent debate technique. Listing it as a best practice would have allowed me to point out the results were admitted to have been made up.
He also claims: “some organizations can actually achieve a positive ROI,” As an endorsement, that’s right up there with Benjamin telling Mrs. Robinson that he found her to be among the most attractive of all of his parents’ friends.
It’s also a total walkback of his previous certitude, like:
Just like Gary Hart invited reporters to follow him to show he wasn’t sleeping around, Ron invited “everybody to go in and look at [the Koop Awards] to determine whether they are telling the truth or not.” And, just like Miami Herald reporter Tom Fiedler did with Gary Hart, I took him up on his offer…and found that almost every award over the last five years showed provably fabricated savings figures. [Postscript: once again, I wrote this in 2015, before the Wellsteps award this year, which raises fabrication of Koop Awards to a plateau that even presidential candidates can’t reach.]
So Ron managed to lose his own rebuttal round–even when, as with his opening statement, I didn’t say anything. The debate has pivoted badly for him…and it’s only going to get worse.
Postscript: At 37:28, he says people with “high biometric measures…are more expensive” than people without. This means he knows full well that Wellsteps is lying in their 2016 award when they show increased biometrics but massively reduced costs.
As a public service to Ron and his cronies, I am listing the top 25 hospitalizations in order of spending. See if you can find one or two that are “preventable” by eating more broccoli or being poked with needles.
If Wellsteps and the Koop Committee can show they aren’t lying, they can collect the $1-million reward
Those of you with long memories may recall our standing offer of a $1-million reward to anyone who can show that the wellness industry has broken even during this century. You need a long memory because no one ever claimed the reward. For all the bluster of Ron Goetzel and his cronies, apparently none of them actually believe what they say…or they would be $1-million richer.
The offer is legally binding. There are clear rules. There is an entry fee, but it is refundable to the claimant if they win.
We would now extend that offer specifically to Wellsteps and/or the Koop Award Committee, and we’ll throw in HERO too, since it’s all the same inbred crowd. All they have to show is what they have already claimed: that Wellsteps made Boise School District employees so much healthier — perhaps by reciting their mantra that “it’s fun to get fat and it’s fun to be lazy” — that the School District could, as a direct result of this enhanced employee health, reduce their healthcare benefit spending by roughly one-third after three years.
To make it extra easy for the these people, I’ll relax the requirements:
- They can submit the existing “This Is How You Win a Koop Award” self-congratulatory paean. That means both that they don’t have to do any extra work (besides adding to up 20 links at their option, as the rules allow), and that the word limit on the reward application is waived to accommodate the size of that posting.
- Any or all Koop Committee members can participate with you in the oral arguments, but I myself am not allowed to bring a second. This means they can gang up on me, by crowdsourcing their IQs.
And of course they already know what arguments I am going to make because I posted them. That’s like having the debate questions in advance.
They would have to file the entry fee, or formally request a month’s extension, by November 1. The only reason for the deadline is that when they ignore this offer, as they inevitably will, I can start saying they are admitting they’re lying as early as November 2.
As with the regular award, I am perfectly happy to offer it the other way around, where I pay the entry fee, and I have to prove they’re lying, as opposed to them proving they are telling the truth. That way they can’t say the game is rigged, since I’m willing to play either hand.
Since the Koop Committee members are all such civic-minded citizens, they need not personally collect the windfall if they win. I am perfectly willing to — indeed, would prefer to — donate a million dollars to the Boise School District, either as an unrestricted gift or to set up a fund to update, enhance, and increase employee (and student) access to their fitness facilities and equipment.
Surely, Mr. Aldana and Mr. Goetzel, if you truly care about the health and well-being of those employees, you will make the small effort required to secure this million-dollar contribution on their behalf.
And, Mr. Aldana, please don’t pretend you aren’t applying for the award because you are unaware of my work. For instance, you view my Linkedin profile with a regularity roughly halfway between obsessive and man-crush.*
*As recently as…
This posting is for folks who found us via award-winning journalist Sharon Begley’s “Wellness Award Goes to Workplace Where Many Health Measures Got Worse.” (Note that no one has ever challenged any of her two dozen awards.)
In the event that you are new to the Wellsteps./Boise School District debacle, here is the back story, very quickly.
- Wellsteps lied about savings.
- I predicted the combination of lying, incompetence and cronyism would win them a Koop Award.
- Wellsteps said: It’s fun to get fat. It’s fun to be lazy.“
- Wellsteps showed a complete failure to understand wellness.
And so, inevitably…
Wellsteps won a Koop Award. Ron Goetzel and Seth Serxner have never let their friends down in the past, so why should integrity, competence and facts stand in the way this time?