Nebraska State Employee Wellness Program Motto: “First, Do Harm”


If Nebraska’s public relations blitz about the success of its wellness program is to be believed, state employees have sixty times the cancer incidence of former residents of Love Canal. The only other interpretation is that, in the name of wellness, state employees were subject to the most overdiagnosis and overtreatment ever documented—at taxpayer expense, no less.

Here is the one fact known to the public. Prompted by a mass mailing and copay waivers encouraing them to go get cancer screens, 514 of the participating state employees who underwent biometric screens were identified as having undiagnosed “early stage cancer,..resulting in early treatment.” (There were also 26 with later-stage cancer, for a total of 540.)

The question is, 514 out of how many? Both the state’s vendor, Health Fitness Corporation, and point person for the program Roger Wilson are refusing to say absent a Freedom of Information Act request—the marketing equivalent of “pleading the Fifth” for a program they previously couldn’t shut up about—so we can only guess. Start with the roughly 7000 employees who took part in a basic blood test. Let’s call that the pool (out of a total of 20,000 program-eligible employees and spouses) of potential screening participants, on the theory that almost no one would submit to a complex screen without also submitting to a simple one.

Then, take out maybe 30% who were too young to be screened for cancer, and assume another 20% were already getting appropriate screens, you’d be screening 3500 people anew. That yields a cancer rate of 15% in a two-year period. As mentioned in the first paragraph, to put this massive overdiagnosis in perspective, Love Canal residents had a 5% cancer rate in a 20-year period—one sixtieth of the alleged Nebraska rate.

Nebraska’s massive overdiagnosis is not a belt-and-suspenders approach that saves lives even if some people don’t benefit. Quite the opposite is true—cancer treatments themselves have health consequences, but no doubt most of those 15% identified with early-stage cancer elected to undergo expensive, debilitating, futile and potentially harmful “early treatments” that the state could have avoided by taking the recommendations of medical societies not to screen and/or simply doing a little arithmetic and not sending out mass mailings recommending cancer screens, and/or realizing that 15% of people do not have undiagnosed clinically significant cancer and that state employees should stop overutilizating screens. (Ironically, “overutilization of healthcare services” was one of the justifications for Nebraska’s program cited in their report.)

The state also opened its checkbook to reduce or eliminate co-pays on many chronic disease medications, which proved a windfall for state employees, because fully 2400 new annual prescriptions (among those 7000 participants—once again, a very high diagnosis rate) are now being written for hypertension or high blood pressure, as a result of further screening.

Yet somehow, despite the cancer expenses, waived copays, and large proportion of the population being newly medicated, the state “cut employee health claim costs by millions.” Such are the magic beans of wellness. It doesn’t matter how much you spend—in order to continue to receive funding, you simply claim impossible savings and hope no one notices you’re lying. Or if the program administrators aren’t intentionally lying and genuinely believe they saved $4.7 million by having risk factors decline at least temporarily for roughly 160 participants (saving a mathematically impossible $30,000 per participant who lost a little weight or recently stopped smoking), they would certainly lack the sophistication needed to recognize massive cancer overdiagnosis. One more reason they shouldn’t be “playing doctor” with their employees’ health.

Considering all that overdiagnosis, overtreatment and the obviously fictional savings figures, you might be thinking, “This program must be an outlier. The whole industry can’t be like this.” And you’d be right. The Nebraska program is an outlier—but in the other direction. The combination of fictitious savings and cancer overdiagnosis/overtreatment won Nebraska the 2012 C. Everett Koop Award as one of the country’s best wellness programs, as well as awards from the Wellness Council of America and others. (In case you haven’t heard of WELCOA, here is an overview.) Both the fictitious savings and the 500+ cancer cases received plaudits from America’s Health Insurance Plans as well.

The major question raised by this debacle and the cover-up that has followed is, why isn’t there any adult supervision of these programs? Oh, wait a second, there is adult supervision: Nebraska’s wellness vendor is accredited by the National Committee for Quality Assurance.

So a better question would be, who is supervising the adults? Someone better start doing it soon, because statistically speaking it won’t be long before a state employee actually dies from complications of one of these cancer overtreatments, in the name of wellness.

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Al Lewis is founder and President of the Disease Management Purchasing Consortium International, Inc. ( DMPC is by far the leading outcomes measurement evaluator in the field of disease management and wellness for health plans, self-insured employers, states, and brokers seeking valid results measurement. He also confers the only recognized certifications in two areas. The Consortium website,, lists the 200 people who have earned Critical Outcomes Report Analysis Certification and the 25 employers, health plans and states that have received Savings Measurement Validity certification. He also provides and guarantees Letters of Validation for programs that achieve savings when validly measured. His critically acclaimed category-bestselling book on outcomes measurement, Why Nobody Believes the Numbers, chronicling and exposing the innumeracy of the health management field, was named 2012 healthcare book of the year in Forbes. His new co-authored book, Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care, released July 1, 2013, is already a trade bestseller. Al’s co-authored “Is It Time to Re-Examine Workplace Wellness ‘Get Well Quick’ Schemes?” became January’s most tweeted Health Affairs article, a lay version of which was featured in the Harvard Business Review and an updated and expanded version in the Wall Street Journal. He has also published op-eds or essays in the Boston Globe, San Francisco Chronicle and Newsweek. He is widely acclaimed as a speaker on disease management and wellness economics. He is also the “whistleblower” whose forensic analysis has led to the proposed dismantling of North Carolina’s expensive and ineffective Medicaid patient-centered medical home program. His radio program, The Big Fix, exploring novel economic policy ideas, was carried on the NPR-affiliate in Washington, DC and may be renewed for 2014. Al holds undergraduate (1978) and law (1982) degrees from Harvard University phi beta kappa and taught economics at Harvard, and is currently a Visiting Scholar in health policy at Brandeis University. But he still can’t get his kids to clean up their rooms.


  1. This is really sad since they have one of the best Master’s programs for Health Promotion that is focused on holistic practices that move people towards lifestyle change instead of more testing.