Work-Based Wellness Incentive Programs — Yay or Nay?

Back in 2003, USAToday.com had a story about the rising cost of insurance and how this could and would probably lead to employers taking a personal interest in the health and wellness of employees in an effort to find ways to cut costs — not because they genuinely like you, though that might also be the case too. Who knows, right?

They’re offering wellness assessments that ask about vegetable and alcohol consumption, smoking and exercise. They’re tracking lab tests and prescriptions to predict which workers may fall ill. Some employers are offering bonuses for keeping cholesterol in check. A few are penalizing smokers or those who don’t wear seat belts.

Personal responsibility is the latest buzz.

“The secret of health care is not passing along costs to employees. The secret is asking employees to take control of their health,” says Howard Leach, human resources manager for Logan Aluminum in Russellville, Ky., where workers get an additional $200 a year for voluntarily filling out a health risk assessment.

[…]

Yet many question just how far employers should go in offering incentives or disincentives.

Should smokers be charged more for their health insurance as an incentive to quit? What about coach potatoes, fast-food addicts or those who enjoy high-risk sports?

“There are a number of consumers saying, ‘Why should my health insurance premium cover people who have made the choice to smoke?’ ” says Peter Lee of the Pacific Business Group on Health, a coalition of employers. “But … you get on a slippery slope. Where do you stop?”

Privacy is also a big concern. Most employers say the programs are voluntary, and they don’t review individual data. But consumer advocates are skeptical. Even new federal privacy laws may not cover some programs.

“People should be nervous about giving information about their health status to their employers,” says Robert Gellman, a privacy consultant in Washington, D.C. “It may be perfectly reasonable, but the questions to ask should always be: ‘How will the data be used? Who will share it? How will I be helped by it, and how might I be harmed?’ ”

Lawyers say some programs could run afoul of federal law if they discriminate against workers with health problems, say by charging overweight workers more, or if they single out pregnant workers for treatment that differs from those who are not pregnant. Requiring seat belt use, however, may be OK if the requirement is clearly spelled out in the health insurance package.

[…]

As yet, most employers have preferred the carrot approach — incentives to stay healthy — rather than the stick: fees or disincentives for living an unhealthy lifestyle.

“I see companies taking an approach of trying to put incentives toward involvement in (health) programs,” says Alan Spiro, a medical doctor and consultant with benefits firm Towers Perrin. “In terms of charging people more if they smoke, I haven’t seen that in any kind of widespread way yet.”

He says incentives that encourage people are best. “You don’t want to punish people for bad health,” he says.

But some say bad habits should be targeted.

“Automobile insurance rates rise appropriately for those who won’t drive responsibly, and life insurance is more expensive or unattainable for those who have high-risk behaviors,” writes John McDougall, a doctor and nutrition book author, in a January opinion piece on the Web site Health Leaders. “Why not apply the same standards for health insurance?”

While some agree with promoting greater individual responsibility for health, they say McDougall’s ideas currently will not fly.

“The reason is we have a society that says this stuff is not within my control,” says Kelly Victory, vice president of medical operations at Whole Health Management, a Cleveland-based firm that works with employers to create on-site medical centers and wellness programs.

“We live in a society where people sue McDonald’s because they are overweight,” she says. “Until we adopt a society where people take personal responsibility for behaviors, we won’t be successful in employing that type of incentive.”

Still, give it another year or two of double-digit premium inflation and employers may try anyway.

“It’s been politically incorrect in health care to charge more and to ask people to take personal responsibility for unhealthy behaviors and practices,” Victory says. “I think that’s going to change.” [“Employers get nosy about workers’ health” (USAToday.com]

Our health insurance is actually charged currently based on whether or not we are smokers.  It’s been that way the last two years.  My understanding is that it’s been that way for much longer than that.  I work for a rather larger, very well-respected hospital.

This year, we’ve been notified that our 2008 insurance is going to go up a lot.  Not just the usual expected two to five or so dollars per year it’s  been going up.  They haven’t said how much but apparently, it’s going to be nightmarishly high.  To compensate, they’ve set up a wellness incentive program that could lower our 2008 insurance.  I’m not quite sure I understand how exactly each incentive counts toward lowering the cost.  Here’s some examples:

• 5 Points for filling out a risk assessment
• 5 Points if you’ve seen your GP between Oct 1, 2005 and Oct 1, 2007
• Variable Points added for age and gender appropriate screenings like cholesterol, blood pressure, pap smear, dental exam.  (This seems kind of unfair.  There are more female appropriate screenings on the list than male.)
• 3 Points if you complete 9 weeks of a 12 week Weight Watcher program.  (Again this is unfair.  Weight Watchers only accepts people who need to lose 10 lbs or more.  Skinny people do not benefit from this  incentive.)  Oh, and they’ll give you a $50 rebate voucher.
• 3 Points if your body mass index is less than 25.  Muscular people will never be able to get this.
• 2 Points if you always wear your seatbelt.
• 2 Points if you get the flu shot.
• 5 Points if you complete a 6-week class on managing your health.
• 3 Points per class up to 2 classes for attending wellness or health education classes
• 1 Point for completing WebMD’s Online Stress Assessment
• 1 Point for enrolling in WebMD’s Online LEAP Fitness Program.
• 1 Point for completing WebMD’s Cardiovascular Health Assessment.
• 1 Point for completing WebMD’s Online Nutrition Improvement Program.
• 1 Point for completing WebMD’s Online Back and Neck Assessment.
• 1 Point for completing Fall 2006 Physical Activity And/Or Nutrition Program.
• 1 Point for completing Spring 2006 Physical Activity And/Or Nutrition Program.
• 5 Points can be earned for seeking treatment for various chronic conditions like diabetes and depression and for quiting smoking too.

I can’t find anywhere on the website or in the rules what these “points” really mean or how they lower my insurance.  I’ve also looked around on the website.  There’s places to enter my “conditions”, but once I’ve entered them I’m not really sure what it does with them.  I did notice that once I’ve entered my medication, it will show me alerts about my medications when new information comes out about such things.  I haven’t figured out where to enter where I’ve accomplished any of those things on the list of things I can do to earn points either.  The website is way too complicated.
So, here’s the worry.  I know that a third part is running and maintaining this website that’s tracking my “conditions” and medications, but how do I know that my information isn’t getting back to my employer?  (Ignoring the fact, of course, that my employer is also my healthcare provider and I work in the IT department and I know that we regularly run reports against employees’ names to make certain that employees aren’t accessing employees’ health data inappropriately — a fact I’m sure of because I have to report when I have tests run or hospital stays so such reports can be run and I know who runs the report.   And it’s one of the reasons why I was so impressed with this IT department to begin with. ;)  However, ignoring what I personally know…)

After all, it was only last year that Weyco instituted a policy that employees couldn’t smoke not only onsite but ever.  The owner did this due to rising insurance costs and he does test for tobacco usage.  If you test positive, you can be fired.  Michigan law doesn’t protect smokers from this kind of discrimination.

But some workers wonder how far it might go, if one day your boss might instruct you to eat all your veggies or go home without pay. [“Smokers Need Not Apply Here” (CBS News)]

One of my co-workers is quite incensed by the whole thing.  Well, of course, he’s one of those people who’s not happy unless there’s something to be unhappy about, but that’s just something else entirely.  I wonder if he doesn’t have a point, but I haven’t made up my mind yet.  Basically his attitude is that he feels that we should get paid for doing our job.  Lately, he complains a lot about other people not doing their jobs.  He seems to think that the incentives and the rewards are payments for things that don’t involve actually doing our work and that some of the hubub surrounding the rewards programs is distracting people from *gasp* doing their work.

Like this latest thing.  E-mails and fliers have been going out and up about the new program.  Without even looking at it in detail, I was turned off…and I like healthy eating, but it sounds stupid.

“Colorful Choices”

Colorful Choices is a healthy eating program with a fun, color theme. Your goal is to eat at least 5 servings of produce (1 from each color group) each for 56 days.  Easy-to-use online logging and tracking tools provide instant feedback and positive reinforcement for your accomplishment.

By the way, I couldn’t find anything about it when I signed on to the actual online tool, though supposedly it starts today.  (Oh, and you get 1 Point if you log 42 of the 56 days.)

Anyway, I haven’t decided if these incentive programs are a good thing or a bad thing.  I think they have the potential to be either good or bad.  And, yes, it bothers my paranoia a little that my employer is getting a little pushy about my health.

What do you think?

tags: wellness, incentive programs

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