As the cost of healthcare rises, so does corporate interest in keeping employees healthy. A 2008 poll, published in the New England Journal of Medicine, found that 91 percent of employers believed that they could reduce healthcare costs by influencing employees to adopt healthier lifestyles. Wellness programs have traditionally been sponsored by employers, with the object of making employees healthier and more productive, and to slow the rising costs of company health insurance. Historically the programs have involved health-risk appraisals; lectures on stress, weight management and nutrition; gym memberships; or even worksite fitness facilities.
Incentives
According to the NEJM, the number of employers who offered worksite wellness programs more than doubled between 2004 and 2006. Wellness programs help lower corporate healthcare costs by providing employees lectures on the various facets of wellness, providing healthier food options in the workplace cafeteria, or proving a space to exercise -- all useful ways to make employees healthier and more productive. The problem starts when employers, or their insurance carriers, begin offering incentives to employees for participating in specific wellness programs. Incentives can come in the form of additional paid days off, cash prizes and reduced healthcare premiums. Other employers have gone farther and have tried to punish those who don't participate or meet certain criteria.
Discrimination
Incentive-based health programs can be tainted by discrimination against employees based on socioeconomic status, health status, or behavioral habits. Smokers are one group who are frequently targeted by employee health campaigns. Some employers have gone so far as to exclude tobacco users because of their increased risk of health problems, and others have fired employees because a screening for illegal drugs came back positive for tobacco. It's also easier for a CEO or senior managers to pay for an expensive mandatory gym membership, and therefore keep their weight within a 'satisfactory' range, compared to members of the cleaning crew who make minimum wage.
HIPAA
In 1996, the Health Insurance Portability and Accountability Act, or HIPAA, was passed. This bill states that insurers cannot discriminate against those with certain health conditions, genetic disposition, claim history or disability. In other words, insurers cannot charge higher premiums because of conditions such as diabetes, cancer or obesity. HIPAA does not, however, prevent insurance companies from offering incentives to those who participate in wellness programs or meet specific targets.
Often these incentives come in the form of premium discounts for things like staying in a healthy body mass range or maintaining healthy cholesterol levels. These incentives are deemed legal as long as the cost of the incentive doesn't exceed 20 percent of the cost of healthcare coverage. Some insurers have tried to increase the amount of this incentive to 30 or even 50 percent as part of healthcare reform. The Healthcare Cost Monitor website warns against such an increase, suggesting that insurers will simply increase premiums, and unfairly shift the cost of healthcare to 'unhealthy' workers who cannot reach specific targets -- even if that's due to medical conditions or genetics.
Compliance
The NEJM recommends some actions that will keep employee wellness programs legally compliant. First, the program objectives should be listed, as well as how your specific program will help you achieve those goals. Incentives should be awarded based on participation and not acheiving certain results. For example, encourage your diabetic employees to attend an educational seminar on controlling diabetes, rather than demanding that their blood sugar levels stay within a specific range. Reward employees for having their cholesterol checked -- not for the results.
Keep the programs voluntary. Make all programs accessible for persons with disabilities; alternative options should be available for those who cannot participate. Another key recommendation is to retain a third party to manage employees' medical information. This reduces the exposure of sensitive medical information and keeps the results of medical examinations and health risk appraisals confidential. Employers will then see only summary reports of employee behaviors, allowing them to focus on broad issues that affect the majority of employees.
References
- New England Journal of Medicine: Wellness Programs and Lifestyle Discrimination -- The Legal Limits; M. Mello et al; 2008
- New England Journal of Medicine: Carrots, Sticks, and Health Care Reform -- Problems with Wellness Incentives; H. Schmidt et al; 2010
- Healthcare Cost Monitor: Wellness Programs: A Threat to Fairness and Affordable Care; Kristin Voigt and Harald Schmidt
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