Can My Company’s Wellness Program Really Ask Me To Do That?

doctor exam

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“Wellness” is like apple pie, isn’t it? What could possibly be bad about companies helping their workers be healthier?

I wouldn’t dream of finding fault with many typical wellness offerings: Quit-smoking programs, on-site gyms, more appealing cafeteria salads. Good for worker, good for employer, everybody’s happy. But consider this email I received from an employee at a major national retailer:

Carey,
I see you’ve written several articles about the new health insurance laws, etc. The company I work for has [a major national insurer]. Last year we received a $25 discount bi-weekly if we filled out a health questionnaire, which of course everyone felt compelled to do as that would be a savings of $650 per year. Most people I spoke to felt uneasy doing it, as they felt it would lead to other invasive practices. Well, sure enough, this year, if you DON’T smoke cigarettes you get $10 off bi-weekly, but to get the additional $25 not only do you have to fill out a questionnaire, but everyone employed [here] (and taking the health insurance) has to have a screening which involves:
1. Waistline measurement
2. Blood pressure measurement
3. Blood draw to test for glucose, HDL and triglyceride levels.
If you do not pass these tests, you will lose your $25 if these are not brought down to an acceptable level by August (when we will be tested again).
Needless to say, this really shook a lot of people up, as it is so invasive, and is this even legal?
Would love to hear your thoughts on this.

Let’s cut to the chase. Yes, it’s legal. And it’s a huge trend that began with only “carrots” — discounts on gym memberships, fun health fairs — and is now progressing to sticks. Or at least, to carrots that can feel a whole lot like sticks.

There are some important limits on what your company’s wellness program can do. More on that soon. But here’s the bottom line: Under federal law, your employer can vary your health insurance premium by up to 20 percent based on a “health factor;” that goes up to 30% as of 2014 and the government could eventually raise it as high as 50%.

Why should you foot the bill for all your Marlboro-packing, Miller-cracking, Big-Mac-chomping co-workers?

Readers, what do you think? On the one hand, if you’re a fit, non-smoking, careful eater, why should you have to help foot the bill for all your Marlboro-packing, Miller-cracking, Big-Mac-chomping co-workers? An unhealthy lifestyle is known to be a major contributor to health care bills. and health costs have skyrocketed for years, sending premiums through the roof, hurting businesses and costing jobs. Any levers to bring them down must surely be tried.

On the other hand, there is clearly a potential yuck factor here. Having my employer measure my waist, or draw my blood??? Getting weighed and monitored in the workplace setting, or in the personnel filing cabinet, may not always be comfortable. What if my boss starts a “fun” pedometer contest among our company’s departments and I’m the morbidly obese one? What about my medical privacy?

I asked the retail employee how people had responded to the wellness program. She replied:

I spoke to 3 people – all three are outraged.

The first person is refusing to have the tests – without giving too much info she has long term health issues and needless to say has huge out of pocket expenses as it is, but will sacrifice the $25 because she does not want any additional information on file other than what they already have.

The second person feels it is an invasion of privacy, but can’t afford to pass on the $25.

The 3rd person I asked also said she felt it was an invasion of privacy and is furious that we are being “forced” into doing this for the $650 per yr.

And on another note: we all work in the office and overall are paid on a higher level than a typical store associate (cashiers avg $9 per hr). To a store associate that $25 is HUGE.

And of course, $25 is only the beginning. If an average family pays close to $20,000 a year in health insurance premiums, and the health-factor differential could ultimately go up to 50% — you do the math. Kaiser Health News reports that already, among employees of the Swiss Village Retirement Community in Indiana, “Those who don’t smoke, aren’t obese and whose blood pressure and cholesterol fall below specific levels get to shave as much as $2,000 off their annual health insurance deductible.”

So what are your rights? Here are the basics, courtesy of Patricia Moran, an employee benefits law expert at Mintz Levin.

The general rule: Federal law generally prohibits plans from charging different premiums to different employees based on a health factor. However, there is an exception for “bona fide wellness” programs.  These programs allow an employer to vary premiums up to 20% based on a health factor (such as cholesterol, weight, smoking) but only if the employer offers a reasonable alternative to those for whom it is unreasonably difficult to meet the standard.

For example, let’s say the standard is a cholesterol count of 200. If an employee is below 200, he/she gets the better premium.  This is okay so long as the employer offers an alternative standard to employees who are above 200. For example, take a cholesterol drug or attend nutrition classes.

Voluntary programs available to all outside of the medical plan are generally okay – for example, a gym discount, or a reward for attending a health fair.

Health Risk Assessments [like measurement of blood pressure and waist circumference] are sort of a legal land mine under the Americans with Disability Act and GINA [which protects genetic privacy], but it depends on what is asked and what it is used for.

An alphabet soup of other federal laws are at play here along with GINA and the ADA: HIPAA, which protects medical privacy, and ERISA, which governs employer health plans. I asked David Wilson, a partner at Hirsch Roberts Weinstein and an expert on wellness law, to parse all the legalese into a few principles that might be most useful to employees. He offered these points to remember about wellness programs:

Incentives, not penalties: A wellness plan is legal if it creates incentives for participation instead of penalizing an employee for not participating. A wellness program is considered voluntary as long as an employer neither requires participation nor penalizes employees who do not participate.

Avoid specific standards: To comply with the ADA, both voluntary and mandatory wellness programs should refrain from requiring the employee to achieve any specific health standard. The law bans discrimination based on health factors like health status, genetic information, medical condition, medical history and disability. An example of an impermissible health plan is one that gives a 20% premium discount for employees participating in the wellness plan with a cholesterol level under 200.

But the plan can use standards if…The reward is (for now) less than 20% of the total cost of coverage. The wellness program is “reasonably designed” to promote health. It gives employees a chance to qualify for the reward at least once a year. It allows a “reasonable alternative standard” to anybody for whom it is unreasonably difficult due to a medical condition, or medically inadvisable, to satisfy the initial standard. The employer may also choose to waive the standard for an employee who shows good cause. And it discloses that alternative standard in all wellness materials.

When it’s mandatory: Employers may also have a mandatory wellness plan under certain circumstances. A mandatory plan cannot request family medical information or genetic information. If a mandatory program requires an employee to achieve a certain health standard, that standard should account for and be adjusted for age.

“The way to think about these things is that you can’t use a stick, you have to use a carrot,” Wilson said. “Employers can’t use penalties but they can use incentives.” And from the worker’s point of view, you should get the reward “If you meet the goal or if you try to meet the goal.”

Wellness law expert David Wilson

And if I think my company is violating these rules? Ideally, he said, I would go to the director of my company’s Human Resources department, who should be “the gatekeeper of fairness.” If I don’t get satisfaction, I can either consult with a lawyer or file a complaint with a government agency.

If I think I’ve been discriminated against based on a “protected characteristic,” such as age or genetics, I can file a claim at the Massachusetts Commission Against Discrimination or the Equal Employment Opportunity Commission. They would then send the complaint to my employer for a written response.

If my complaint is based on ERISA or HIPAA, those are federal laws and I could sue in federal court. Also, Patricia Moran noted,  if I think the company’s plan discriminates under ERISA, I can call the Employee Benefits Security Administration for help.

Smart Ways To Wellness

In an ideal world, of course, I’d be so raring to get healthier that nothing my company’s wellness plan did would bother me. That’s the ideal for the wellness programs, too: To help me develop a long-lasting, sincere desire to get healthier. The catchword in the fledgling field of wellness research is “intrinsic motivation,” and the data suggest it’s the best way to go.

In contrast, financial rewards like the national retailer’s $25 outcome-based incentive discount are “extrinsic,” said Anne Marie Ludovici, director of wellness at Tufts Health Plan and a leading author and consultant on the topic. People who are not ready to change but suddenly face a major financial push like that may “dig their heels in further,” she said. And incentives that backfire could reduce employee job satisfaction and engagement.

Yet, she said, it’s becoming typical for large brokers and employers to add progressive requirements to wellness programs, going from simple questionnaires in the first year, to physical tests in the second, to required outcomes such as being tobacco-free or thinner in the third.

‘If you’re a high-risk driver you’re going to have to pay more in premiums.’

The problem: “Even though you’re saying that you’re giving discounts, people see it as being penalized,” she said. “So it is very controversial. That’s called ‘outcomes-based incentives,’ and I would never encourage a client to start with that, because it’s definitely very controversial and may not be very well received.”

What’s a better way? How the whole issue is framed is very important, Ludovici said. The company can explain that it’s putting its faith in its workers, counting on them to try to get healthier even though the company won’t see immediately lower health insurance costs. It can use its wellness program to help give employees the sense that they’re cared about, she said, and working in a good place oriented toward high performance.

She, herself, has been known to use a car-insurance analogy: “If you’re a high-risk driver you’re going to have to pay more in premiums. And I think the industry is driving — excuse the pun — in that direction. If you want to eat triple cheeseburgers every day, go ahead, but you’ll pay more.”

Mari Ryan of AdvancingWellness, chair of the board of directors of the new Worksite Wellness Council of Massachusetts, says similarly that she would recommend starting a wellness program by first explaining to employees how their health is important both to them and to the whole company. “Self-care” can be a company value.

She would never advise going right to a “standards-based” program that offers rewards for reaching health goals; rather, she said, she would focus on creating a supportive environment: through, say, smoking policies and smoking cessation programs, or putting healthier food in vending machines.

Anne Marie Ludovici says that she sees the key as “engagement” rather than accountability. “Our philosophy at Tufts is we try to keep people engaged in health coaching if they need it,” she said, “and keep them engaged in the behavioral change programs that will result in those improved outcomes. That feels right to me. I ran the governor’s initiative in Rhode Island, and I saw that what was really getting people excited was being part of a healthy culture where employees thrive and feel this is a great place to work. And focusing on outcomes could really defeat that whole purpose.”

Readers, please weigh in. How do you feel about your company’s wellness program?

Further reading:

• Consensus statement on reasonable wellness incentives by the Health Enhancement Research Organization.

• Harvard School of Public Health researchers lay out the legal landscape of wellness programs in The New England Journal of Medicine here.

• Also in the New England Journal: Lessons from behavioral economics on how to design more effective wellness programs.

 • A report on wellness programs by the Massachusetts Office of Consumer Affairs and Business Regulation.

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  • Steve

    I was.released from my job because of an accident I had. I was never givin a drug test nor did I refuse one. I was told the CEO wrote that I did refuse to take it. Now they want to rehire me. I was told to go take a drug test, at my expense and bring the results back. I did. then they sent me to HR to take another. I did. I passed both. Now they want me to get a drug assessment done snd I have to pay for it. my question is, How can they make me do this when I never failed or refused a drug test? Do they have the right to do this?

  • john

    the rates for my employers program are close to double the price if you dont participate in the program. this doesn’t appear to be legal from what ive been reading. any help?

  • http://RentFitnessEquipment.com Steve Paterson

    My Company RENTS Health Club Quality fitness equipment on a month-to-month contract to Corporations that want to provide a health onsite fitness program for their employees. I want to know how much tax credits the affordable care act will provide for these Corporations? http://RentFitnessEquipment.co

  • Kempis

    My Company requires you to pass three out of five defined health conditions (BMI, Cholesterol, Blood Pressure, Glucose and I can’t remember the other..good cholesterol?). If you don’t pass your are charged $40 per pay until Sept at which time you can retake. If you don’t prove the you took the test by the deadline (the deadline for taking the test and proving you took it are the same), you are charged $40 per pay through April of 2015. I found out through others that the company they use (Quest) has unethical practices (Taking 10 lbs off for clothes for friends, telling them to suck in their gut as much as they can, etc.. ). I went through my own doctor as a result, three days later I came down with a severe case of Bronchitis and was unable to prove that I took the test within the allotted time so I get to pay them $40 per pay (or $1,040). I may have passed, I don’t even know.. but it doesn’t matter. whether I did or not, I missed the deadline. This whole thing has been extremely stressful. My blood pressure goes up every time I think about it. If they were more ethical about it, it would be one thing. I do care about my health and understand they need to get their costs down, however, the people that are penalized are older. I have friends that are in their 60′s and the criteria is the same. Bottom line, when you are in your sixties, you are NOT going to have the same numbers as in your 20′s. So I have a lesser opinion about the company I work for and they have a much less satisfied workforce. And I wonder about the legalities of these practices.

  • ollie

    its all an invasion of privacy…….a big scam for the insurance companies

  • sjs

    My husband’s employer switched him to all night hours, which isn’t healthy. Maybe the insurance can talk his boss into giving him more decent hours so his weight, etc. can improve. Part of an employees health is a healthy work environment, including decent hours.

  • Medea mange

    This is the only country where people get health insurance through their employers.. It’s a really bad system. Slaves

  • Medea mange

    My company now wants to know how much and how often you drink alcohol, if you are stressed at home, how many cigarettes have you smoked and for how long, your weight, BP, cholesterol, BMI and activity level. No one will answer, though it’s not tied to how much $ we pay. That should tell you something right there. We don’t like it

  • Mimi Strong

    my company make me pay extra if i don’t make there assiment dealine

  • cali

    After reading some of these comments, there are lots of good arguments both pro and against the wellness programs. I think the key phrase is to have the employees engaged, coach them, educate them and then ask them what would be the best way to move forward. Status quo is simply not sustainable and as a physician I see what it does to people’s healths. The other issue is patient autonomy vs patient making their own health care decisions. Unfortunately, I also see such decisions and people drive toward their cliff and there is not much I can do for them. Therefore, the cholesterol guidelines, smoking, flu shots etc are recommended by physicians because there is strong evidence that they are beneficial in vast majority of people. I would caution the average layperson against making their own medical decisions because the outcome is usually disastrous. My recommendation to the employers will be to engage their employees and design a program that fits most. My advice to the employees would be to look at wellness program not as carrot or stick or adversarial……but as a chance to liver better, healthier and happier lives. A single person can bring changes in the whole family–both good and bad. Remember, our kids are most likely going to eat what we do and from a doctor’s perspective, the most difficult thing to see is a young person, say 29 years old, with diabetes (adult onset) coming in with stroke and heart attack. I think the key word is to work together as a team.

  • Conservative

    I don’t beleive it’s any business of an employer to know what’s going on in my health. The whole reason we have insurance is to be able to afford doctor visits. I also believe it is wrong to charge more for non-compliance.
    Here’s my question. Who is going to pay for those healthy meals? It costs significantly more to eat healthy. You can bet your employer isn’t going to foot the grocery bill so you can eat healthier.

  • Marlene

    The thing that bothers me, is that THEY derfine what is healthy and what is not. If I do NOT believe mammograms are healthy, and so choose not to have them,I get a lower score. If , from my own research, I believe flu shots are not healthy, and therefore I do not get one, I get a lower score. If I do not believe that eating red meat sveral times a week is the best choice for my health, I get a lower score. If I do not drink cow’s milk, but drink almond milk instead, because I deem it better for my health, I get a lower score. They don’t even HAVE questions on the assessment asking if I take vitamins, minerals, herbs, etc. “Their” choice of what criteria to use to judge my healthy lifestyle choices are arbitrary and binding. If I do my own study and reseach, and come to a different path to “health” than they believe is right, there goes any chance of my ever being allowed a bite of the carrot!

  • Kelly O’Connor

    A lot of pontificating from the health nuts but you are missing the point. How far into your personal life should your employer intrude? For example – you are healthy but you can’t conceive, Under your employer’s insurance plan AI will be covered maybe once or twice but no more than that because you used to be a smoker. Your child has cancer but you are obese so that will be considered a factor. You end up in the ER but you didn’t go for your biometric tests so you have to meet that $1k deductible before your cover kicks in.

    I consider myself employed due to my skills and experience because that’s what I bring with me. If my employer decides that one of the benefits they offer now has strings attached, I feel compromised. But I am free to find another job that does not require my vital statistics (fasting readings of course). My body and my health are my business and that of my doctor should I so choose. I am lucky I can choose. My colleagues have children and have to jump through the moral breaking hoops of having their cheeks swabbed for nicotine even though they are admitted smokers, going for annual mammograms which is far above the recommended rate of every three years, bending over, opening wide, just so they have no worries when they end up in the ER with their kids.

    As for Obamacare – the elephant in the room is insurance. The Bill of Basic Human Rights lists access to medical care, not insurance. The profit-driven medical insurance industry in this nation has stomped over the Human Bill of Rights. If I am in a third world country I have better access to medical care than a Walmart employee, let alone a veteran who has served his country, or a child in a lower middle class home.

    While wellness programs are a good idea, it is the execution which is loaded with compromises that is a failure. My life. My skills and experience. Employers can have one but not both. Slavery has been abolished.

  • Cassandra

    Are there any limits as to how frequently these tests can be done? My husband is a 31 year old, healthy male, and we didn’t mind submitting to the blood tests and BMI test initially for the $500 medical spending credit card we received. However they are asking that he along with everyone else submit to this testing every six to nine months!!! My husband has done this testing three times and is healthy, so I don’t know why they require the testing this often. It seems a bit ridiculous to me to waste time assessing a healthy person this often, or that there isn’t say less frequent testing for younger or healthier individuals. We are both nurses, so we know how stupidly excessive this testing is in my husband’s situation. If things keep progressing this way in terms of invading everyone’s privacy, I am concerned that we will end up complete gerbils for all of these insurance companies and employers…as it is borderline at this point already.

  • Jess

    Can a company require it’s employees to participate in the wellness program? Ours has been optional in the past and is now mandatory. Also, if my spouse does not participate he will be dropped and they will not cover him.

  • Can’t Believe It

    The basic problem with these “wellness plans” is that workers have no idea how the collected data is being used or who has access.

    There is no protection from an executive, wellness manager, medical department employee, or lawyer compiling a “layoff list” based on those who show signs of acute or chronic disease.

    Corporations and their officers are by law, custom, and training not supposed to act ethically. They are only supposed to do what is most profitable for the company, and one of the easiest way to make profits is by laying off or firing the workers who have the highest potential for heart attacks, cancers, and strokes.

    • ceecee52

      And who really knows what “actual” tests they really do on your blood sample??? I don’t trust it at all..

  • bvdonjuan

    I hate the police/nanny state this country has turned into. It amazes me that so many are ok with these intrusive wellness programs perhaps because they are just peachy-keen, but eventually they too will feel the same way when age takes it’s toll.

    Just say no to all this crap.

  • phkat

    Our company insurance has just impemented a “total health management” program whereby they are increasing our rates but then giving us a $20 per pay day “incentive” to get all this preventive testing done. And benchmarks that we are supposed to achieve. But guess what… the company refuses to subsidize our membership to the local (and only) health club/athletic center in our town
    . “Lose weight, get healthy but we’re not behind you enough to even offer a token discount to the health center”. Humm…..

  • Mike Gleason

    Is it legal for my employer to require my spouse to also have a health assessment done and be considered healthy or face a fee?

  • http://www.facebook.com/pelsass Paul Elsass

    As I always say, “One man’s stick is another man’s carrot”. How you view this totally depends on what you plan on doing with your health. I take care of myself and the quality of my life is important to me. Thus, I see this as a carrot. If you like to do what you want, even at the expense of your health, then it is a stick. You may not like it now, but if it saves you in later years you may thank your employer later.

  • Siobhan

    I personally loathe my employer’s insurance company’s manner of handling this. I live paycheck to paycheck. Prior to taking this job I had a far more active one and had a much lower BMI. Now I’m sedentary, the front line for any disgruntled individual to come in and yell at, and getting constantly harped at to not go into overtime – to the point that I actually have to do part of my job off the clock to achieve the “good customer service” my employer claims to want.

    Now, I know that I’m overweight. Hell, I’m unhappy with it. That’s why I pay for – out of my own pocket with no special discounts – and use my gym membership on a regular basis. That’s my choice. I also am relatively healthy – the most I’ve used my health care in the five years I’ve had it is 1 visit for a knee injury to make sure I hadn’t dislocated it again and 1 for a sinus blockage. Both were appointments, not urgent care or emergency care and the most treatment either of those got was a prescription for Sutafed so I didn’t get hit with the pharmacist thinking I was trying to make meth. Primarily, I use my insurance for the vision plan as I’ve had poor eye sight all my life and generally need a checkup and update to my prescription about once a year.

    Two years ago, my employer said “tell us if you’re a smoker or not” and claimed they were giving a “discount” of $10 dollars a paycheck or about $40 a month. I’m not, but I didn’t feel my employer had any need of that information, so I refused. Surprise! I got a $10 increase in my health care premium when the deadline passed. Last year it was a “go to a CVS clinic and have them give you this health assessment” for another “discount” of $15 a paycheck or $60 a month. Again, not their right to know my personal medical information, so I refused. Surprise! Another premium hike of $15 and when I complained, I was told “it’s not a fee!” and given a runaround.

    Now this year, they’re demanding that I speak with some person I /do not know/ over the phone and give them my personal medical information over an /non-secure medium/ of a phone line or receive a premium hike of $50 a month. In three years, that’s a grand total of more than $150 /every month/ raise of my premiums. Every time I complain about being forced to participate in programs that require my allowing my personal medical information to strangers that I have no reason to trust, I’m told it’s perfectly legal.

    Combine all that with working a job that involves sitting at a computer for 8+ hours a day, being the front line for any nut that wants to come in screaming about the company I’m contracted to as well as any disgruntled person in the building that decides to take it out on me, and trying to manage living paycheck to paycheck with an ever increasing bite being taken out by BS “wellness” premium hikes and I would just LOVE to know how I’m supposed to stay healthy and keep my stress levels low. This crap would raise a saint’s blood pressure!

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  • chas

    My wife has MS and many of the “suggestions” of the wellness program are impractical or unsafe. Can they be held responsible for malpractice?

  • chas

    What if the wellness program threatens the employee’s incentive? Can the wellness programs actually require the employee to participate to their “standards”?

  • Deb

    Aside from any other thoughts I have, I wonder specifically about the issue of customizing goals (if there are goals) for individuals and the potential costs if goals aren’t customized. For example, a number of important psychiatric medications lead to wait gain and increases in cholesterol. Would we prefer people NOT to take their psych meds (even from the vantage of productivity) in order to attain weight/cholesterol goals? What about people like my friend with MS for whom it is very difficult to get aerobic exercise. Are we going to penalize him for the secondary toll his MS takes on him? What about the well-established fact that — at least by the time they enter the workforce — are of a weight that is simply difficult to change? Do we want them to crash diet before assessments to get their weight down? We use such crude instruments to influence behavior and often fail to consider the impact on outliers. Its the tyranny of the fit — who take, whether they deserve it or not, their fitness as a signal of the moral superiority, without adequately considering the lived lives of others.

  • http://www.facebook.com/people/James-VanLanduyt-Jr/100000157685089 James VanLanduyt Jr

    I’m currently in a similar situation. If I were single without a family it would be simple. I would drop my insurence and start looking for a job with a better benefits package. The government will be taking the option away from me of going without insurence.

    I do have a family and I would not risk not having insurence on them. So for the time being I am forced to follow the dictates of my company. I have already started looking for companies without such restrictions.

  • infeaux

    Wellness incentives can be a good thing, but they have to be implemented intelligently, by people who are knowledgeable about health, wellness and medicine. Also, they must have as their goal the improvement of health outcomes, not just saving money for an employer by finding yet another way to shift costs on to the individual.

    They have to take into account the full range of factors and challenges people face in thier earnest efforts to stay healthy, rather than just dwelling on some moralistic, punitive notion of “personal responsibility”.

  • http://pulse.yahoo.com/_S65RBEEMYRFYVMJZMRRADQMMAI gardenia

    If employees would pack their own healthy lunch for work, 30 minutes is plenty of time to eat whatever he/she chooses. For a nice relaxed lunch, what do these complainers want? A couple of Martinis?

  • Philippe

    It seems fair that those who chose to live unhealthy lives will have to pay more because of their self-induced risks. Likewise, those who say no to doughnuts, cigarettes and being a couch potato will be less burdened by the poor choices of others. It’s a form personal responsibility. I am not a conservative or a libertarian, I believe in employers and government helping out when needed. I do, however, think that responsibility is a two way street. Also, it seems that those who are outraged by the privacy issues are less concerned with basic rights than having their “dirty little habits” protected.

  • tahoe f1 nut

    In socialized health systems the government has an incentive to cut costs by increasing overall health, and creating the laws to do so. In a privatized health care system such as ours the companies that profit from it have the same incentive. they should be able to change the rules to incentivize people to be more healthy. Pick your poison: government control and waste, or Private company and investor greed. I personally believe that waste and corruption in a government run system is less expensive than being responsible to private shareholders. here’s why; I can vote for the people in charge of government, I can’t vote for people who invest in health care to make themselves richer. Who do you want making decisions about your health care, someone with a steady salary and benefits, or someone who makes more money by treating you less?

  • http://www.facebook.com/profile.php?id=701537216 Krystal Kelley

    We do this at my job now. We do an annual “health risk assessment” for which we must let them prick our finger to do an analysis on our blood for cholesterol and triglycerides, etc. Doing so earns us $250/year to go onto our health credit card to pay for co-pays and things. We also can earn another $250/year by wearing a Virgin HealthMiles (Sir Richard Branson has his hands in everything) pedometer and taking at least 7k steps a day. It’s all optional if we want them to contribute money to our health credit card. Otherwise, we pay the total out-of-pocket amount before our co-pay kicks in. We don’t have to do it. There are other ways to earn HealthMiles besides just taking steps, but we definitely have to be more active if we want to earn the total amount.

    We had a number of people complain and say it was invasive and didn’t like being tracked that way, but again, it’s all optional and they don’t have to participate. Since we have to pay $750 out-of-pocket before the copay kicks-in, I think $500 is a good amount of money to earn towards it. That means I only have to spend $250 of my own money before my 80/20 co-pay kicks in. I see it as a trend to move us more into a preventive health mindset as opposed to the corrective health mindset we’re accustomed too. We too get additional points toward our HealthMiles if we sign a No Smoking Declaration and if we show improvements in our blood work and BMI.

    There is definitely potential for it to become invasive, but I don’t see it as being invasive just yet. I would if they started making things mandatory. Time will tell. Given that I’m making healthy changes in my life because of it, I think it’s a good thing.

  • Ableanne

    The employer I recently worked for required all employees to participate in the “wellness” program, but gave no incentives, only higher insurance premiums for those not reaching their imposed goals within a year. Many of those who could least afford the extra costs were the ones who had the most trouble reaching their goals, i.e., had the least access to healthy food, time for exercise, etc. No time off was given for exercise, no on-site gym, same old chips and sodas in the vending machines, etc. I was one of the lucky ones blessed with good health anyway, but it wasn’t fair to use monitary punishment rather than incentives. It was just a way for the employer to lower their costs.

  • http://twitter.com/BrienneCalmer Brienne Calmer

    My company’s wellness plan pushed a diet with questionable research behind it. Instead of giving us access to a nutritionist or a physician or even a nurse, our appointed “health coach” was a fresh-from-undergrad B.A. in some major that was clearly invented in the last five years. The coaching sessions were entirely optional, but I would have been really angry if I were losing money based on getting or following his advice. Insurance should be working *with* patients and their doctors, not trying to find shortcuts around them.

  • Namepick

    I support national healthcare. Healthcare should not have anything to do with your employer. Management has enough trouble running the business and knows nothing about healthcare. Everyone should be lobbying for national healthcare. Everyone who has looked into national healthcare knows that it works. If we don’t adopt it, the future will be worse than the not so great present.

  • K. Sorensen

    I am not a doctor, but lately I have had a number of tests.
    One year my cholesterol was 178. A couple of years later it was up to 202. I remarked that this was a problem and asked what to do about it. My doctor told me that not only was it not a problem, but that is was really good because it was high due to my “good” cholesterol. If that is the case, then the sum of the cholesterol numbers is not a good indicator of anything.

    In the last 6 months I have intentionally lost weight because I read once that lowering you weight by 10 lbs reduces you chances of getting diabetes by 25%. It is recommended that BMI should be below 25 in order not to be overweight. So I get my weight down to a BMI of about 22 only the read in the NY Times that studies have shown that people with BMI between 25 and 30 have lower mortality rates than people with BMI between 20 and 25 and people with BMI over 30.

    My blood pressure measurements seem to be all over the place. Earlier this year at my physical, the nurse took my B.P. using a machine and the diastolic pressure was 92. My doctor, just a few minutes later, measured my diastolic pressure at 82. This is a significant difference. Recently I have had a diastolic pressure as low as 66.

    My point in all this is that before anyone starts using metrics to determine insurance premiums or state of health, there better be evidence that those metrics are really meaningful.

  • http://www.facebook.com/people/Julian-Penrod/100003232038763 Julian Penrod

    The same characteristic denunciation of things like cigarettes, sugar, fast food. And so many fundamental facts that the New World Order demanded no one think of go unbnoticed.

    Such as, for example, that diseases so often associated with smoking today were limited to the point of being unknown yeqars ago. But, then, maybe they had raw tobacco, tobacco that was rougher or, perhaps that wasn’t “treated”. Dioxin was discovered in the paper used in cigarettes. How reasonable is it to say that the tobacco must be the problem?

    For that matter, what problem? Remember, cigarette smoking is supposed to inhibit appetites. The primary cause of any outbreaks of obesity seems to be forcing people to cut back on smoking! People were trim years ago, and many ate fatty meals! And how many lung cancer cases were heard of in the ’40′s?

    And note something important. The “wellness” emphasis on cutting out sugar, salt, fat and so on carefully ignores the fact that these are part of what are called “confort foods”, foods that calm and can provide a sense fo ease. Add the lie of the “war on ‘terror’”, NWO quislings championing big business doing whatever it wants with employees because, “If you don’t like it, then starve!”; “Castle Doctrine” laws establishing iron clad precedent that someone can kill you, spout out, “Ithoughtmylifewasindanger” and the Nazi “justice” system will congratulate them; cops killing first, for sport, then rigging up “accusations” and you have a constant initiative by the New World Order to wreck the health of the “rank and file”. They condemn certain foods only because they can keep the public from being assassinated.

    In the end, there is choice advice in the matter, simply don’t get sick! NWO programmed parrots will laugh out loud, itslef part of the agenda to keep the people from realizing they can have a say in their future.

  • LJF83802

    My organization has a very good plan. It offers great flexibility, two main pathways to chose from but lots of options in those two paths: paid time off for wellness activities or reimbursement up to a set amount for gym memberships or other programs that have definit wellness benefits. I take advantage of the paid time off because my location has an onsite gym that’s free to use and I am not a huge fan of them anyway, prefering to exercise outdoors or in a more comfortable atmosphere – my living room or garage.

    • Djpal

      Just found out my husband s company is wellness program will be mandatory for everyone to pass 5 thing to stay in the better ins. At the lower cost. Your chol., and trig have to be low, waist line for women 35 inches, blood pressure has to be low, and there was one more I am forgetting. I am very upset with this. I have worked in health care for 36 yrs. 2 yrs go I went on disability for fainting. I also have diabetes. It had been in control til recent. I currently cannot work. If I could I would be exercising! My blood sugars are all over the place. I am ck my sugars every 2 hours with insulin injections 2-8 times a day. I also am dealing with having a breast biopsy checking for breast cancer in 2weeks. I don’t need more stress from some ins. Company telling me what I need to be doing. I already know I need to fight to live. II already worry about that much less healthy. Let them walk one day in my shoes then there ideas might change. You big wig do ins. And let us in medical do the medical.

  • Jena

    I certainly understand many people don’t want their employer to know their personal medical information, but if you were an employer trying to provide insurance coverage for your employees wouldn’t you do the same thing? I don’t want my employer to know this information either, but for me, that is yet another reason why I support a single payer healthcare system. Why do we expect our employers to provide health insurance options when they have absolutely nothing to do with our healthcare? If you don’t want your employer to know about your medical info then you DO have options: don’t jump through their wellness plan hoops and instead just pay the rate you “qualify” for, purchase your own insurance plan that is separate from your employer, or support a single payer healthcare plan and vote accordingly.

  • Me

    “The way to think about these things is that you can’t use a stick, you have to use a carrot,”

    Rubbish. All they do is play semantics here. The “stick” is built in unless you play the game and submit. That’s not really an “incentive,” or at least not a positive incentive. I’m tired of today’s penchant for semantic BS.

    Luckily I am in a union environment and our labor contract forbids the “wellness” program from being used as a stick against us. They call me and call me and call me and I blow them off with zero effect on my premiums. Oh, but my employer tries to change this every time we have to renegotiate our contract. So far no dice.

    On the other hand, I see my doctors regularly. They perform the tests the “wellness” program does and more. The conditions I do have are well controlled by medication and other controls. I do not need my employer & insurer butting in.

  • jb

    I’ve advised all my clients to drop their medical plans and side step the issue in its entirety. Most are waiting for the exchanges to open up and will simply take the fine and provide some additional cash compensation inlieu of the benefit

  • TobySaunders

    There is a good way to do it; if you’re a boss & are negligent of your employees, that’s bad, & if you’re tyrannical, that’s bad, so there is a good way to do it in between. Drawing blood takes it too far, that actually hurts, but taking blood pressure & the like is fine, surely. In closing, the US should have public healthcare; the most successful healthcare on Earth is public.

  • http://www.smedette.wordpress.com Smedette

    I’m an RN and worked at a large hospital and research institution. My health insurance company offered something similar and many of us felt compelled to participate. If I was going to lecture my patients about healthy lifestyles, it seemed only appropriate to set a good example.

    There is an in-house gym and working in such a setting provides access to things that I felt I needed to take advantage of (nutritional counseling, etc).

    Looking over the other comments, perhaps working in healthcare gives one a different perspective on a program like this. I personally loved it, but can also see how others may view it as invasive and/or unethical.

  • Minisculio

    Insurance companies seem to have rather less medical knowledge than doctors, which is what worries me in the matter of incentives. “Wellness” programs that distinguish by a total non-fasting cholesterol count are fantasizing. Mine, for instance, is over 200, though I exercise daily and eat a restricted diet that excludes dairy fats, red meat, eggs, tropical oils and all refined starches (e.g. white flour, white rice, potatoes). But the ratio of HDL to LDL is “splendid,” according to my excellent and attentive doctor of 25 years. It’s the ratio that matters for your arteries, not the total number. We actually need the “good cholesterol”: driving that number down to meet an insurance company’s goal would harm my health. Just one example of what can go wrong with insurance companies overseeing our health instead of physicians. I understand their motives, and as long as we don’t have single-payer coverage their motives will persist. You can’t really fix this system, which no other developed country shares. That’s the tragedy of the well-intentioned Affordable Care Act: it ducked the single-payer solution that has made France, e.g., the country with the best overall health, greatest longevity, lowest infant mortality and finest medical practitioners in the world. (I lived there for a year and discovered another plus: same or next-day medical appointments!)

  • A.F. Kaplan

    Not only our companies imposing this invasion of privacy on their employees, but they are also taking the additional step of imposing these screenings on spouses who are insured by the employee’s health plan as well, even if the spouse being covered IS NOT AN EMPLOYEE. I know, because that is what I have been subjected to by my spouse’s employer, the same employer that rejected me SIX TIMES when I tried to apply jobs there. They wouldn’t even give me an interview.

    Frankly, I resent it! I resent having my privacy intruded upon and having this company treat me like I am their property when I AM NOT EVEN THEIR EMPLOYEE! I am by no means obese, I have never smoked, rarely drink alcohol, and do get cardio exercise on a regular basis, but that is beside the point.

    The point is that we all now find ourselves on a very slippery slope. What will these companies demand next, DNA screenings, microchip implants to monitor our habits 24/7? Where does it end? Is this the end of privacy that has been foretold by such authors as George Orwell and Phillip K. Dick? Is there nothing we can do to stop or at least delineate limits on this kind of intrusion? Will no one stand up for the rights of the individual, or will profit come before people yet again, as we have seen so many times in recent years?

  • RES

    I’m a resident physician in family medicine. I haven’t yet designed my ideal model of an employee wellness program as it relates to ‘health’ insurance premiums and other incentives. But I wanted to share an experience from yesterday:

    Of the 5 patients I saw yesterday afternoon, 3 came to see me because of insurance incentives for establishing with a primary care provider (PCP), before October, when the insurance cycle starts over again, and they’d have to wait another year for the opportunity. They were all young healthy adults ages 20-35. I do support this incentive: one of the strongest correlations to good health outcomes is simply having a PCP. In other words, having someone to call “My doctor,” or “My PCP” (to include all non-physician PCPs, like physician assistants or nurse practitioners).

    One of them, in his early twenties, again the epitome of health, whose close family members were healthy (including no history of heart disease, diabetes, or cancer), brought in a piece of paper from his company saying if had the following things done with his established PCP, he would get an insurance discount for the upcoming fiscal year. They included vital signs like blood pressure, height and weight (and therefore body mass index, or BMI), all usual cholesterol studies, blood sugar, and maybe a few others.
    - Now, according to the United States Preventive Services Task Force (USPSTF), which is influenced by both evidence-based medicine and politics (including lobbyists, money, politicians, etc.), screening for high blood pressure is a Grade A (meaning, solid, definite, strong) recommendation in all adults ages 18 and older. Fine – great idea on this piece of paper.
    - For cholesterol, the screening recommendation as it applies to this patient, is Grade C, meaning, they ‘make no recommendation,’ and the evidence says that in general, it will neither benefit nor harm your average patient. If he had a strong family history, it’s a Grade B, or ‘maybe,’ recommendation. Otherwise, I’ll start screening him at age 35. That’s not until over ten years from now!
    - For blood sugar, the recommendation is similar for him: it’s a Grade B recommendation to screen for diabetes by testing his blood sugar *if* he had high blood pressure. (His blood pressure is normal.) Because his is normal, the recommendation is Grade I, which means there’s not enough evidence to even weigh in on the matter.

    I asked my administrative staff to call the company while I started my visit with my new patient. (They had the contact person’s name, address, and fax number. I googled her to find her phone number.) She was told these tests were ‘recommended,’ but not required, for him. I presume this is to receive the insurance incentive, but maybe what she meant was, ‘sure, you don’t have to test for these things, but he just won’t get the incentive.’ I finished my visit note with my patient in the room. (Typically I spend several hours after seeing patients just charting notes from the day.) I clearly stated it is not medically indicated to test him for blood sugar or cholesterol. (What if his blood sugar happens to be high after lunch that day, and we end up diagnosing him with diabetes, and give him medicine, and make his sugar too low? This is called hypoglycemia, and can be fatal.) I advised him to call and let me know if he doesn’t get the insurance discount.

    Lastly, I saw him on Friday, September 28th. He won’t know for who knows how long if he gets the discount. I’m happy to try to work with his insurance company. Maybe it’s not worth it for me to spend that much time away from my other patients, and I’ll cave and just do the blood tests. But by then, it’s a new fiscal year. And he’ll have to wait another 12 months to get this discount. All because I was stubborn and tried to make a point.

    • swrish

      I would think that as “new patients” that these individuals would have been told to fast so that the blood work would be legitimate. I know that as a patient myself I am told this when getting my annual physical. Now I can see that you may not get a base line EKG or chest film on a young healthy individual but I would establish baseline comprehensive labs on a new patient.

      • RES

        I appreciate your thoughts. I stand by my clinical judgement and the evidence. Labs are only numbers, the random collection of electrolytes, blood proteins, and other elements that happen to be collected in a peripheral sample of blood at one point in time. I only order a test (blood test, EKG, chest radiograph, etc.) when I have a question I’m looking for an answer to, and there is a clinical indication to do something with that answer. Meaning: I only order something if it’s going to change what we do, with medications, procedures, etc. For two of these three patients, the risk of checking baseline labs, getting an abnormal number, and doing something about it, with the potential for negative side effects (some of which are quite serious), is greater than/more likely than the benefits of actually detecting a problem that requires medical management.

        I suppose it’s like servicing my car: I take it in regularly for check-ups every 4,000-ish miles. Every 30,000 and 90,000 miles she gets minor and major overhauls. But I wouldn’t get a 30,000-mile check-up every 4,000 miles. And I wouldn’t get new breaks in a car that breaks just fine, just because eventually all breaks wear down, and some at faster rates than others, depending on how they’re driven. Also, every time I take the car in to be serviced, or get the breaks fixed, there’s always the chance that it’ll come back with a new problem. (Especially with some car dealership service shops…)

        Does that make sense?

        • Julie Oliver

          I’m a cardiac nurse and I applaud your decision as a physician not to test, however it may cause red tape problems for the employee. However it is the physicians responsibility to provide for the safety of the patient and having random labs drawn could have not only warranted/required action. (required because abnormal labs must be treated regardless due to legal liability bulshit that puts the Dr. At risk for lawsuits) Also I would love for my Dr. to have my back and give me an opportunity to eat healthy for and fast before the tests. This would have been a great oportunity to educate the patient about health eating habits in order to have good results for the next employee wellness screening. My employer has started this and it feels like we are being attacked and to have a doctor looking out for you is great, and I would be very receptive to his advice on getting the best numbers for cholesterol and glucose.

    • addie cass

      You’re a family doctor and you only see 5 patients in an afternoon???? Wow, you need more of these people forced to come see you!

      • RES

        I’m a resident physician, I only spent a half-day in clinic that day, and three of these patients were new patient visits. Please be empathetic toward physicians-in-training as we work toward the 15-minute visit. And please work with me as I work to change the 15-minute visit back to a 20-45 minute visit, as patients deserve better, and providers can’t do most patients justice in a 15-minute visit for a list of 7 issues. Thank you.

  • alizzila

    And of course, there are millions of angry school moms across the country, because school lunches are healthy this year.

    How ridiculous does this country have to get before we realize destroying your body isn’t “freedom.” Poisoning yourself with cigarettes and too much sugar doesn’t free you from anything.

  • Ben Fort

    I’m thankful for my company’s wellness program. We had incentive to get our cholesterol tested, and I learned that mine was too high. I’ve been able to change my dietary habits and keep this from becoming an issue down the road.

    I’m 26, and I wouldn’t have even thought about cholesterol for a long time. The wellness incentive approach is a long-term vision. If young employees like me have incentive to live healthy, then we hopefully won’t have preventable illnesses down the road. Yes, the company is looking at the bottom line and trying to reduce costs and group premiums, but I appreciate that it keeps me accountable.

  • bob marley

    What if your employer is Frito-Lay, or Taco-Bell? Isn’t that a comflict of interest or just plain old hypocracy?

  • Swirish

    I work at a major hospital in a metropolitan area. If you are not convinced about the drain smoking and obesity have on the economy and healthcare dollars then just come and work one day in my shoes. I would have to guess that 80% of chronic illnesses are self inflicted by those 2 factors alone, smoking and obesity.

    All you have to do is look around at the airport, mall, or even a smaller sampling of society, the grocery store to see that a huge portion of Americans are well…huge. And they are passing on the bad habits to their children (note NPR’s story on childhood obesity) Nutritional counselling and physical education need to be part of school curriculum but it needs to start at home too. If children see mommy and daddy eating junk food and fast food every day they will do that also.

    Yes America is a free country, but unfortunately healthcare is not free. It is way past time to charge people who are morbidly obese and those who smoke more than someone who works hard at staying healthy. If a carrot does not work then by all means go to the stick. My employer has been doing waist measurements and BMI for years. They have given non-smokers big discounts for years too. I understand that changing bad behaviors is not an easy thing. I tell my patients to literally take baby-steps, start a walking program that you know you can achieve, set your goal to start walking 5-10 minutes a day for 2 weeks. When you have done that then increase your time 5 minutes every 2 weeks until you have achieved at least 30 minutes of cardio activity a day. If you happen to hate walking then choose something that you do not hate, you do not have to love it, just not hate it. If you hate it then it will more than likely take more discipline than you have to continue in the program.
    As someone who loves her sweets too but works out and eats in moderation, I want to see incentives. I do everything I can to stay healthy and avoid being the patient and it is high time that the rest of America does too.

    • fporch

      Agreed! I too have worked most of my career in hospitals. Patients who are obese and diabetic and do not improve and manage these conditions are called “non-compliant patients.” While being accountable with higher costs may motivate, I weekly met indigent Medicaid and Medicare patients who never pay a bill and who enjoy the attention and service they receive when in the hospital (“three hots and a cot” is the way one such patient described it to me). They have no reason to manage their health and will continue to use the ER for their primary care and let their chronic conditions run uncontrolled, resulting in expensive emergent inpatient care. Changing this behavior is going to require a change about how we view healthcare – is a right or a privilege? The ethical implications of such a discussion (and eve change in the law) is staggering. Are we ready for such a discussion?

    • VictoriaH

      I agree. I used to smoke and drink and generally led an unhealthy lifestyle – overweight, but by about 10 pounds, so nothing crazy but still a problem. Cigarettes cost money, snack foods, processed foods, to-go foods all cost more money than a practical shopping list. The drinking was unhealthy for me and was catching up, I stopped. The smoking was affecting my breathing and energy and was getting increasingly more expensive, I stopped. I have to feed a growing boy in addition to myself (and in addition to all of the other expenses of raising a child), so making well planned nutritional decisions is essential. No more donuts and ice cream. Changing all of the behaviors I did, one at a time, was not at all easy. The drive behind some of it was definitely money. On a fixed income, I cannot afford the health costs of getting sick, and I cannot afford the products that are potentially making me sick. Not without giving up a lot of other things in order to spend the money on those products. I gave up buying milk (and other things) for the house too many times to make sure I had enough money for cigarettes. Not cool. I couldn’t afford to smoke, and drink, and eat crap.So I stopped. I can’t pay for a gym right now, so I walk 3 miles during my lunch break in the afternoon. If people want to live an unhealthy lifestyle and say that it’s their own business and we can mind ours, then they should pay for their lifestyle. I do not want to pay the cost of a lifestyle choice. Just as you are, I am working really hard not to be a patient.

    • Joseph

      I have to call you out on your misuse of the word “literally,” but I agree with your point.

      • http://twitter.com/BrienneCalmer Brienne Calmer

        I have to call you out on your calling out. Sorry.

        • king

          No way, use the damn word correctly!

          • http://twitter.com/BrienneCalmer Brienne Calmer

            Not until the self-appointed grammar police can punctuate. *eyes comma splice meaningfully*

          • Joseph

            I love that comic, but it’s not about grammar: it’s about word definition.

    • jb

      As someone who advises employers on the issue my recommendation has been to drop health benefits and simply offer increased compensation. The area is a minefield that ideally should be avoided. Most companies are waiting for exchanges to implement, they will eat the associated fine

      • http://www.facebook.com/profile.php?id=701537216 Krystal Kelley

        Interesting suggestion. I like the potential for making people responsible for their own health care. I guess it’s a good way to make us more financially responsible for our healthy and unhealthy choices.

        • http://twitter.com/BrienneCalmer Brienne Calmer

          Yes, it will work great, until the extra compensation turns out to be not enough to cover your kid’s chemo. Sick kids tend not to appreciate being told to take personal responsibility.

  • Lee

    I wish I could participate in such a program! This person is lucky! They have a bi-weekly chance at $25 (potentially $650 per year?!). I’d happily submit to those basic screenings, if they were free. I might get $25 + I’d know my health status at no cost. If I were embarrassed about my health status, but wanted a chance at the $25, then I would get in shape and then take the tests. Simple. Am I missing something?

  • Jim Booker

    You’ve got to wonder how did this become a legal activity? America needs to be rid of insurance companies. We need socialized medicine in this country.

    • B Jones

      lol These laws have nothing to do with corporate greed and a lack of socialized medicine. If you think this is intrusive, look Great Britain’s socialized health care program. They consider overweight children to be child abuse and can compel parents to place them into government monitored weight loss programs at the risk of loosing their parental rights. This employer interference is mostly a result of the Affordable Healthcare Act. Remember that great piece of legislation that was going to fix everything? Well…… here it is.

    • George

      You’re bothered by a wellness company having your medical data (not your employer) but you’re ok with the government having it? No thanks.

  • barbara necker

    Big Brother comin’ atcha from all directions

    • KevinKJT

      Barbara, I call “Big Brother” a peer tyranny. Though it is more and more obvious that on THIS farm, some animals are more equal than others.

  • KevinKJT

    I am amazed by these comments. We are a debt society, when you take on debt, you give another power over your liberty. Get out of debt, get rid of “stuff”. Stuff owns YOU, you don’t own stuff. BE FREE in your mind and you’ll be invulnerable to stress as you move about your life roles in confidence. It took me my whole life to figure out what was wrong with my life. Sadly, in America, there is nothing that can’t be taken away from you, so even owning IS stress -from income tax to property tax. A state conscript on the one hand and paying rents to your lords on the other. Health care? Allowed to artificially grow on a socialized cost scale. It is designed to bankrupt the elderly and redistribute their wealth.

  • KevinKJT

    We are increasingly the victims of a peer tyranny asserting “money makes
    right” might. Freedom and liberty have been twisted into dirty words
    for public consumption and dismissed as the radical ideals of retro
    American throw backs. The foundations are being laid for abuse on a colossal scale. We are being taught that independent self reliance and responsibility are no longer to be achieved and can’t be expected. You MUST be forced to do the “right things”, you CAN’T make these decisions alone.

  • riverwaif

    It is understandable that employers want to lower health care costs since they carry a great share of those, and one way is to help employees be healthier. But it is a slippery slope when employers start using that health insurance lever to intrude more and more into personal life choices and habits of employees…when do we stop being “employees” and become “property” to be dictated to and monitored, whether officially onte the “clock” or not? This is another problem with out country’s reliance on employers as the main vehicle and financer of health care benefits. Now, I know…arguably (and some maintain already) government could/would insert intself into our personal lives if we had a single payer system. But at least we still do have courts and constitutions which give protections against undue and unwarranted governmental instrusions…most employees have no such protections against employer actions, no way to assure those actions are vetted before being implemented or that they are fairly applied, based on sound medical evidence or accomodate the great diversity of our population.

  • Anne D.

    I agree with the chronic stress comment. I’m in a office that is micromanaged where you are tied to your chair all day-employers ought to think about the work environment that is beyond staff’s control. By the way, if your health plan if self-funded or you submit receipts for an HSA-chances are your medical records are not very private in HR. I went thru a similar situation as the guy w/ FMLA and didn’t have a union, I ended up getting fired.

  • angry at the players

    The wellness plans….the high risk = higher premium argument, the higher deductible, same premium, fewer services for more money, forcing employers to invade the privacy of its workers to satisfy a MANDATORY law for individuals to be insured, with the intent to help carry the burden of the cost of health care in the commonwealth and soon to be the country?…I would like to know if the CEO’s of insurance companies have been willing to take less salary?….And what about the REAL costs of health care in this country? I am not a smart man by any means….but it really seems that Health Care Delivery in the US is a modern day wild west that some of the brightest, greediest and most cynical have created a system that we are told and now mandated to have, the rules are set in place by the smartest and the richest and we, the “regular” folks are told that OUR lack of health is NOW the major cause of health care in this country, what about the TECHNOLOGY, or the MEDICAL SCHOOLS, or the salaries for the INSURANCE COMPANY EXECUTIVES, HOSPITAL renovations( I have never seen a hospital NOT under construction in 20 yrs in health care). Someone who spoke on a weekend program put it well…have you ever noticed all the beautiful entryways to our hospitals???? glass elevators, au bon pain…I would like some truth about the real costs of health care in America….anyone??? I think that the lobbyists and the corporations, and the supreme court are only creating the next bubble in this country…..health care….and when that pops….like real estate….then what?…anyone….

  • Infeaux

    I agree with Kathleen L.’s point. All the talk of “wellness” is nice, but one of the biggest dangers to personal health is chronic stress, such as that which can arise in an understaffed, over-worked, underpaid and insecure employment situation.

    I have other misgivings. Despite the various privacy laws which are supposed to protect employees, I still think it’s highly inappropriate for one’s employer to have any access to one’s medical information.

    I work at a local Ivy League university, and had a medical issue a couple of years ago. I used my own banked sick time. But when I came back, Human Resources handed me a sheaf of forms to fill out, asking all kinds of personal information. They didn’t ask what my diagnosis was, but they did want other information such as the names and areas of speciality of the doctors I saw (which makes it pretty easy to figure out). Their excuse was that they had to ask this as part of the Family Medical Leave Act.

    My G.P. doctor was apalled, too, and wrote me a note saying I was fit to return to work without going into details. Even so, ultimately I had to go to my Union Rep to get HR to back off. But most people don’t have a union to advocate for their rights. They claim that such information is kept in a separate, confidential file, but I just don’t find their assurances convincing. Why should there be a file full of my personal medical data kept in the Human Resources office?

    One other problem with “wellness” benchmarks used by insurers or employers is the BMI. BMI was developed as an epidemiological tool, not to assess individual health. And yet… my body fat is around 15 percent, which is good for a male in his late 30′s. I also have good cardiovascular health. But, I have a large frame and do a lot of weight-lifting so my BMI is around 28 (overweight) despite my body fat being in the normal range. It’s infuriating to think that I, and others like me, can be penalized for actually being in above average physical condition.

    • Infeaux

      I should say, I’m actually in favor of wellness intiatives overall, and I agree that making them incentivizing rather than penalizing is a good idea. But we do need to be circumspect about privacy and be sure to rely only on scientifically valid measurements of “wellness”.

      Also, a cynical part of me wonders if, under such programs, healthy people won’t be charged less, but instead the new “normal” rate will continue to increase as it always has, and insurers will have an excuse to charge even more of people who don’t pass muster.

    • azima

      If your G.P. had complied with the school’s request, I think that would have been a HIPAA violation. Of course that didn’t stop HR from asking, and that, to me, is typical HR Dept. behavior.

    • jane

      YES– that’s exactly what I’m talking about!
      If you do exercises that build some muscle (and any wise exercise regime for a healthy adult should include that) then you risk looking drastic on the simplified BMI scale, especially if you do not have a slender frame. The numbers lie. They don’t say anything true about your health. Someone with a fast metabolism and slight frame who is very sedentary, spends time waiting to exit a busy parking garage every week, and eats a lousy diet, will pass the BMI with flying colours, but is probably still at high risk of cancer, osteoporosis and heart disease.
      And, if they DO get cancer, being a sedentary low BMI actually means they are much less likely to survive the chemo.

      There are much more accurate weighs to measure for body fat percentage and health risks, but just designating a healthy weight per height
      is much easier and more cost effective, from the health industry’s point of view.
      Insurance companies don’t want to pay for the time it would take your G.P. to do the measurements.

      • Guest

        The same is true for total cholesterol. Doctors go by the total instead of the ratio of HDL to LDL . I may have a high total, but my ratio is good and so are my triglycerides. Next, employers will be using that total against us. Measurements can be interpreted in more than one way to suit the situation.

  • Evan Pankey

    I think that these wellness programs will be some of the best drivers for improved population health. Experimenting and iteratively improving programs at the Employee level is infinitely easier than public health “soda bans” or “shaming McDonalds”, etc. Incentivize employees to be healthy and they will figure it out.

    The challenge is for the wellness programs to use the “best evidence” which would involve using well demonstrated biomarkers and evolving them as the evidence changes.

    This is the new major front for what we now call “public health”….only it’s not public.

    The magic is that companies can use their culture to drive lower health care cost through prevention…the best kind of medicine.

    Doctors and Public health organizations don’t have cultural pull.
    This is the key….in my opinion.

  • http://pulse.yahoo.com/_6JNEJZPTE2XFGFEH2FL5C7GZKU Kathleen L

    Wouldn’t it be wonderful if employers were held responsible for reducing stressful work practices that lead to exhausted workers staggering home carrying loads of stress, which in turn leads to a lack of will and time to exercise, poor eating habits, abuse of alcohol, etc.?

    • Teresa

      Excellent point. Stressful and unfair labor conditions are but one of many contemporary societal ills that lead to poor life style choices. Our culture is rife with other variables that encourage poor choices; declining education standards, lack of available nutritious food in urban settings, unemployment, lack of access to health care, poverty, single parent families, and violence. An even more worrisome threat to our collective health are politically divisive notions such as 47% of our populous are free loaders or that corporations are people too *my friend.

      • Vider

        Has anyone actually seen the whole video? Many things can be put together and taken out of context to say what ever they want. I think we should stop crying about how hard things are because it comes down to our choices, I work 11 to 13 hours a day have 2 kids and manage to work out and eat decently plus I’m type 1 diabetic which brings a lot of other things to worry about ad well. As I said it all comes down to choic you make the difficult one or take the easy way.

    • Lerkero

      One problem with “stressful work practices” is that complaints will differ between employees. Some employees can complain of stress even if they are doing minimal work. Stress is part psychological and part physiological.

      On the other hand, a wellness plan is designed for quantitative testing of the body. Neither the employer or employee will be able to take advantage of the situation because the quantitative results of the tests speak for themselves.

      • Jane

        I disagree that ALL the test results speak for themselves, Lerk…
        I am, by scale measurement, considerably overweight with an unhealthy BMI.
        But while some of it is fat (my body type is naturally chubby, and has never budged) a good chunk of that weight is muscle. I do five to six hours of aerobic exercise a week, plus light weight resistance, and plenty of walking and swimming. I do not drink or smoke, do not eat junk food. No potato chips, no soda, no white bread, no french fries, EVER, for years. I am careful to manage stress and get enough sleep, I eat my cruciferous vegetables and avoid red meat,
        wear sunblock, and floss everyday.
        I put in WAY more effort than many of my thinner friends.
        My cholesterol, blood sugar and blood pressure are all STELLAR!

        Still, based on weight and waist measurements alone,
        my health insurance could penalize me if they wanted to save money.
        That’s not fair, and it’s certainly not objective.

        • Lerkero

          Quantitative health measurements would not be based on weight alone. You have already addressed the main concern by saying “My cholesterol, blood sugar and blood pressure are all STELLAR!” If you are overweight yet have no internal health problems then it is okay.

          I would argue with your use of the phase “considerably overweight”. I find it hard to believe that you are putting that much effort into your health and are still “considerably overweight”. Outside of some kind of thyroid or genetic problem, that just wouldn’t hold up for a normal person.

          • jane

            Right– you say it will all be taken into account.
            But there is absolutely no reason why a health insurance provider would stick with that, when they could save money by doing otherwise.
            THAT is the potential outcome that worries me.
            When the goal is profitability, there’s no real reason to stick to a less profitable but more accurate way of measuring ACTUAL body fat ratio and realistic health risk.

            And perhaps my “considerably overweight” is not what you’re imagining— though, either way, you come across as condescending. As I said, I mean “considerably overweight” according to BMI charts, not reality. My primary care physician repeatedly reassures me that I am healthy and should not be concerned with dieting.
            If you saw me, I would look just slightly chubby, not morbidly obese. Because that’s all I am –slightly chubby.
            But that chubbiness is not going anywhere. While training for my last fundraiser run, I walked/ran five miles a day for months. I slimmed only slightly, and only in the legs.

            I have a large frame, plenty of muscle, and the modest but unshakeable bit of fat that virtually everyone in my gene pool has. The only two people in my family who ever got “thin” did so via eating disorders. After recovering, of course, both found they had demolished their metabolisms. Now, they are the heaviest people in the family, rather than the thinnest, because their bodies desperately cling on to every last calorie they consume! =( This is the norm for someone with genes that want to conserve calories to begin with. Yo-yo dieting isn’t always a sign of “moral inferiority”…it’s often a desperate struggle doomed to failure, and less healthy than being a slightly-non-ideal weight that exercises sufficiently, and eats modestly and well.

            Also, “wouldn’t hold up for a normal person”…you’re probably male, I’ll say that up front. Or, if female, you’re quite young and have never had children.
            Suffice it to say, I will never look like your “normal person”
            because that person does not exist. You can’t imagine how hard it is for some people to lose excess weight and *keep* it off.
            The best thing is to not gain it, and to not try to lose anything quickly to begin with. Every highly-calorie-restrictive round of dieting slows the metabolism, often permanently.

            Instead, I am healthy, happy, confident, attractive,
            and not at all concerned with the crude, simplififed versions of BMI that do not adjust for different frames, and do not have a
            muscle weight variable.

          • Lerkero

            I am a male in my early twenties. I was previously obese but in my mid-teen years I decided to lose weight. It was 90-100 pounds that I lost.

            My body shape will never be normal because the elasticity of my skin is shoddy on many parts of my body. I do aerobic exercise 4-5 mornings a week and anaerobic exercise 4-5 nights a week. My BMI is usually on the high end of normal for somebody my weight, but I assume all of my other biological parameters are okay. However, no matter how hard I try, my stomach will never be flat like someone with a similar build who had never been obese.

            In no way was I intending to be condescending because I am not a health expert at all. I was just trying to imply that from the positive description you were giving of yourself there is no way for an employer to deny that you are healthy. It is well known that BMI does not apply in all situations, and that is why I doubt employers would solely rely on BMI. They would supplement that data with waist, cholesterol, and heart rate measurements as was described in the letter posted in this article.

            I do thank you for clarifying your original comment.

        • talllulah

          my husband was an Olympic cyclist, National Champion in two events for several years. His BMI was above average (many athletes have BMI above average due to muscle mass) and his cholesterol was and is REALLY high ( in his case a hereditary condition. His arterial scans were great). He’s in great shape, but would fail these ‘objective tests’.

    • http://twitter.com/BrienneCalmer Brienne Calmer

      How about those exactly-30-minute lunches that leave no time to prepare healthy food on the job? Or those jobs that encourage people not to eat, drink, or pee during the day at all?

    • Guest

      What about the personal responsibility to bring your lunch to work? I work at a place that has 30 minute lunches and I bring my lunch to work in a pre-chilled lunch bag. There are ways to eat healthy on short lunch. It would be great if companies provided seminars on how to reduce stress during and after work hours too. I know that’s ideal and most companies won’t do that. When it makes sense to do it, I think the “high performers” at the companies have to start kicking up dust about the high stress, start asking for those perks or just plain leave the company and provide feedback in the exit interview to get those stress laden companies to change their awful ways.