Workplace wellness regulations: First, do no harm

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Right now the Department of Labor, in conjunction with HHS and the IRS, is considering regulations governing workplace wellness programs under the Affordable Care Act, which includes provisions designed to stimulate such efforts.  Encouraging businesses to set up workplace wellness programs can help move us toward a healthier citizenry and reduce healthcare costs, but as now written, the rules don’t reflect best practices and could result in significant unintended consequences by penalizing unhealthy workers and those with the least access to nutritious food and healthy physical activity.

So what sort of effective workplace wellness program should the new federal rules encourage? When The Greenlining Institute and Prevention Institute reviewed current research and interviewed small business owners, we found that the most effective workplace wellness programs included several  key components.

One important part is collaboration between workers and management in the design of programs. Rather than imposing workplace wellness as a top-down directive, managers should work with employees, who should have a voice in selecting program elements. This will also help ensure that programs are culturally relevant to the firm’s workforce.

The best programs also make use of comprehensive, multifaceted strategies that focus on both individuals and their environment. These can include a variety of elements, including counseling and information, assessments to help employees identify and address key risk factors, and establishment of policies and practices to support a healthy workplace, such as encouraging the use of stairs and establishing healthy food guidelines for cafeterias and vending machines. Sadly, while 90 percent of workplaces report some sort of wellness activity, only seven percent provide the multiple elements necessary for a truly effective approach.

We also have a pretty good idea of what doesn’t work, and heading the list are strategies that tie individual employees’ share of health insurance premiums to health-related behaviors and/or meeting health benchmarks. Increasing or decreasing an employee’s contribution to health premiums based on blood pressure measurements or health behaviors such as smoking means that, according to the Washington Post, “American families with average health benefits could have $6,688 a year riding on blood tests and weigh-ins.”
 
While superficially attractive, this approach is problematic for a number of reasons. First, the evidence suggests it doesn’t  work. Punitive measures haven’t been linked to improved health outcomes and may instill resentment among employees. Second, raising premiums based on health benchmarks will shift health care costs to the least healthy workers. This can have the perverse effect of making health care (including wellness and preventive care) less available to those who need it most. In this way, the rules run counter to the spirit and intent of the Affordable Care Act. And finally, such punitive measures will have the most damaging effects on people of color and low-income workers. These workers are most likely to suffer from chronic conditions and to lack resources to improve their health, virtually guaranteeing that they will be disproportionately penalized.

The pending regulations present a tremendous opportunity to move U.S. health policy in a positive direction — if they lead to the creation of comprehensive programs that really work rather than punitive efforts that set us back. Advocates and others who want to weigh in on this important issue have until Jan. 25 to get their comments in, and we strongly encourage them to do so.

Saporta is health policy director at The Greenlining Institute. Cantor is program manager at the Prevention Institute.

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