It’s open enrollment season at workplaces around the country. Employees and their families are weighing their options for health insurance. While premiums for employer-based policies have risen slower than for open market policies, employees are shouldering a larger portion of the cost, and looking for ways to decrease health expenses.
One way to do this is through participation in a workplace wellness program (WWP). WWPs are employer-sponsored health programs that can include activities such as annual health screenings, health education classes, or even on-site clinics.
WWPs can also be popular with employees, with 80 percent of those with insurance through an employer in support of employers offering them. But when WWPs are seen as invading privacy or an attempt by employers to increase employee share of health coverage costs, employee support fades, with only 37 percent remaining in support when employers charge higher premiums for non-participants and 22 percent when employees are required to pay higher premiums if they are unable to meet certain health goals.
Health professionals and employees should join together to resist implementation of WWPs that are coercive or intrusive to privacy.
This is the first open enrollment period since a federal judge ruled against the U.S. Equal Employment Opportunity Commission in regards to WWPs, saying that the high penalties allowed in the agency’s rules were not consistent with the claim that such programs are voluntary. This decision supports the characterization of some WWPs as coercive. Employees shouldn’t have to decide between spending thousands extra on health insurance for their families or literally giving their blood to their employers.
The Affordable Care Act has brought increased reimbursement for wellness and health promotion, such as treatments for tobacco dependence and obesity, and WWPs have flourished alongside this. So it might be tempting to view WWPs in the same way as health promotion services provided to patients by health professionals. This would be a mistake.
Effective health behavior change programs, like all health services, need to be patient-centered, allowing for individual preferences and motivations regarding the priorities and timing of change. Most WWPs are not structured to operate this way. They are employer-centered, not patient-centered.
And, while some people who did not realize they had high blood pressure or diabetes may be identified in employer screenings, and those would of course represent good individual outcomes, an overall framework that is coercive or does not adequately address privacy concerns will not bring positive benefit to employee health overall.
I do health promotion and wellness work. I also try my best to practice what I preach. Last year I lost over 20 pounds, bringing my BMI into the “normal” from the overweight range for the first time in over 5 years. Yet in my participation in my WWP, I didn’t get the full incentive, because one of my lab values went up above threshold. My own primary care provider has recommended against treating this number medically at this time.
So I won’t be getting the full “incentive” this year. My family healthcare costs approach the “out-of-pocket maximum” every year due to long-term health issues of multiple family members. My effort to decrease my family healthcare costs through the WWP was unsuccessful this year. I won’t be participating next year.
Health behavior change is difficult, and is best supported by collaboration and trust between health and wellness providers and the patient. Many WWPs may not be able to meet this bar. For example, my employer used to allow me to report my tobacco use on the WWP forms. But that is no longer sufficient. Despite having quit tobacco use decades ago, to try for the full incentive, I have to provide a blood sample for testing for cotinine, the chemical that proves to my employer that I am not a tobacco user.
Employees understand that WWPs are setup to decrease costs for employers. A single payer health program would mitigate much of the financial risk assumed by employers providing health insurance benefits for employees. Of course they would still have a financial interest in helping to avoid excess employee absenteeism due to illness.
But they would be freed from the direct expenses related to employee illness. And perhaps fewer WWPs set up in that kind of health system would have the problems with coercion and privacy we see now. Removing some of the financial incentive for companies to seek information on their employees’ health could lead to improved WWPs. In the meantime, we should all work to make them more patient-centered.
Alice Geis is an assistant professor at Rush University College of Nursing and Director of Integrated Health and interim medical director at Trilogy Behavioral Healthcare.