An Unhealthy Debate Around Wellness

SidorovThere’s an adage that, except for their tax revenue, American business is something the left loves to hate. And who can blame them, what with executive compensation, minimum wage and overseas job outsourcing powering the left wing’s ascent faster than corporate gunships in a greedy search of Avatar movie unobtainium? Being the principal source of health insurance for their employees hasn’t helped the liberals’ view of American business either, not only because it gets in the way of their cherished public option, but because their constituents’ benefits have been squeezed by the specter of an unholy alliance with managed care over caps, deductibles, co-insurance and co-pays.

So when it came out that the Senate’s proposed health reform legislation would increase employers’ and insurers’ ability to incentivize employees’ participation in worksite-based health promotion activities, progressives zeroed on it  like Air Force One on a Massachusetts political rescue mission. Believing that any use of any financial rewards is just plain wrong, opponents have cast incentives as penalties on those who don’t participate in workplace wellness programs – a sneaky, indirect and backdoor way of making the sicker pay more for their health insurance.

Egads. Follow this line of logic far enough and you’ll ultimately conclude employers have no involvement in health care.  But wait a minute…maybe that’s the intent of my liberal colleagues. But I don’t think their reasoning holds up under the light of real world experience or what’s been published in the peer-reviewed scientific literature.

First off, federal law already allows employers and insurers to provide incentives up to 20 percent of the premium. Current legislation proposes to increase that to 30 percent. The point here is that argument over the use of premium differentials was settled years ago; what is different is the amount, which in the Senate bill, is intended to give employers greater flexibility in the design of their incentives.

Second, worksite wellness programs are almost always designed with the employees’ input. Early attempts to concoct programs ”from the top down” quickly established that they always fail, and fail miserably, no matter how much money is on the table. Premium incentives alone can be a necessary ingredient. But by themselves, they are not sufficient. Employers always have and always will seek their employees’ counsel over the many components of a successful program, including incentive levels.

Third, monetary incentives, like all employee incentives, are not the purpose but are really part of the solution to achieving outcomes in the fight against tobacco abuse, obesity, poor nutrition, lack of exercise and stress in the workplace. Communications campaigns, health risk assessments, building facility redesign, cafeteria menu selection, other aspects of the insurance benefit package, visible leadership support/participation and providing employee-free time are only some of the other ingredients that need to be assembled for this to work. The idea that this is only about the employees’ money is a myth. It’s about tackling issues that are driving up local health care costs and crippling our economy.

Fourth: There is considerable research that has shown that line employees welcome financial incentives. Unsaddled by an oppositional union leadership disorder to all things having to do with business, the rank and file support in favor of this is probably based on a perspective lost on their union leadership: money talks, especially when it’s walking into your pockets.

Fifth: Are there any reports, outside of some anecdotes framed by an extremist bias, of measurable harm to patients subjected to a premium differential? Other than conjecture or theory, there are none. What is true is that SOP in business is to study the outcomes of worksite wellness initiatives and PLEXEVAD (plan, execute, evaluate and adjust) the components of the program against the outcomes achieved. There is no scientific literature that has shown that patients’ access to care is hurt by these employer programs.

Sixth: Worksite wellness programs are designed by the same minds and energy that has propelled the United States to unparalleled economic achievements. While this record has not been free of any serious mishaps, the fact is that the genius of private enterprise is far more likely to develop successful health promotion initiatives than anything in the public sector. Case in point: who has been better at getting H1N1 vaccinations to persons at risk: Goldman Sachs or the New York City Health Department?

Last, I’m not hearing any suggestions about alternative approaches to health promotion from my colleagues, other than “no.” It is obvious that to succeed in battling the scourge of chronic illness, we’re going to need the unions and health care advocacy groups, as well as constructive participation of government, public health, academia, the health care system and the insurer community. The reason why benefits are being squeezed is because health care costs are exploding thanks to the very health care problems that worksite wellness programs address. Hobbling the employers is consistent with ultra-liberal disdain, but fails to capitalize on the fact that we’re all in this together. Business bashing is fine, but it’s time to harness this energy more effectively. As Benjamin Franklin famously observed, on this health care issue, we hang together or we’ll hang alone.

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Louis Pik Pik Noir
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Margalit Gur-Arie
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Margalit Gur-Arie

Nate, the “straw man” comes from the unfortunate association of health care and employment.
If insurers had nothing to do with employment and insurers had to accept all comers and couldn’t adjust premiums based on risk and they augmented their services to include clinically competent folks to run wellness programs, I wouldn’t have a problem with some form of voluntary risk assessment.
The reason for the last caveat is that some folks would object to being forced to accept medical care.
Of course you can always entice insureds with gifts and freebies. However premiums should have nothing to do with it.

Peter
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Peter

“Second for an insurance plan to manage people’s health,…
Isn’t that between a doctor and their patient? Ask people if they want insurance companies managing their health and you’ll get a resounding NO. Only insurance companies want to micromanage the risks and split people into smaller and smaller risk groups to maximize their premiums. Fat people on the right, less fat people in the middle and slim people on the left. Sorry Nate, but the solution is not more onerous insurance. I’d rather tax risky behavior and use the funds to pay for healthcare.

Nate
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Nate

No one advocated for HRAs as condition of being hired, that was never suggested. As a condition of joining the insurance plan makes perfect sense. For starters everyone should know their health. Second for an insurance plan to manage people’s health, something they are expected to do for some reason, don’t they first need to know what they are working with. Waiting till someone has a stroke to manage blood pressure seems counter productive. How can you argue for forcing insurance companies to insure risk without knowing what that risk is or allowing them to manage it? Where did this… Read more »

FG
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FG

I’ve read Pollan’s book as have most at our company, watched the movies, understand the cultural issues, tax stuff , government support etc. Prevention is a comprehensive program that looks at the person, their environment, and other factors in order to change behavior.
As for the 75% number its from the Partnership to Fight Chronic Disease, Ken Thorpes group and I beieve they reference a CDC report.

Vikram C
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Vikram C

There are two things which are getting mixed up here. 1. Providing basic incentive to promote healthy behavior 2. Investing in wellness program over and above the basic incentives in assumption it will make strong dent into claims volume an dollars in medium timeframe, say 1 to 3 years. When I say Insurance companies offering wellness program, by that I mean providing ‘substantial’ incentives to employeed in form of lower premiums. This is referring to my second point of expecting strong reduction in claims. I would like to question how much you want to invest in it in form of… Read more »

Margalit Gur-Arie
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Margalit Gur-Arie

First of all, is there any data behind the assertion that “75% of health care cost growth can be attributed to an increase in the incidence of chronic diseases”? I understand that chronic disease is prevalent and expensive, but is there a 75% increase? Increase from what baseline? Second, what is the economic reasoning for subsidizing corn? Is there a national benefit to such subsidy? In the day and age of “what’s in it for me”, may I ask the same thing about corn and the other agricultural subsidies? If we have to manage our budget and cut wherever possible,… Read more »

The Mind Relaxer
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Hmm, maybe we should hang ourselves? just joking, very nice and informative information. Keep it up!

Peter
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Peter

“When 75% of health care cost growth can be attributed to an increase in the incidence of chronic diseases, many of which are preventable, the solution is pretty clear.” Apparently not clear to you Fred. History, culture and politics subsidizes high fat, high carb, high sugar diets and marketing junk food to children through a rigged corporate food system that’s about cheap quantity not quality. Get the video, “Food Inc.” and “King Corn” and you’ll see how “clear” it is. If you’re into reading I’d also suggest Micheal Pollan’s book, “The Omnivore’s Dilemma” Nate, employers already discriminate because “they are… Read more »

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Nate
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Nate

“And Nate, man, you overstep the bounds of what you know. People do not need small financial incentives in the form of health insurance contributions or cash rewards to stay healthy.” Interesting jd, speaking of bounds, how exactly do you know what I know? Like Vikram’s statement you really have no basis at all to make that comment. As to your conclusion how many patients did you speak to today trying to get them to change their habits? Being a monday it was slower then most days but I spoke to three. In an average week I usually speak to… Read more »

jd
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jd

Vikram C: “By the way, do insurance companies implement wellness program for their employees? I think not.” Vikram, a couple minutes’ Googling would have answered this question for you. They do. Not all of them, but plenty do and I think all the big ones. Note that not all wellness programs are created alike. They don’t all have financial incentives built into the premium contribution. I may have missed it in the discussion, but we really need to stop thinking about being healthy as primarily about reducing medical costs. More than 50% of the savings to companies comes from improvements… Read more »

Fred Goldstein
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Fred Goldstein

When 75% of health care cost growth can be attributed to an increase in the incidence of chronic diseases, many of which are preventable, the solution is pretty clear. And while there are a large humber of groups against premium differentials, to get a sense for how strong public support is for prevention/wellness programs go to http://www.moregoodyears.com and watch the video of Fox and Friends featuring Frank Luntz and his “dial” results. There are clear reasons why employers are interested in these programs, and the means to get engagement such as premium differentials; other proposed solutions have not worked. Additionally,… Read more »

Vikram C
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Vikram C

I am in agreement with Peter. We don’t want company’s benefit administrators in charge of well care. They are too squeezed to implement the program where you have a nanny overseeing employees. Cost reduction will be only target of Benefit Administrators and as wellness takes so many years to fructify it is likely that program will degenerate into meaningless experiment. Gift cards and example set up by executives will be more than sufficient. By the way, do insurance companies implement wellness program for their employees? I think not. Human body is strange machine. The output is just not discernible corresponding… Read more »