Tag Archive: workplace wellness

Workplace wellness program controversy could have major influence on future of employer-sponsored health coverage

In the United States, the majority of working age adults receives health coverage through employer-sponsored health plans. As the cost of those plans has risen in recent years, employers are looking for ways to hold the line. Dropping those plans and telling employees to buy their own coverage has multiple downsides for large employers. They would lose a major income tax deduction and large employers would face penalties under the Patient Protection and Affordable Care Act for failing to offer coverage to full time employees and their child dependents. Plus they worry doing so would run the risk of making it harder to recruit and retain staff.

Looking for options to shed health benefit costs, some large employers are turning to “workplace wellness” programs that monitor employee health status and enforce health maintenance with rewards and penalties applied to employee premiums and cost sharing.

“Employers are carrying a major burden of healthcare in this country and are trying to do the right thing,” said Stephanie Pronk, a vice president at benefits consultant Aon Hewitt told Reuters in this article on wellness programs. “They need to improve employees’ health so they can lead productive lives at home and at work, but also to control their healthcare costs.” As the Reuters piece reports, critics see wellness programs as a thinly veiled effort to shift health plan costs to employees, pointing to studies that indicate wellness programs don’t produce meaningful reductions in health care utilization. And the Obama administration is taking some large employers to court, alleging they are violating the wellness program rules of the Affordable Care Act that allow employers to offer voluntary programs by mandating all employees participate.

Princeton University health care economist Uwe E. Reinhardt and other critics view wellness programs as the medicalization of the workplace, arguing employers shouldn’t be in the business of monitoring the health of their employees. However as Pronk suggests, since employers are paying the bill when they need medical care, they have a natural stake in employee health. The outcome of this debate could well determine the future of employer-sponsored health coverage in the U.S.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Workplace wellness flash point of large employer frustration with rising medical costs

Frustration among large employers over the continued high and rising cost of providing medical coverage for their workforces nearly five years since the Affordable Care Act’s 2010 enactment is reaching a flash point. The flash point is workplace wellness programs amid questions over their ability to reduce medical utilization costs by improving the health status of their employees. And specifically whether large employers who require biometric testing of employees are running afoul of rules promulgated to implement Patient Protection and Affordable Care Act provisions governing the programs.

The Affordable Care Act sanctions two types of wellness programs employers can offer as part of employer-sponsored health plans. In addition to the traditional participatory wellness programs such as discounts on fitness club memberships, health assessments and seminars, employers can also offer — on a voluntary basis — contingent wellness programs that require participating employees to take part in health improvement plans designed to help them reach health status goals such reducing weight, body mass index (BMI), blood pressure, or cholesterol levels. Employers can provide those achieving their goals economic incentives in the form of reduced health plan premiums.

However, the U.S. Equal Employment Opportunity Commission (EEOC) has sued some large employers, charging they are requiring all employees and not just those participating in voluntary, contingent wellness programs to undergo biometric testing. That goes beyond contingent wellness program rules and violates Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) since the testing is not job-related or consistent with business necessity, the EEOC claims.

Reuters (via Yahoo News) reports the federal government litigation has ticked off large employers to the extent that they are now politically turning against the Affordable Care Act and may work to undermine it in Congress and the courts.

The application of the workplace wellness rules isn’t the real issue. Large employers have known the how the rules governing voluntary and contingent wellness programs work for two years. Their real beef is over the fact that they’re not seeing their health costs being meaningfully reduced by the Affordable Care Act. Nor are they likely to without reforming their organizations to support a culture that truly respects the health and wellness of their members and affords them ample opportunity to engage in health promoting behaviors.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Wellness isn’t at the office

We spend the majority of our waking hours at work. The office environment has a great deal of influence over the shape and structure of our lives. While the doctor’s visit is where many health conversations start, it is rarely where they continue to live. Workplaces have the opportunity to keep this conversation going. As Catherine Baase, Global Director of Health Services for The Dow Chemical Company, states, “The workplace, through its established culture, can have greater long-term impact than the visit with your doctor, the reach of government and even the sphere of your family. It is the secret sauce to driving outcomes — and an essential factor in achieving population health.”

Influence also stems from an organization’s ability to create an ecosystem of health around an individual. While a doctor’s advice often fails to stick because it gets drowned out in our hectic lifestyle, workplaces can support an individual’s adherence to health everyday by surrounding an employee with a physical and social environment that makes health the simple and meaningful choice. At USAA, it’s hard to ignore the physical representation of health. The company has made it so convenient it’s become part of the fabric of the organization with amenities, such as bike stations, BMI testing rooms, indoor and outdoor walking paths, stairway signs estimating calories burned for use, energy rooms, healthy food and a massive gym. Culturally at USAA, health has been woven in, with departments competing to collect healthy points. The reward—a sense of group pride—is a compelling force to action and holds people accountable. When we bump up against these attitudes and resources day in and day out at the workplace, they influence our perspectives on health.

via Reach and influence: Why corporate wellness programs really do work.

I respectfully disagree with the notion that workplaces are the magic bullet for encouraging health promoting behaviors to ward off preventable, lifestyle-related chronic conditions that cost organizations billions in health care costs and lost productivity. Yes, knowledge workers do spend the majority of their waking hours at work. But the daily — and needless — commute of 40 to 120 minutes to sit in an office for 8 hours is one of the worst things we can do for our collective health.

The more sensible — and less costly for both organizations and their members — approach is to leverage information and communications technology to shift away from the overarching centralized commuter office culture. Treat staff as adults and let them manage where and when they get their work done. That way, they’ll have more freedom and freed up time from ditching the daily commute to hit the (real, not office mini) gym, walk, run, swim, and cycle on their own schedules. If organizations want their members to adopt health promoting behaviors, they need to give them maximum freedom and support to make that choice. And they’ll likely benefit from reduced real estate and health care costs, lower turnover and higher staff attraction and retention.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Symbolic wellness programs will remain just that – and get bubkes for results

Yahoo! provides an example of a highly symbolic participatory wellness program that isn’t likely to significantly improve the health status of Yahooligans.

Here are some excerpts from the story by Bloomberg BusinessWeek:

In an effort to whip its desk-bound, tech-loving workforce into shape, Yahoo! (YHOO) is offering free Jawbone Up fitness bands to all employees—with a few conditions. If workers want use the gizmo (retail price: $129.99) to tally their every action while exercising, commuting, sitting, and eating all that free Yahoo food, they must first agree to run or walk at least 100 miles in 30 days.

While commuting? Few Yahooligans likely walk or cycle to the Yahoo! campus, instead most arriving on site after long and stressful Silicon Valley commutes (among the worst in the nation) that degrade their health status.

Yahoo already offers such old-fashioned health resources as onsite fitness centers with classes in yoga, cardio-kickboxing, pilates, golf, and so forth. Even those who work in locations without a fitness center receive $100 quarterly reimbursements toward health-club memberships, according to the company’s website. Sure, the wristbands can reveal depressing data about how many hours a person sits in front of a computer monitor and how many doughnuts are consumed. Whether the results can persuade a user to hit the gym isn’t something a device can control.

Yahooligans stressed out from the commute can release some of that stress in the on site fitness center. While management decreed earlier this year all Yahooligans must to show up on campus every work day, hopefully it doesn’t expect them to spend the day in their cubicles since that isn’t going to score points on their fitness bands.

Instead of nannying staff, a better wellness approach than this highly symbolic, one size fits all PR stunt would be would be to treat people as adults and give them control over when and where they work. Wellness is a personal lifestyle choice. People must have the freedom to make that choice according to their individual needs and devote the necessary time to achieve it.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Wellness isn’t just in the “workplace”

The Patient Protection and Affordable Care Act’s use of modified community-based rating and its outlawing medical underwriting has drawn criticism that the policy unfairly subsidizes those who lead unhealthy lifestyles and drive up costs. While individual and small group market health plan issuers can no longer base premiums on an individual’s lifestyle or health status for coverage beginning January 1, 2014 or later, a type of risk rating is available to employers under the law. It’s in the form of “workplace wellness” programs that allow employers to reduce what employees have to pay toward their health insurance or offer financial incentives if participating employees meet specified health status metrics such as weight, BMI, blood pressure and serum cholesterol.

Studies of the effectiveness of these programs yield mixed results, suggesting they have only limited influence on the health status of employees, this Atlantic article indicates. Since engaging in health promoting activities is largely driven by peoples’ personal choices and circumstances, I believe the best thing employers can do is to maximize their employees’ ability to make healthy lifestyle choices rather than essentially bribing them to do so. That means affording them the ability to devote the necessary time to properly engage in them.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Survey suggests lack of schedule control limits participation in wellness programs

Organizations are struggling with the transition from a commute-to-the-cubicle, 20th century Industrial Age environment where work is performed during set times in centralized locations to one that affords more control over when and where work is performed. As a result, many are also struggling with wellness programs, finding that staff lack the time in their daily schedules for sustained physical activity, as shown by the recently released 2013 Global Workplace Health and Wellness Report. The findings of the survey 378 organizations in various industries and a link to the report can be found in this Forbes article, Employees Don’t Have Time for Wellness Initiatives.

The survey’s finding that lack of time for exercise is a major obstacle for wellness programs is hardly surprising. The Industrial Age work style consumes most of people’s waking hours and energies in minimum 8-hour-long “shifts” and time sucking, stressful commutes. All involving prolonged sitting that studies show adversely affect health status. Then when they get home mentally exhausted, it’s more inactivity and collapsing onto the couch, often with take-out food. And we wonder why as a society we’re getting fatter and sicker.

Achieving wellness requires exercise.  And sustained exercise performed on most days takes time. The implication to be drawn from the Global Workplace Health and Wellness Report is wellness isn’t so much as a “workplace” issue as a personal time management and lifestyle issue.

The good news is organizations have 21st century Information and Communications Technology (ICT) at their disposal to help alleviate the time crunch. ICT allows staff to work most any place and time, affording them more control over their personal schedules to engage in exercise programs in their own communities chosen by them and their health care professionals. While organizations clearly have a stake in the health of their members, health is ultimately an individual lifestyle choice. The National Wellness Institute defines wellness as “an active process through which people become aware of, and make choices toward, a more successful existence.” Making the right choice for health requires organizations provide their members sufficient control over their work schedules to exercise that choice.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Morale hazard a major risk facing health plans

Insurance no matter what variety assumes two kinds of risk. First, the underlying peril that could result in a covered loss, such as a windstorm or a fire in the case of homeowners insurance. Second, human hazards that can increase the risk of loss. For example, there’s moral hazard (such as filing a fraudulent claim to collect on the insurance by setting one’s house on fire) and morale hazard. What’s morale hazard? This definition is a good one:

A term used to describe a subjective hazard that tends to increase the probable frequency or severity of loss due to an insured peril. Morale hazard, as contrasted with moral hazard, does not imply a propensity to cause a loss but implies a certain indifference to loss simply because of the existence of insurance. For example, an insured’s attitude may be indifferent if a loss occurs because they have insurance. (Emphasis added)

The emphasized part is directly applicable to and has major implications for health insurance. In the context of health insurance, a clear example of morale hazard would be the failure to engage in health promoting behaviors and lifestyles. For instance, an individual with a family history and propensity to develop cardiovascular disease eating an unhealthy diet and not regularly exercising. Granted, that individual may not want to have a stroke or heart attack. But if they have the attitude that they can shift the risk of costly medical care should that happen to their health plan, they may be less motivated to adopt a lifestyle to help head off those eventualities.

As one strategy to stem rising costs, health plans must strike a balance between providing people the peace of mind that comes with having coverage for potentially financially ruinous medical costs while also motivating those they cover to take responsibility to avoid them.

This becomes especially critical starting this October, when health plans in the individual market must begin pre-enrolling applicants for coverage beginning January 2014 regardless of medical condition or history. No longer will plans be able to practice risk avoidance to control claims costs, rejecting those deemed too risky to cover or charging small employers higher rates based on the medical condition of their employees.

That leaves mitigation of morale hazard as their only remaining form of risk management. Large employers as well as smaller ones are looking to so-called “workplace wellness” programs as a form of addressing morale hazard, including contingent wellness programs that provide employees economic incentive to engage in health promoting behaviors to reduce the likelihood of their incurring major medical costs. Whether such programs have a meaningful impact remains to be seen given mixed outcomes such as reflected in this 2011 survey and a study published this week in Health Affairs.

With limited financial incentives available to both plans and employers to reduce morale hazard, it will likely take a big shift in societal attitudes to achieve a measurable reduction. For example, viewing both personal health and health coverage as a common social good that should be respected and preserved. If the resources to pay for health care are shared and finite – and they are – we should regard them as a societal asset that should be preserved. That change in outlook will also require us to re-examine our values and strive for balance in our lives that supports preserving our individual and collective health.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Time for sustained exercise to bend the healthcare cost curve — and promote better thinking

Knowledge workers earn their livings analyzing, abstracting and communicating.  In today’s Information/Internet economy, all too many knowledge workers needlessly do so working under legacy Industrial Age 8-5 office schedules, spending even more time each day relatively immobile than sleeping.  Add to that another 1-3 hours spent sitting in a daily commute to a central office location.  Month after month, year after year of this occupational lifestyle sets the stage for the development of preventable chronic conditions such as diabetes, hypertension and obesity that drive the health cost curve and the health insurance crisis.

But that’s not all.  Lack of physical movement can also dull the knowledge worker’s most important tool: their brain.  This Sacramento Bee article cites research linking physical activity to the brain’s ability to perform learning and memory tasks.

The clear conclusion to be drawn is sustained exercise could produce dividends for organizations by not only lowering their healthcare and insurance costs, but also the added bonus of better and more creative thinking.  For knowledge organizations, affording workers control over their schedules and time for sustained exercise probably is likely the most cost effective “workplace wellness” program going.  A key program component is ditching outmoded Industrial Age commuting and office hours and becoming a more virtual organization and maximizing the use of Information and Communications Technology (ICT).  Knowledge work can be done anywhere, and some of the most creative thinking happens during and after sustained exercise.  That requires freeing up time for it every work day by getting people out of their cars and cubicles.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Schedule control necessary if contingent wellness programs are to achieve meaningful results

In November, the U.S. Department of Health and Human Services (HHS) issued a proposed rule governing wellness programs offered as part of employer-sponsored health plans for plan years beginning January 1, 2014.  The proposed rule is aimed at boosting incentive for large employers to increase the health status of their employees since large employers will be continue to be regarded as discrete risk pools under the Patient Protection and Affordable Care Act, whereas small employers will be collectively treated as a single risk pool.

In addition to the traditional participatory wellness programs such as discounts on fitness club memberships, health assessments and seminars, the proposed rules create an enhanced incentive for employers to offer health contingent wellness programs.  The contingency?  Employees must adopt a lifestyle changes and health improvement plans designed to help them reach target biometric goals such reducing weight, body mass index (BMI), blood pressure, or cholesterol levels.  If they hit the prescribed targets, the proposed rule would allow employers to reward the employee with a payout of up to 30 percent of the cost of the employee’s health coverage for the plan year, an increase over the current 20 percent permitted under rules adopted in 2006.

The rulemaking’s preamble suggests HHS believes the increase in the maximum reward is necessary to boost participation in contingent wellness programs. It cites a 2010 survey by NBGH and TowersWatson in which just four percent of responding employers reported offering financial incentives for maintaining a BMI within target levels.  Only three percent did so for maintaining targets for blood pressure and cholesterol levels.  Based on these numbers, increasing the maximum award level alone isn’t likely to produce a significant increase in the number of employers and employees participating in contingent wellness programs.

However, if such programs were joined with affording employees greater control over when and where they work, participation could increase substantially and employers would see a potentially large payoff in improved employee health status and reduced medical utilization.  Schedule control eliminates the “I don’t have time” excuse for not engaging in health promoting behaviors such as regular exercise and getting sufficient amounts of sleep.  If employers want employees to take responsibility for their health, they must give them the means to adopt healthy lifestyles and avoid the daily sedentary (and hardly health promoting) routine of commuting to and from and sitting in a centralized office.  Plus they would likely enjoy the added bonus of crisper and more creative thinking and better ideas from employees getting plenty of sleep and exercise thanks to having more control over their work schedules.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Integrated Benefits Institute: Poor Health Costs U.S. Economy $576 Billion

Poor Health Costs US Economy 576 Billion.pdf (application/pdf Object).

SAN FRANCISCO – September 12, 2012 – With the upcoming presidential election hinging on health care and the economy, analysis shows that poor health and its impact on productivity costs the U.S. economy $576 billion per year. This is according to estimates by the Integrated Benefits Institute (IBI), a nonprofit health and productivity research organization.

In addition to showing the entire financial burden of poor health, IBI researchers found that 39 percent—or $227 billion—is due to lost productivity associated with poor health. Lost productivity results when employees are absent due to illness or when they are underperforming due to poor health (“presenteeism”—when employees are at work but not performing at their peak).

This is a staggering number and clearly indicates Americans need to change how they work and live to achieve healthier and more balanced lives.  The status quo harms their quality of life as well as the fiscal health of their employers.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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