Caution urged on wellness incentives
Caution urged on wellness incentives
Make sure targets are fair, groups urge
Six health care organizations have come together with one strong message: Be careful in your design of wellness incentives so that they don't treat some employees unfairly or restrict access to health insurance.
Wellness incentives have become increasingly popular among the nation's employers, including hospitals. More than two-thirds of employers use incentives to encourage employee participation in health promotion programs, according to a 2012 Towers Watson/National Business Group on Health employer survey.1
A growing number of employers are using "outcomes-based" incentives which base financial rewards or penalties on meeting successful goals, such as smoking cessation or weight loss. That was the focus of the joint statement, which provides detailed guidance on designing wellness incentives so they encourage good health habits but are not discriminatory.
The statement was drafted by the Health Enhancement Research Organization, American College of Occupational and Environmental Medicine (ACOEM), American Cancer Society, American Cancer Society Cancer Action Network (ACS CAN), American Diabetes Association, and the American Heart Association.
"It's a balancing act to try to foster movement in the right direction [toward better health] without being perceived as picking on those who medically were not dealt the deck of cards that make it so easy to do that," says T. Warner Hudson, MD, medical director of occupational and employee health at the UCLA health system and campus and the immediate past president of ACOEM.
Employers combat chronic disease
ACOEM and the other organizations are not endorsing outcomes-based incentives, Hudson notes. But they recognize the momentum. The workplace has become ground zero for combating the epidemic of chronic diseases.
Most employers start with incentives for employees to complete a health risk assessment, to talk to a health coach or to attend educational or exercise sessions.
"Some employers start to think, 'Let's put in some rewards if people hit some targets, whether they move the needle on their weight or they succeed in quitting smoking,'" says Hudson. "If you're going to do that, what are some of the boundaries around the programs that have outcomes based incentives?"
Smoking cessation is the most common target. About 35% of employers provide rewards or penalties related to smoking or tobacco use, and another 17% were planning to add them in 2013, according to the Towers Watson/National Business Group on Health survey.
Only 10% of employers used other targets, such as weight management or cholesterol levels, but another 23% of employers said they planned to add such targets in 2013, according to the report.
Offer 'reasonable alternative'
There's a delicate balance between providing resources, including incentives, for employees to improve their health status and punishing employees for having a chronic health condition. HIPAA allows employers to design outcomes-based incentives valued at up to 20% of the cost of health care coverage (the employer and employee contribution). In 2014, the Affordable Care Act will increase that cap to 30%. (Employees who meet the goal would receive a discount off their premium.)
Employees must be offered a "reasonable alternative standard" or a waiver if they have a medical condition that would make it medically inadvisable to meet the target, or if they would need medical intervention, the joint statement notes.
"You do have to be sensitive to the ADA [Americans With Disabilities Act] issues and people who have medical conditions," Hudson says. "[For example,] kidney failure will give you high blood pressure."
Likewise, someone with a joint replacement or back injury might be unable to reach a target based on an exercise program. Employees may be required to provide a note from their physician regarding a disability or medical condition, but HIPAA, ADA and state regulations still protect the privacy of their personal health information.
For people with lifestyle-oriented chronic conditions, incentives can become discriminatory if they are difficult to meet and if they produce a significant financial penalty, the joint statement says.
Commit to a culture of safety
Whether you design wellness incentives based on participation or outcomes, there are some other workplace considerations. Employees will view the efforts more favorably if you also have demonstrated a strong commitment to a safe workplace, says Hudson.
"The culture of health and safety has to be palpable for initiatives to work well," he says.
Employers should provide opportunities for healthy habits in the work environment, such as stairwells that are wide and inviting, walking paths, healthy food in the cafeteria and vending machines, and periodic farmers' markets, he says.
Work may impact employee health habits in other ways. For example, the night shift has been associated with health risks, including obesity, depression, fatigue and gastrointestinal disorders. (See HEH, June 2010, p. 71.)
Of course, hospitals require 24-7 staffing. But what if the work schedule puts the employee at a disadvantage in meeting personal health goals?
Ultimately, health care employers may need to address the fatigue and sleep issues associated with workers on night shifts, says Hudson. "I think it's the health issue of the next decade, to begin to foster better fatigue management and sleep hygiene in the workforce," he says.
[Editor's note: The joint statement, Guidance for a Reasonably Designed, Employer-Sponsored Wellness Program Using Outcomes-Based Incentives, is available at www.acoem.org/uploadedFiles/Public_Affairs/Policies_And_Position_Statements/JOEM%20Joint%20Consensus%20Statement.pdf.]
Reference
1. Towers Watson/National Business Group on Health. Performance in an Uncertain Era: 2012 Employer Survey on Purchasing Power in Health Care, 2012. New York, NY. Available at www.towerswatson.com/assets/pdf/6556/Towers-Watson-NBGH-2012.pdf. Accessed on September 23, 2012.
Six health care organizations have come together with one strong message: Be careful in your design of wellness incentives so that they don't treat some employees unfairly or restrict access to health insurance.Subscribe Now for Access
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