Story first appeared in USA Today.
Once a year, employees of the Swiss Village Retirement
Community in Berne, Ind., have a checkup that will help determine how much they
pay for health coverage. Those who don't
smoke, aren't obese and whose blood pressure and cholesterol fall below
specific levels get to shave as much as $2,000 off their annual health
insurance deductibles. These tests also contribute to
the Workers’ Compensation Insurance allowances that the company purchases.
At Chicago-based Jones Lang LaSalle, a real estate firm,
workers can earn up to $300 in cash for having a physical and hitting certain
medical goals, or completing health coaching programs.
Gone are the days of just signing up for health insurance or
Workers’ Comp Insurance
and hoping you don't have to use it. Now,
more employees are being asked to roll up their sleeves for medical tests — and
to exercise, participate in disease-management programs and quit smoking to
qualify for hundreds, even thousands of dollars' worth of premium or deductible
discounts.
Proponents say such plans offer people a financial incentive
to make healthier choices and manage chronic conditions such as obesity, high
blood pressure and diabetes, which are driving up health care costs in the USA.
Even so, studies of the effect of such
policies on lifestyle changes are inconclusive. And advocates for people with
chronic health conditions, such as heart disease and diabetes, fear that tying
premium costs directly to test results could lead to discrimination.
Nonetheless, such plans appear to be the wave of the future.
Faced with crippling health care costs,
the number of employers embracing such programs inched up from 49% in 2010 to
54% last year — and more say they expect to do so soon, according to a survey
by consultants Aon Hewitt. Big-name
participants include insurer UnitedHealthcare, car rental firm Hertz, postage
meter maker Pitney Bowes and media owner Gannett, owner of USA TODAY. More employers are expected to adopt them
starting in 2014, when the health law — if the Supreme Court upholds it — would
allow them to offer larger incentives or penalties.
Cost savings seen
Leaders at Swiss Village credit their 8-year-old wellness
program, along with a high-deductible insurance plan and an on-site fitness
center, with slowing health care cost increases. Indeed, workers saw no increase in premiums
from 2005 to 2011.
Of the employers who offer such programs, about one-third
offer financial incentives to those who undergo specific medical tests,
according to the Aon Hewitt survey. And
5% of those tie the financial rewards or penalties to meeting specific medical-based
standards. The survey also found an
expansion of such tests is on the horizon: 57% of employers said they planned
to add incentives for spouses and dependents in the next three to five years.
Employers will still have to craft plans to comply with
federal and, in some cases, state requirements.
The programs must be voluntary — meaning an employer can't require a
worker to participate as a condition of coverage — and the employer must offer
a reasonable alternative to qualify for the reward, or to avoid the penalty for
those who can't achieve the goals.
In an effort to slow rising costs, Broward County in 2009
began asking workers to fill out a health information form and have a
finger-stick blood test each year to check blood sugar and cholesterol levels,
according to court filings. Workers who
declined were docked $40 a month. Those who participated were offered
disease-management programs if they had asthma, high blood pressure, diabetes,
congestive heart failure or kidney disease. The county stopped docking those who declined
to participate Jan. 1, 2011, after a lawsuit was filed, court documents show.
The lawsuit, which argues that the county's program violates
the Americans with Disabilities Act, is likely the first of its kind in the
nation. Without ruling on whether the
wellness effort was voluntary, a federal district court judge backed the county
in April of last year, saying the plan fell under provisions of the law meant
to protect bona fide benefit programs. The case is now on appeal. Broward County
attorneys did not return requests for comment.
Some state lawmakers are also concerned about the potential
for discrimination. Colorado passed
legislation in 2010 that requires wellness programs to be accredited, bars
penalizing workers for not participating or failing to meet a health standard —
and allows appeals if an employee is denied an alternative. A similar bill was brought unsuccessfully in
California last year, according to a February report by Georgetown University's
Health Policy Institute. A similar law could be written
regarding New York Workers’ Comp Insurance Quotes, in relation to employee
testing.
Concern for consumers
While supporting wellness programs in general, several
patient advocacy groups warned the Presidential administration last March that
additional consumer protections are needed. Tying medical test results to financial incentives
or penalties in premiums or deductibles could discriminate against some
workers, especially those who already have health problems, the groups said.
Employers argue, however, that since they're on the hook for
the bills, they can ask workers to take more responsibility.
The first worker wellness programs, which began about a
decade ago, rewarded simple participation: attending a health fair or filling
out health risk assessments, with the worker perhaps receiving a $25 gift card
in return.
Today, many offer discounted premiums to workers who meet
standards related to blood pressure, cholesterol and weight, with the value of
those discounts running between $30 and $60 a month, says founder and CEO of
Bravo Wellness in Avon, Ohio. Bravo
administers such programs for about 220 employers nationwide, including
Colorado construction firm Oakwood Homes and Nashville's Ardent Health
Services.
Although employers may set specific goals — such as a body
mass index (BMI) below 30, the level considered obese — many also reward
achievement of less daunting targets. One employer rewarded workers if their
test results didn't worsen.
At Swiss Village, workers get $500 off their deductible for
each of these measures: not smoking, having a BMI of 27.5 or less, a
low-density lipoprotein cholesterol level (LDL) of 130 milligrams per deciliter
or less, and blood pressure of 130/85 or less. LDL levels above 129 are associated with
higher risk of heart disease, while blood pressure greater than 120/80 is
considered a risk factor for heart attack and stroke.
A second tier of awards allows employees who approach those
ranges to earn $250 per category. The testing takes place at an on-site health
fair or at a doctor's office, with the results gathered by an independent
insurance firm that runs the company's program.
The information is generally gathered by firms that run
wellness programs or insurance plans. UnitedHealthcare, which offers its
Personal Rewards program to large, self-insured clients, says it does not use
the information to set premiums.
But do they work?
Given the available data, it's hard to parse how much of the
reported savings from such programs come from improved health, and how much
from the frequent pairing of such programs with high-deductible policies.
The medical literature shows they work best when
participants have choices: get below a certain BMI, or lose 5% of current body
weight, for example.
At Jones Lang LaSalle, workers who make a pledge — on the
honor system — that they don't smoke, or will take a stop-smoking class, and
achieve a healthy weight, get 10% off their contribution toward insurance
premiums.
In 2010, the firm added a cash bonus program, offering $50
to workers who get a physical and another $50 for every one of four medical
tests they take: weight, blood pressure, glucose and cholesterol, plus an extra
$50 if they do all the tests. If they
meet specified goals — or complete a coaching program — they receive the money
as a cash bonus.
Last year, 65% of employees participated. While it's early,
indications are the program is having an impact on costs: Health spending rose
6% in 2010, but only 3% in 2011.
