As healthcare costs have risen in recent years, a concept developed at large corporations has spread to companies large and small. According to a congressionally mandated report released last year, about half of U.S. employers now use workplace wellness programs.
Marketed as a way to help improve employee health and thereby reduce absenteeism, increase productivity and cut employers’ health costs, workplace wellness programs include “disease management” assistance for conditions such as diabetes and heart disease, and “preventive” health programming, which might involve health education and coaching, weight-loss programs and on-site fitness resources.
No one can argue against the virtues of good health, but these programs — and employers’ involvement in them — are raising questions of privacy, discrimination and effectiveness. While some programs are voluntary and are framed to offer “incentives” for participating, many require employees to fill out questionnaires, called “Health Risk Assessments,” which require disclosing personal information such as if they smoke, how much they weigh, how much they exercise, if they feel depressed or stressed and even their waistline measurement. They also might require medical screenings, to find out data such as cholesterol levels and blood pressure.
If the benefits sound nice but you’d rather not participate, get ready to pay. In a well-publicized case last year, faculty at Pennsylvania State University (PSU) were charged $1,200 to opt out of their wellness program. And CVS required employees to submit to a medical exam or pay a $600 fine. The Affordable Care Act has strengthened companies’ abilities to charge an employee a significantly higher premium or deductible — as much as 30 percent of their insurance cost — if they refuse to return a questionnaire or get a screening.
As a result, it’s not hard to see how the issue of wellness becomes one of privacy. But it also can become a question of discrimination, particularly if wellness programs charge employees who fail to meet health goals, such as losing weight, quitting smoking or lowering “bad” cholesterol levels.
Under the Health Insurance Portability and Accountability Act (HIPAA), employees cannot be discriminated against based on a “health standard.” What that means for wellness programs is that the plan must offer employees a “reasonable alternative standard” for bypassing the penalty, such as by participating in a smoking cessation program or proving they are on a cholesterol-lowering drug.
Beyond these legal and ethical dilemmas, some say the programs can do more harm than good for employees’ health and the employer’s bottom line. Stay tuned: we’ll look at the cost effectiveness of workplace wellness programs in next week’s post.