I have long been interested in wellness and disease management plans developed by employers for their employees (see: A Clear and Simple Way for Employers to Cut Their Healthcare Costs; Filling Out Health Questionnaires for Employers; Financial Incentives for the Pursuit of Wellness; Possible Impact on the Clinical Labs). There is an inherent tension in such plans. As healthcare costs rapidly increase, there are powerful incentives for employers to exercise more control over these plans and, in effect, force their employees to pursue healthier lifestyles. Access by employers to sensitive personal health information is also a bone of contention here. A recent article discussed both the carrots and the sticks in wellness and disease management plans (see: Employee Wellness Programs Use Carrots and, Increasingly, Sticks). Below is an excerpt from it:
It may be an offer employees simply can no longer refuse. Workers increasingly are being told by their companies to undergo health screenings and enroll in wellness programs, as a way to curb insurance costs. Many employees now face stiff financial penalties — often in the form of higher premiums — if they do not have their cholesterol checked or join programs to lose weight or better manage diabetes. And a ruling late last month by a federal judge in Wisconsin is likely to further embolden companies to prod workers to join these programs, despite growing concerns over employee privacy and health management. The court decision is the latest setback for the federal Equal Employment Opportunity Commission, which in the last few years has pursued legal action against programs it says violated federal anti discrimination laws. The agency has argued, unsuccessfully in some cases, that employers have wellness programs that violate laws prohibiting them from demanding medical information from workers. In addition to bringing several lawsuits, the agency has also issued proposed regulations that would forbid companies to make health screenings a condition of insurance coverage. The standoff will need to be settled by the courts unless the agency revises its rules....While most large employers offer wellness programs, companies and workers alike may find the rules difficult to navigate. The Affordable Care Act allows employers to impose hefty penalties on individuals who do not participate. Nearly half of the large employers offering screenings and wellness programs use some sort of financial incentive to persuade employees to comply....But the E.E.O.C. seems to have adopted a different standard, and its proposed regulations do not mesh neatly with the health law. The agency appears to be facing pressure from the White House and Republicans to make sure it does not derail corporate efforts to rein in health care costs.
Read the whole article if you have an interest in this topic. It's long and complex and I can't do it justice to it in this short blog note. As I understand the issue, there is growing tension between the EEOC, on the one hand, and the Affordable Care Act on the other. The EEOC defends the rights of workers and the ACA allows employers to impose hefty penalties on individuals who do not participate in wellness and disease management plans. When do such plans become too intrusive and to what extent do incentives for workers to pursue a healthy lifestyle impinge on their individual rights? As I have stated in a previous note, disease management programs by employers are one of the most efficient ways we have to bring down the cost of healthcare in that more than 75% of health care costs are attributable to chronic conditions (see: Disease Management Programs Provide More Cost Savings than Lifestyle Programs). This approach has been shown to be effective in lowering health insurance costs by the Cleveland Clinic for its large group of employees (see: Cleveland Clinic Lowers Health Insurance Costs with Preventive Medicine).