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.
Aon Hewitt’s survey shows a growing number of employers are beginning to link incentives to a result, as opposed to simply participating in a program. Of companies that offer incentives, 58 percent offer some form of incentive for completing lifestyle modification programs, such as quitting smoking or losing weight. About one-quarter offer incentives for progress or attainment made towards meeting acceptable ranges for biometric measures such as blood pressure, body mass index, blood sugar and cholesterol.
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“Employers know that eight health behaviors, including risks such as lack of physical activity and failure to complete recommended preventive screenings, drive 15 chronic conditions that lead to higher medical costs and increased absence from work. An effective incentive strategy rewarding those who take action to improve their health is fundamental for improving health and reducing cost,” said Stephanie Pronk, clinical health improvement leader for Health & Benefits at Aon Hewitt.
Rather than offer incentives for healthy lifestyle choices, employers seeking measurable gains in the health status of their workforces and decreased medical utilization for preventable conditions should afford employees more control over their schedules in order to free up time for exercise and adequate sleep. One of the biggest reasons employees don’t exercise is lack of time — largely due to the outdated expectation that they must commute to an office five days a week in order to perform their jobs. It effectively chains workers to their cars and their desks most of their waking hours and is a prescription for employee sickness, not wellness. This situation cannot be rectified with any amount of “wellness” incentives. Instead of trying to bribe workers to take better care of themselves, employers should treat them as adults and give them more responsibility and control over their schedules as long as they get their work done. How? By adopting a Results Only Work Environment (ROWE).
This article makes a point also made on this blog: that increasing access to health care fails to address the root cause of increased health care utilization and particularly lifestyles that lead to preventable chronic conditions that are a major driver of that utilization.
Employers are becoming increasingly sensitive to the rising cost of health care, driving interest in prevention and wellness programs designed to reinforce healthy behaviors such as exercise. Some are paying workers rewards to take good care of themselves and even strapping pedometers on them.
But will these measures have a meaningful, long-term impact on getting rising health care costs under control? I’m doubtful because I view this not so much as a workplace issue but more of a work-life time management issue, particularly for office/information workers. If they are commuting to an office five days a week there’s often not much time or energy in the workday for a significant and beneficial amount of exercise and the seven to eight hours of sleep many medical experts say people aren’t getting but should. Sitting in a commute and then sitting in a cubicle for eight or more hours does not a healthy lifestyle make. Just look at the many supersized workers who inhabit this work environment.
One employee wellness intervention that employers of this large category of workers should consider implementing to get measurable results is allowing them to work from their homes or from locales close to their homes for some or most of the workweek. The freed up commute time can then be used for an hour of exercise based on the average U.S. commute time. There’s also the added plus of more sleep time since teleworkers can start work soon after rising without having to prepare for a trip to the office.