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.
For sedentary office-based jobs, workplace wellness is something of a non sequitur. Especially considering American adults spend nearly half their waking hours at work (not counting commute time) as was pointed out earlier this week at a Sacramento, Calif. symposium on wellness incentives hosted by the California Senate and Assembly Health committees and the California Endowment. Employers remain split on the benefit of workplace wellness programs. In a recent survey, equal numbers indicated that the programs have either improved or had no appreciable impact on the health of their workforces.
Symposium participants discussed making it easier for cubicle-bound workers to move around more at work by providing onsite exercise classes and breaks. Also, installing standing “tread desks” that allow workers to walk a treadmill while working. I imagine typing on a keyboard is rather challenging in this moving position that aside from the cost of these machines calls into question its widespread use and adoption. The tread desk has great ironic symbolism attached to it. It represents — to the point of absurdity — how some employers are attempting to accommodate a deeply embedded industrial age notion that knowledge work can only be accomplished in a office or cubicle located in an urban center or office park while at the same time encouraging office workers to get off their duffs and move more in order to reduce health care utilization and absenteeism.
A more elegant and sensible solution is to treat knowledge workers as knowledge workers instead of assembly line workers who can only do productive work at a “bench” or desk during set timeframes. Knowledge workers conceptualize, analyze, synthesize, problem solve, write and report. That work is essentially performed in the brain. The brain goes wherever the worker goes and is location independent. Moreover, as many office workers can attest, it doesn’t easily switch on and off in “work time” and “non work time” mode. With information accessible most everywhere 7/24 via the Internet, it’s potentially always working. The best and most creative ideas and solutions to tough problems are often conceived outside the formal workplace. They bubble up during sleep and exercise, particularly vigorous exercise when the brain is flooded with endorphins and oxygen.
Some of the best thinking and problem solving can be done outside the workplace doing the very things health experts say most Americans need more of to maintain better health: sleep and exercise. That’s a prescription for potentially enhanced employee wellness and improved productivity. Throw in using office space for meetings instead of housing workers in cubicle farms five days a week and there’s the added bonus of saving on office overhead as well as employee health costs.
The ultimate workplace wellness program for knowledge workers is to allow them to work anywhere and manage their schedules. They’ll have a lot more time for exercise when they’re not commuting and sitting in traffic. Measure their work product by the quality of the product — and not by how many hours they put in at the office.
The prevalent U.S. sedentary office worker/long commute and minimum exercise/high calorie diet lifestyle is beginning to take a major toll, according to a report released today by the UnitedHealth Group’s Center for Health Reform & Modernization. The alarming report, The United States of Diabetes: Challenges and Opportunities in the Decade Ahead, projects more than 50 percent of Americans could have diabetes or prediabetes by 2020 at a cost of $3.35 trillion over the next decade if current trends continue.
All of that pre-diabetes and diabetes will account for an estimated 10 percent of total health care spending by 2020 at an annual cost of almost $500 billion – up from an estimated $194 billion this year, according to the report, which calls for lifestyle interventions to combat obesity and prevent prediabetes from becoming diabetes and medication control programs and lifestyle intervention strategies to help improve diabetes control.
It will have to go far beyond that. Lifestyle changes mean work/life changes so people can spend a lot more time exercising and less time commuting and sitting in cubicles — as well as getting sufficient sleep. This is the ultimate workplace wellness program. Simply doing a few stretches and yoga at lunch and trying the latest diet fad isn’t going to make a dent in this problem.