Employer Wellness Programs Are a Great Idea—Right?

[eridani]

http://www.thenation.com/article/employer-wellness-programs-are-a-great-idea-right/

Actuarially driven discrimination can be as technologically sophisticated as it is socially regressive. Some programs rely on arbitrary formulas like the Body Mass Index (BMI)—a metric derived from height and weight used to bluntly assess obesity—instead of more holistic health examinations.

Insurers can’t be blamed for using BMI as a rough indicator of obesity-related risks within an insurance pool. But for an individual worker, such as the diabetic retiree with asthma who might exceed her target BMI but is not in a position to crash diet to achieve a “wellness” benchmark, how would making her doctor’s visits more costly make her healthier?

The very concept of “incentives” raises questions of medical efficacy. How would insurers even measure the long-term “success” of linking premium rates to a weight-loss program? As NPWF’s testimony pointed out, “There is scant—if any—empirical evidence that monetary rewards can result in sustained weight loss. Crucially, there is no independently evaluated research demonstrating that linking the cost of employer-sponsored insurance to certain biometrics has an impact on health outcomes.”

A possible side effect of biometric surveillance, the group argues, is anxiety: Arbitrary health assessments could lead to “more people refusing testing and treatments they need for fear employers and insurers will use the information against them,” and, while premium rates continue to inflate in general (worker contributions to insurance plans have jumped over 80 percent since 2005), the wellness gap could impose “higher health insurance costs for the consumers who can least afford to pay.”

[Ilsa]

1. I hate that my health insurance sends me letters

telling me to take my medicine daily (they know I don't because I don't order it enough to make them happy) when actually I only need it occasionally.

They also have a program where you can sign up to talk to a lifestyle coach. That may be great for some people, but I'm not good at establishing rapport with a stranger over the phone. I don't want to discuss my very personal health issues with a stranger.

If they want to be proactive, they can offer coverage for programs they've research to be helpful, not create their own incentive plans that are more likely to result in long term failure.

[REP]

4. Because I have a Group Medicare Supplement Plan

I'm disabled, retired and middle-aged - I get to go over my prescriptions with a pharmacist once a year whether I want to or not (I don't; it's a huge waste of time). The pharmacist didn't mention my insulin can cause hypokalemia (severe enough I have to take enormous horse pills to correct it); that my fibrate is linked to a serious increased risk for cancer; or that statin and fibrate use in someone that is both hypotensive and with CKD is at risk for rhabdomyelosis ... but did make sure to tell me the 400 IU of Vit E (recommended by my physician) has been linked to an increased risk of prostate cancers in some studies. I was born without a prostate because I'm a woman. Rhabdomyelosis, on the other hand, is really serious and the cancer risk from fibrates is not negligible.

I did get a prescription for enough needles that I don't have to use the same one for my Lantus and Humulin R injections, but still, hardly worth it.

[wryter2000]

2. That's not wellness

That's just pestering and causing stress.

My employer did offer wellness programs. You got points for doing things like attending weight loss classes, whether or not you lost weight, exercising, going to the farmers' market, or even taking a shuttle to Lake Merritt at lunch to lower stress. Then you got cool stuff when you accumulated enough points. I'm wearing a Fitbit contraption they gave me. (This is in past tense for me because I'm retired, with a pension and 401k, I might add. The program is still going on.)

I lost 70 pounds and got rid of my cane because of the program. That's wellness.

[Igel]

3. One size fits all.

That's how programs work.

Otherwise you have 500 programs individually tailored for 100 million people, and need to have bureaucrats--typically not in the top 70% of their graduating class, except for the top level folk--trying to monitor 500 million different options.

And if one person makes one computer entry error, it's national news and people are calling for that person's head on a pike.

The more programs, the more people, the more you're required to be average, which is to say, equal, with everybody else. Welcome to theory meets reality.

[mythology]

5. That's just one way to do a wellness program.

My company covers acupuncture, it offsets gym costs, it offers a rewards program for buying healthy food. There's no cost if you don't participate.

[deucemagnet]

6. Incentives would be nice.

My workplace health insurance just threatens us with higher deductibles if we don't comply.