The actions of companies like CVS Caremark [TTA Telehealth Soapbox] have aimed a white-hot klieg light onto corporate wellness and the various methodologies companies are using to force a change in employees’ behaviors to positively affect their healthcare spend. Both positive and negative incentives have their pros and cons–positive incentives tied to completion of wellness ‘tasks’ seem not to work long term, penalties can be a blow to morale and verge on full-blown discrimination and lawsuits. Increasingly the price of being in a corporate health plan seems to be acceptance of ‘intrusion for your own good’ and privacy loss. On the other hand, why should health insurance be any different than home or auto, at least in the US? The Wall Street Journal has written several non-firewalled articles on this issue in recent days: Your Company Wants to Make You Healthy; Carrots and Sticks: Which One Works The Best (infographic); If Workers Are Out of Shape, Should Companies Make Them Pay? (At Work Blog–read over 85 comments)
In terms of effectiveness, the only study this Editor has seen was published this month in the Journal of Occupational & Environmental Medicine from wellness/disease manager Healthways’ Center for Health Research, as mentioned in a secondary article by the Integrated Benefits Institute. According to IBI’s summary:
Looking at over 19,000 employees at five employers, the authors find that employees who reduced their total health behavior risks over a 12 month period—for example, by increasing exercise or improving their diet—had a lower likelihood of absence, less presenteeism [working while sick–Ed.], and better job performance.
But some of those 19 factors included work-related risks such as “poor supervisor relationship, not utilizing strengths doing job, and organization unsupportive of well-being” (JOEM)–not health related at all. And the total reduction was a whopping 5 percent.
Magic 8 Ball says: ‘picture cloudy, try again’.
So perhaps the real choice has become this: adhere to employer requirements–or not have any coverage at all. There’s been a 10 point decline in Americans covered by employer-sponsored insurance, from 69.7 percent in 1999/2000 to 59.5 percent in 2010/2011 (SHADAC/Robert Wood Johnson Foundation). Much of that is also the US 7.6 percent ‘official’ unemployment rate (U-3)–but the real accelerator here is the 13.8 percent U-6 rate which counts in part-timers and the ‘marginally attached/discouraged’ who are not going to have employer insurance. The Affordable Care Act and its requirements/fees have also discouraged many smaller employers who are simply dropping insurance coverage.
So what is the bottom line? And where there are the opportunities for consumer engagement and self-maintenance linked to telehealth and mobile health which can mitigate cost? Understanding the ill-defined situation companies are in, especially in the US, will help in identifying them.