Posts Tagged ‘employer wellness programs’
December 11th, 2015
Fellow blogger Al Lewis has an excellent post on Huff Post Business on the promotion of fat-shaming in “employer wellness” programs. He points out that (a) these programs do not cause weight loss, (b) they are often structured to embarrass and harass overweight employees by their colleagues, (c) the penalties for failure to reach an employer goal of a specific BMI or weight loss amount are outrageous. What he might add is that millions of American workers are affected by these programs, them the largest human experiments in history. No doubt the numbers of affected employees dwarfs those in medical or surgical treatment programs. What he does not explain is the absence of outrage in the scientific and medical community over these scams.
November 2nd, 2015
The EEOC has (at last) issued proposed regulations on employer wellness regulations under the Genetic Information Nondiscrimination Act (GINA). The EEOC issued proposed regulations in April for employer wellness programs under the Americans with Disabilities Act.
In this proposal, the EEOC requests comments on seven specific issues. They are:
“Whether employers that offer inducements to encourage the spouses of employees to disclose information about current or past health information must also offer similar inducements to persons who choose not to disclose such information, but who instead provide certification from a medical professional stating that the spouse is under the care of a physician and that any medical risks identified by that physician are under active treatment.
Should the proposed authorization requirement apply only to wellness programs that offer more than de minimis rewards or penalties to employees whose spouses provide information about current or past health status as part of a (sic) HRA (ED: health risk assessment)? If so, how should the Commission define “de minimis”?
Which best practices or procedural safeguards ensure that employer-sponsored wellness programs are designed to promote health or prevent disease and do not operate to shift costs to employees with spouses who have health impairments or stigmatized conditions?
Given that, in contrast to the status quo when the ADA (Americans with Disabilities Act) was enacted, most employers today store personnel information electronically, and in light of increasingly frequent breaches to electronically stored employment records, should the rule include more specific guidance to employers regarding how to implement the requirements of 29 CFR 1635.9(a) for electronically stored records? If so, what procedures are needed to achieve GINA’s goal of ensuring the confidentiality of genetic information with respect to electronic records stored by employers?
In addition to any suggestions offered in response to the previous question, are there best practices or procedural safeguards to ensure that information about spouses’ current health status is protected from disclosure?
Given concerns about
of genetic information, should the regulation restrict the collection of any genetic information by a workplace wellness program to only the minimum necessary to directly support the specific wellness activities, interventions and advice provided through the
information collected through the program’s HRA (health risk assessment) and biometric screening? Should programs be prohibited from accessing genetic information from other sources, such as patient claims data and medical records data?
Whether employers offer (or are likely to offer in the future) wellness programs outside of a group health plan or group health insurance coverage that use inducements to encourage employee’s spouses to provide information about current or past health or past health status as part of a (sic) HRA (health risk assessment), and the extent to which the GINA regulations should allow inducements provided as part of such programs.
The deadline for comments is December 29, 2015.
January 30th, 2015
The Senate Health, Education, Labor and Pensions Committee (HELP) held a hearing on Jan. 29, 2016 on employer wellness programs. (See video here.) The purpose of the hearing appeared to be to put pressure on the Equal Employment Opportunity Commission (EEOC) which has recently sued several companies alleging that their wellness programs violated the Americans with Disability Act.
Ranking Democrat Patty Murray indicated that the EEOC would be issuing a proposed guidance in the near future, as reported earlier.
While billed as a debate over employer wellness programs, most of the witnesses were representatives of business groups, with the exception of one representative of the Consortium for Citizens with Disabilities, Jennifer Mathis, who gave the most detailed statement. The business representatives gave the usual pep rally cries of “these programs work” line, citing a couple of positive anecdotes and avoiding the volume of studies showing incentives and penalties do not work.
December 17th, 2014
Contrary to White House Press Secretary Josh Earnest assertion that employer wellness plans, a majority of Chief Human Resource Officers surveyed by the Consero Group think otherwise. In the survey, 56% said that their wellness program had not achieved a significant reduction in health care costs; only 22% of respondents said their company had achieved a significant cost reduction. Forty-eight percent said that their wellness program was ineffective while only 40% said it was effective. The survey was among 42 Chief Human Resources Officers from Fortune 1000 companies so it cannot be said to be highly representative of this group.
A recent Wall St. Journal report states that 38% of firms now cover bariatric surgery, one-third offer weight reduction wellness program. A small number of companies are “warming” to newly approved weight-loss drugs. However, the report also notes that 71% of employers representing 600,000 workers said overcoming stigma and embarrassment represented the biggest hurdle to effective corporate weight-loss programs.
An article by Shannon Pettypiece in Bloomberg yesterday stressed the personal information asked by employers, including whether the employee (or spouse if covered by the employer paid health insurance) is sexually active, how much one drinks, etc. The article includes a number of assurances from providers of wellness programs that their data is secure. Baloney. If Sony and the National Security Agency cannot protect their secrets how good is security at your local wellness office? Health risk assessments may also inquire whether the employee owns guns, something sure to raise the hackles of the National Rifle Association.
To clear up one confusing aspect, namely, whether health information given to an employer directly or to an employer wellness program is protected by federal law. According to the website of the Department of Health and Human Services, Office of Civil Rights, health information provided to employers or as part of a wellness program is NOTprotected by the Health Insurance Portability and Accountability Act (HIPAA). Just because a program is covered by HIPAA this does not mean the information is protected. The Office of Civil Rights records numerous cases of data breaches. A Washington Post story by Jason Millman reported that over 30 million Americans have had their personal health care data breached.
December 16th, 2014
The whole premise of weight-focused employer wellness programs is that a significant amount of weight can be lost (by voluntary or involuntary participants) sufficient to reduce obesity-associated co-morbidities and, hence, health care costs, excessive sick days, etc. Unfortunately there is little to no evidence to support this premise.
Let’s just examine one part of this premise, namely, what is a sufficient weight loss to reduce costs. We have a systematic evidence review from the US Preventive Services Task Force which explored behavioral counseling to promote a healthy lifestyle for cardiovascular disease prevention and found, “In general, intensive interventions that combined lifestyle interventions did not reduce CVD (cardio-vascular disease) events or mortality with up to 10 years of follow-up.” The researchers found “substantial statistical heterogeneity for weight outcomes” which is science-speak for ‘we can’t make heads or tails of the data’.
Now come three important studies. The first, from Tom Wadden and colleagues, looked at randomized controlled clinical trials that recruited overweight and obese subjects for primary care intervention, were provided with behavioral counseling (on diet, physical activity and behavioral therapy) for at least 3 months with at least 6 months of follow-up. They found that mean 6 month weight changes ranged from a loss of 0.3kg to 6.6kg. In the control group, mean change ranged from a gain of 0.9kg to a loss of 2.0kg. Weight loss in both groups declined with longer follow-up.
The second study from researchers in Canada looked at the assumption that a weight reduction of 5% to 10% was ‘clinically important.’ This is important because the economic arguments of employer weight wellness programs focus on achieving 5-10% weight loss. However, the employers do not realize that the great majority of health care costs are incurred by persons who have severe or morbid obesity. What these researchers found was that the amount of weight loss needed by persons with severe obesity was markedly higher than what conventional (i.e. behavioral) therapy can deliver. In other words, rather than a weight loss of 5-10%, persons with severe obesity need a weight loss closer to 20% for clinicallly important improvements. This amount of weight loss can only be obtained using bariatric surgery. In other words, the type of interventions usually seen in employer wellness programs are insufficient to impact the higher costs associated persons with severe obesity.
The third study is from John Cawley and colleagues. They looked at the medical cost savings that can be achieved from a given amount of weight loss by people at different BMI values. They found that the savings from a given percent reduction in BMI are greater the heavier the individual with obesity and are greater for those with diabetes than those without diabetes. In other words, savings from a given BMI will be greater the higher the starting BMI. So the savings of a given amount of weight loss is going to be greater among persons with Class 3 obesity (BMI>40) and decline through Class 2 and Class 1.
The implications of these studies for employer wellness programs focusing on weight control is that they should be focused on the heaviest individuals and bariatric surgery should be provided for in the employer’s insured benefits. Wellness programs, properly structured, may provide useful, ancillary support but cannot alone reduce the higher costs associated with higher levels of obesity.
February 10th, 2014
The Hartford Business Journal has an interesting article on employer wellness programs incorporating sensor devices in their programs. For some interesting discussion of the development of passive sensor technology in nutrition and physical, see this video from David Allison’s program at the University of Alabama, Birmingham on wearable sensors for human behavior monitoring and biofeedback from 2012.
And Al Lewis and colleagues have a new book, “Surviving Workplace Wellness with Your Dignity, Finances and Major Organs Intact”, on the problems with employer wellness programs. Read this interesting review in Forbes on the three hazards of worksite wellness programs. Meanwhile the FDA has approved two wearable fitness trackers for use in clinical trials.
January 7th, 2014
The New York Times is reporting a study of 67,000 people eligible to participate in PepsiCo’s Healthy Living wellness program. Participants were continuously involved in the program for seven years, far longer than most studies.
The study found that the part of the program designed to help people with chronic conditions through education and adherence to their medication regime (disease management) resulted in significant cost savings. However, the ‘lifestyle’ management component which addressed weight management or stress reduction resulted in no net savings at all.
The disease management reduced costs by $136 per member mainly due to a 29% reduction in hospital admissions. Lifestyle programs had no effect on health care costs. Lifestyle programs did show some drop in absenteeism but not enough to cover the costs of the program.
Perhaps this study will enlighten corporate America to the point that weight loss is complex and will not be solved by the simplistic programs they have been sold over the last dozen years. I would suggest that this study leads to another study: Use the disease management model with the administration of the FDA approved drugs for the treatment of obesity with or without lifestyle programs. This might take the best of both methods to find meaningful and sustainable weight loss.
The study is published in Health Affairs.
September 25th, 2013
New York Times’ Natasha Singer reports today that Rep. Louise M. Slaughter (D-NY) has asked the Equal Employment Opportunity Commission to investigate employer wellness programs that seek intimate health information, like Penn State’s program, and to issue guidelines preventing employers from using such programs to discriminate against workers. The EEOC held a hearing on employer wellness programs in May, 2013.