Mandatory health coaching is sometimes the ‘price’ for lower-cost health coverage

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    As workplace wellness programs become more popular, some employees are having second thoughts about the bargain they’ve made.

    The evidence is mixed on whether they work, but many employers have bought into the idea that wellness programs can slow disease and save money. In a typical plan design, employees agree to do certain health-related activities, or reveal certain things about their health—in exchange–for deeply discounted benefits.

    Companies commonly ask workers to fill out a health-risk survey—and some workplaces collect or monitor basic medical information such as blood pressure, cholesterol or tobacco use.

    72-year-old Sally Mirick filled out her health assessment earlier this year. She says she was completely honest about her habits, stress and emotions.

    Mirick walks her beagles two hours every day in the woods around her home. She’s been Jazzercising for 25 years and says she’s “disgustingly healthy” for her age.

    “I told them I was taking an antidepressant; I told them I smoked 50 years ago,” the slim Bucks County resident said.

    Mirick says one of the final survey questions asked if there was ‘anything else’ she could work on.

    It felt arrogant to say ‘no,’ she says. So even though she calls herself an ‘almost vegetarian,’ Mirick indicated that she could eat more fruits and vegetable each week.

    “I really think that that’s what flagged me, but if that’s what they are using, that’s entrapment,” Mirick said. “I mean it’s ridiculous.”

    Soon after her wellness assessment was complete, the insurance plan notified Mirick that she had to enroll in telephone health coaching in order to keep her lower-cost coverage.

    Now she’s scouring her health plan agreement looking for a way to get out of the mandatory coaching.

    Mirick gets her insurance through her husband’s job in Tennessee. The State Group Insurance Program designed the Partnership Promise program and hired the vendor Healthways to run the wellness program.

    On average, a single person can save $600 in premiums and co-payments each year by agreeing to the wellness partnership, according to the plan’s public information officer Joan Williams. Typical savings for a family is $1,100.

    To protect privacy, Williams won’t talk about Sally Mirick’s specific situation. But she says, in general, people can be selected for coaching for different reasons.

    “This includes responses to the wellbeing assessment, which is an online questionnaire, biometrics and lab data as well as medical, pharmacy claims,” Williams said.

    One severe health risk, such as smoking or obesity, can lead to required coaching. A combination of moderate risks such as depression, stress, high total cholesterol, or high blood pressure can lead to coaching too.

    When the program representative reviewed Mirick’s case, she says she was told she has to continue health coaching because her total cholesterol is high and because she takes depression medication.

    Mirick counters that she scored a 96 on her overall wellness assessment—and says her mood is good these days.

    “My job, my friends, my environment, my happiness level is very high. They don’t want to hear about the context of it,” Mirick said.

    “I think preventive health is great, and coaching can be great, but I am not a case for this,” Mirick said. “This is a scam as far as I’m concerned.”

    Mirick says Healthways, the company managing the wellness program, is misinterpreting her medical information. Plus, she’s convinced Healthways selected her and other ‘healthy’ people for coaching to sign on more clients.

    State Plan spokeswoman Joan Williams says plan members with low health risks are not tapped for coaching.

    Healthways is paid per active member per month, she said. That payment is linked to health outcomes such as getting people to lose weight, avoid unnecessary hospital visits and take their prescription medicines.

    The state health plan in Tennessee is facing rising health care costs similar to many other large employers—especially those that are self-insured. When an employer is ‘self insured’ the company pays the health care costs for its covered population—instead of having an insurance company manage the financial risk.

    “Currently, 45 percent of our Partnership PPO members are obese, 24,000 plan members are pre-diabetic, so we are doing what we think we need to do to try to address these challenges with our plan,” Williams said.

    The number of employers who are establishing workplace wellness programs is growing, and the Health Enhancement Research Organization offers a guide.

    This is the third year of the Tennessee program. The plan has also gathered many satisfied testimonials from workers, Williams said. An evaluation is underway.

    Early results show high rates of PPO members getting cancer screening tests, taking medicines as prescribed and monitoring their blood sugar, Williams said.

    Members in the Partnership PPO (who are required to join the wellness program and keep certain health ‘promises’) have higher preventive screening rates compared to people enrolled in the group’s other health plan options, she said.

    Skeptics say that can be a misleading benchmark of success because healthier workers are more likely to sign on to wellness programs and be more willing to fill out probing health surveys.

    Among the plan options available, Williams says most members choose the wellness program option with the lower-priced coverage.

    As for Sally Mirick, she said she might drop her husband’s workplace coverage to make Medicare her primary insurance.

    It’s a move that would be cheaper for her former health plan.

    Al Lewis says there’s plenty of evidence that workplace wellness program don’t work.

    “There’s a negative return on investment,” said Lewis. He monitors industry claims on his blog

    Lewis’ book is called “Surviving Workplace Wellness” … With Your Dignity, Finances and (Major) Organs Intact.” He’s CEO of Quizzify, a health-benefits education company and vocal critic of workplace wellness companies.

    “Pry, poke, prod and punish, is what they do,” Lewis said.

    Workplace wellness surveys are a common tool but often are poorly designed, or the programs are overzealous and don’t follow recognized preventive-health recommendations, he said. A favorite example is from a fight that happened back in 2013 at Penn State University.

    “Among other things, if you were a woman, they asked you what your plans were to become pregnant, and if you didn’t tell, it cost you 12 hundred dollars,” Lewis said. He says workers were required to fill out the entire wellbeing assessment to qualify for benefits savings.

    “And by the way, it’s a completely useless piece of information because the problem pregnancies aren’t amongst the people who plan, it’s going to be amongst the people who don’t plan.”

    Eventually the university dramatically scaled back its wellness program. But still there’s lots of debate, and questions come up all the time about what’s allowed. Recently, the Equal Employment Opportunity Commission tried to clarify the rules. Regulators suggest that a wellness program is voluntary as long as the reward—or penalty—is not greater than 30 percent of the cost of the worker’s insurance.

    “There’s nothing in my mind that’s fundamentally wrong with those programs,” said David Asch, a physician and policy researcher at The Wharton School at the University of Pennsylvania.

    “Even if you are a patient with a chronic illness you might be in front of a physician a couple hours a year, but you spend the other 5,000 waking hours a year living your life,” he said.

    Health is ultimately determined in those other 5,000 hours, he says, and doctors and hospitals can’t be the only ones working to make Americans healthier. So now the government and the health system are looking for ways to enlist family, friends, churches, schools, and workplaces in the push to improve health.

    Still, Asch understands the hesitancy to participate in workplaces wellness.

    “You don’t normally think, well gee, I’ve got a problem with my health, I’ll just walk down to my neighborhood, friendly HR director and ask for help,” he said.

    While wellness programs continue to be popular, a lot has been made of the studies that find a negative return on investment for employers.

    Asch says it’s true that investments in worker health today may not pay off quickly. Problems like obesity and smoking are hard to fix, and can take a long time—or many attempts to improve. Encouraging workers to do things now that could prevent a stroke later—may turn out to benefit the worker’s next employer, he said.

    Asch says it’s important to count up other kinds of ROI. He says companies with a workplace wellness plan reveal themselves as someone who cares and attract workers who are healthier to begin with.

    Asch’s big complaint about workplace wellness is that many programs could be designed better.

    He wants to “‘supercharge and increase the potency of incentives” offered at work.

    Most health-incentive plans discount the price of a worker’s insurance coverage, but Asch says a typical $500 savings gets spread out over the year and buried, hardly noticed in a bi-weekly payment stub.

    He favors more instant payoffs to motivate workers.

    “It’s quite possible, that if my employer–just right on the spot–handed me a $200 gift card, which by the way would cost them less than the $500 discount on the premium, I might think ‘wowy zowy this is real money I could go take this and use it effectively,'” said Asch, he’s director of the university’s Center for Health Care Innovation.

    There’s a rule in health behavior economics: “If you aren’t aware of the incentive, it can’t be effective.”

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