Wellness at the Workplace: Contested Terrain

Wellness workplace programs are growing. The recent flap over CVS’ Workplace Wellness Program, brought the issue into focus. CVS is hardly alone in devising workplace wellness programs, but it offers a case study of many similar programs.

PatientPOV is pleased to host a post by Margaret W. Crane, a New York-based freelance writer specializing in health care, medicine, social policy and human rights. She offers a perspective that has not been out in much coverage of the issue. Her credits appear in the LA Times, New Politics, on abcnews.com and other websites. Crane can be reached on twitter at pegcrane.

Workplace wellness programs are nothing new. From gym discounts to on-site weight-loss programs to lunchtime workouts, many companies offer “carrots” to encourage employees to adopt healthier lifestyle choices. Financial rewards, too, can be part of the typical incentive mix.

According to a 2012 survey of 800 U.S. employers, among the 83% that offer wellness incentives, a majority rely on the carrot approach, with only 5% reporting the use of penalties—mainly health insurance premium increases—to motivate their employees to quit smoking, exercise regularly, and lose weight.

These numbers are expected to shift dramatically in the next few years. In an update of the 2012 survey slated for publication later this month, Aon Hewitt predicts

that 58% of survey respondents plan to impose penalties on employees who “do not take appropriate actions for improving their health.

At CVS, “appropriate actions” translate into two principal requirements: Employees are being asked to fill out a health questionnaire and to undergo biometric screening. Failure to comply will result in higher insurance premiums to the tune of $50 a month.

CVS Caremark’s employee wellness program has continued to generate headlines over the past several weeks, including a recent story in The New York Times. The pharmacy chain is one of a growing number of employers, including Walmart, PepsiCo, and Home Depot, who are using negative incentives to promote healthier behaviors among their employees—the start of an ominous trend.

Punishing the Victim

Most people don’t routinely share their weight, blood pressure, or BMI with their friends, much less their employers. HIPAA was designed to protect such private information, which could otherwise be used to deny coverage, services, and even employment. Even though CVS and others using these strategies claim that there is a firewall, the whole approach seems to be a slippery slope.

CVS insists that its wellness policies will help prevent employees from developing obesity- and smoking-related chronic diseases. But according to Stephen Soumerai, MD, there’s something fundamentally wrong with the entire incentives/penalties paradigm. A professor of population medicine at Harvard Medical School, Dr. Soumerai has been looking at the way negative incentives are being used to penalize hospitals with high readmission rates—a feature of healthcare reform. He finds the approach unfair, whether it’s used to incentivize improved performance on the part of doctors, hospitals, or employees.

“The literature in support of this approach is very weak,” he said. “We seem to be going in the wrong direction.” While voluntary provision of health information “could be useful in helping to identify risk groups,” the requirement to do so will most likely be met with resistance among employees. And rightly so. Why should a CVS store attendant report private information that could be used to raise his or her insurance premiums? Do patients’ rights end at the workplace?

For Their Own Good?

CVS, a chain that’s supposed to be all about promoting health, actually houses aisle after aisle of candy, snacks, and sodas: food products that are known to drive obesity, especially among lower-income families. Seen in this light, the chain’s commitment to employee wellness seems pretty specious.

You can’t dangle chips and chocolate bars in front of people all day long and then blame them for their moral turpitude when they over-indulge. How much temptation are employees, not to mention consumers, expected to resist?

It’s hard enough to bear the multiple burdens that people with obesity are made to endure, from the condition’s impact on health to its painful social and moral stigma. But when an overweight employee is forced to reveal all or face a hefty penalty, that’s cruel and unusual punishment for a non-crime.

CVS and other like-thinking employers are exacerbating the very problems that healthcare reform should be alleviating. Instead of leveling the playing field and broadening access to care, negative wellness incentives are curtailing insurance coverage for those who need it most.

Rising Costs as Rationale

Businesses point to skyrocketing healthcare costs as a major drain on the nation’s economy. It’s common knowledge that costs are continuing to soar, despite the Obama Administration’s efforts to rein them in. In the media and the public discourse, “rising costs” seem like a natural disaster rather than like a series of economic phenomena capable of being analyzed and understood. In the so-called healthcare industry, the marketplace invisibly decides costs in a way that places them beyond scrutiny.

Until costs are rendered transparent, neither businesses nor their government allies should be able to carry out unjust policies with the putative goal of reining in costs.

What’s more, employers should treat their employees like adults, not like naughty children. And anyway, if CVS Caremark is truly serious about wellness, they should prove it by losing the junk food.