Employer wellness programs are on the rise. In 2009, according to The Wall Street Journal, 57% of employers used incentives to coax employees into participating in health assessments and other preventive activities. Now that number is up to 86%. As evidenced by this explosive growth, companies are willing to try just about anything to curb ever-increasing health care costs. The idea? Joel Shalowitz, a clinical professor of management and strategy at the Kellogg School, explains that theoretically employers can lower health costs “by gathering data and anticipating health care problems by identifying certain profiles of high-risk patients.”
But Shalowitz, who has studied the health industry extensively, fears that the challenges posed by wellness programs may well overwhelm their potential benefits. Indeed, if the recent rebellion displayed by employees of Penn State University is any indication—employees were asked to stomach annual surcharges of $1200 unless they submitted to online wellness questionnaires, physical exams, and biometric screenings—concerns are only growing.
A Matter of Privacy and Efficacy
For one, there is the little issue of privacy. Employees may not feel comfortable answering sensitive health-related questions from anyone but their doctors. Sure, HIPAA stipulates how medical information can be used—disallowing, for instance, the transfer of protected information to outside parties, including most employers. But as recent security breaches across all industries have demonstrated, the chasm between aiming to protect data and actually protecting it is discouragingly vast.
A related problem, says Shalowitz, is that of intrusion. Once an insurer identifies high-risk patients, how will it funnel them into the all-important preventive services? Call them on the telephone? Send them letters or emails? Employees may feel harassed, or even bullied.
Finally, the efficacy of these preventative services is not at all clear. Most programs are rather toothless, as people generally can’t be forced to change unhealthy behaviors—and, under the Affordable Care Act, can only be penalized to a limited degree. And even if an employee is willing to make changes, there’s still no guarantee her efforts will prove successful. “You follow the recommendations, do what you’re supposed to do, and what’s the evidence that these things actually work?” asks Shalowitz. “The evidence is very spotty. There are some programs that work in some places, but it is not the same as saying, ‘If you do this you will get better.’”
Making It Work
Still, if companies are committed to implementing wellness programs, says Shalowitz, there are right ways to do so, and there are wrong ways. Penn State’s problem, he says, “is not necessarily what they did but how they did it.” It was, in fact, “very typical of what not to do. You have to involve the people who are going to change their behavior. This is like Psych 101.”
So what works? Not threats or arguments, but peer pressure. “Campaigns about paying taxes don’t work. What works is saying, ‘Did you know that 98% of your neighbors pay their full share of taxes on time?'” says Shalowitz. The key is to establish the normalcy of healthy behaviors, “and then put peer pressure on top of that.”
And it isn’t enough to wield sticks or carrots to enact permanent health changes. Companies would be wise to consider also altering the underlying stimuli that lead us to behave unhealthily. Consider what causes us to reach for that donut or cigarette. “Instead of taking a smoking break, what could you do? You could pair up with someone and go take a walk,” says Shalowitz, “because the stimulus is taking a break: something pleasurable and relaxing.”
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