One of the most significant debates about wellness programs has been what works best, the carrot or the stick.  Can you increase wellness amongst a population by providing incentives to employees to watch their health risk factors, or is it better to punish them for not getting healthy?

The July 8 edition of the Wall Street Journal Online has an interesting article about the efforts of AmeriGas to increase employee participation in its “voluntary” wellness program.  Workers were given 1 year to complete various physicals, which were covered at 100%, or risk losing their health insurance.  The article goes on to discuss the anecdotal results of employees who discovered poor health as a result of the tests and were encouraged to get healthier.

Obviously the “complete the tests or lose coverage” sounds like a big stick.  But ultimately the wellness program still ends up relying on employees wanting to get healthier after hearing their tests results.  AmeriGas did not tell employees they would lose coverage if they had bad test results, which is a significantly different stick.  I have talked in the past about the difficulty of requiring employees to get health or face higher premiums.  I have also talked about the possibility of using a reduction in premiums for employee who do get healthier, through things like smoking cessation incentives, weight loss incentives and the like.  The AmeriGas approach presents a third option, forcing them to get tested so at least they can see what they need to fix.

The recent congressional efforts to address nationalized health care have wellness components as part of the focus.  The problem will be if employers take this effort too far and start to discriminate against workers based on health conditions.  Any employer thinking about implementing any type of wellness program, be it increased premiums, decreased premiums or mandatory testing, must take into consideration the discrimination laws of the state in which it operates.  States vary considerably in their definition of “protected classes” for disability purposes.  Mandating a particular lifestyle could subject employers to claims of discrimination depending on the steps taken.

The article about AmeriGas makes it a point that the actions of the employer were carefully vetted between its legal department and its benefits administrator.  Consideration was given to medical privacy laws as well as employment relations issues.  And apparently the jury remains out on whether the program is actually working to curtail costs.  Still, it is a step taken in what they believe is the right direction.  My caution to employers thinking about taking a similar step is to make sure they do just what AmeriGas did: discuss, consult, get legal advice and guidance, don’t do anything on the spur of the moment.  Implementing any wellness program without good analysis before hand can cause more problems than it solves.


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