Workplace wellness programs seem poised for takeoff, and yet there are still many questions about whether they can truly improve patients’ health and if they will do enough to include physicians as partners, or just add to the ever-growing administrative burden.
The programs have been gaining popularity over the years, especially with large employers. An estimated half to three-quarters now offer some type of wellness program. The typical – and most common – program offers the employee a small reward – cash or otherwise – to fill out a health risk assessment survey or be screened for diabetes or high blood pressure, for instance, or to participate in a self-help or educational program. Less common are programs that offer incentives for, say, getting blood pressure to a certain target. Used even less often are penalties for failure to participate at all or to reach certain goals.
Physician groups like the American College of Physicians have seen some merit in the programs. But there are concerns about potential downsides, too, said Dr. Molly Cooke, president of the American College of Physicians (ACP). Among them: the potential for discrimination against workers who can’t meet the standards. These workers might be disadvantaged by genetics, socioeconomic status, or a medical condition, Dr. Cooke said in an interview.
Courtesy ACP
Dr. Molly Cooke
The ACP is also concerned about the carrot-and-stick philosophy being used more frequently by wellness programs. "The ACP generally prefers an approach that rewards people for being healthy as opposed to penalizing them for doing things that are unhealthy," said Dr. Cooke, who is also a professor of medicine at the University of California, San Francisco.
Dr. Reid Blackwelder, president-elect of the American Academy of Physicians, agreed. "We’d rather see employers incentivize healthy choices," he said in an interview.
"Incentives can be an effective way to motivate some employees to participate in workplace wellness programs and to begin behavior changes," said Larry Hausner, CEO of the American Diabetes Association, in a statement in July 2012. "If not implemented carefully, however, incentives can also operate as penalties – imposing financial or other burdens on employees which may be counterproductive," he said.
The ADA, along with the Health Enhancement Research Organization, American College of Occupational and Environmental Medicine, American Cancer Society, American Cancer Society Cancer Action Network (ACS CAN), and American Heart Association, issued guidelines for the programs, with the aim of protecting workers.
It’s also not clear that just offering incentives will somehow get people to change their lifestyles, said Dr. Cooke.
The programs are premised on the idea that workers aren’t sufficiently motivated, she said. But years of caring for patients who have unhealthy lifestyles have taught her that "the real issue is as simple as that they just haven’t gotten with the program yet."
Dr. Cooke said that charging patients an additional $25 or so a month for their health insurance if they don’t lose weight "may not be that powerful an additional factor for a lot of people who already recognize the complications in their lives."
Another issue: whether the physician will become an integral part of the process of improving the employee’s health. A key step would be for employers to create a connection with family physicians in the community, said Dr. Blackwelder. With wellness programs, "there’s a potential to fragment care further," he said.
Dr. Reid Blackwelder
The American College of Cardiology sees wellness programs as an opportunity, said Dr. Joanne Foody, chief medical expert for the ACC’s CardioSmart@Work program. "The workplace is a logical place for us to address cardiovascular disease and stroke prevention," said Dr. Foody, who is also the medical director of the Cardiovascular Wellness Service at Brigham and Women’s Hospital, Boston.
CardioSmart@Work builds on the ACC’s CardioSmart program. Started in 2008, CardioSmart offers patients and physicians tools to manage heart disease, primarily through a website. This year, the ACC partnered with INTERVENT, a Savannah, Ga.–based disease management company, to join the CardioSmart tools with INTERVENT’s work-site wellness programs. Now the ACC’s imprimatur is on programs offered to at least one major employer, and several others. CardioSmart@Work aims to eventually expand to help physicians steer patients to the wellness programs.
The Obama administration is also giving its backing to wellness programs – specifically encouraging them in the Affordable Care Act. The workplace programs have been regulated by a hodgepodge of rules from a variety of federal agencies. They must comply with federal and state laws, including the Americans with Disabilities Act of 1990 (ACA), the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA).