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Bosses assign a new task: Stay well

In an effort to lower costs, more employers are taking a hands-on approach to workers' health. Such efforts aren't always welcome.

November 17, 2003|Daniel Costello | Special to The Times

Mind telling your boss how much you weigh? How about explaining why you missed your last doctor's appointment? Frustrated with years of skyrocketing health costs, a growing number of employers are relying on an innovative tactic to contain them: nagging -- and sometimes arm-twisting -- employees to get healthier.

The companies are asking employees to report such things as detailed eating habits, how much alcohol they drink and if they made their last checkup or filled their prescriptions on time. Some are hiring "health coaches" to design individual health programs for employees; the coaches then call or even stop by work as often as once a month to check up on their progress. Others have begun screening for diseases themselves, offering mammograms and cardiac stress tests at work.

Although employers have for years used limited health-management tactics, such as smoking-cessation programs and discounts at local gyms, benefits experts say these expanded health programs are now entering the mainstream.

So far, most of the programs, known as health and disease management plans, are voluntary. But a small number of companies are already jumping to what may be the next step -- penalizing employees who either don't join the health-management plans or who do but fail to make enough health improvements. Others are pondering whether to ban holdout employees from the company's health insurance plan altogether.

Better managing employees' health "is an idea whose time has come," says Peter Lee, president of the Pacific Business Group on Health, a nonprofit employer coalition representing 50 employers. "Employers are realizing they can't just keep paying more and more for health care without getting at the root of the problem."

To encourage participation, employers offer everything from free prescriptions to substantial discounts on annual health insurance premiums. This year, El Segundo-based Hughes Electronics is reducing employees' health insurance premiums by $300 if they take a health-risk assessment exam and join a lifestyle management program if any health risks are identified. The city of Asheville, N.C., now pays for prescription drugs and other health costs for those with diabetes or heart disease, two of the most expensive chronic conditions, if they agree to monthly counseling sessions. In January, Marin General Hospital in California introduced employee insurance premiums of up to $1,200 a year, but is waiving them for anyone who enrolls in its extensive wellness program.

Some employees see the trend as intrusive and an invasion of their privacy. Benefits experts report significant numbers of employees are resisting the new programs, which are attracting as little as 10% of them at some firms (although participation at firms with incentives can be substantially higher). While some workers may be avoiding making lifestyle changes required by the programs, many worry that the information they provide could somehow be used against them in employment decisions.

"I think employees are rightly skeptical about their employer wanting to know all this information and are wondering just what they'll do with it," says Lewis Maltby, president of the National Workrights Institute, a workers' rights advocacy group based in Princeton, N.J. "How far will this all go? Are they now going to tell us we can't skydive? What about driving too fast?"

Some privacy experts say they fear employers could find ways to use the information punitively to control health-care costs, especially as workers become more accustomed to sharing such information. But most believe such abuses are unlikely.

A string of state and federal laws ban companies from using health information to make hiring, firing or promotion decisions. And many of these health-management programs are handled through companies' insurers or outside disease management firms, so much of the data is kept off the work site.

It also remains unclear if and how companies can penalize employees over health issues. Laws such as the Americans With Disabilities Act forbid discrimination on the basis of disability in employment, which some courts have said includes obesity and other conditions.

For their part, employers insist health and disease management is a measure of last resort. Health insurance costs continue to rise rapidly, and employers say they have little choice but to reanalyze their health-care offerings. According to a recent survey by Towers Perrin, a human-resources consultant firm, health-care costs nationally are expected to rise another 12% next year, constituting a doubling in costs since 1999.

It's also becoming clearer that the recent quick fix of simply passing insurance increases on to employees can't go on forever. Many of the recent employee strikes around the country, like those at several California supermarket chains, have focused squarely on climbing health-care costs and how much employees should bear.

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