By SUSANNAH LEVINE, a freelance writer with 25 years of experience writing and editing for trade publications.
CVS Caremark's new policy of fining employees who fail to report biometric data has raised some eyebrows as well as questions about the legality and effectiveness of the program.
Starting in July, CVS plans to fine nearly 200,000 employees $50 per month if they fail to report their weight, body fat, blood pressure and glucose levels to WebMD, a third-party administrator. CVS pays for the screenings, which are available at CVS's MinuteClinics in more than 600 stores and its corporate headquarters in Woonsocket, R.I. Employees can also take the tests at their own doctor's offices. The fines only apply to employees with company health insurance.
The program's purpose is to "encourage your health and well-being in a way that respects your privacy," wrote Lisa Bisaccia, CVS's chief human resources officer in a letter to employees on the company's website.
But the approach is rare. Of the 83 percent of companies that offer wellness programs, only 5 percent impose penalties for non-compliance, according to Aon Hewitt.
Employers that use penalties in wellness programs often draw particular ire, both on effectiveness and legal grounds. Patient Privacy Rights founder Dr. Deborah Peel minces no words.
"The assumption that chronic diseases such as diabetes and high blood pressure are a consequence of bad lifestyle choices is simplistic and appealing, but it's wrong," she said. "The program ignores genetics, the price and availability of healthy foods, unhealthy working conditions and lack of time," all of which may dictate the exercise regimens and grocery lists of low-wage earners.
In addition to faulty program design, Peel said the CVS wellness program raises legal questions.
"It's coercive because $600 [per year] is a lot of money if you earn minimum wage, and it violates Americans' strong legal protections on their health information," she said.
Punishment fails as a behavior modification tool, said Bruce Elliot, manager of compensation and benefits at the Society for Human Resource Management. When designing his own company's wellness campaign, he "ran as far and as fast" as he could from punitive penalties.
Instead, he favors "know-your-numbers" campaigns, in which top management is fully involved.
"You start creating a culture around wellness, where you sponsor exercise programs and charge less for a salad in the company cafeteria than a loaded pizza slice."
But some studies suggest that the stick works better than the carrot. After all, the Nobel Prize-winning Prospect Theory says most people value losses more than they value gains.
"The fear of loss is very effective at changing behavior," said François de Brantes, executive director of Health Care Incentives Improvement Institute. He predicts a CVS compliance rate near 95 percent.
"CVS isn't punishing employees for a lifestyle behavior that's hard to change," he said. "It's creating a potential loss of $600 for employees who don't complete an administrative task."
But while the fear of financial penalties might produce compliance with the administrative task, they may not produce long-term behavioral changes, such as weight loss or smoking cessation, said Jeffrey Kullgren, an assistant professor of internal medicine at the University of Michigan Medical School.
"We found financial incentives are much more successful for a sustained period when awards are based on a group's performance," Kullgren said.
CVS continues to defend its policy and said that it is not aware of any lawsuits related to it, according to Mike DeAngelis, CVS's director of public relations.
The company points out that it will never see the biometric data entrusted to WebMD, and HIPAA laws protect the data's use and dissemination.
Still, the detractors have their doubts. But Peel said that, historically, health data is sometimes used for other purposes, like making hiring and promotional decisions. Meanwhile, Elliot said potential legal conflicts could arise under the Privacy and Protection Act, Americans with Disabilities Act, and Title VII of the Civil Rights Act.
"If the data were used to create a separate class of employees who were treated punitively," he said, "that would be discriminatory."
April 16, 2013
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