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Apr 3, 2013

Last month I shared a story on health care costs titled The Bitter Pill.

That might’ve been what CVS felt they swallowed when they saw their name splashed across the virtual front pages of Fox News, The Huffington Post, The Today Show, The Washington Post, and The Boston Herald, who “broke the story” about a CVS health care surcharge. CVS, these stories reported, plans to fine employees $600 a pop if they don’t get a health screening that collects height, weight, body fat, and cholesterol levels.

I use quotations because there was no story to break. CVS was tying a penalty to inaction, an approach taken by a considerable number of employers today, with more to come this year and next. At least the reporting on the surcharge was accurate.

Getting employees to have “more skin in the game”

CVS was also slammed for their intention to force employees to reveal private health information. This misleading information left individuals seriously concerned. I received tweets from friends asking whether or not this was legit.

It’s not. What CVS is doing with their surcharge and how they are collecting this data is common practice. If you look at the 18th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care, you’ll find:

  • 37 percent of companies structure employee contributions based on employees taking specific steps (e.g., health assessments).
  • 36 percent plan to use penalties in 2014 for individuals not completing requirements of health management programs.
  • 54 percent percent require employees to complete a health risk appraisal/biometric screening to be eligible for financial incentives.

Getting employees to make healthy choices

The Towers Watson/NBGH study and the others that paint the same story are depicting a world where employers increasingly demand more “skin in the game” from employees.

That “skin” is going to come in the form of choices — choices each employee must make. Do I shop around for cheaper health alternatives or run down my health savings account sooner? Do I lose weight or pay more? Do I quit smoking or lose my job?

We really don’t know yet whether these choices will pay off for the individual or the employer. There’s a lack of research on the effectiveness of outcomes-based wellness. This lack of research is behind the concerns expressed by the American Heart Association, HERO, and the American Cancer Society; primarily the concern that these requirements will reap negative — not healthy — outcomes.

But from the employers’ perspective, you can well imagine their urgency. Facing spiraling costs and employees bedeviled by the difficulty of swapping less healthy habits for healthier ones, employers are moving ahead with new tactics. Like it or not.

This doesn’t mean we should approach this shift with a big shrug. Companies moving in this direction need to pay more attention to how they implement and communicate these changes.

As the CVS tale shows, misunderstanding can be the most bitter pill of all.

This was originally published in April’s Work. Health. Communication. newsletter.

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