“It is true that for incentive-based programs to work, they need to do more than encourage completion of a 15-minute health risk assessment,” he wrote. “Programs need to apply behavior change theory to engage people in the task of taking better care of their health. They need to convince them that a healthy lifestyle is not just about earning a financial reward—but rather a path to feeling better, experiencing a better quality of life, having more energy, and generally improving their well-being.”
Virgin Pulse, a workplace-wellness vendor, says they agree with the Rand study, but they contend that most programs’ failure is in their execution. While many programs offer biometric screenings and health assessments in an effort to get employees to “know their numbers,” Virgin says the trick is to build in activities, like walking contests or even sleep tracking. In Virgin’s view, employees can, say, use Fitbits to track their steps each day and use their progress to earn rewards, such as gift cards—or, yes, discounts on their health insurance.
“We’re not simply trying to get the sick to behave better,” Ron Hildebrandt, Virgin Pulse’s vice president of product, told me. “We assume that everyone can be a better version of themselves and give them the means to do so.”
But Hildebrandt also said he usually centers his pitch to CEOs on how Virgin Pulse can help make offices more fun and engaged, rather than on the program’s money-saving potential.
With healthcare costs climbing and large companies mandated to offer health coverage under Obamacare, it’s understandable that CEOs would like employees who go to the doctor as infrequently as possible. But the debate over wellness programs raises a deeper issue rooted in the fact that health benefits are still largely tied to one’s job: Just how involved should a company be in the private lives of each worker?
Henry Ford famously spied on his employees at home to ensure they were living virtuously and thus were eligible for a $2.66-a-day bonus. Today’s programs are far less creepy (thankfully), but they still come with hairy work/life division issues:
“If you're requiring an employee to get a sign-off from a doctor [to receive their health insurance discount], you're asking a doctor to sign off on how much to pay an employee for their job,” Horwitz told me. “Is that a breach of fiduciary duty to the patient? Are you encouraging the patient to lie to the doctor?”
Or, could the employer extrapolate the health impacts of various lifestyle choices even further? For example, as Horwitz speculated, somewhat sarcastically, in Health Affairs: People without children have more time to exercise, and “aren’t held hostage to the culinary tastes of toddlers so can eat kale, and aren’t exposed to all the illnesses of the schoolyard. Is the employer justified in telling its employees to not have children?”
Luckily, we don’t live in a post-apocalyptic hell, so that won’t happen. But the fact that something as seemingly innocuous as office-wide Fitbit tracking has grown so controversial is a word of warning for employers who seek Patagonia-level fitness among their own workers.