A Corporate Counsel View of Wellness Programs

As companies continue to view wellness programs as an effective means of addressing employee health and health care spending, many are exploring the creation of in-house wellness programs.  While wellness programs are beneficial – healthier employees equal reduced illness, increased productivity, reduced absenteeism, and, over time, lower insurance premiums/reserves –- creating an in-house wellness program as a means of achieving these goals is not a good idea for a variety of reasons.
 
 
 

Participation
Participation is the key to realizing a cost-savings benefit from a wellness program.  Full participation requires information about life away from the workplace.  Generally, employees are extremely wary about sharing details about their out-of-office choices, lifestyle, and habits.  They are innately suspicious about what their company or insurance provider might do with the information.  Their reticence to share this information creates an insurmountable hurdle to implementing a successful in-house program.

Capability
Chances are, you know more about how to run a business and about the particular business you’re running than you do about providing a clinically sound wellness program. 

Exposure
Driven by all the right reasons, companies can become overzealous in the information collecting aspect of implementing a wellness program and run the risk of inadvertently violating existing privacy laws.  Even inadvertent non-compliance puts them at risk of violating pertinent state and local insurance laws, and national acts such as the Health Insurance Portability and Accountability Act (HIPAA) and Americans with Disabilities Act (ADA), which include privacy protections.

The key to implementing a successful wellness program is using a third-party provider.  Third-party providers have the distance necessary to be fair and impartial, and overcome employee reticence to share the personal information key to full participation.  The challenge is identifying a qualified provider.  Here are some tips to identifying the right provider for your company.

Experience/Expertise
The third-party wellness provider should have documented evidence of providing the type of service you require.  What is their track record?  Are they able to demonstrate their ability to overcome human resistance to change?  Do they provide the services you require?  Are they clinically knowledgeable and accredited by recognized agencies?  Will they represent you in a manner consistent with your approach and culture?  It’s important that the third-party provider is skillful in addressing the issues of your employee population; a service firm with desk workers is likely to have different health issues/risks than an industrial facility with factory workers or a delivery company with drivers. 

Certification
Look for providers that have been certified by recognized regulatory bodies such as URAC (formerly Utilization Review Accreditation Commission, now acronym only) and the National Committee for Qualification Assurance (NCQA), both of which are government-sanctioned accreditation entities that qualify the soundness of a health care services provider.

Foundation
The third-party provider must be able to function independently of your organization, and have the legal understanding and support necessary to insure they won’t inadvertently run afoul of local and state laws, and/or national regulations governing employer/employee interaction.  Additionally, it’s important that they have a general sensitivity to discrimination and privacy issues.  Ultimately, the non-compliance of a third-party service provider is your company’s responsibility, and your company will be held responsible and liable for whatever penalties may be associated with that non-compliance. 

Lastly, beyond all the clinical, legal, and regulatory issues, the best way to insure successful adoption of a wellness program is management involvement.  While providing encouragement, access, and freedom to participate is important, it’s not enough.  Management cannot simply direct, it must walk like it talks and lead by example.

And, perhaps most importantly, is it working?  While not every dollar spent will reflect a dollar saved, your company must realize a cost benefit and this must be matched to the company’s bottom line.  Be sure to measure the results.

Wellness programs have proven useful in improving employee health and indirectly reduce health care spending.  While implementing a wellness program in-house may seem tempting, it’s not as easy as it may seem and it’s fraught with risk.  Even contracting with a third-party provider requires careful due diligence to eliminate risk and garner the desired outcome.