IMPROVING health while holding down health care costs is the kind of having-your-cake-and-eating-it combination that most people can get behind. In fact, both ideas are embedded in the Obama administration’s Affordable Care Act. But an uprising among faculty members at Pennsylvania State University over a new employee wellness plan is challenging at least some of the methods designed to achieve those aims.
Penn State administrators quietly introduced the plan, called “Take Care of Your Health,” this summer in the deadest part of the academic calendar. But that didn’t prevent some conscientious objectors from organizing a protest online and on their campuses, culminating last week in an emotionally charged faculty senate meeting. The plan, they argued, is coercive, punitive and invades university employees’ privacy.
The plan requires nonunion employees, like professors and clerical staff members, to visit their doctors for a checkup, undergo several biometric tests and submit to an extensive online health risk questionnaire that asks, among other questions, whether they have recently had problems with a co-worker, a supervisor or a divorce. If they don’t fill out the form, $100 a month will be deducted from their pay for noncompliance. Employees who do participate will receive detailed feedback on how to address their health issues.
At a university where some employees earn less than $50,000 annually, the faculty members contended that an $1,200 annual surcharge for nonparticipation — or $2,400 if the employee has a spouse or domestic partner on the school’s plan when that person has the option of coverage from his or her own employer — amounted to a strong-arm tactic. What’s more, they argued, the online questionnaire required them to give intimate information about their medical history, finances, marital status and job-related stress to an outside company, WebMD Health Services, a health management firm that operates separately from the popular consumer site, WebMD.com.
“You can’t force people to disclose the state of their marriage or fine them $100 a month. That’s just wrong,” Matthew C. Woessner, an associate professor of political science at the university’s Harrisburg campus, told me. “There are ways to have a veneer of wellness without coercing people to hand over their private information to third parties.”
AS medical costs skyrocket, employers who subsidize health coverage are increasingly turning to wellness plans. The theory is that making employees aware of their own health risks could lead them to, say, eat better or exercise more, hindering diseases like diabetes from progressing to stages that are more expensive to treat.
Susan Basso, vice president for human resources at Penn State, said it adopted the wellness program in an effort to slow double-digit annual growth in health expenditures. Penn State is self-insured, meaning that it directly covers the health care costs of about 40,000 employees, spouses and dependents, at an estimated cost this fiscal year of $217 million. The new plan is projected to hold cost increases to 5 percent in 2014, she said, ultimately saving $62.9 million over the next five years.
“What we are telling faculty is that the status quo is not an option,” Ms. Basso told me last Wednesday.
The wellness trend is likely to grow. Scheduled to take effect next January, the wellness rules for the Affordable Care Act allow companies to offer a reward of up to 30 percent of health coverage costs for employees who complete a participatory program like a health risk assessment, or biometric tests like waist measurement.
Now the Penn State uprising is challenging the wellness industry’s data collection practices and the nature of the inducements that employers may use to prod employees to participate.
“The tensions between having employers manage health care coverage and employees wanting to have some private space are crashing into each other,” says Matthew T. Bodie, a professor of labor and employment law at the St. Louis University School of Law. “It’s probably going to get worse.”
Many employers — 36 percent of large companies with wellness programs — use financial incentives to nudge employees to participate, according to a new study by the Kaiser Family Foundation. But Penn State’s plan differs from many in that uses a stick, not a carrot, to sway employee behavior.
“They could have said, ‘Here are the medical costs if you participate and here are the costs if you don’t,’ instead of saying, ‘We’ll dock your pay,’ ” says Michael O’Donnell, the director of the Health Management Research Center at the University of Michigan.
Penn State, Ms. Basso says, did consider alternate ways of introducing a cost-containment strategy — like artificially inflating employees’ premiums by 35 percent and then offering a discount to those willing to participate in the wellness program. But administrators felt that the $100 surcharge was more transparent. “It was an intentional design to drive participation,” Ms. Basso says, “and it is driving participation.”
Anna Silberman, vice president for clinical client relations at Highmark Health Services, which administers Penn State’s health care claims and recommended the wellness program, said the Penn State surcharge fell well within industry norms.
The Penn State questionnaire asks whether employees have recently had problems with a supervisor, a separation or a divorce, their finances or a fear of job loss; another question asks female employees whether they plan to become pregnant over the next year. Although the form requires employees to answer these intimate questions, Highmark officials said the data was protected by the federal Health Insurance Portability and Accountability Act, which controls how health plans disclose protected employee health information to employers.
“That information is absolutely private,” Michael Fiaschetti, Highmark’s president for health markets, said at the Penn State faculty senate meeting. He added: “We have never leaked that information.”
That in no way reassured Kimberly Blockett, one of more than 200 faculty members attending the meeting.
“As an English professor, I think I am having difficulty with your definition of ‘private,’ ” Ms. Blockett responded to Mr. Fiaschetti. “For me, discussing my reproductive plans with an unknown entity at an insurance company does not constitute private.”
The reaction may have caught Penn State by surprise, because administrators did not extensively examine the WebMD program before signing up for it. When I asked Ms. Basso who at the university had reviewed the questionnaire for scientific validity and ethical propriety, she said: “We have a relationship with Highmark. This is their tool. If we were going to use a health risk assessment, it was going to be theirs.”
Because universities have generally lagged behind corporations in adopting wellness programs, the objections of some faculty members may well be explained by the shock of the new, says Ms. Silberman at Highmark. “This is the first time we have experienced this kind of resistance,” she told me.
But faculty members offered a different explanation.
James M. Ruiz, an associate professor of criminal justice and a retired police officer, told me that he objected because he felt Penn State had failed to do basic due diligence, signing off on the wellness plan without using the rigorous scientific methods that faculty members routinely require of students. He has urged the faculty senate council, of which he is a member, to ask the university to delay the program for one year so that administrators may consult outside experts on wellness plan efficacy, data security and privacy.
“Convince people this is necessary and ethical,” Mr. Ruiz said, “and this protest will evaporate instantly.”