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Healthy Incentives
Healthy Incentives -- Posted by tigerlilly@privacy.net.org.com on 06-10-05 10:19
Seattle Times staff reporter
Eileen Salas is 5 feet 1, weighs a disgusting 208 pounds and suffers from slight
arthritis. The 58-year-old microbiologist, a veteran of weight combat who
wants to lose 50 pounds, recently re-enrolled at Jenny Craig and joined a
gym.
"I'm tired of huffing and puffing when I go up the stairs. I'm tired of not
being able to wear certain clothes," Salas said. Most important, "I'd like
to have some more years ahead of me in good health."
Starting next year, Salas will get another compelling reason to tackle her
obesity — it could cost her hundreds of extra dollars for health insurance.
Salas is one of 13,000 King County employees who will be asked to
confidentially divulge whether they're overweight, smoke, speed while
driving or engage in other health-related vices. Those who decline to
answer, or choose not to reform, will pay higher deductibles and a bigger
share of their medical bills.
The new program, named Healthy Incentives and based on an honor system, is
designed to save money at a time of galloping health-care costs. And it's
part of a nationwide movement by public and private employers to use money
— either by giving it or taking it away — to entice workers into healthier
lifestyles.
But experts say few rigorous studies exist to show whether such incentives
or penalties lead to significant savings. And worker-rights advocates say
the practice raises serious questions about privacy and fairness.
King County Executive Ron Sims counters that employers who pay the bills
have the right to demand some cooperation.
"You have to create a reason for people to feel motivated" to get
healthier, Sims said. Right now, "we have no ability to influence
behavior."
To do that, King County will ask workers next year to fill out health-risk
surveys with height, weight, exercise levels, dietary habits and other
information. The assessment is voluntary, but not if the employee wants to
avoid the highest out-of-pocket costs.
Personal plan
To maintain their current benefit levels, employees and their spouses or
partners, but not their children, will have to follow a personal plan to
improve their health. For a smoker, for instance, that might mean enrolling
in a cessation class, or getting a nicotine replacement.
Then when Healthy Incentives coverage starts in 2007, each family will have
points to rank them in one of three levels: bronze, silver or gold.
The health survey works on an honor system; workers won't get weighed or
have their cholesterol levels checked. And the county won't see employees'
individual survey answers. The company that handles the surveys will only
report whether the employee and family is gold, silver or bronze. "The
county won't have any way of knowing if employees are lying," said Caroline
Whalen, King County's deputy administrative officer. "But it's in their
best interest to be honest."
The final benefit details are still being worked out, said Kerry Schaefer,
the county's compensation-and-benefits manager. But the cost difference
between bronze and gold levels likely will be substantial. A bronze-level
family — which opts out of the survey — may have to pay the first $1,500 of
their annual medical costs, and 20 percent of their subsequent bills. A
gold-level family — one that fully participates — might only pay $300 in
deductibles and a 10 percent co-pay, Schaefer said.
Scoring is based on the adult family member who scores lowest, so if a
worker's spouse declines the survey, the whole family will be in the bronze
level, even if the employee fully participates.
Sims said the county, which is self-insured, no longer can afford carte
blanche health care. Last year, 39,000 employees and dependents racked up
$136.7 million in claims. That was up 57 percent from 2000, while
cost-of-living raises for workers rose only 14 percent. Without changes,
total health-care costs were projected to climb to $205 million by 2009,
more than doubling in less than a decade.
Healthy Incentives is the centerpiece of a strategy to shave $40 million
from the county's benefits spending between 2007 and 2009. The effort also
includes providing a 24-hour nurse hotline and helping workers with
diabetes and other chronic conditions to better manage their health, among
other things.
King County officials expect 30 percent of employees and their partners to
opt out of the health-risk survey, putting them in the bronze level. Ten
percent are expected to earn the silver level — taking the survey but not
following the personal action plan — and 60 percent are expected to reach
the gold level.
So the county is hoping to save an estimated $18.5 million by 2009 by
having fewer claims from healthier employees, and by collecting more money
from those who won't participate.
In 2004, chronic conditions such as heart disease, obesity and emphysema
made up some of the county workers' most common medical claims. But
catastrophic events, such as premature babies and aneurysms, accounted for
some of the biggest spending.
Other employers' incentives
King County is joining a relatively small but growing list of employers who
are opting for the tough-love approach.
To cut back on expensive premature births, the meat-packing company E.A.
Miller, a subsidiary of the Colorado beef processor Swift & Co., requires
expectant mothers to attend two prenatal classes to receive insurance
coverage. In Georgia, state workers who smoke pay $40 in extra monthly
premiums.
Other companies go even further. Union Pacific railroad has been declining
to hire smokers in some states, including Washington, eliminating 22
percent of job applicants.
Impact questioned
Still, little research has measured whether such incentives or penalties
produce differences in health-care costs, said Meredith Rosenthal,
assistant professor of health economics and policy at Harvard's School of
Public Health. Wellness programs tend to attract motivated workers who may
already be fit. And it could take years for any savings to materialize from
such efforts as controlling blood pressure or lowering bad cholesterol
levels, Rosenthal said.
King County's efforts "may be a good thing for public health, but not all
employers will see the payoff in the short term," Rosenthal said.
Even so, unions for county workers say they support rewarding personal
responsibility. Dustin Frederick, business manager for the Service
Employees International Union Local 519, contends that Healthy Incentives
is a more democratic health plan.
"If you are unhealthy and you don't want to make any effort whatsoever, you
still get the same benefits, but you have to pay more," said Frederick,
whose union represents 911 dispatchers, jail employees and others.
King County workers currently pay no monthly premiums for health insurance
and that will not change. Frederick said his union supports anything that
would keep insurance affordable.
Kam Man, an office technician at county-owned Boeing Field, said she's OK
with King County applying a little pressure on workers.
"It's unfair that people smoke, drink and eat, and end up in the hospital
and they use up all the insurance," said Man, who has worked for the county
for 25 years. "Everyone should be responsible for their health. Not just
for the medical insurance, but for your own good."
Sims stresses that the county will reward effort, not results. So smokers
who can't quit, or dieters who can't shed weight, will still earn points if
they keep trying.
"Folks, relax. We're not in the punishment business," said Sims, who admits
to a weakness for peanut butter and jelly and says his weight is not as low
as his doctor would like it to be.
But Lewis Maltby, founder of the National Workrights Institute of
Princeton, N.J., a workplace human-rights group, argued that socking
smokers with higher fees, for example, is inequitable unless companies can
show an actual financial basis for it.
"A surcharge is only fair if it represents actual cost to the employer,"
said Maltby. Trouble is that most employers "pull a figure out of thin
air."
Maltby also disputed the county's assertions that workers can choose not to
disclose their health status.
"A voluntary program with a penalty attached isn't really voluntary,"
Maltby said. "Asking people about their private behavior, unrelated to
their jobs, because of health-care costs is a practice that could easily
become intrusive."
Salas, the microbiologist who works for Public Health — Seattle & King
County, worries that she and others like her may end up getting penalized
despite their best efforts. Salas says she doesn't need her employer to be
reminded that she has to shape up. People's health struggles ought to
remain private matters, she said.
"So many people that are obese have been that way for a long time," Salas
said. "It worries me that they might be able to legislate what you do."
Kyung Song: 206-464-2423 or ksong@seattletimes.com
Re: Healthy Incentives -- Posted by Lady Veteran on 06-10-05 21:01
-----BEGIN PGP SIGNED MESSAGE-----
Hash: SHA1
On Fri, 10 Jun 2005 10:19:47 -0700, wrote:
>Seattle Times staff reporter
>
>
>Eileen Salas is 5 feet 1, weighs a disgusting 208 pounds
You are just like a piece of shit that won't flush.
LV
- ------------------------------------------------------
I rode a tank and held a General's rank
When the blitzkrieg raged and the bodies stank
- - - - Rolling Stones - Sympathy for the Devil
- ----------------------------------------
Today's mighty oak is yesterdays nut that held its ground.
- - -unknown
- ----------------------------------------
You are your greatest obstacle.
- - - unknown
- ----------------------------------------
If you are reading this in a group where the message
is cross-posted into more than three groups and subject is being fat,
it means the idiot who started this thread is trolling
me or soc.support.fat-acceptance and I flamed his ass.
I consider the idiots I flame a waste of humanity
and deserving of all of the ill treatment I can
hand them. Idiots who ridicule fat people are worse
then vermin as far as I am concerned. If you don't
want to read my responses, trim the groups to where you want
he message to go and you will not hear from me.Otherwise,
your eyes will burn from the venom in my reply.
- ----------------------------------------
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