Employers Roll Out Aggressive Wellness Programs

Example 1: If you were to 'pressure' your asthmatic employee' to be compliant to their inhaler, you'd realize that you also put them at risk for the conditions that are listed as side effects, perhaps osteoporosis. Now, let's say that this employee takes the inhaler daily like their PBM contracted, that their employer put in the benefit design with input from their health plan and now their doctor is forced to make a choice based on all of that, but has patient with a family risk of osteoporosis, who is at fault for this outcome? Who should bear the risk of the side effect of the medicine that results in this outcome? How should that decision process really flow?

Example 2: Employee with hereditary high cholesterol or depression is 'forced' to take medication to reach their HRA 'parameters', and they gain weight (a known side effect of many of these drugs). Who is responsible? How much can this employee really do about this weight gain, which is medication induced? Years ago the theory was that patients can control their cholesterol by eating right and exercising. What no one knew until later, was that only 10-15% of that cholesterol risk could be modified by what they did. Only after a pharmaceutical company came along and pointed that out, were patients and their employer privy to that information, but it would have been too late for these employees and this employer.

Where do we draw the line? Finally, when will we realize that medicine is not perfect, and what we don't know today, if imposed too heavily on patients, can harm them today and later. While I understand the rationale and financial desperation many face, health and wellness is very individualized and in many cases, there are negative outcomes to today's 'desired' financial outcomes. While including individuals in the planning of their care is obviously important, mid-to-longer term healthcare cost management will not occur by pressuring individuals who are not skilled in healthcare (e.g. employee). We really need to focus on the inputs to our healthcare system, and putting control back into the clinician's hands with a new set of operating tools and systems to support their decision-making in collaboration with their patient. At the moment, these healthcare providers are not given cutting edge tools with which to enable the back and forth transmission of information through the patient, no matter which health plan, which pharmacy, which provider, which hospital, or employer they choose to visit. Penalizing employee or patient is not the key to the bottom line. Employees are just the most accessible. Let's put healthcare decisions back in the hands of people who are trained, and place expectations on all of those who benefit from the patient's dollars to spend their money improving the system for the patient (e.g. everyone who derives financial and other value from the work that healthy people do).

Donna of PA 9:25AM March 13, 2011