Wellness Programs - Incentive or Violation of Privacy

[MatrixRn]

I find this topic interesting.

As a nurse I absolutely see the value of Wellness programs, and preventative medicine. If we are able to coach or give incentives to enhance wellness then intuitively it seems we will save money and people's health down the road.

However, to implement such plans the insurers must dig into people's private lives.

A way to strike a balance would be ideal.

According to this article:

"Under the proposed rule, a wellness program is considered voluntary if employees aren't required to participate, it doesn't deny or limit health insurance coverage if people don't participate, and it doesn't retaliate against or otherwise interfere with employees who don't participate."

EEOC Proposal On Wellness Program Earns Business Praise, Consumer Concerns | Kaiser Health News

[ixchel]

My insurance company contracted with Healthways a couple of years ago. I have chronic conditions, so when I got my first letter from them, I was curious enough to research them. Their website was directed toward recruiting insurers as clients, bragging about how much they had saved their other insurance company clients. I chose not to respond to their letters and phone calls.

The impression I get is you are assigned a case manager who investigates your conditions and health history and makes recommendations. I have absolutely no desire to have my insurance company to start calling more shots than they already are. One of my conditions (anterolisthesis) has a surgical intervention option. Over time, that would be the cheapest option. However, with medications, acupuncture and chiropractic care, I have achieved a generally fantastic quality of life most days and while that remains my baseline, I will not allow some almost stranger to decide I need to change what I am doing.

I don't trust these companies with my care.

[ixchel]

I've just realized what I'm talking about is different than what you are referring to. Never mind!

[caliotter3]

My insurance company, not connected with employment, sends me little "reminders" printed up on slick bond paper after every time I go through the trouble of seeing the latest PCP, and sometimes at other times, to point out the obvious. I highly resented the one that told me to take my medications on a regular basis. I had just told the PCP that I needed new prescriptions written for everything because I had not taken meds for about a year due to the fact that I had no money. How insulting to have an insurance company tell me to take meds that I had not been taking because I could not pay for the freaking meds, not because I am noncompliant to be noncompliant. I think the money they waste on printing and mailing this baloney could be better spent on their flawed PCP database, among other things. The employer that gets intrusive with their "wellness" program won't have me as an employee. I have enough trouble with obtaining what the system calls "healthcare".

[Mavrick, BSN, RN]

My employer offers an incentive to the tune of $600 /yr off my medical insurance cost by accumulating 700 points on the wellness website. I get points for an annual physical, dental visit, participating in a heart walk etc. But I also can scratch out points by lying about how much I sleep, talk about my stress, eat breakfast, substitute healthy snacks, steps I walk per week, etc. It gets a little ridiculous when you consider everyone is probably lying just to get the points.

Or am I the only one lying about these things??? ( I'm such a terrible person:sour:).

[HouTx, BSN, MSN, EdD]

Nah - the healthcare industry has arguably the most highly educated workforce in the US... it doesn't take long for everyone to figure out how to take advantage of employer benefits like wellness programs. We KNOW they can't be intrusive or require us to divulge confidential info. Many of us are very suspicious/skeptical and prefer to maintain an absolute separation between our health info and employer, even avoiding using our own facilities whenever possible & getting services on the down low to minimize the chance of employer awareness - LOL.

So, of course people are lying to accumulate those wellness points. Maybe it's just individual rebellion against hypocrisy... towards an employer touting 'wellness' but actively discouraging nurses from calling in sick, failing to supply lift devices to prevent back injuries, creating workloads that perpetuate exhaustion and stress . . . .

[MatrixRn]

Like I stated above I see the value, however I do not and will not participate. I do not want to divulge my personal information.

I am afraid, however, at some point the metrics taken at the MDs office -weight, BP - will be used as a mandatory report item.

[xoemmylouox, ASN, RN]

We save on our insurance premiums if we submit paperwork proving we have a PE and that we do not smoke. Those add up to serious $$$$. They send us occasional reminders, often they are wrong and outdated. It isn't to terribly intrusive at this point.

[NurseGirl525, ASN, RN]

It's insurance companies doing, not the company you are working for. I cannot stand the insurance industry and I used to be in it. Some actuary sits there and crunches numbers on how much they are going to save their company and in turn your employer by implementing these policies. They come around saying how much they are going to save you the consumer when all this does is hurt those with chronic health conditions and can't help it. I do not agree.

Plus, since when does some insurance person know better than me and my physician about my health? You can't even get 2 different people at the same company to give you the same answer to the same question. I feel they should be spending more time on training their own employees on their policies, than trying to put their nose in my medical history.

As you can see this annoys me. My own experience working the industry and being a consumer and dealing with my own policies, is the insurance industry doesn't care about anything but what's in the best interest for them. I don't care how many commercials they put on tv, they don't care about the consumer who is paying their way. Plus, my medical history is between me and my physician, they are there to pay the claims nothing more.

[MunoRN, RN]

Insurance companies have actually always had access to your health history, including BMI and other health indicators. As part of their basic role, insurers have also taken into account the actuarial costs these indicators predict, and in the past have been able to charge more based on these indicators. The problem with that has been that those extra insurance costs often just makes it harder for people to try and reduce those health risks, so the new rule is that insurers can't charge more for being overweight for instance, they instead can charge less as an incentive for taking part in some sort of wellness program administered by the insurer or a third party. This reduction is available to anyone regardless of BMI or other risk factors. Giving people an incentive to help reduce the overall costs of healthcare seems pretty reasonable to me, and considering the amount we pay insurers for their services it shouldn't be considered above-and-beyond for insurers to do this.

[banterings]

Are you ready to be really afraid?

Then read on....

A medical credit score, also known as a medFICO® score, is a fairly recent development on the credit scene and was ostensibly created to help hospitals determine an individual's credit score for healthcare and track a patient's medical credit history. (Source: freescore.com)

It is true that they have back pedaled on the medFICO, but that is because your regular Credit Score Can Also Describe Health Status. (Source: Duke University)

Think of all the nightmares with your regular credit score and trying to fix things like identity theft. Do you really want those issues with health? medFICO is suppose to be about your ability to pay, but it is really about your health status.

As to ixchel's comment about Healthways: The same companies offer management of insurance subscribers' chronic health conditions AND offer wellness programs. It is basically the same service.

Here is another issue with wellness programs; one of the areas that they "monitor" are your sexual practices. I read an article about CVS implementing a mandatory wellness program on a Human Resources site (CVS Anal Probes Employees [...well not really]...) and it examines the slippery slope of wellness programs and legal implications for employers.

Confidentiality in healthcare is a myth anyway. Patients are never told EXPLICITLY about routine disclosures of your personal information, it is hidden in the fine print in their HIPPA policy. Look at the Dental Services at University of the Pacific HIPAA policy routine disclosures:

b) Uses or Disclosures Permitted under this Section 5 - The situations in which the School of Dentistry is permitted to use or disclose PHI in accordance with the procedures set out in this Section 5 are listed below.

The School of Dentistry may disclose a patient's PHI to that patient on request.

The School of Dentistry may disclose to a patient's personal representative PHI relevant to the representative capacity. We will not disclose to a personal representative we reasonably believe may be abusive to a patient any PHI we reasonably believe may promote or further such abuse.

The School of Dentistry will not use or disclose a patient's PHI for fundraising purposes without the patient's Authorization.

The School of Dentistry will not use or disclose PHI for marketing without a patient's Authorization unless the marketing is in the form of a promotional gift of nominal value that we provide, or face-to-face communications between us and the patient.

The School of Dentistry may use or disclose PHI in the following types of situations, provided procedures specified in the Privacy Rules are followed:

For public health activities;

To health oversight agencies;

To coroners, medical examiners, and funeral directors;

To employers regarding work-related illness or injury;

To the military;

To federal officials for lawful intelligence, counterintelligence, and national security activities;

To correctional institutions regarding inmates;

In response to subpoenas and other lawful judicial processes;

To law enforcement officials;

To report abuse, neglect, or domestic violence;

As required by law;

As part of research projects; and

As authorized by state worker's compensation laws.

...c) Other's Requests - The School of Dentistry will rely, if reasonable for the situation, on a request to disclose PHI being for the minimum necessary, if the requester is: (a) a covered entity; (b) a professional (including an attorney or accountant) who provides professional services to our practice, either as a member of our workforce or as our Business Associate, and who represents that the requested information is the minimum necessary; © a public official who represents that the information requested is the minimum necessary; or (d) a researcher presenting appropriate documentation or making appropriate representations that the research satisfies the applicable requirements of the Privacy Rules.

Routinely, insurance companies request the SOAP notes in order to process payment. Now EMR make transfer, storage, and searching of medical records easier. These wellness programs are subject to EMR rules.

Remember what Fox Mulder from the X-Files said: "Trust no one."

[ixchel]

OMG comparing wellness programs with Nazi Concentration camps? Are you serious?!

Caution: this thread now requires tin foil hats to proceed any further, beginning with the post prior to this one.