A Fine Line Between Carrots and Sticks

The line between being proactive about healthcare costs and being invasive

A Florida sheriff's office is requiring some applicants to take a polygraph test with questions about their smoking habits. In 2007 Benton County, Ark. government, told their "out-of-shape workers to get healthy or be punished because the cost of providing health care coverage for them was out of hand." In 2009 the Indiana-based hospital chain Clarian Health Partners will begin charging employees as much as $30 every two weeks unless they meet weight, cholesterol and blood-pressure guidelines.

Is it your job to push health and wellness? And, how far should you go in imposing health-related requirements on your employees? Just how involved should you be in your employees' health without becoming invasive and regulating private behavior?

These questions are driven by larger ones: How important are profits, employee morale, job satisfaction and the ability to attract and retain good employees? You've seen the eye-popping statistic that today more than 50 percent of corporate profits go to healthcare (vs. only 7 percent 30 years ago). You probably also know that today more than half of all deaths in the United States are attributed to preventable behaviors, including smoking, overweight and obesity, and lack of physical activity. You and your employees already know that the healthier they are, the fewer claims they are likely to file. And you know too that the number of claims filed-or not filed-has a direct impact on insurance costs, costs that in a number of ways are ultimately passed on to your employees.

Wellness is the unwelcome gorilla in every HR manager's office. Trends indicate that more employers are beginning to look at the solution as a proactive one, focusing on prevention while at the same time finding ways to incent employees to take a more active role in their own long term health and wellness goals. At the same time, efforts to rein in healthcare costs are leading more employers to also take an active role in how employees manage their health-and herein lies the fine line. It is a line initially composed of sticks and carrots. These are the questions that help define that fine line:

• Do you "punish" employees who refuse to participate in a wellness program with disincentives?
• Do you charge those employees more for healthcare?
• How much of an incentive is necessary to encourage reluctant employees to participate?
• What percentage of employee participation are you trying to achieve?
• Will you include dependents of employees in your wellness initiative? (You will reach a broader base of coverage and when behavior changes are reinforced at both work and at home and they are more likely to become long-term changes.)

As more employers begin tying the cost of healthcare premiums to participation in health initiatives, whether through sticks or carrots, the answers to these questions will determine to a large extent, the program's success. No one will argue that helping employees get healthy is a good thing, but many will argue that carrots are more effective than sticks. The essential challenge is to engage employees so they are motivated to change behaviors in the interest of their own long term health and wellness.

A wellness strategy is no longer an option. But, you need to decide what you want the program to accomplish. Then you need to promote participation. Just putting the program "out there" does little to enlist employee participation. That requires enthusiastic and motivated participants, support from management and ongoing encouragement.