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Prediction: Not Just Carrots But Sticks Coming To Wellness

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Of these eleven sage predictions for health care in 2011 just posted by Evan Falchuk, president of Best Doctors, Inc., the one that grabbed me most was #5:

5. More employers will start charging employees surcharges for being overweight, smoking, or otherwise not taking care of themselves. Among self-insured employers, who pay for a huge proportion of American health care costs, this is becoming increasingly mainstream. These employers are saying to their employees: it’s your business if you don’t take good care of yourself, but it’s mine to pay for the consequences of it. So, employees are being told they need to pay extra for their health coverage, unless they participate in programs the employer makes available to help them quit smoking, lose weight and manage their chronic illnesses.

I'd just been thinking that even though I post a daily reason to exercise and I'm afloat in health information, it's stunning how hard I find it to do the right thing in terms of diet and exercise every day. "I need coercion," I thought. "I need a workplace where they make everyone go to gym class at noon."

That won't be happening soon, but I did ask Evan about this trend he'd identified — let's call it the "wellness stick."

It began two or three years ago, he said, and so far it's happening mainly outside of Massachusetts, perhaps because we tend to be healthier already than other states.

One of the first companies doing this was PepsiCo, he said. The company's head of benefits told him that their employees who smoke had been informed: "If you smoke, we’re going to charge you $600 a year extra in your health premium — unless you participate in a smoking cessation program. You don’t have to quit, you just have to participate." They had huge success with people signing up — though the tactic is still playing out; many people quit, but many people have said they'll just pay the $600.

Another example: The supermarket firm Safeway and obesity.
Starting about two years ago, Evan said, Safeway plotted its employees' Body Mass Index scores on a chart, and found the expected bell curve but there was "a big lump on the right hand side of people with really high BMI," to the point of clear health risks. Safeway said in effect, "We'll have surcharges for those people because they’re costing everybody more money, but also create a very supportive environment to help them lose weight."

"It's the carrot and stick approach. It's not enough just to dangle the carrot out there. A lot of companies are putting in these stick-like approaches," Evan said, and he knows of several Massachusetts employers who are contemplating adding sticks to their wellness plans. (Though WBUR's Martha Bebinger tells me that she's been looking and looking for wellness sticks among state employers, and found none so far.)

Readers, does your company use a stick? Do you think that it should?

This program aired on December 15, 2010. The audio for this program is not available.

Carey Goldberg Twitter Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth blog.

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