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The New Equation in Health Insurance: Cooperate in Screening or Pay More

Posted Apr 06 2013 12:00am

There is no question in my mind that mandatory health screening will be the norm for many of us, at least those who receive health insurance as a job benefit. Such screening has the dual effect of alerting an individual's healthcare providers about real or potential problems and also engaging the individual in the process of monitoring his or her own health. The covered individual can opt out of such screening but it's going to cost more money to do so. Details about the plan offered to CVS Caremark were discussed in a recent article (see: A Choice for Employees: Get a Health Screening or Pay an Extra $600 ).  Below is an excerpt from it. Also see: If Workers Are Out of Shape, Should Companies Make Them Pay? (paywall).

CVS Caremark employees with company health insurance are being asked to take a free health screening—for basic metrics such as weight, body fat, blood pressure, and glucose levels—or have their premiums increase by $50 per month ($600 annually). In other words: Get examined or pay up. Fair....CVS Caremark said in a statement that “79 percent of large employers have health assessments incorporated into their programs.” By making employees aware of their numbers, the company hopes to encourage healthier habits—and ultimately reduce overall health-care costs....Not everyone is convinced. Deborah Peel, founder of Patient Privacy Rights, a group that advocates for patient control of health records, says workers are being penalized for not handing over private health information. She [noted in an interview] that that while CVS says it never sees the personal health data, there is no way to verify that, and there’s a risk employers will discriminate against unhealthy workers. Still, as health costs rise, employers will look for ways to cut back. Encouraging workers to get in shape, especially those with costly conditions such as obesity, is a growing priority. In addition to screenings, many employers also subsidize gym memberships and organize on-site fitness activities. Financial incentives, even negative ones, do seem to get people’s attention. A recent Mayo Clinic study of obese Mayo employees and dependents found that when money is involved, people do better at losing weight. Those with money at stake—either penalized $20 each month if they failed to meet their goals or offered $20 per month for meeting weight-loss goals—lost more weight than those with no money on the line. Many Americans clearly are not good at maintaining their health for its own sake. But $20 a month? Apparently that’s worth some effort.

I am sure that this CVS Caremark model is similar to the the way in which most corporate health insurance plans will evolve. Financial incentives, both carrots and sticks, will rule the day. The more benign employers will use more of the former and more aggressive more of the latter. The goal is to improve the health of their employees and simultaneously lower the cost of health insurance. A variation on this theme is to provide a richer mix of benefits to the employees who take better care of themselves and and less coverage for the same price to employees who can't achieve the health targets (see: A Lottery to Improve Patient Adherence to Warfarin TherapyPaying Patients to Stay Healthy; Discrimination Against the Poor?Financial Incentives for the Pursuit of Wellness; Possible Impact on the Clinical Labs ). As to whether this is fair or not, I will leave it up to you to decide. Cleveland Clinic decided not to hire smokers about two years ago and Geisinger has followed suit (see:  Want a Job at the Cleveland Clinic?: Smokers Need Not ApplyGeisinger Follows Cleveland Clinic; Won't Hire Smokers) . The University of Pennsylvania Health System has just announced a similar policy

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