In Las Vegas, the house always rules. The same maxim may apply to how you obtain health benefits through your employer.
Under a growing employer insurance option called "house money/house rules," employers are increasingly calling the shots on how employees receive their benefits — and workers may be penalized or rewarded depending upon how they take care of themselves. That means they may be subject to regular monitoring and told to enroll in health care management programs.
While all of this sounds intrusive — some of the programs are voluntary while some are not — it's another step that employers are taking to lower their health care costs over time. Some 40 percent of companies surveyed by the consulting firm AonHewitt "expect to migrate to the House Rules approach."
At the core of the House Rules are personal mandates to take responsibility for your own health. Instead of a traditional fee-for-service approach to every visit with a health care provider, you're asked to take steps to eat better, lose weight, exercise and monitor various conditions on your own. If you don't, then you could face penalties like higher premiums.
In corporate America, the trend towards personal health care accountability is accelerating. Some two-thirds of companies surveyed by AonHewitt in 2011 said they would have reward programs in place within the next five years that are designed "for those who achieve specific health outcomes." So the clock is ticking.
What might employers reward employees to do? Lowering blood pressure and blood sugar, losing weight and exercising more seem to be at the top of the list. Xerox, for example, last year started screening employees for nicotine use and offering up to $1,200 in insurance discounts for employees and their covered spouses who tested tobacco-free. About 10 percent of employers said they would "penalize" employees who had "unhealthy outcomes."
How 'House Rules' Works
The House Rules will either reward or charge employees depending upon the results of regular screenings. One program called a "Plan for Health," for example, was instituted about a year ago for employees of CVS Caremark, one of the nation's largest pharmacy chains.
Under the CVS plan, employees were given the choice to complete an annual "screening and wellness review" or pay $600 to the company. Ultimately, the company is hoping that it will "drive consumerism in health care, and, at the same time, it will drive accountability for all of us."
The philosophy behind the CVS House Rules plan is simple: Make choices to improve your health or pay more for health coverage. It's a carrot and big stick approach. If you want to stay in the company plan, you must abide by the rules or pay a stiff penalty.
While forcing the issue from the realm of corporate paternalism into personal ownership isn't new — witness the elimination of traditional pensions that were replaced with self-managed 401(k)s over the past 30 years — applying this strategy to health care will have some complications.
If corporate health care shifts to more of a "401(k) model," then it risks falling into a knowledge chasm on what behaviors are best reinforced to improve overall health. There's a lot of debate over which diets and exercise regimens are effective over time, and it's brutally difficult to change behaviors in eating and activity when most of the population is sedentary and works behind desks all day.
Even with financial penalties, can employers convince their workers to break their addiction to supersized sodas, donuts, french fries, hamburgers and cookies?
Moreover, in order to make healthier choices, workers will need to divulge to their employers their habits, diets and medical conditions, which some privacy advocates say crosses a red line. According to the group Patient Privacy Rights, House Rules may go too far:
This approach does not create a culture in which people willingly work together to figure out the best ways for improving health, reducing costs, and increasing personal responsibility. Rather, it forces them into situations where they have to reveal personal information about themselves and have no control over what happens to it. `House Money, House Rules' may work when you’re dealing blackjack, but not when you’re dealing with people’s health and livelihood.
As a cultural imperative, taking personal responsibility for one's health isn't a bad thing. Many costly diseases such as diabetes and lung ailments are directly related to lifestyle, obesity and smoking, which can be addressed in a number of ways.
The larger question, though, is what incentives work best — both in private and public health care — to change behaviors that could lead to costly chronic and avoidable diseases. It's a lot easier to talk about the bottom line than it is to change habits and lifestyles.
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