The corporate wellness market is booming. According to a report from the RAND Corporation, which was sponsored by the Department of Labor and the Department of Health and Human Services, more than half of U.S. employers with 50 or more employees currently offer corporate wellness benefits.
Some use outside vendors to administer these programs. And some of those vendors have insight into employee health care data that might come as a shock to workers — even those who have opted into the service. In a recent Wall Street Journal article, Rachel Emma Silverman explains how corporate wellness companies access and analyze health data:
Typically, when a company hires a firm like Castlight, Jiff Inc. or ActiveHealth Management Inc., it authorizes the firm to collect information from insurers and other health companies that work with the client company. Employees are prompted to grant the firm permission to send them health and wellness information via an app, email or other channels, but can opt out.
Based on data such as an individual’s history, the firms can identify a person who might be considering costly procedures like spinal surgery, and can send that person recommendations for a second opinion or physical therapy.
Silverman notes that other corporate wellness companies like Welltok and GNS Healthcare Inc. buy data from brokers that provides additional insight using consumer behavior. For example, Welltok found that workers who vote in midterm elections are often healthier than those who don’t. Another researcher tells Silverman that workers with lower credit scores may be less likely to show up for follow-up appointments at their doctor.
How Much Can Your Boss Learn About You From This Data?
For the most part, these apps and programs work by providing general information and directing messages at employees, not by revealing health data about specific employees to their employers. For example, employers might be able to see data on how many of its employees are likely to have back problems, but not which specific workers are likely to need expensive treatment.
Federal law also provides limitations on how employers can access employee health information. But, a health-care lawyer tells Silverman that “self-insured employers have more leeway.” Plus, these programs are often opt-in — and legally, employers may be allowed to ask you to share your health care data on a voluntary basis. Per the Health Insurance Portability and Accountability Act (HIPAA)’s Privacy Rule:
Your employer can ask you for a doctor’s note or other health information if they need the information for sick leave, workers’ compensation, wellness programs, or health insurance.
However, if your employer asks your health care provider directly for information about you, your provider cannot give your employer the information without your authorization unless other laws require them to do so.
Generally, the Privacy Rule applies to the disclosures made by your health care provider, not the questions your employer may ask.
Beyond that “…the potential for corporate misuse is definitely there,” writes Joanna Rothkopf at Jezebel. “…should employers obtain the information for any number of reasons, it could be used to discriminate against employees whose healthcare could prove costly, which is fairly terrifying.”
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Is Voluntary Participation Really Voluntary?
Employers use all sorts of financial rewards to induce employees to participate in wellness programs, from free swag like digital fitness trackers to discounted health insurance for those who meet health goals (being tobacco-free, for example). But if financial incentives are high enough, participation can feel less than voluntary.
“In 2015, the EEOC proposed a rule treating wellness programs as ‘voluntary’ if they involved premium differences of no more than 30% of the full cost of a health plan,” explained Michael Hiltzik in a 2017 column at The Los Angeles Times. “Worker advocates were aghast — 30% of a full-price premium could amount to thousands of dollars, and since the workers’ share of their health plan premiums often was only 30% or so, the penalty could double their annual costs. For many families, that made voluntary programs effectively mandatory.”
In 2017, a federal judge agreed, overturning a federal rule that allowed employers to offer 30% health plan discounts — or levy 30% penalties — based on participation in wellness programs.
Workplace wellness programs can also create a morale issue for some staff.
“…one potential problem with wellness programs is they can create an atmosphere in which certain health behaviors or levels of physical performance are expected,” says Anna Kirkland, J.D., Ph.D., a professor of women’s studies at the University of Michigan in Ann Arbor, speaking with Consumer Reports. “Employees with disabilities or other reasons for not participating might feel discriminated against or not welcome.”
Kirkland notes that an employee who can’t hit a fitness goal — say, 10,000 steps a day — might feel like they don’t fit the profile of an ideal employee at that company.
How Safe Is Your Health Data?
According to the Privacy Rights Clearing House, there have been over 9,000 public data breaches since 2005. The private information of billions of consumers has been exposed. It’s no wonder that more than half of Americans distrust the ability of the government or social media sites to protect their data. Should they trust their employers to safeguard their health data?
“Ensuring the privacy of employees’ personal health information, and tracking how wellness providers, health insurers and employers may use it, can be a tricky prospect for HR, given the different types of wellness programs and various laws covering them,” writes Dinah Wisenberg Brin at the Society for Human Resource Management.
In 2016, the World Privacy Forum filed comments on proposed changes to the interpretation of the Genetic Information Nondiscrimination Act, focusing on how these changes could affect privacy:
Employers offering wellness plans that allow unfettered data sharing and secondary use of consumer data may not fully understand the extent to which identifiable or re-identifiable data about individual consumers may be entering the secondary marketplace.
…No one should collect any personal data unless it there is clear and convincing evidence that the data is necessary for a wellness program. Even then, use of patient claims data and medical record data should be expressly prohibited without the affirmative, voluntary, and recent consent of the data subject.
Recently, Consumer Reports sponsored bills in California and New York aimed at limiting health data collection and prohibiting employers from requiring participation in corporate wellness programs.
“We are sponsoring these bills so that participation in wellness programs is truly voluntary and so that those who do join a wellness program have their privacy protected, without unintentionally or involuntarily entering into unfair deals,” says Dena B. Mendelsohn, senior policy counsel at Consumer Reports, in an article on the publication’s website.
Do Workplace Wellness Programs … Well, Work?
If you’re debating whether to join your company’s wellness program, it may interest you to know that the health benefits may be less compelling than advertised.
A recent study published in The Quarterly Journal of Economics reported:
We designed and implemented a comprehensive workplace wellness program for a large employer and randomly assigned program eligibility and financial incentives at the individual level for nearly 5,000 employees. We find strong patterns of selection: during the year prior to the intervention, program participants had lower medical expenditures and healthier behaviors than nonparticipants. The program persistently increased health screening rates, but we do not find significant causal effects of treatment on total medical expenditures, other health behaviors, employee productivity, or self-reported health status after more than two years.
A large-scale, peer-reviewed analysis showed that “people who worked at sites offering the program exhibited notably higher rates of some healthy behaviors, but no significant differences in other behaviors compared to the control group.”
Further, the trial found that, “Employees working at sites offering the program did not have better clinical measures of health such as body mass index, blood pressure or cholesterol after 18 months, nor did they exhibit lower absenteeism, better job performance or lower health care use or spending.”
In short, you might not get very much in return for sharing your private health data — and it might not even be in your employer’s best interest to ask for it.
Tell Us What You Think
Do you belong to a corporate wellness program — and if so, do you think that it’s been helpful? We want to hear from you. Share your story in the comments or join the conversation on Twitter.
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