I have been reporting on the coverage of Penn State's newly announced wellness program in the news, and to capture all sides of the debate, one that regrettably did not occur within Penn Staten before the imposition of the program, about the value of eugenics based programs like this in terms of cost savings, the quantification of health benefits and the risks to employees that the university will permit on their behalf. (Penn State's New "Wellness Program" in the News (UPDATED Through 8 August 2013).
(Pix (c) Larry Catá Backer 2013)
Since this last post Penn State University continues to be very much in the news about its wellness program. This post provides an update not just about recent coverage but also to provide links to experts whose views about the soundness of aspects of the program may broaden the scope of discussion. It is provided in the interest of analysis and debate, including on the general issues raised by programs of this kind of benefits offered by enterprises in the U.S. It also suggests some of the complications of emerging issues of consultation in shared governance contexts in the face of increasingly large informational asymmetries between administration and faculty.
As a matter of core principle, I continue to emphasize that, like any other institutional organ, an enterprise (like a university) must exercise substantial restraint and sensitivity when it seeks to manage or to appropriate to itself a power to manage or control the personal choices of individuals in ways that touch on the human dignity and personal autonomy of the individual. In many highly developed Western states, the protection of human dignity and personal autonomy is a matter of constitutional commitment. At its limit, of course, that protection serves as a rationale for the suppression of slavery and the incidents of slavery as a matter of law. But between slavery and complete personal freedom there is a large space within which the state, and the enterprises it permits to operate within its borders, permit some control of autonomy. That space, of course, is essential for the operation of a free society, and is usually grounded, in the area of human economic activity, on the boundaries within which enterprises may hire labor to meet its specific objectives. However, the existence of this discretionary space is not meant to produce a place where autonomy and human dignity may be completely disregarded in the drive toward enterprise welfare maximization. To permit that freedom would be to allow slavery by other means--and the state of peonage, the closest model for that sort of society, has also been suppressed in most civilized states. As a consequence, enterprises ought to be sensitive to the detrimental effects of the instrumental use of their authority over their employees when they seek to that power to manage and control the human beings they employee. This responsibility to be sensitive to the detrimental effects of employer self interested actions ought to be especially strong where the mechanisms of control and management touch deeply on matters of human dignity and autonomy. That responsibility to respect the human rights of their employees may not be strictly required by law but is central to the social license of enterprises to claim a right to legitimate operation within the societies in which they operate. This notion reflects emerging consensus at the international level around the responsibilities of enterprises for the human rights effects of their activities. (e.g., United Nations Guiding Principles on Business and Human Rights) These are no less binding on universities where they act as economic actors. Where enterprises rely principally on their raw power and expand their control of elements of production, especially human beings, for reasons other than to respect their human dignity and autonomy (for example for reasons of cost reduction or productivity gains, both quite respectable in their own right of course), the enterprise ought to bear a special duty to be sensitive to human dignity concerns in fashioning such programs. That duty increases as the human dignity and autonomy effects of these actions increase, including potential violations of privacy interests and the effects of the appropriate of the right to exploit employee information by employers. When the enterprise fails to exercise this sensitivity in its imposition of dignity and autonomy affecting projects, it may rely on its coercive power, supported perhaps the discretionary space permitted by law, to impose its will. But it will also act in ways inconsistent with the sort of respect for human dignity and autonomy at the core of our values. Individuals may conform because they must, but trust is lost and the willingness of individuals to cooperate may decrease. Eugenics programs sit at the very core of human dignity and personal autonomy, and absent substantial and comprehensively explained reasons, these merit substantial sensitivity and engagement before they are either formed or imposed. That an enterprise may impose its will in these matters in this country as a matter of law does not necessarily mean that it is the right thing to do.
Bill Toland, Penn State gets tough on staying healthy, Pittsburgh Post Gazette, August 11, 2013 12:18 am
In the health care realm, where various carrots and sticks are deployed to get employees to live healthier or lose weight, Penn State University is wielding one of the bigger sticks out there.
On Jan. 1, Penn State will charge a $100-a-month fee to those employees who don't participate in the school's "Take Care of Your Health" initiative, which launches this autumn.
According to materials distributed by the university, employees and spouses covered by the university's health care plan must complete an online wellness profile, schedule a physical exam and have a "biometric" screening, which measures lipids, blood glucose, body mass index and other physical attributes.
If they don't take those steps, their health care premiums essentially go up $1,200 a year. (Penn State's health plan is offered through Pittsburgh health insurer Highmark Inc.)
Faculty, naturally, weren't enthusiastic about the new plan requirements.
"There was a sense among faculty and staff that this was new and different, and not in a good way," said Larry Cata Backer, a globalization and international affairs professor at Penn State, and former head of the school's faculty senate at the main campus.
"No one had been really prepared for it."
While Penn State faculty may have been caught off guard by the wellness plan and the $100-a-month charge for noncompliance, such plans are becoming more typical. Highmark itself uses such a plan design, with the same $100 monthly surcharge for those employees who don't agree to health and wellness screenings.
"This is where companies are going," said Mike Fiaschetti, president of health markets for Highmark's insurance wing. Highmark's own research suggests that for every $1 spent on wellness programs, $1.65 in health care costs are saved down the line. And, despite some grousing, most employees eventually comply.
At Highmark, the compliance rate for the wellness and screening programs was 88 percent in 2012.
Which begs the question -- why are the rest of the participants flushing money down the toilet? Mostly out of privacy concerns, or because they are simply forgetful or disorganized, Mr. Fiaschetti said.
While everybody can benefit from a wellness screening and physical every now and again, the main goal of the screening is to find the "walking time bombs" -- those who have high blood pressure or high cholesterol, but don't know it yet. Those conditions are treatable, and preventable, if caught early enough.
Norm Kerr of Buck Consultants' health and productivity division said different companies see different results when it comes to more punitive plans like these.
Among his clients, "Fifty percent of the employers can't tell whether it's saving them money or not, [and] the other half say it is," Mr. Kerr said.
In the long run, though, prevention will pay dividends, he said. "Am I a supporter? Yeah. Do I think wellness matters? Yeah ... every employer has their reasons for doing what they need to do to control costs," Penn State included.
Penn State cited those very reasons when asked about the new wellness policy and associated fees.
"Health care costs have been growing for years at the university, and without significant action they will quickly become unmanageable," said Reidar Jensen, a spokesman for Penn State.
While acknowledging that the premium differential might be initially "unsettling," Mr. Jensen said that the university's "health care spend is projected to be $217 million in 2013-2014. Without intervention, this is a growth of approximately 13 percent over the previous year.
"Passing large increases year after year on to employees or our students is not a sustainable strategy."
Mr. Backer, the Penn State faculty member, said he did not question the school's money-saving motives, but wished the school's 17,500 employees -- there are 40,000 health plan beneficiaries in all -- had been consulted more regularly along the way (the school says its human resources team briefed the several faculty senate committees and advisory councils before finalizing the new health plan).
From a professor's standpoint, "This really touches on what other people might call human dignity concerns ... social engineering and health engineering," Mr. Backer said.
So far, according to the Penn State, more than 5,100 faculty and staff have scheduled an appointment for a biometric screening and more than 4,200 already have completed a wellness profile.
Will Mr. Backer?
"Of course," he said. "Wouldn't you?"
In commentary, Brian Curran notes, This is not the full story. More than 1800 Penn State faculty and staff (plus a few alumni) have signed a petition calling for the immediate postponement or cancellation of these policies pending a true and open review. You can join us here: http://www.change.org/petitions/penn-state-president-rodney-a-erickson-benefits-office-and-trustees-stop-the-new-penn-state-wellness-program-and-its-surcharges.
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An interesting article on the potential privacy dangers attendant on the sale of aggregated medical data follows. It's "bottom line"--"Medical data sold cheaply by state health agencies often contain details that can be used to identify patients.":
Jordan Robertson, "Your Medical Records Are for Sale," Bloomberg Businessweek, Aug. 3, 2013,
As hospitals shift to digital medical records, administrators promise patients better care and shorter waits. They often neglect to mention that they share files with state health agencies, which in turn sell the information to private data-mining companies. The records are stripped of names and addresses, and there’s no evidence that data miners are doing the legwork to identify individual patients. Yet the records often contain patients’ ages, Zip Codes, and treatment dates—enough metadata for an inquiring mind to match names to files or for aggressive companies to target ads or hike insurance premiums.
Latanya Sweeney, the director of Harvard University’s Data Privacy Lab, identified 35 patients from a Washington database by buying state medical data and creating a simple software program to cross-reference that information with news reports and other public records. “All I have to know is a little bit about a person and when they went to a hospital, and I can find their medical record in this kind of data,” Sweeney says. She says data in 25 other states are just as vulnerable.
From a brief local-news story on a motorcycle crash, she matched retired Vietnam veteran Ray Boylston to a patient file documenting a broken pelvis, ruptured spleen, kidney failure, and bladder removal. “I feel I’ve been violated,” says Boylston, 62. “I don’t really feel that the public has a right to read up on my medical history.” Most of the patients whose names Sweeney uncovered asked to remain anonymous, including an executive treated after being assaulted whose medical records say he’s addicted to painkillers. Another businessman, who appeared in a missing-person report, has been diagnosed with pancreatic cancer and attempted suicide by poison, according to his medical records.
Exempt from federal health-privacy laws, states have long sold medical data to help finance public health studies. Demand for the information, which is relatively cheap, has shifted from university research programs to commercial data miners, which incorporate it into reports and databases they sell to direct marketers, insurers, and makers of drugs and medical devices. Twelve of the most populous U.S. states generated $1.91 million from 1,698 data sales in 2011, the latest year for which figures are available, public records show. (The data-mining industry, which buys the information and resells it to medical companies, will top $10 billion in revenue by 2020, McKinsey estimates.) Washington State’s health agency sold its database 95 times that year, collecting a mere $15,950. Donn Moyer, a spokesman for the state’s health department, says it chose to release extra identifying information such as patients’ Zip Codes to make its data more useful.
Companies that buy the state data include IMS Health, a provider of prescription data; OptumInsight, a division of UnitedHealth (UNH), the biggest U.S. health insurer; and WebMD (WBMD). Danbury (Conn.)-based IMS purchased Boylston’s record, as did IVantage Health Analytics, a Portland (Me.)-based evaluator of hospital performance. IMS’s U.S. marketing director, Jody Fisher, says his company, which sells medical data to drug companies for sales pitches to doctors and consumers, maintains a database of 260 million prescription-drug patients but doesn’t try to identify any whose names have been redacted. John Morrow, executive vice president of IVantage, says his company scrubs information like Zip Codes. With that kind of identifier, he says, “You might as well have the patient’s electronic medical record number.”
Jim Pyles, a principal at law firm Powers Pyles Sutter & Verville who specializes in health law and policy, says digitized medical data has the potential to prevent physicians from missing a key element of a patient’s history or to help analysts identify larger health trends, such as hospital costs or the spread of diseases. The sale of that data, though, makes patients even more vulnerable than they already are in an era of increasingly sophisticated hacking, he says. “Electronic health information is like nuclear energy,” Pyles says. “If it’s harnessed and kept under tight control, it has potential for good. But if it gets out of control, the damage is incalculable.”
Health agencies for Washington, Tennessee, Nevada, and Arizona say they have begun reviews of their collection policies following a Bloomberg News story published on June 5 about state health data collection. (Washington now requires buyers to sign a confidentiality agreement, though a full review of the policies will take months, says Moyer.) California, Illinois, New Jersey, Massachusetts, Connecticut, Nebraska, and Alaska already had reviews under way, according to those states’ agencies. “The real takeaway,” says Harvard’s Sweeney, “is we can do better than this.”
The bottom line: Medical data sold cheaply by state health agencies often contain details that can be used to identify patients.
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Matthew Woessner has written an op-ed recently published in the Patriot News, Matthew Woessner, PSU's punitive new health policy is an invasion of privacy: As I See It, The Patriot News, Aug. 7, 2013. The comments suggest some of the contours of the arguments currently being advanced on all sides of this issue.
Penn State requires log in to its internet wellness program site. But here is a list of recent coverage of Penn State's wellness programs as listed on its news website (with links):
Benefits changes focus on employee wellness, long-term cost savings
Jul 25, 2013 ... Penn State officials have announced a new, comprehensive strategy designed to improve employee health and to curb the rapidly growing cost ...
http://news.psu.edu/story/282659/2013/07/25/administration/benefits-changes-focus-employee-wellness-long-term-cost
Lehigh Valley campus to hold wellness fair | Penn State University
Apr 2, 2013 ... Penn State Lehigh Valley will hold a wellness fair for the campus community from noon to 2 p.m. Wednesday, April 10, in the auditorium (Room ...
http://news.psu.edu/story/271436/2013/04/02/health-and-safety/lehigh-valley-campus-hold-wellness-fair
Tags: Health and Wellness | Penn State University
2/11/13. UNIVERSITY PARK, Pa. -- Penn State students who are interested in
promoting health among their peers can apply to participate in HealthWorks, ...
http://news.psu.edu/tag/health-and-wellness
Penn State Hershey CNAP becomes the PRO Wellness Center ...
Apr 10, 2013 ... The Center for Nutrition and Activity Promotion (CNAP) at Penn State Hershey has changed its name to Penn State Hershey PRO Wellness ...
http://news.psu.edu/story/272403/2013/04/10/penn-state-hershey-cnap-becomes-pro-wellness-center
President Erickson attends dedication of Beaver's new Wellness ...
Sep 7, 2012 ... Penn State President Rodney Erickson was one of four speakers at the
dedication of Penn State Beaver's new Wellness Center on Sept. 6.
http://news.psu.edu/story/146834/2012/09/07/president-erickson-attends-dedication-beavers-new-wellness-center
Smeal Alumni in Profile: MIS alumna's business fosters women's ...
Smeal Alumni in Profile: MIS alumna's business fosters women's health, wellness. May 2, 2013. Smeal Alumni in Profile: MIS alumna's business fosters women's ...
http://news.psu.edu/story/275739/2013/05/02/impact/smeal-alumni-profile-mis-alumnas-business-fosters-womens-health
Walking and wellness expert to present healthy living workshop ...
Jun 4, 2012 ... Once nicknamed "butterball," Robert Sweetgall today has other names. The real Forrest Gump. The Pied Piper of walking. The only person to ...
http://news.psu.edu/story/148577/2012/06/04/walking-and-wellness-expert-present-healthy-living-workshop-june-19
Wellness program available at Penn State Schuylkill - News - Penn ...
Aug 25, 2009 ... Eat Well For Life is a lifestyle improvement program that champions optimal health, vitality and long-term weight management through the ...
http://news.psu.edu/story/174827/2009/08/25/wellness-program-available-penn-state-schuylkill
Thousands think healthy at wellness fair | Penn State University
Apr 27, 2009 ... Thousands of Penn State employees sipped, tasted, stretched, played, talked, ran and learned last Wednesday (April 22) at the inaugural ...
http://news.psu.edu/story/177037/2009/04/27/thousands-think-healthy-wellness-fair
Tags: Health and Wellness Services | Penn State University
9/25/12. A free program at Penn State Erie, The Behrend College, on Tuesday
looked beyond the classic image of a school bully - a large boy forcing a smaller
...
http://news.psu.edu/tag/health-and-wellness-services
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A colleague who writes and researches int he area of employment bvenefits and health care plans notes (with links to some discussion):
There is no evidence for what Penn State is doing in terms of these changes. In other words, no evidence that these exams, or penalties, or collected information will result in the types of changes the PSU brass. See the following, though there are more as well:
--Al Lewis and Vic Khanna, Is It Time To Re-Examine Workplace Wellness ‘Get Well Quick’ Schemes? Health Affairs Blog, Jan. 16, 2013 (http://healthaffairs.org/blog/2013/01/16/is-it-time-to-re-examine-workplace-wellness-get-well-quick-schemes/).There of course are a lot of other issues employees might take issue with, such as privacy issues, or lack of transparency or involvement in the PSU community on this issue. Those are important too, but to me the key thing here is that the university is assuming, arguing and even defending this change as though there is evidence to support the changes. Per the articles above, I simply don't believe that to be the case. The other two Penn academics mentioned in the Philly.com article, Pauly and Volpp, are two of the world experts in this area.
-- Jill R. Horwitz, Brenna D. Kelly and John E. DiNardo, “Wellness Incentives In The Workplace: Cost Savings Through Cost Shifting To Unhealthy Workers,” Health IT, Payment and Practice Reforms 32(8) (2013) (http://content.healthaffairs.org/content/32/3/468.abstract)
--Gowrisankaran G, Norberg K, Kymes S, Chernew ME, Stwalley D, Kemper L, Peck W, “A hospital system's wellness program linked to health plan enrollment cut hospitalizations but not overall costs,” Health Aff (Millwood). 2013 Mar;32(3):477-85. doi: 10.1377/hlthaff.2012.0090 (http://www.ncbi.nlm.nih.gov/pubmed/23459726).
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Among a number of web sites with information about wellness programs, I note that of Disease Management Purchasing Consortium, Inc. based in Waltham. MA, a group that provides assistance in contracting services and evaluating outcomes in disease and population management. It has its own strongly held views that one is free to engage with.
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For interested in the tools available to enterprises seeking to roll out a wellness program, the on-line resources at Wellness Proposals.com are useful. The operator f the site describes itself as "The world's largest, free resource for wellness programs and health promotion initiatives. Our free wellness library contains nearly 16,000 free health and wellness programs, handouts, posters, presentations, tool kits, wellness newsletters and more. We also provide a free service that allows you to get wellness quotes from up to 30 different wellness companies by completing one brief request form." The marketing advice may be of interest:
It is very important market the wellness program to make people aware that the wellness program exists and to motivate them to take advantage of it.
The planning process itself can be a powerful marketing tool and thus should be taken advantage of when deciding on wellness marketing. For example, broad employee involvement in planning promotes a sense of ownership of the program.
Selection of a creative name or theme for the wellness program often excites interest. A good needs and interests survey and health risk assessment identifies health issues and program activities in which workers are already interested.
Dedicated wellness committee members are natural spokespersons and can market the wellness program to their peers and co-workers. An endorsement of the wellness program from the company president, executive director and/or senior manager is an effective marketing technique and is cost-free.
E-mail, bulletin board and/or newsletter announcements are also free or inexpensive. Perhaps the best marketing tools of all, however, are pleased wellness program participants who advertise for you by word-of-mouth. (Market the Wellness Program)
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If readers have additional resources that support or suggest concerns with programs of this sort, in any of its aspects or with respect to any of its potential effects (good or bad), I would be happy to post.
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