Imagine if your child was in a car accident and admitted to the hospital with serious injuries. A nurse calls to offer help coordinating your child’s care but you’re not in the state of mind to add an extra layer of health professionals to your contact list. As you say no thanks, the nurse tells you your employer will charge you an extra $100 per month for declining the service.
This may seem far-fetched but it’s an example of how some employers are penalizing their employees for declining participation in health management programs. Serious and actionable health conditions like the car accident with injuries described above and others like uncontrolled diabetes, heart disease, kidney failure and cancer may trigger outreach by your insurer to help members manage their health conditions and navigate the medical system. The conditions treated through these programs can be costly and have employers wondering how they can reduce costs.
Employers may see that some employees with costly medical conditions aren’t willing to participate in these health management programs. In an attempt to rein in costs and engage employees, some employers implement penalties for not participating in these programs. The penalties I’ve seen include premium dollars at risk, resulting in the employee paying more for their insurance and the employer paying less. I’ve seen penalties as low as $100 a year to as high as $100 a month.
Although I personally do not recommend penalties for individuals not engaging in these types of health management programs, I know employers will continue to use them. I want to stress that a well thought out strategy can help both employer and employee have less headaches if a penalty is implemented. I encourage you to consider these six mistakes I’ve seen happen before putting a penalty in place.
- Not trying a communication campaign first.
I’ve seen groups successfully increase participation through education, such as strong communication campaigns, using onsite resources, such as Human Resources or onsite nurses for referrals and by promoting employee success stories. Employees need to understand the “what’s in it for them” because they may not realize the benefits they can get from the services. Give your employees some context for why they should pick up the phone and engage. If you let your employees know that someone may be calling them to offer help with their medication, resources for closing a financial gap or a free glucometer, they may be more likely to pick up the phone.
Not understanding how your employees will interpret this message.
Think of your messaging. I don’t think there is a way an employer can ever craft a message that is warm and fuzzy when coupled with a penalty. “Hi Susie, I’m calling on behalf of your employer, who really cares about you and wants you to take care of your health by participating in our disease management program. If you don’t participate, your employer will charge you $600 in additional medical premiums.” If you have established a culture of accountability and responsibility, then your employees may not bat an eye at a penalty. If you have never had a penalty before and don’t have any kind of health and wellness culture in place, expect your employees to be upset and voice their concerns.
- Not deciding what the penalty will accomplish.
I’m often surprised this isn’t discussed before putting in a penalty. Maybe you are implementing a penalty because your disease management participation numbers aren’t high enough. Or maybe you believe it will lower the amount you spend on high dollar claims. Whatever your reason, be mindful of the result you are expecting from putting a penalty in place and monitor the results. If you aren’t tracking your results, what’s the point of putting the penalty in place after all?
- Not deciding how long the penalty will be in place.
Most groups think year to year, so when implementing penalties or incentives, I don’t often hear the conversation around what happens after year one. If you put a penalty in place one year and you see measured success, chances are that you’ll need to continue (or increase) the penalty to continue to see the result. Participation rates typically decrease when the penalty is taken away. If you aren’t in it for more than a year, then it may not be worth it.
- Not clearly defining the penalty.
Reaching out to people for health conditions requires an individualized approach. Some people may need one call, others may need eight. Regardless of who is providing your health management services, it is up to the employer to define what constitutes as “engagement”. Is it one phone call, completing all calls or does something done to complete the engagement? What happens if they decline? Can they re-engage and not have the penalty? I’ve seen employers put a penalty in place and these questions don’t come up until an employee starts questioning their participation. Make sure you see and understand the reporting before your penalty is in place. Otherwise, you’ll be faced with interpreting reports when employees tell you they didn’t decline the services offered.
- Thinking compliance equals engagement.
If this is a penalty that affects your employees’ paychecks then you’ll get people going through the motions and not really happy about doing so. Think about the last time you were angry or felt backed into a corner. Were you in the mood for someone to coach you on your health? Our nurses giving the message of the penalty often have to spend time calming a person down before they can attempt to educate them. Sure, your employees will participate in the program but that doesn’t mean they’ll truly engage and have better health outcomes.
I encourage you to find other ways to reach your goals other than a penalty. If you’d rather implement a penalty, I encourage you to consider the points I’ve outlined above.