I am one of the lucky Americans who currently have good health insurance, provided through the auspices of my employer. My employer strives to be considered a premium employer in the marketplace, and the provision of good benefits obviously plays into this. Despite this, I have learned that (due to rising health care costs) my employer will soon be making changes to our health care plan. While they’ve not released full details about the changes that are forthcoming, I do know that we will move from having a choice of three plans to a choice of just two. We will see increased deductibles and increased employee premiums - all the usual, and not surprising. After all, these changes are representative of a trend that has been going on for years – higher employee premiums, worsening coverage, etc. But there is one aspect of the proposed changes that is completely new – to me anyway – and one that I find extremely disturbing...
Over the years, I have worked in the realm of Employee Benefits, and I’ve also done substantial time working for health insurance companies. I’m familiar with a variety of employer-based health insurance plan models, and how the relationship between insurance companies and employers work. I know that health insurance companies regularly report to employers – in the form of aggregated data - what trends are occurring in their employees’ health experiences. I’m also familiar with the typical ways in which a growing number of employers provide their employees with tools to make healthier lifestyle choices; incenting employees to take care of themselves by providing on-site fitness facilities, on-site weight loss and smoking cessation programs, etc. I know that these are good things, and they’re done with the belief that healthier people will have lower health care costs. My experience with these wellness incentives has always been that they are voluntary, and that the incentives are positive incentives – such as providing a credit toward plan premiums for non-smokers. I always believed that ultimately, my choice – the choice to take care of myself or not - was my business, or possibly my business and that of my doctor. I never expected the day to come when my choices would be monitored and reported back to my employer. Well, that day has come.
Today I learned that my employer has decided that there needs to be a stronger emphasis on employee wellness and preventative care as an element of our health care plan than what we have driven in the past. They’ve determined that our health plan model will include both incentives for healthy choices and disincentives for not-so-healthy choices. In order to execute this plan as intended, my employer will make use of a "third party" that operates in the space between our health insurance carrier and my employer to monitor my health care choices and report back to my employer about my decisions...
This third party will, for example, monitor if employees have had annual physicals, pap smears, mammograms, etc. They will monitor whether or not an employee is regularly seeking refills on medications that they are supposed to take every day, to manage an illness. Should they report back to our employer that an employee is not "engaging in healthy choices", my employer will, in turn, increase the employee's share of the health care premium, as a penalty for their poor choices.
Please understand: I’m not against the concept that we are, each and every one of us, responsible for our choices. I’m not even against the idea that I should have to pay more premium than someone who is doing everything in their power to stay healthy, if I’m not doing the same. My objection is to the idea of being monitored by some random corporation that is being paid to spy on me, and having my choices broadcast back to my employer. This is new to me, and I find it outrageously intrusive. I’m told that the third party is being used to "protect my confidentially", and honor HIPPA laws. I don’t understand how that can be even remotely true; this third party will have access to our employees’ medical track records via their insurance claims, and they will report what they find to my employer, identifying - on an individual basis - which employees have engaged in healthy behaviors and which have not, and how specifically they are not engaging. I find it hard to believe that this is even legal, but I am guessing that somehow, it is...
In the town where I live, there is a small, quaint building in which an insurance agency has their office. The agent has put a sign out in front of the building that reads "Who do you want involved in your health care – you and your doctor, or a politician?" Obviously, this agent – who no doubt makes a living from selling health insurance - believes that government should stay out of health care. After all, health care issues should remain in the sacred realm that exists between doctor and patient, right? But if that is true, how can it be that I will soon have an insurance company, a third party, and my employer all privy to information about my health care choices?
This is yet another symptom of a failing health care system; it’s not enough that my employer is narrowing my choices, raising my deductible, and raising my premiums. It’s not enough for them to simply provide wellness incentives and tools. Costs are still rising. It’s come to the point in America where – in an attempt to cut health care costs and preserve profits – employers are willing to pay a "third party" to intercept my health care records, and those of my co-workers, and use the information they obtain to pressure us regarding the choices we make about our own health, our own bodies. So - how is the status quo preserving anything that we care about? How is it dealing with rising costs? How is it preserving the sanctity of doctor-patient relationships? How is it ensuring that health care will be affordable for you and I tomorrow? How is it ensuring that our privacy about the most personal issues in our lives is preserved? How is having my employer know about my health care choices not as Big Brotherish as having the government involved in the health care game?
Perhaps others here have heard of what I describe here, or have experienced it themselves. I have not. I’d be interested to know if any one here has experienced this, and/or if they know anything about these "third parties" – who they are and how they operate. I just don’t have enough details yet from my employer to know the answers...