04 Jul When Your Only Tool is a Hammer, Everything Starts to Look Like a Nail

Don’t mistake activity for successful results

The Affordable Care Act (ACA) continues to present daily questions, challenges, and opportunities as we work with our clients one by one to determine what (if any) modifications they need to make to their wellness incentive strategy. It comes as no big surprise that many of these customers are receiving postcards, email solicitations, and webinar invites suggesting that the new regulations require health coaching and/or other participatory outreach programs to be provided to anyone who fails to achieve a health standard in order to be compliant with the new rules.

Of course, we find in every instance that these companies are selling coaching, on-site lunch and learns, or web-based, self-guided education. It’s no wonder that they promote their “hammer” as the “required” way to comply with the new regulations, without other tools on hand that meet ACA requirements.

While it is absolutely true that the new regulations require that an alternative way to qualify be provided to anyone who fails to achieve a health standard (even in the absence of a medical issue preventing them from doing so), it is also true that the alternative provided is permitted to be a modified, easier-to-achieve health standard.

For example (as stated in the regulations), “if the initial standard is to achieve a BMI less than 30, a reasonable alternative standard for the individual could be to reduce the individual’s BMI by a small amount or a small percentage over a realistic period of time.” If a person cannot achieve the standard or the alternative standard, the individual’s personal physician can provide a second alternative standard, consistent with medical appropriateness.

This is a high-touch, complex way to measure, track, and administer such programs but it is the only way that achieves most employers’ goal in implementing an outcomes-based design in the first place: the desire to only reward results instead of simple activities that may or may not have any real or lasting impact. For nearly five years, Bravo has administered hundreds of plans this way and is well equipped to track personal progress goals, modified on occasion by personal physicians.

It is not illegal (and it is arguably more conservative) to provide full rewards to those who fail to achieve a health standard if they complete a few telephonic coaching sessions, attend lunch and learns, wear pedometers, and sign up for health challenges, but at the end of the day, is that what you really intend to reward? Additionally, the overlooked victim in these designs is often the person who chooses to purchase a home-gym, hits the salad bar and starts running in the neighborhood in order to get into shape. These are often the most deserving of rewards but they are disqualified because they didn’t go to YOUR gym or meet with YOUR telephonic personal trainer. If they lost the weight or lowered their blood pressure, do you really want to deny the reward because they didn’t do it your way? Conversely, if I called my coach religiously for six months but gained 20 pounds during the same period, do you really want to cut me a reward check?

I applaud the regulators for making sure that no employee is left with a hopeless goal they have little to
no chance of achieving in their employer wellness program. Requiring employers to reward meaningful,
reasonable progress is the perfect solution and it is worth the extra effort. Coaching, departmental
challenges, lunch and learns, and health risk assessments are all valuable tools that should be made
available as optional ways to help employees overcome obstacles and gain the education they need on
their wellness journey, but like any well run managed business objective, you cannot afford to mistake
activity for success.