Wellness incentives in the workplace: cost savings through cost shifting to unhealthy workers.

The Affordable Care Act encourages workplace wellness programs, chiefly by promoting programs that reward employees for changing health-related behavior or improving measurable health outcomes. Recognizing the risk that unhealthy employees might be punished rather than helped by such programs, the act also forbids health-based discrimination. We reviewed results of randomized controlled trials and identified challenges for workplace wellness programs to function as the act intends. For example, research results raise doubts that employees with health risk factors, such as obesity and tobacco use, spend more on medical care than others. Such groups may not be especially promising targets for financial incentives meant to save costs through health improvement. Although there may be other valid reasons, beyond lowering costs, to institute workplace wellness programs, we found little evidence that such programs can easily save costs through health improvement without being discriminatory. Our evidence suggests that savings to employers may come from cost shifting, with the most vulnerable employees--those from lower socioeconomic strata with the most health risks--probably bearing greater costs that in effect subsidize their healthier colleagues.

The law, policy, and ethics of employers' use of financial incentives to improve health.

The Patient Protection and Affordable Care Act (ACA) turns to a nontraditional mechanism to improve public health: employer-provided financial incentives for healthy behaviors. Critics raise questions about incentive programs' effectiveness, employer involvement, and potential discrimination. We support incentive program development despite these concerns. The ACA sets the stage for a broad-based research and implementation agenda through which we can learn to structure incentive programs to not only promote public health but also address prevalent concerns.

When public health and genetic privacy collide: positive and normative theories explaining how ACA's expansion of corporate wellness programs conflicts with GINA's privacy rules.

The Patient Protection and Affordable Care Act of 2010 (ACA) contains many provisions intended to increase access to and lower the cost of health care by adopting public health measures. One of these promotes the use of at-work wellness programs by both providing employers with grants to develop these programs and also increasing their ability to tie the price employees pay for health insurance for participating in these programs and meeting specific health goals. Yet despite ACA's specific alteration of three different statues which had in the past shielded employees from having to contribute to the cost of their health insurance based on their achieving employer-designated health markers, it chose to leave alone recently enacted rules implementing the Genetic Non-Discrimination Act (GINA), which prohibits employers from asking employees about their family health history in any context, including assessing their risk for setting wellness targets. This article reviews how both the changes made by ACA and the restrictions recently put place by GINA will affect the way employers are likely to structure Wellness Programs. It also considers how these changes reflect the competing social goals of both ACA, which seeks to expand access to the population by lowering costs, and GINA, which seeks to protect individuals from discrimination. It does so by analyzing both positive theories about how these new laws will function and normative theories explaining the likelihood of future friction between the interests of the population of the United States as a whole who are in need of increased and affordable access to health care, and of the individuals living in this country who risk discrimination, as science and medicine continue to make advances in linking genetic make-up to risk of future illness.

Trying to compensate. Latest ranking of CEO compensation finds stock options still key to pay as experts monitor for effects of SEC rule changes.

Despite past outcries from critics, stock options continue to play a starring, albeit smaller, role in compensation for CEOs at top companies, based on research by accounting professor Steven Balsam, left. Read about the 30 healthcare executives who brought home the biggest pay packages in our annual ranking of CEOs' compensation.

Regulatory and tax issues for worksite wellness programs.

Worksite wellness programs continue to grow and find expression in employer organizations of all types. As these programs mature and are offered to larger and larger numbers of employees in more worksites increased opportunity exists for regulatory problems. Applicable legislation and major federal regulatory issues affecting worksite wellness programs are explored and categorized. Final rules regarding Title I non-discrimination provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) are described and implications for employers are identified. Due to the increasing importance of incentive rewards in programming, the tax implications of various types of program expenditures are also described. Finally, suggestions for legislative amendments and regulatory changes that would enhance wellness program effects are described.