Be Healthy Or Else
December 30, 2016 6:03 AM   Subscribe

How Corporations Became Obsessed with Fitness Tracking

Once companies amass troves of data on employees’ health, what will stop them from developing health scores and wielding them to sift through job candidates? Much of the proxy data collected, whether step counts or sleeping patterns, is not protected by law, so it would theoretically be perfectly legal. And it would make sense. As we’ve seen, they routinely reject applicants on the basis of credit scores and personality tests. Health scores represent a natural — and frightening — next step.
posted by I_Love_Bananas (83 comments total) 44 users marked this as a favorite
 
My employer rolled out a plan like this a few years ago. I'm fortunate that I can afford simply not to participate - it's a several hundred dollar annual discount on your insurance rather than a thousand dollar surcharge.

I chose not to participate partly because when I asked the person who called to sign me up for a health survey about data security, he said some really disturbing stuff, partly because I really hate the erosion of medical privacy and substantially because I've heard stories about how people are judged negatively for following their own doctor's policies rather than the suggestions of the doc-in-a-box hired by their employer. I don't want some pill-happy quack on retainer to my boss telling theoretical older-Frowner that I need a gazillion meds when my actual doctor says I don't.

It's very frustrating - they're always trying to get you to sign up for fitness classes, etc, and a lot of them sound really interesting. I'd love to sign up. But it turns out that they're just a proxy for getting a full, extremely intrusive medical history, as I discovered when I went to sign up for one of those lunchtime yoga classes. You have to fill out this enormous form detailing a bunch of stuff that even my doctor doesn't really ask about, and I'm like, no thanks, I have a Y membership where all I had to do was sign a waiver saying that I wouldn't sue if I keeled over while lifting weights.
posted by Frowner at 6:21 AM on December 30, 2016 [78 favorites]


"Did you lose your keys here?"
"No, but the light is much better."
posted by leotrotsky at 6:22 AM on December 30, 2016 [8 favorites]


And I thought making us pee into a cup was an invasion of privacy...
posted by kozad at 6:24 AM on December 30, 2016 [7 favorites]


The really galling thing is that employers put the burden of these 'wellness' programs entirely on the employee. They want employees to walk 10,000 steps per day, for example, but don't provide breaks for employees to go for a walk during the day. If you're a sedentary office worker, this effectively means making the wellness program an unpaid second shift. It's a hell of a racket.

These 'incentive' programs should be legally required to be completable during normal, paid work hours. If an employer wants its employees to go to the gym, then the employer can damn well pay for their memberships and let them count time spent there as work.
posted by jedicus at 6:37 AM on December 30, 2016 [150 favorites]


It's like the linking of employment and health insurance coverage had unforseen consequences.

Not that companies wouldn't have gotten around to this eventually, in any case ...
posted by penduluum at 6:38 AM on December 30, 2016 [28 favorites]


I don't need a privacy scare to hate these wellness training requirements and tracking. I do a crazy thing called going to my doctor for real, trusted, vetted, professional advice. Every time I've ever gone in with a form for him to fill out regarding wellness (for that damn "discount") he reminds me that he's read the literature and there is no proof these programs work at all - and he is concerned that if poorly managed they discourage people from going to their doctor for good advice and general wellness check-ups. You know - a physical.

You know it's a scam when the insurer doesn't simply have the alternative of your doctor fill out a form saying they are your doctor and you visit them at least once a year and go over the categories of interest - general health, diet, etc. There is money to be made here, not lost.

I'm frankly insulted by this whole debacle of a system where some dipstick fitness coach, with a half-assed degree in nothing from community bullshit school tries to tell me about wellness issues they read about on some fake news site over the best-in-class doctor I've chosen that's known me for ten years.

Fuck you very much, American health systems.
posted by Muddler at 6:39 AM on December 30, 2016 [51 favorites]


Aside from the intrusiveness, the motivation is biased in the wrong direction.
Ultimately, a sufficiently large corporation sees its employees as a set of costs. Multiply those costs across an organization and you look for ways to change the multiplier, you know, for the good of the corporation since decreasing costs means increasing profit, right? So we'll put up a web page with pretty pictures of models in bike shorts and set up a portal to track and say things like "we'll charge you less for your insurance1 if participate and meet our arbitrary goals."
Well, likely wrong.
I'm under the belief that if you provide top-notch health care without false "incentives", a healthy model of life/work balance, and don't give people grief for going on a walk/run/bike ride during lunch, then you're much more likely to have happy, productive, workers. That should make a far greater improvement on the bottom line. Oh, and you know what also makes a huge difference? Have a "don't be a hero" policy. If you're sick, stay home. You'll feel better and you won't infect your co-workers. But how do you measure that? Where's the data?

1This has the feel of states that said "You can't charge extra if someone pays with a credit card." so gas stations instead offered a discount for paying with cash. It's about the flimsiest BS.
posted by plinth at 6:41 AM on December 30, 2016 [23 favorites]


Oh, yeah, Whole Foods does this, it's... pretty hateful.

"Weigh Less, Pay Less: Whole Foods Offers [Employee] Discount Based On BMI"

The article is from 2010, but this was mentioned to me when I briefly worked there two years ago, so it's still been an ongoing thing, apparently, although not all stores participate.
posted by ITheCosmos at 6:45 AM on December 30, 2016 [1 favorite]


Imagine what they could do with aggregated data from social networks. I'm sorry Mr. COD, we've learned that you've checked in bars and pubs 135 times over the last three years. We don't think you'll be a good fit in our company.
posted by COD at 6:46 AM on December 30, 2016 [5 favorites]


My organization has several health incentive programs, but none are mandatory, and most are not intrusive. For instance, we get a $25 gift card every year if we do a yearly physical with a healthcare provider of our choice (gyno visits count) and we have another fitness competition with rewards that relies on self reporting steps. Promoting health doesn't need to be a data grab.
posted by tofu_crouton at 6:47 AM on December 30, 2016 [12 favorites]


I can't imagine why so many people seem to feel 'entitlement" programs are a liberal scam when they have these kinds of lovely options presented to them under the guise of some given individuals saving a few bucks. These kinds of programs catch on with the well off, who see their lives as the right kind, and them screw those who don't quite fit into the same mold they came from. The sad thing is how many people who think of themselves as liberal fall for this crap too.
posted by gusottertrout at 6:48 AM on December 30, 2016 [1 favorite]


My employee wellness program does have some real perks, including a subsidized gym membership. On the other hand, every year I have to take a health survey and get dinged for failing to do things that would definitely not be safe for me to do, because I'm in recovery from an eating disorder. (And that fact is truly none of my employers' business.) I have mixed feelings about our wellness program, because I'm not opposed to the idea, but there are a lot things about the implementation that seem concerning.
posted by ArbitraryAndCapricious at 6:48 AM on December 30, 2016 [12 favorites]


You know what's worked for me in terms of improving my health? Working half as much as I used to.

Combine this with the research that working double the hours doesn't accomplish near twice as much work, and you have a great method of increasing employee health at less of a cost than would be expected. But I don't see anyone rolling that out.
posted by Trifling at 6:53 AM on December 30, 2016 [39 favorites]


These programs are a fair warning that were anti-discrimination laws weaker, there'd be notices posted along with employment listings, for no fatties or olds. The next step of course then it for the employers to find a way to get out of paying at all, but keep the discriminatory hiring policies 'cause, you know, aesthetics and all.
posted by gusottertrout at 6:54 AM on December 30, 2016 [15 favorites]


My previous employer did this: yearly health screenings, "just so we'll have the information on hand," CERTAINLY not to do anything nefarious with that data. {|} At first, it was voluntary, so I opted to pay the extra few hundred bucks in premiums every year. The next year, it was compulsory if you wanted the Cadillac plan, so I switched to the slightly more paperwork-intensive mid-tier plan. The following year, it was compulsory for everything except the Chevy Nova plan, so I grudgingly trudged to the clinic they had helpfully set up in the breakroom for my blood pressure test and blood screening. At this point, I had a 2-month-old infant at home, hadn't slept more than 3 hours at a clip in weeks, had drunk something like 6 cups of coffee to compensate, and had forgotten that there was a blood sugar test that required a 12-hour fast. My test results were, uh, not conducive to lowering company health care costs.

The next year, I loudly announced my plans to see if I could outperform the previous year's results, and ate an entire bag of chocolate-covered espresso beans before the screening. Upon looking at my numbers, the nurse seemed vaguely credulous that I was alive and able to walk and/or talk.

The next year, I left the company and went to work for someone who doesn't try to pull this kind of thing.

I'm not sure what the moral of this story is, but I heartily recommend doing anything you can to throw a wrench in the works of any employer who's using this kind of horseshit to try to shame their employees into behaving differently.
posted by Mayor West at 7:18 AM on December 30, 2016 [61 favorites]


I used to work for one of the companies mentioned in the article and the first year it was a discount for the employee. Then it was extended to the spouse, which meant I now had to find a time to take both of use for a half hour checkup that was a lot less thorough than our yearly physical. Since they manage clinics in addition to their retail stuff, I assumed it was just a plot to make us use their underutilized clinics.

I also regained all the weight I lost prior to working at the company. So I guess it worked really well.
posted by inthe80s at 7:25 AM on December 30, 2016


We had a similar discussion a year and a half ago, and I'll just repeat my general points here.

There's nothing necessarily wrong with choosing to do fitness tracking for yourself. There's a huge problem in being coerced to do fitness tracking and other health metrics for your company.

I'll also add that companies would be a lot less inclined to pull this shit if we had universal, government run healthcare.
posted by SansPoint at 7:27 AM on December 30, 2016 [28 favorites]


A fun thing about my wife's insurance is that it relies on BMI and monitoring-device-reported exercise-sessions (which tends to get picked up only for extended cardio), so any weightlifting results in zero benefits for the healthplan. This has occasionally resulted in me repeatedly shaking the robot while reading to trick it into thinking steps are happening, while one room over, my wife is doing like 1.5x bodyweight deadlifts.
posted by Greg Nog at 7:32 AM on December 30, 2016 [40 favorites]


Another reason I didn't want to sign up - about half the exercise I do "doesn't count" in our program because, like with Greg Nog's, it's not steps. Also, the only way to get your bike riding to count is to have an RFID tracker on your bike, and that's not happening.
posted by Frowner at 7:39 AM on December 30, 2016 [3 favorites]


This has occasionally resulted in me repeatedly shaking the robot while reading to trick it into thinking steps are happening

Do you have an active pet or a child? It seems like the least they could do is generate some steps for you in exchange for the years of free food and shelter you are providing.
posted by Dip Flash at 7:43 AM on December 30, 2016 [28 favorites]


I work for a hospital, which means aside from the initial drug screening, titers, and a legnthly initial wellness screening (and for me a psychiatrist stateing I can actually work) I am evaluated by employee health at my return from any illness lasting more than 3 days, and if I end up in the ER (like the car accident I had) they have additional information .

So, I kinda just gave up on health privacy at some point.
posted by AlexiaSky at 7:55 AM on December 30, 2016


My last employer started out with one of these. Then one year, the health care plan demanded that you submit to a blood test to prove that you weren't a smoker or you'd get a $600/year fee on your insurance cost. I wasn't going to literally bleed for the company, so I declined to submit for the test.

The next year, after I had blood work for a real thing, I tried to get them to acknowledge the results. Hours of phone calls and faxes, it was maddening.

I don't work there any more.
posted by fifteen schnitzengruben is my limit at 8:02 AM on December 30, 2016 [2 favorites]


Just wait until employers start offering free AncestryDNA accounts. "Hmmmm...That's quite a checkered lineage Employee #1024368 hails from. They just aren't management material."
posted by Thorzdad at 8:11 AM on December 30, 2016 [6 favorites]


For the past few years, my company has given a slight discount for doing a blood test, and an even bigger discount for filling out a health survey and going down the health coaching route. I started the survey a couple of years ago. Funny, I had no trouble cheerfully saying I was fat and didn't exercise as much as I probably should, but then there was a section asking a lot of questions about mental health, and I noped the hell out.

While I don't have any diagnosed mental health issues, I have had extensive counseling in the past for trauma. I'm sure that's enshrined in my medical file, but for a survey that was going to some random third party my "none of your goddamn business" alarm went off. In hindsight, it probably should have gone off from page one, but that's what it took.
posted by pianoblack at 8:13 AM on December 30, 2016 [4 favorites]


Just wait until employers start offering free AncestryDNA accounts

That, at least, is legally prohibited. The Genetic Information Nondiscrimination Act of 2008 "bars employers from using individuals' genetic information when making hiring, firing, job placement, or promotion decisions." It also prohibits denying insurance coverage or charging higher premiums on the basis of genetic information.
posted by jedicus at 8:16 AM on December 30, 2016 [4 favorites]


My company was just bought by a company that has a $600 "discount" on the health plan if you do this. It's BMI and blood pressure, although if you fail, you can use a fitbit to get enough steps to qualify. However, you can't just sign up for the fitbit thing. I walk 1-2 miles a day (it's a half mile from the subway station to my office and then additional depending on how far I walk for lunch) and would easily pass the fitbit part. But I can't just sign up to walk a certain number of steps a day. I figure I'll do a cut water weight thing that the wrestlers at my high school did, discard about a gallon of water (which should also lower my blood pressure) get weighed and go on about my merry way.

So I'm planning on inflicting an unhealthy condition on my body in order to qualify for a health benefit. Campell's Law in action.
posted by Hactar at 8:20 AM on December 30, 2016 [9 favorites]


This stuff has to be game-able. A bot to simulate exercise - that sort of thing.

The only way to fight big data right now is lots and lots of lies.
posted by Strange_Robinson at 8:21 AM on December 30, 2016 [5 favorites]


Ha. Yeah, they tried it here, even handed out cheap knockoff tracking devices. Which they said were a gift, so I got $15 on ebay for it. When asked why I wasn't participating, I showed them the 4" scar on my ankle and explained about the pins holding my foot together, along with the multiple surgeries and rehab just so I could walk on it a bit. Too much and I end up not being able to walk at all for a few days, so they asked for their watch back.
posted by Blackanvil at 8:22 AM on December 30, 2016 [9 favorites]


This stuff has to be game-able. A bot to simulate exercise - that sort of thing.

Pay a college student to wear your Fitbit. They're walking all day around campus.
posted by Thorzdad at 8:25 AM on December 30, 2016


This stuff has to be game-able. A bot to simulate exercise - that sort of thing.

There was a mefi thread a while (like more than a year?) ago about people putting fitbits on metronomes or rigging up dinguses with slowly-turning drills (and gears?) to simulate jogging.
posted by ROU_Xenophobe at 8:28 AM on December 30, 2016 [1 favorite]


I'm part of an affordable wellness collective, because as a group of practitioners we want to be able to provide options that are normally out of reach to so many different communities. When struggling to figure out how to feed your family or adjust to life in a new country, you may not even know what your options could be. The wellness programs at work could have fulfilled this, but instead I see it as just another way to penalize anyone who didn't grow up in the right family or background.

This reminds me of a Harvard Business Review article I read yesterday: Research: How Subtle Class Cues Can Backfire on Your Resume. The data shows that law students who aren't from a wealthy background are judged as being the wrong fit.

It's mind-boggling to me that something that could do a lot of good is being twisted in such a way.
posted by A hidden well at 8:29 AM on December 30, 2016 [15 favorites]


We've had something like this at work for about three years now. For the first two years we had to get a screening with basic tests, which we could either get through their service or take a form to our own doctor. Last year for some reason we didn't have to do that. And otherwise it's been absurdly easy to blow the whole thing off. The idea was we had to earn "points" per quarter of the year. But a point could be as simple as logging onto their website and saying "I worked out today." Whether you actually did or not. Sure, I'll click a box on a website a couple times a month to save $50/month in extra insurance charges.

(This coming year apparently they've replaced the program but we've been given no details yet. I'm hoping it's no more "intrusive" than the previous one.)
posted by dnash at 8:41 AM on December 30, 2016 [1 favorite]


This stuff has to be game-able. A bot to simulate exercise - that sort of thing.

There was this WSJ article that is interesting, not because people are cheating on their fit bits (because duh), but because the companies that collect the data are investigating the cheaters.
posted by peeedro at 8:41 AM on December 30, 2016


A large hospital system in my area did a Fitbit challenge where the group with the highest number of steps got an all-expenses trip to Paris as the top prize. Cheating was absolutely rampant: a person running the treadmill in the gym would have several step trackers on, a receptionist with a jiggly foot would have a few trackers strapped to her ankle.

Needless to say, they never repeated the contest.
posted by dr_dank at 8:55 AM on December 30, 2016 [23 favorites]


I participated in good faith with the wellness program at my last employer, and they still tried very hard to screw me out of the $200 screening participation incentive, because my waist circumference was outside the recommended healthy range, when I was eight months pregnant.

Someone in HR did finally relent and credit me the $200 (after about 30 emails which I'm sure added up to way, way more than $200 of billable hours). The "wellness" company they hired to administer the program never did come through and admit it was OK for me as a pregnant woman to have a big belly.
posted by beandip at 8:58 AM on December 30, 2016 [58 favorites]


The last time tech was as democratizing of power as computers are today was the gun back in the 19th century. And like guns, it's easier to attack than to defend. Cyber cops, god bless them, have their future work cut out for them.
posted by Strange_Robinson at 8:59 AM on December 30, 2016


I'll also add that companies would be a lot less inclined to pull this shit if we had universal, government run healthcare.

I am – as with every police officer and politician in a press conference ever – not prepared to speculate on hypotheticals, but I offer this data point: in thirty or so years in the workforce of a country with universal healthcare, I have never had an employer require this nonsense from me.
posted by ricochet biscuit at 9:01 AM on December 30, 2016 [12 favorites]


That insurance companies are doing this is entirely predictable and awful. The point of insurance is risk pooling. By shrinking the pools down to individuals levels they can then divide and conquer and exchange insurance for what in effect becomes a pre-payment plan. So they are trying to turn health insurance into the same model as dental insurance.
posted by srboisvert at 9:09 AM on December 30, 2016 [11 favorites]


I lie during my health assessment, because frankly my employer's goals are at odds with my health insurerers and I'd rather cater to what makes me look like a good employee so I don't get fired, than what makes me look like a healthy one. For example, my wellness program repeatedly tells me to work on reducing stress, but my employer expects that I work 65 hours a week, including nights and weekends, without vacation time. So.

But I participate, because I can't afford not to, and because I'm lucky enough and young enough to easily meet the threshold for no additional costs. But I recognize it's a really fucked up program, and more than 50% of my office gets downright pissed off the day of the annual employee weigh-in.
posted by likeatoaster at 9:25 AM on December 30, 2016 [6 favorites]


I've never had a job that offered health insurance outside of graduate school, so the stories everyone is telling here are outside my personal experience.

They seem like something out of a 90's sci-fi novel - you know, the kinds with the cliched corporate dystopia.

Jesus. Are you guys sure you're not just basing your comments on the terrible fiction I wrote as a teen?
posted by Kutsuwamushi at 10:02 AM on December 30, 2016 [5 favorites]


On the other hand, every year I have to take a health survey and get dinged for failing to do things that would definitely not be safe for me to do, because I'm in recovery from an eating disorder. (And that fact is truly none of my employers' business.)

This is hands-down the thing that terrifies me. There is no consideration in these sorts of initiatives for the fact that diets and weight loss are sometimes actively dangerous. But as long as they judge that relapse is going to be cheaper for them than the potential that I might need medication for diabetes, that's the way they're going to lean. Even though diabetes stands a chance of "being inconvenient and lowering my life expectancy somewhat" and ED relapse will quite possibly ruin my life. As long as it's cheaper to ruin my life, I don't doubt they'll try.
posted by Sequence at 10:09 AM on December 30, 2016 [7 favorites]


I refused to participate in my companies "health screenings" for years until they actually released the document with fine print promising that the data collected will be anonymized and will only be used for determining aggregate data. The truth so many face today was the "paranoid" fear my co-workers claimed I was having for years.
posted by Megafly at 10:17 AM on December 30, 2016 [3 favorites]


My work gave us an app that pings you a few times a day and asks you some questions about your emotional state. I got to see the final results report. It was unbelievably depressing -- apparently all my coworkers are bored, sad, angry, or upset virtually all the time. It's funny since I actually like my job and my coworkers don't seem that unhappy in person.
posted by miyabo at 10:32 AM on December 30, 2016 [15 favorites]


Holy shit, miyabo, that's some dystopian nightmare stuff.
posted by something something at 10:35 AM on December 30, 2016 [18 favorites]


Just wait until employers start offering free AncestryDNA accounts. "Hmmmm...That's quite a checkered lineage Employee #1024368 hails from. They just aren't management material."

With mine it would be "putain merde renvoie-là oh fait chier comment elle a eu une épée aaaahhhh NOOOOONN *gargling sounds of dying*"

One of my Viking ancestors liked to invade France. Hee hee hee. Our family's actually descended from his marriage to Aslaug too, so all sorts of fun stories in there. Unfortunately my pointed grins when I say "oh reeaaaally?" at remarks that I'm not "truly French" haven't yet inspired anyone to ask me why I'm so certain that Frankish sorts could be relatives. Shame.

Back on topic. Over here, with single-payer socialized medicine, we do actually have doctors who follow up on us when we're salaried employees. It's from the other perspective, however: employers have to prove they're providing a healthy workspace. Checkups with occupational doctors are strictly confidential; the only thing they can tell employers is in the case of a job-related medical issue. And in that case, the employee is still entitled to be paid – employers have to, again, prove that they've changed the work context in order to allow the employee to return and recover. If you're fired because, from a medical point of view, you're no longer able to work in a place, it has to be proven and you have the right to unemployment compensation. As with all things it's not perfect, unsurprisingly it's come under fire from corporate types and they have sadly succeeded in weakening the presence of occupational doctors.
posted by fraula at 10:40 AM on December 30, 2016 [10 favorites]


miyabo: "My work gave us an app that pings you a few times a day and asks you some questions about your emotional state. I got to see the final results report. It was unbelievably depressing -- apparently all my coworkers are bored, sad, angry, or upset virtually all the time. It's funny since I actually like my job and my coworkers don't seem that unhappy in person."

I never have to worry about that at least. I work at a mental health non-profit.
posted by Samizdata at 10:59 AM on December 30, 2016 [3 favorites]


I'll also add that companies would be a lot less inclined to pull this shit if we had universal, government run healthcare.

Just because we have universal, government-run health care (along with employer-sponsored extended health benefits) doesn't mean that there aren't real barriers to accessing health care. Even salaried white-collar types in big cities run into this. I've worked at places with PTO policies and organizational cultures that are so restrictive that they effectively prevent people from using recurring health care services like PT or therapy because the negotiations around making up time at work would turn into a potentially career-damaging communication nightmare.

Not saying that the American system is better, but there are most certainly employers in single-payer healthcare countries that set policies that "out" people whose lives and bodies aren't perfect.
posted by blerghamot at 11:11 AM on December 30, 2016 [3 favorites]


My previous employer did this. The company they subcontracted t out to had a genuinely crappy website that did not at all inspire confidence in their security. I called my employer's liaison; the security of my personal health information had literally never occurred to them.

I lied about everything. You could get points for watching health videos. Pretty sure they bought old 1971 films; ridiculously dull and uninformative, but press play, mute the computer, go do something more useful.
posted by theora55 at 11:17 AM on December 30, 2016 [2 favorites]


I too wrote bad dystopian fiction as a teen. It stops being comically-over-the-top-and-dystopian when you're filling out forms with your local HR representative for an 'Executive Exception to the Fitbit Fee' policy because you're disabled and can't walk 5,000 extra steps a day, and it's a maybe 50/50 thing that you'll get it. But you know, what's an extra $600 a year, ontop of the extra medical services I already have to buy fairly?

It's literally the signature of our system that it creates 'Policies that were originally intended to be fair to everyone' that end up 'Specifically punishing the most vulnerable and sick.' That fits my label for 'dystopian', teenage weltschmertzy or not.
posted by mrdaneri at 11:20 AM on December 30, 2016 [16 favorites]


While I am not an overall fan of these programs, the one at my workplace was a huge benefit to me. When I started my job I had really let myself go, stopped exercising all together and put on a surprising amount of weight. I found out at my yearly well-woman exam that they would only cover a pap smear and if I wanted to have blood work done or discuss my overall health not related to my vagina I would need to make a separate appointment and pay for it out of my deductible. My work offered wellness screenings as part of one of these programs and I decided to go to save $25 on my insurance. I knew my weight and waist circumference would look bad, but they also told me that my cholesterol numbers were not good at all and encouraged me to change my diet and add exercise to my routine. It was a real kick in the pants for me and I ended up making some huge changes in my life because of it. The wellness program offered coaching and regular training that was actually very helpful. When I went back for a screening a year later, they couldn't believe the difference I had made.

On the other hand, we were told at our open enrollment period for next year that if we had covered spouses on our insurance plan that they would raise our rates $600 and that our spouses would need to fully participate in the wellness program in order to earn a $600 incentive discount. I knew this would never happen, so he has now switched to a much worse plan through his workplace. Not all of my coworkers are that lucky.
posted by galvanized unicorn at 11:42 AM on December 30, 2016 [1 favorite]


I'm sort of on the other side of this at the moment,

I'm at work procrastinating over a health and safety report. I've got a ton of data on accidents and injuries and looking for ways to actually make a difference.
Fortunately, the element of insurance coercion isn't an issue here because for now we still have the NHS (for now...).
So really I'm looking at how not to hurt or kill people.

Thing is, when you start looking across a huge amount of data the whole health, safety and wellness stuff really jumps out.
Sure, you're not going to trip over that thing and break your arm, but in one out of fifty thousand times someone will, so let's move the thing or install better lights or something.

People complain a lot about these "pointless wellness bullshit" initiatives, but when you see all the data you can see places where they added a rubber doohickey to the end of a thing vs where they didn't. One of the locations has a guy with fewer eyes than he should have and about six thousand more bruises.

The output of this work also includes how you monitor, record, analyse and incentivise this sort of stuff.
I guess it should also include how NOT to incentivise it.
Monitoring stuff like this is really difficult, because people hate to become data (for good reason usually).
So you could probably save lives if you could monitor how people moved around your site, or exactly when people arrived at work or left or took breaks, and how they transitin from work to not work or from task to task.
But of course people HATE that. They know that although your health database might be anonymised and only used to keep people safe and healthy that eventually a sleazy guy in a suit is gonna sidle up and suggest that he takes a quick look at your data so he can fire 10% based on unsuitable metric A,B or C.
So, the upshot is that here I am looking at a jagged and messy dataset trying to make some graphs look nice.

* I know a lot of what I'm talking about is Health and Safety rather than Wellness, but it's the same dataset ultimately.
posted by Just this guy, y'know at 11:52 AM on December 30, 2016 [5 favorites]


A friend of mine lost the monetary "discount" (not sure how much, but a couple hundred dollars) because she exceeded the BMI threshold. Because she was pregnant.

(We told her she should protest/sue, but she had a lot else going on and didn't want to cause trouble for herself.)
posted by puffyn at 11:57 AM on December 30, 2016 [5 favorites]


I hate these stupid things that focus on BMI. BMI is a useful tool for public health...at the population level, since it is a proxy for a lot of other things, though the extra weight may not actually be causing the other things. At the individual level, it is basically useless.
posted by rockindata at 12:03 PM on December 30, 2016 [8 favorites]


I'll also add that companies would be a lot less inclined to pull this shit if we had universal, government run healthcare.

So... here's a thing. Washington State employees have a "SmartHealth Wellness incentive", which IIRC was established by law. It's voluntary and the incentive is pretty small ($125 off your annual deductible), but don't think it's just corporations going for this sort of thing. Industry article from a couple of years ago cites at least six states.

America being what it is, I can totally imagine this taking off as a side feature of universal health care.
posted by epersonae at 12:24 PM on December 30, 2016 [1 favorite]


A friend of mine lost the monetary "discount" (not sure how much, but a couple hundred dollars) because she exceeded the BMI threshold. Because she was pregnant.

Pregnancy entails many associated possible health problems, and collectively represents a huge liability for insurers; I'm sure they'd love to assess a large penalty for pregnancy itself if the optics weren't so awful -- and you're not likely to get them to give up even the relative pittance they recoup by including pregnancy under the BMI rules without a fight.
posted by jamjam at 12:25 PM on December 30, 2016 [8 favorites]


I know a lot of what I'm talking about is Health and Safety rather than Wellness, but it's the same dataset ultimately.

You say you "know" this, and yet your comments are nonetheless total non-sequitors. Nobody is using these health and wellness programs in office settings in order to reduce workplace accidents. They're using them to squeeze money out of their employees (by reducing their benefits unless they put in effectively free work to make them more attractive to insurance companies), so as to pad the bottom line of the employer and the insurance company. At no point is any of this being used for the actual wellness of the employees.

This shit is vile and frankly I wish it was illegal.
posted by tocts at 12:48 PM on December 30, 2016 [19 favorites]


Agree with all of this. My insurance company offers discounts based on 10,000 steps a day. That means those few in our company who have the discipline to meet their IMHO ridiculous requirements get $1 discounted off their deductible each time they manage the guidelines.
As a fairly active, bike-riding, exercising person I rarely meet those guidelines and have no interest in doing so. So I'm penalized by comparison to anyone who has the free time or anal-retentive nature to do this regime.
I think I'm going to take this little step tracker and go smash it under a convenient rock.
posted by diode at 12:50 PM on December 30, 2016 [2 favorites]


Sorry tocts, I have to disagree.
It depends a lot on the specifics of what we're talking about of course.
I'm in the UK so the companies are not involved in healthcare purchasing. The economics are very different.
(i.e. I get to talk about the good stuff in the first half of the article, not the intrusion, coercion and general horror in the second half)

The companies I'm working with are absolutely using wellness programmes to reduce workplace accidents.
That doesn't mean of course that they're doing it just because they care about their employee's health, there is a bottom line at play.
If your employees get sick or injured then they are not at work, and of course, you'd prefer your salaried employees to be at work. But I'd also rather be at work than be sick or dead.

Added to that there is another cost. If you have someone die at work and you didn't try to prevent it then you're liable for that. There are fines for poor safety performance, fines for deaths, fines for serious injuries and fines for not reporting properly. (These ones are more Health and Safety than wellness).

I agree with you wholeheartedly that ANY cash-based incentive, any coercion and any miss use of data must be strictly avoided, and it gets way messier when you pay for health care and/or your healthcare is via your workplace. Employer provided health insurance comes with a boat load of deeply troubling incentives and counter-incentives.

I do agree that I probably rambled a bit more about H&S than wellness, this is all down to the report that I should be writing.
posted by Just this guy, y'know at 1:08 PM on December 30, 2016 [1 favorite]


I would clarify that data focused safety programs are very different than data focused wellness programs with a profit margin attached.
posted by mrdaneri at 1:41 PM on December 30, 2016 [4 favorites]


Yes, that's probably true. This is more wellness creeping in via Health and Safety, which is indeed a very different thing.
posted by Just this guy, y'know at 1:48 PM on December 30, 2016 [1 favorite]


My company does this, but:

1. It's 100% voluntary and has no impact on health insurance premiums

2. You only have to participate for 4 weeks to get reimbursed for the Fitbit

3. The steps goals translate into a quarterly bonus of about 250-300 USD

4. Several groups of people take walking breaks throughout the day to get their steps in. This is encouraged by senior management.

Also the ONLY thing we track is the steps, nothing else (no annual checkups/weigh-ins/etc).

I think it helps that we are a very small company and our CEO and COO are both really really into fitness.
posted by Doleful Creature at 3:13 PM on December 30, 2016 [1 favorite]


> BMI is a useful tool for public health...at the population level

But only certain populations.

Anecdote: I noticed when I was working in a preschool that some kids were heavier than others when I picked them up. My own kids seemed dense, other kids seemed fluffy, but they looked to be the same size. A friend told me she felt -- and had more anecdotes to back this up -- that BMI measurements discriminate against African-American children like hers, who for whatever reason were often heavier but not apparently larger than white children.
posted by The corpse in the library at 3:20 PM on December 30, 2016 [5 favorites]


Zen fascists will control you
100% natural
You will jog for the master race
And always wear the happy face
posted by Apocryphon at 3:53 PM on December 30, 2016 [7 favorites]


Pregnancy entails many associated possible health problems, and collectively represents a huge liability for insurers; I'm sure they'd love to assess a large penalty for pregnancy itself if the optics weren't so awful

My employer requires a Wellness Survey in addition to a blood test and possibly optional phone health counseling in order to get the discount. Thankfully no creepy Fit Bit stalking...yet. Anyhow, I stopped participating after the first year it was offered because the survey actually asked me (after asking age/sex), if/when I planned to become pregnant: within a year? two years? three to five years? I was just floored at how inappropriate that was. Like what if someone lies and gets pregnant anyway? Or refuses to answer? You can't fire someone for actually being pregnant, but could you for saying that someone might want to be in the near future? They've steadily increased the incentive for participating/penalty for not participating over the past few years, so it's now at the point where I really can't justify refusing to do the damn thing.
posted by eeek at 4:53 PM on December 30, 2016 [4 favorites]


Pregnancy entails many associated possible health problems, and collectively represents a huge liability for insurers; I'm sure they'd love to assess a large penalty for pregnancy itself if the optics weren't so awful

The thing that's funny about this, though, is the normal-person BMI (and waist measurements, etc) would just absolutely TERRIBLE health-wise for both the mother and the fetus.

You'd think that kind of thing would lead to health care costs, too . . .
posted by flug at 6:01 PM on December 30, 2016 [2 favorites]


We have to do a wellness screening and an evaluation for $500 off our insurance (actually, $1000 off because the mister and I work for the same company, although I carry the insurance). Fortunately, they don't care that we're fat, in that we still get credit no matter our BMIs. There's a combined $1800 premium for smoking, although this year we had the option to waive that by choosing "planning to quit." I have my patches ready for the new year (I don't do resolutions, but I'll be at a party with smokers, so it's just practical) but my spouse is a lying liar who lies. Which is fine, because before we had this option, and when it was cheaper, I just made him give me $600 every January because he wouldn't let me lie on the form for a cheaper rate. We also have regular Fitbit step challenges. I'm hyperflexible and prone to joint injuries, so my boss emphatically prohibits me from participating in those. I mean, yeah, it's weird and intrusive, but I also have a fantastic insurance plan, and I met my deductible months ago (it's been a bad year) so I've been seeing specialists and getting expensive tests done and refilling every prescription I have ever had for free. I just picked up five refills today and it cost $22 only because my 90 day supply of generic Claritin isn't covered by my insurance. $22 for three months worth of Claritin! That's awesome. So go ahead and measure my fat waist, because I am literally thankful every day for my health insurance.
posted by Ruki at 11:06 PM on December 30, 2016


"This reminds me of a Harvard Business Review article I read yesterday: Research: How Subtle Class Cues Can Backfire on Your Resume. "

TIL to change my last name to Cabot and also that whatever law school career services office is letting people put "pick up soccer" on their resumes is committing malpractice because SERIOUSLY??? How was the class signalling there not already abundantly clear?

"Welcome my dear friends to Boston,
Home of the bean and the cod,
Where the Lowells speak only to Cabots,
And the Cabots speak only to God."

posted by Eyebrows McGee at 2:02 AM on December 31, 2016 [3 favorites]


Okay, I also have to go a bit against the grain and argue that, while there are many examples here and elsewhere of poor implementation, I don't think that the idea of wellness programs in which insurance companies provide financial incentives for healthy behaviors is bad in itself. Caveat being, the fact that it is (directly or indirectly) our employers who are collecting data about our health is weird and disturbing and could have unintended repercussions. But I think that's a symptom of the larger problem of insurance being linked to employment more than a problem specifically with this idea.

Take your current pool of health insurance participants and freeze everything - the plan, its price, the participants' behavior. Select one individual in the plan. Say that statistically, doing behavior X results in $Y saving in average health expenditures. The individual doesn't find it worthwhile to do behavior X initially - many other things compete for her limited hours in a day, and behavior X just doesn't make the cut. But, when her insurance company offers her $0.5*Y in exchange for doing X, she decides that the financial incentive more than compensates her for the effort of doing the healthy activity. She is better off (both financially and health-wise), her insurance company is better off, and nobody else in the insurance pool has been harmed. You can argue any which way that there are problems in implementation (counting BMI for pregnant women, counting steps for cyclers, etc), that the greedy insurance companies use this as a ruse to produce higher profits, or whatever, but I think the idea is sound. In fact, it seems that any insurance plan that doesn't offer a wellness program is by definition suboptimal, since splitting financial gains from healthy behaviors could make both the company and (some of) the individuals better off (without making other individuals worse off) pretty much 100% of the time.
posted by exutima at 7:21 AM on December 31, 2016


I've been in jobs with a very invasive wellness plans (go through their testing, have to talk to their health consultants, even when I've been working closely with my own doctors, and can document that - and that I have health stuff that makes some of the standard advice actively destructive to me and my ability to work.)

Incidentally, that was also the job that when a location change for my desk lead to persistent migraines (basically daily until I got a new job, about 9 months) it was impossible to get them to take it seriously. (As a friend said "Doesn't your work *want* you to do work?" You'd have thought!)

My current job has a much more sensible approach: we have to do three wellness things a year to qualify for the lower rate. You can basically pick any three things that you can argue for, but the most common option is a self-reported "I don't smoke" form (committing to quitting would also count), a "I have seen a doctor for an annual visit" thing (that the doctor has to sign), and a "I've done whatever bloodwork that doctor recommends I do this year." (self-reported, they don't want to see the results, just the statement that you've done the recommended things.) I see my doctor quarterly, so we just pick one of those visits to be the annual.

If one or more of those don't work for you, you can write up a thing that says "I go to the gym at least X times a week." or "I am working with a physical therapist" or whatever and submit that instead. They also give us some other benefits - $100 toward fitness equipment, money toward fitness club memberships, a discount at a local club that brings it from very pricy to more manageable.

Here's the thing: current workplace just had its first increase in healthcare costs to employees in 5 years. Previous job had significant (8-10%) jumps each year I was there. I find that fascinating.
posted by modernhypatia at 7:57 AM on December 31, 2016 [2 favorites]


But I think that's a symptom of the larger problem of insurance being linked to employment more than a problem specifically with this idea.
If gravity didn't exist, then jumping off tall buildings could be an awesome hobby, but it's kind of irrelevant, because we live in a world in which gravity does exist. These programs are being undertaken by American employers (rather than insurance providers, btw, which is significant) in a context in which healthcare is tied to employment. In a different system, which provided universal healthcare and in which they were overseen by healthcare providers rather than workplaces, these programs might not be sinister. But that's not what we're talking about here.
posted by ArbitraryAndCapricious at 8:03 AM on December 31, 2016 [7 favorites]


My concern with this stuff, after having worked in HIPAA-audited firms is that some places do a great job with data, and some places don't. Some places are fully HIPAA compliant years in advance, have a culture of 'customer-first' policies, and basically, are just great. Other places, you can bet are emailing your PHI in an Excel sheet to their vendors with a password of 'Password'.

Add in that a lot of this stuff is outsourced to third party firms-- so your actual fitness data probably takes a weird route like Your HR Person--> Upstream Broker --> An Aggregator --> Insurer and you can bet that several Excel sheets were in the middle.

I, the end 'customer,' have no visibility into any of this. I get to take the insurance plans on offer, and that's pretty much it. If I don't like it, I'm welcome to find my own coverage at radically increased cost, because, that's the elegant beauty of the free market, love it or leave it.
posted by mrdaneri at 8:50 AM on December 31, 2016 [2 favorites]


Workplace wellness plans are not necessarily covered by HIPAA. The ones that offer discounts on insurance premiums are, but other ones aren't.
posted by ArbitraryAndCapricious at 9:04 AM on December 31, 2016 [4 favorites]



The thing that's funny about this, though, is the normal-person BMI (and waist measurements, etc) would just absolutely TERRIBLE health-wise for both the mother and the fetus.


Yeah, if they actually cared about employee wellness, as opposed to profits (and it sounds like some people here have experienced better plans than others), it would not be hard to make this a useful program. Like, waive the BMI requirements for pregnant people (or really anyone with extenuating medical circumstances) who is under a doctor's regular care. Allow self reporting of e.g. time spent swimming or other non step activities. Etc. Basically make it more like helping you get and stay healthy and less like setting you up to fail (at your cost).

(On preview what others have said.)
posted by puffyn at 9:44 AM on December 31, 2016


While I was waiting to interview for a job about a year or so ago, I flipped through a copy of the company's employee newsletter. (It was in the waiting area.) The cover story was about the company's wellness program and the revamping of the incentives to get discounts on insurance premiums. To get the initial discount, you had to go through a screening and health risk questionnaire with the third-party company they contracted with. Based on those results, you would get a health-related goal to meet, and then you would get the bulk of the premium discount if you met that goal within the year. (It was a very significant discount - well over $1,000.) It just seemed really invasive to me and I was kind of glad I didn't get that job.
posted by SisterHavana at 11:19 AM on December 31, 2016


At least it was an individualized goal. My workplace wellness program assumes that everyone needs to lose weight, which is why next week we start a Biggest-Loser-style weight-loss competition in which various departments are invited to compete with each other to see who can lose the most pounds. I don't need to lose weight, and I have a history of anorexia. I wonder if my department would get an extra prize if I literally managed to starve myself to death, because if history is anything to go by, that could be on the table. It's voluntary, and I'm obviously not doing it, but I'm still pretty pissed that they even thought it was a good idea.
posted by ArbitraryAndCapricious at 11:33 AM on December 31, 2016 [9 favorites]


Oh, I haaaaate workplace Biggest Loser competitions, especially when they pit departments against departments. Ask A Manager covered this earlier in the year.
posted by SisterHavana at 11:46 AM on December 31, 2016 [2 favorites]


> that BMI measurements discriminate against African-American children like hers, who for whatever reason were often heavier but not apparently larger than white children.

Measures of body composition in blacks and whites: a comparative review [Am J Clin Nutrition]: In general, blacks have a greater bone mineral density and body protein content than do whites, resulting in a greater fat-free body density.

posted by porpoise at 11:51 AM on December 31, 2016 [4 favorites]


> My current job has a much more sensible approach: we have to do three wellness things a year to qualify for the lower rate

At that point, what are they hoping to accomplish? Is there anyone who can't come up with three broad, self-reported statements a year?
posted by The corpse in the library at 1:10 PM on December 31, 2016


I'd forgotten in my original comment (our paperwork cycles in June, so it's been half a year) but if you don't do the signed doctor sheet (and want the discounted rate), you have to do a questionnaire and I think a follow-up call plus two other things. However, that's still way better than my previous job where you had to do the external screening whether or not you were also regularly seeing your doctor regularly.

My impression is, however, that it mostly is a "We are treating you like adults who would like to be as healthy as reasonably possible for you", "Here are some options to help with that" and "Here are some incentives to do things to keep our health care costs down and you healthier without us being invasive jerks about it." and that most people take the path they encourage (the "I don't smoke" sheet and doctor's visit/related testing) which is a reasonable one largely in line with current evidence-based research. (I know there's some debate about whether annual physicals are necessary, but what I've seen has been 'they're not wrong, just not an absolutely need'.)

And like I said, from the 'health care costs increase' point of view, they appear to be doing something right with it. And I certainly feel a lot more inclined to take advantage of the other incentives, personally, if I am not being made to feel guilty by my employer for the state of my health on other paperwork. (Which is to say: I am over 6 months into going to the gym at least 2 times a week, and usually 3 unless I have an unusually active weekend planned, and those incentives have definitely made it much more logistically feasible.)
posted by modernhypatia at 1:42 PM on December 31, 2016 [1 favorite]


Our employer gives us a set amount of money each year for professional development and wellness. Up until this year, you could only spend $250 on wellness; now you can spend the whole $850 on any combination of wellness activities, exercise equipment, or professional development you want over the course of the year. Any money you don't spend, you lose. It's a reimbursement program, so you have to put the money up front, but all that's required for the reimbursement is a form saying why the expense will help you meet your (self-defined) wellness or professional-development goals, and it has to be signed by your supervisor. No one tracks anything, you don't have to meet any goals -- you just get a bit of money earmarked for wellness stuff. While I definitely wish there were more money set aside for professional development, having the fitness option is very cool, and makes me feel like the goal is for employees to do what makes sense for them, rather than just to keep insurance costs down.
posted by lazuli at 3:57 PM on December 31, 2016 [2 favorites]


Which they said were a gift, so I got $15 on ebay for it.
That was seriously funny, even if you might not have intended it as such. I already got great mileage out of refusing to carry around a work-sponsored smartphone (to somewhat baffled reactions from management) and I will keep this in mind.
posted by Harald74 at 10:59 PM on December 31, 2016


It's already been said up-thread, but this looks really dystopian to foreign eyes. I, at least, have my union, the Data Protection Authority and, you know, a regular, sane legal framework to head this kind of shit off at the pass. My employer provides a health checkup session and advice for free at a third party, no strings attached.
posted by Harald74 at 11:12 PM on December 31, 2016 [1 favorite]


Yeah my husband's workplace decided to implement a wellness initiative last year. It involved free memberships to Weight Watchers for employees that didn't fit within the prescribed BMI/measurements purview.

No surprise to any of y'all that the only person in his building who was breathlessly hand-delivered her free membership to WW was also eight months pregnant at the time.

(Possibly made even more ironic, though, because it's a Catholic university that refuses to pay for birth control of any kind.)

My suggestion was that she go in a week before her due date and ask slyly, "So... I really need to drop a lot of weight fast, like, by the end of THIS MONTH. Can you guys help me meet that goal? It's for work. I gotta meet the wellness BMI for my discount" but sadly, she was too miserable to do it. September and an extra 38 lbs. will do that to ya in Texas when it's 99F outside every day, and often hotter.
posted by Unicorn on the cob at 11:16 PM on January 1 [2 favorites]


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