Workplace Wellness Plans Offer Big Incentives, but May Cost Your Privacy | Hacker News Reader

Workplace Wellness Plans Offer Big Incentives, but May Cost Your Privacy

npr.org

49 pointsgnicholas11 comments

> Few expect employers will stop offering wellness programs outright — because most hope the programs will hold down health costs by getting workers to take steps to improve their well-being. Critics, however, point out that studies show little evidence that workplace wellness programs achieve these goals.

Insurers like Oscar are very savvy pioneers of what wellness programs actually do: select for healthier pools.

What difference does it make if your insurance costs $4,700 instead of $6,000 this year, if you're so healthy you don't use a dime of it? Oscar's investment exit horizon is nearer than the time it takes health 28 year olds to turn 55 and chronically unhealthy.

How does it select for healthier pools? Older people don't like being told what to do, or to have to use technology like fitness trackers and apps. It's that simple.

As long as gratuitous technology and wellness selects for healthier pools, an insurer's bottom line doesn't care if wellness actually improves health outcomes. At least from an accounting point of view.

Obviously, we should support efforts to make people healthier. But I'm just trying to point out why insurers do this.

Your comments about Oscar do no make sense. Oscar offers insurance in the individual marketplace. As such they are not selling to companies but to individuals directly who don't have insurance through their employer. This means their members do not partake in these types of wellness plans. Also, as part of that marketplace, Oscar can't legally use the members previous medical history to underwrite/rate their policy. This means Oscar has little to no insight to whom they are offering their products, their goal is to get enough healthy people to offset the costly ones.

Also an insurance company who offers commercial group insurance, i.e. sells insurance to companies, does not have their bottom line really impacted as much as you would think. This is based on the fact that they are currently acting as middleman in the system and any increase in costs is merely passed along, hence continually rising cost of healthcare.

> This means their members do not partake in these types of wellness plans.

Oscar members get discounts for walking a certain number of steps a day, and other somesuch things. They are functionally equivalent to employee wellness programs, in that consumers (be they individuals or business) are offered discounts in exchange for fulfilling some behavioural change that intuitively seems to make people healthier, even though there's little evidence that it does. I'm speaking to their prevalence in the industry.

I get that it matters from an accounting point of view that they're an individual marketplace insurer versus a whatever. It doesn't matter from the point of view of why insurers generally like these programs.

> Oscar can't legally use the members previous medical history to underwrite/rate their policy.

Oscar does a lot of things to select for healthier pools. Their marketing is carefully tuned to a particular kind of healthier customer. You're underestimating how goddamned savvy they are. That's not illegal, but it's effective.

There has recently been a rule change that allows insurance pools that are "guild"/union targeted, like only plumbers or insurance offered for the Writers Guild of America (WGA). Surely you see that, if that average writer is 28 years old, and the average plumber is 45 years old, I don't need to look at their medical history or anything to know which pool is healthier?

Even if I pick a pair that's the same age, I bet you the average highly paid programmer at 28 (for my hypothetical programmer's insurance) is going to select for a healthier pool than my 28 year old warehouse and teemsters worker insurance.

> Oscar has little to no insight to whom they are offering their products.

I think when they place an Instagram ad, they're pretty much guaranteed to be "offering" their products to a younger audience than the average American. I don't need to look anything up to get that incredibly cost-impacting insight.

Or maybe I'm targeting iPhone versus Android, and iPhone users are just wealthier on average and therefore just healthier on average.

I get that ANY American can buy their insurance. I'm not going to litigate the role of marketing, because it's pretty obvious that it matters.

> This is based on the fact that they are currently acting as middleman in the system and any increase in costs is merely passed along, hence continually rising cost of healthcare.

From the article:

> The Cleveland Clinic's Rogen, who credits the wellness program for holding medical costs almost flat for the past five years...

I guess I'm just trying to explain why. Your business specifically is a middleman in a system, and you're passing costs along. But there are some actors who, by their accounting have held costs "almost flat," whatever that means.

I'm speculating as to the mechanism by which costs can remain flat, DESPITE your accurate picture of a continually rising cost of healthcare.

discounts in exchange for fulfilling some behavioural change that intuitively seems to make people healthier

I think Oscar is less concerned with whether walking so many steps makes you healthier and more concerned with your ability to walk so many steps as a rough indicator of your health. This is especially useful given the above-mentioned fact that Oscar isn't allowed to underwrite based on your medical history.

With the ACA's pre-existing condition guarantees under threat, it is in every individual's interest to keep as much of their medical information private as possible. The way insurance companies make money is by avoiding elevated risk, after all.

On a related subject, I wonder whether ISPs are selling browsing history to insurance companies.

I was about to get free Fitbit from work program. And then I heard work would have access to data in Fitbit. Nah, screw that.

If I got a free one from work, I'd just put it on my dog.

Wouldn’t work for me. My dog is incredibly lazy. :)

The trick then is to catch a neighborhood squirrel and attach it to the animal.

WHO at Fitbit thought it was a good idea?

Looks like a case of damned if you do and damned if you don't. Privacy of health related information is critical, and as with other things, the people who are relatively poorer would be the worst hit. There's probably no escaping being further exploited or discriminated against.

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