How much is too much?

Employers everywhere wrestle with just how far they can push wellness initiatives on their workforces without alienating them and crossing some invisible big brother boundary into their non-work lives. Compensation director Steven Johnson would like to push it a lot further than he does now.

In my article on the topic in Sunday's Philadelphia Inquirer, Johnson reports that the Naturally Slim wellness initiative now being piloted by business managers in various Philadelphia area private schools and colleges has meant big savings for his organization, Genesis Health Systems in Davenport, Iowa. His health insurance costs not only not risen, which is remarkable by itself, they have decreased over four years, thanks to this program. He's paying 2.5 percent less than he did four years ago and the rate of hospital admissions per thousand has declined by a third.

Johnson is such a big proponent of the Naturally Slim program, which essentially teaches participants a new way to eat, that he provides employees with a significant discount on their share of health insurance if they participate each year. They have to get blood tests. If the tests reveal that they have three out of five poor-health indicators (too much cholesterol, too little good cholesterol, high blood pressure, high blood sugar and a disproportionate amount of weight as a ratio of height), they take a 10-week web tutorial on better eating habits. 

About half of the people who follow the program see a reduction in at least one factor. But, says Johnson, only about half of those who go through the program actually pay attention. Some just let it drone on in their home computers while they watch their favorite sit-com in the next room. 

"We’d like to go to compliance based incentive where you have to do something, but that’s the ultimate solution," he said.  "I can see us getting more aggressive as long as the regs allow it. We’re trying to head for people becoming accountable for their own bodies."

Johnson thinks he'll have a great stick in 2014 when medical exchanges become available through the health reform legislation. "Come 2014, you're only going to be on our plan if you are compliant," he said, more than half-serious.

This seems intense -- is this a discrimination suit waiting to happen? After all, older people are more likely to have  metabolic syndrome, the official name for three out of five bad indicators. The issue is fraught with problems. It's doubtful that the Philadelphia Area Independent Schools Business Officers Association now sampling the program would force such a step on its schools, including most of the region's Quaker schools. 

Yet there's no doubt that health care costs are on a trajectory going the wrong way. And no one will disagree that it's better to be healthy than sick. But then again, how much of us do employers really need to own? How much is too much? As time goes by, we'll see where the new normal falls.