Monday, October 24, 2016

Clearing the Confusion on Tying Rewards to Spousal Wellness Program Participation

by: Barbara J. Zabawa

Since the EEOC issued the final rule under the Genetic Information and Nondiscrimination Act (GINA), there have been a number of questions relating to what is permissible with respect to rewarding employees for spousal participation in wellness programs.

First, to recap, GINA prohibits employer wellness programs for imposing a penalty or disadvantage on an individual because a spouse’s disease or disorder prevents or inhibits the spouse from participating in the wellness program or from achieving a certain health outcome. 29 CFR s. 1635.8(b)(2)(i)(A).

Second, GINA prohibits employer wellness programs from retaliating against an employee because of a spouse’s refusal to provide information about his or her manifestation of disease or disorder to the wellness program. 29 CFR s. 1635.8(b)(2)(v).

So, with those rules in mind, how can an employer wellness program tie an employee’s reward to his or her spouse’s participation, if at all? Let’s look at a few examples:

Employee can earn reward (the value of which is no more than 30% of the total cost of self-only coverage) if both the employee and spouse meet a certain cholesterol level. If either employee or spouse fails to meet the cholesterol target, the employee does not earn the reward. Permissible?
Answer: No, this is not permissible. This program is tying the employee’s reward to the spouse achieving a certain health outcome. As noted above, GINA prohibits employer wellness programs from imposing a penalty or disadvantage on an employee because the employee’s spouse has a disease or disorder that prevents him or her from achieving a certain health outcome. The spouse in this case may have high cholesterol, arguably a “disease or disorder” that prevents the spouse from meeting a certain health outcome. Denying the employee the reward because of the spouse’s disease or disorder is not permissible under GINA.
Employee earns a reward equal to 15% of the total cost of employee-only coverage and another 15% of that cost if both the employee and spouse do the following:

a. Complete an HRA
b. Attend a biometric screen (results are irrelevant for purposes of reward)
c. Attend four seminars
d. Provide evidence of a physical exam by their primary care physician

If either the spouse or employee fail to complete all four activities (which all four are presumed to qualify as “participatory” programs under the HIPAA/ACA rules), the employee’s reward is $0. That is, both employee and spouse must complete all four activities to earn the full 30% reward. Is this permissible?
Answer: Yes, this is permissible as long as the employee does not feel like they are being retaliated against for a spouse’s refusal to participate in the biometric screen, for example. The activities listed above do not ask the spouse to achieve a certain health outcome. Thus, the reward is not tied to the spouse achieving a certain health outcome.
Same facts as #2, above, except the reward is equal to 30% for the employee’s participation and 30% for the spouse’s participation. Would this be permissible?
Answer: No, this is not permissible because the reward equals 60% of the total cost of employee-only coverage, which exceeds the 30% maximum award available under GINA. The employee only gets the reward if both the employee and spouse complete all four activities. If either the spouse or employee fail to complete all four, the employee’s reward is $0, which is the same as a 60% penalty if the spouse refused to provide their biometric information (which violates GINA) or a 60% penalty if the employee refused to provide their health information (which would violate the ADA final rule).
Employee can earn a reward of up to 60% of the total cost of employee-only coverage if both the employee and spouse join a fitness club, attend at least three health education classes (from a list of over a dozen options), and volunteer in the community. Is this permissible?
Answer: Yes, this is permissible because all of these activities are “participatory” under the HIPAA/ACA rules, which does not place a limit on the reward amount. Also, none of the activities involve the provision of health information by the employee or the spouse, so neither the ADA nor GINA rules (and their 30% incentive limits) would apply.
Many of the responses above were confirmed by EEOC Attorney Chris Kuczynski at the HERO Form 2016. The take away is that employer wellness programs should not tie an employee’s reward to a spouse’s health outcome. Also, the program should be careful not to structure an employee’s reward so that the employee feels retaliated against if his or her spouse refuses to provide his or her health information. 

If your wellness program needs compliance assistance, please contact the Center for Health and Wellness Law, LLC at

About the Author:

Barbara J. Zabawa owns the Center for Health and Wellness Law, LLC a law firm dedicated to improving legal access and compliance for the health and wellness industries. Before graduating with honors from the University of Wisconsin Law School, she obtained an MPH degree from the University of Michigan. Immediately prior to starting her own firm, she was Associate General Counsel and HIPAA Privacy Officer for a large health insurer where she advised on Affordable Care Act matters. She was also a shareholder and Health Law Team Leader at a large Wisconsin law firm. Barbara is licensed to practice law in both Wisconsin and New York.

Tuesday, September 27, 2016

6 Key Takeaways from the 26th Annual Worksite Wellness Conference

We recently had the opportunity to attend the WI WELCOA Conference here in Green Bay, WI. We got to hear from industry leaders like Dr. Hunnicutt and Chris Jordan, and also see how companies like Kimberly-Clark Corporation have been leveraging the power of a robust wellness strategy. So what did we learn at this conference? Here a few key lessons learned from the day.

1. The difference between a corporate athlete & professional athlete.

The conference opening keynote was Chris Jordan, the Director of Exercise Physiology for Johnson & Johnson Human Performance Institute. He presented on the eye-opening topic of energy management. And spent time specifically on the comparison of professional athletes and the corporate athlete. While professional athletes train for 90% of the time and perform 10%, us corporate athletes time is flipped. We spend 90% of our time in the office performing, while spending >10% training for our roles. He challenged us to spend more time training for our roles. He also mentioned the idea of recovery. Athletes spend time recovering in order to better perform. We can take this same mentality into not only our lives, but the lives our employees, by encouraging your workforce to take time to train and learn, while also allowing them to focus on recovery.

2. Personalization is the next step in corporate wellness.

A lot of talk at the conference centered around individual wellbeing, but how do you impact every single employee? This is where technology and big data can up its game. How can you use the data collected to personalize the wellness program experience? How can you remain relevant and successful in today’s demanding society? It starts by understanding your demographic and employee needs. Then you can build a digital health strategy to customize the experience for each employee.

3. Practicing more gratitude comes with some surprising research-backed results.

David Hunnicutt, PhD. focused on igniting organizational performance and fueling individual well-being. His presentation was on practicing gratitude and appreciation, and in turn, how doing so can ignite your workforce. The Harvard study he shared was thought-provoking. Helping others led to an increase in productivity, engagement and wellbeing. Overall there will be 50% greater output if you practice gratitude to employees. This simple strategy also makes YOU feel better, more empowered and fulfilled. It leads to a positive cycle of increased happiness, productivity and over well-being for everyone involved. So the next time you come up against something challenging, attempt to practice gratitude and sit back and reap the results.

4. Job crafting is important. 

David Hunnicutt also shared his experience with job crafting, the new wave of helping fuel individual wellbeing in your workplace. He visited the Bass Pro Shop company. When he asked one employee what their job was, he was beyond shocked when she said, “My job is to inspire people to love and cherish the great outdoors.” Creating this emotionally enhanced vividness with job descriptions can help employees feel more inspired and motivated to live up to the expectations. He motivated us to take a fresh perspective on helping employees craft powerful vision statements in order to help them reach their full potential.

5. You should elevate your wellness awards to the same level as your sales/other awards. 

Stephanie Pereira da Silva, Health & Wellness Manager for Kimberly-Clark Corporation, gave an insightful presentation about her personal experience crafting an award-winning wellness program. Her company focus on wellness comes directly from the brand, which is a great core. They offer wellness awards in the same arena as their Sales awards. They place a high value on well-being and painting a clear picture to what is important to the Kimberly Clark brand. By evaluating your own wellness awards to a higher standard you too can show employees what your core company values are.

6. Simplifying your efforts can double your results.

John Weaver presented an interesting topic around why people irrationally fail to choose wellness. Research shows that people in any situation will shut down and stop paying attention when they get overwhelmed. This easily applies to wellness programs. We have worked with many program admins over the years that feel they need to offer “something for everyone” so that they can get more people to engage in the wellness program. Which makes sense on the surface, but in the process of trying to reach every single person, many times we find that the program has become overcomplicated, overwhelming and accomplishes the opposite goal. Instead it’s important for us to focus on what truly matters, creating a clear visual path to success for employees.

Overall, we love attending these conferences because it reinvigorates our passion. What we’re doing has a real impact, and finding new ways to engage and educate our readers is important to us. We can’t wait to use what we’ve learned to help our clients develop their best wellness strategy yet.

Thursday, September 1, 2016

City of Green Bay Launches New Wellness Program

photo credit: Brown County Courthouse

The city focuses on providing healthy choices through the use of an online wellness portal and wearable activity trackers.

City of Green Bay employees are kicking off a healthy fall season with the launch of their Health 1265 Wellness program. The Health 1265 program is a points-based wellness program using a Green Bay based wellness vendor, myInertia, to track and award points for healthy choices.

“We know that supporting the health of our employees is more than just providing good health benefits” says Green Bay Mayor Jim Schmitt. “It’s also important to provide the tools and motivation to make the healthy choice. That was the idea behind the Health 1265 program.”

An important part of the program is to encourage employees to get physically active. To support this initiative, employees were given $55 toward the purchase of a Fitbit or Garmin activity tracker. Employees can earn points for their steps as well as participation in other wellness activities in their myInertia account and have the opportunity to compete in city-wide challenges.

The points also add up to benefit savings. Employees that earn 1,265 points in a year will see an additional savings on their health insurance premiums. One of the most popular motivators is the opportunity to win club seat tickets to a Packer game, signed Jordy Nelson jerseys and a signed Aaron Rodgers helmet. Lynn Boland, Human Resources Director says “We’ve put together a program that is intended to further engage employees in their own health and wellness, which will ultimately result in a healthier workforce that benefits the City of Green Bay.”

The 2016 Health 1265 program will wrap-up in October and employees will have the opportunity to provide input on their experience for program enhancements for the upcoming year. Meredith Baciak, wellness coordinator for the City of Green Bay, who works closely with the participants, states, “We’ve been running the program for only a short-while and I am excited to see some success stories already.”

myInertia works with Employers, Benefit Advisors, and Healthcare Systems to cut through the wellness noise and focus on what really matters: creating meaningful behavior change. Our mission is to help create happier workforces and healthier bottom lines in organizations across the nation. If you would like more details on myInertia’s engaging wellness platform, you can visit, or contact our Director of Wellness Strategy, Sarah Troup at | 920-593-8867.

Thursday, August 25, 2016

What is the REAL Value of Your Wellness Offering?

Most wellness professionals will be familiar with this vignette:
You worked hard to set up a wellness event for your organization that is empirically based, aligned with your mission, and fun for the participants. You put out flyers and used the company intranet to announce your offering. But your sign-ups are going slow.
It is difficult not to be discouraged. Participants in wellness programs often irrationally fail to make choices to improve their health. It is tempting to conclude that the general public is lazy, or does not really care about their health. I believe the problem lies elsewhere. Making decisions that will enhance our health can be more complex than it seems.

As an example, here is an ad that was discovered by Dan Ariely from Duke University (found in his book, Predictably Irrational, 2008). It was an ad placed by the Economist magazine to purchase a subscription:

Welcome to The Economist Subscription Centre
Pick the type of subscription you want to buy or renew subscription: $59
One-year subscription to
Includes on-line access to all articles from
The Economist since 1997.

Print subscription: $125
One-year subscription to the print edition
of The Economist.

Print & Web subscription: $125
One-year subscription to the print edition
of The Economist and online access to all
articles from The Economist since 1997.

Do you notice anything unusual about this ad? If you look carefully, you will notice that the cost of the print only subscription and the print plus web subscription is the same. Dr. Ariely verified with the magazine that this was not a mistake and also experimented with his students to demonstrate that the Economist was actually making an advertising decision that was effective.

He reprinted the ad for 100 students and asked them to select an option. Option one, the option was selected by 16 students. The second option, print subscription only had no takers. The overwhelming choice was option three, the print plus web choice, which was selected by 84 students.

Next he took out the print subscription only option and presented the modified ad to another 100 students. By taking out the option that no one in the first group selected, now 68 students chose the subscription and a mere 32 students took the print plus web option. Why did this occur?

When the Economist placed this ad, most people were still uncertain of the value of an online subscription. They were used to a print subscription, so the cost of $125 did not seem out of line. In comparison, how much is an online subscription worth? Remember, this ad was published in 2007. (The first iPad was not available until 2010, so reading online was still new for most people.) It was difficult for potential subscribers, at that time, to determine how to value an online subscription. They used a comparison of choices as a method to determine the relative value.

This is a similar problem many employees face when they are offered opportunities to participate in a wellness activity. How is the value of that opportunity determined? Activities that are offered before or after the work day will be compared to other commitments with families or friends. (Should I attend the morning Yoga class or stay home with my children until they are on the bus for school?) Activities during the work day are compared to work responsibilities. (If I attend a lunch program, I don’t have time to finish the proposal due this afternoon.)

We often present these wellness initiatives without attempting to establish value because it is so clear to us, as wellness professionals, that what we are offering has value. It is hard to remember that most of our potential participants are far removed from thinking about wellness. Health is something that is considered only when a pain or a problem interrupts the day. It is important to say something about the value explicitly when we are offering a program that will improve a participant’s health.

The second mistake we often make is to talk about the value from a clinical perspective. If we offer a walking program and our statement of value is that it helps the participant meet the minimum requirement that doctors recommend for daily activity, it's value is still not as clear to our participants as it could be.

That is because we establish value by comparing the wellness offering to other things that are also of value to us. How do I judge the value of a walking program in comparison to the time it will take me away from my work responsibilities? The value can be clearer, if instead, it addresses that regular exercise is shown to improve clarity of thought and increase energy, so it may make the participant better at their job. Or perhaps your potential participant will be able to understand the value of a yoga class when she realizes it will help her develop the self-awareness and patience to be a better parent.

These elements do not need to dominate the efforts to engage participants in your wellness programs, but they need to be a part of them so that participants can realize how essential they are to being able to live a full, rich and successful life. This is the ultimate goal of engaging people in wellness.

About the Author:

Dr. John Weaver is a licensed psychologist, the Director of the Healthy Thinking Initiative, and chair of the Wisconsin Psychologically Healthy Workplace committee. He has written several articles and is the author of two books: The Prevention of Depression: A Missing Piece in Wellness and The Healthy Thinking Program.

For information about the impact of psychological science on wellness and applied to the workplace, follow him on Facebook and Twitter @bizpsych. 

If you want further insight into understanding the true value of wellness you can see Dr. John Weaver speak at the upcoming WI WELCOA Conference.
View the skill building session agenda here.

Monday, July 25, 2016

An Inside Look: Cleveland Clinic’s Award Winning Wellness Program

Over the past five years Cleveland Clinic has successfully bucked the trend of increasing healthcare costs by decreasing the amount of healthcare services their employees require. AND they accomplished this without resorting to common cost shifting measures like high deductibles.

myInertia’s new wellness partner, David Pauer, Cleveland Clinic’s Employee Health Plan Wellness Director, recently sat down with us to share some insight into the organization’s powerful approach. 

Confirming the outcomes, David shared,“…Our utilization, the amount of prescriptions and any service provided, is actually down five percent in the past five years. It’s really phenomenal [considering that]…in our primary network of providers we don’t have a deductible at all—no amount that the employee or their family members would have to pay before the insurance kicks in. And we also do not charge co-insurance, so there’s no percentage that people have to pay after the insurance kicks in. And there are also very few co-pays…”

So how has Cleveland Clinic achieved the dual goal of lowering healthcare utilization while maintaining low cost access to these services for their employees? They focused their approach around four main elements:

1. Shift to rewarding healthy behaviors. Back in 2010 Cleveland Clinic faced similar challenges that many employers do - rapidly rising premiums (21% increase) and low wellness program participation rates. As David explained, “We were offering the traditional T-shirts and water bottles, just for filling out a health risk assessment, and we got about 20-25 percent participation. And really no outcomes. We didn’t really show that we improved anybody’s health.”

The key was finding a solution that would motivate employees to engage in the program. David highlighted, “The thought was we should reward people who are helping keep the overall costs down.”

2. Tie coordinated care participation to premium incentives. Their initial focus was to offer a premium discount (now the maximum 30% ACA allowance) to all plan members diagnosed with a chronic condition that joined and completed a coordinated care program. When asked how they chose the specific conditions, David Pauer shared, “We targeted six conditions because they are the most common, have a large effect on people’s health and also have a high cost: BMI greater than 27, diabetes or asthma diagnosis, high blood pressure (greater than 140/90), LDL cholesterol greater than 130, and tobacco use.”

3. Keep the healthy, healthy. In order to make the maximum impact CCEHP knew they needed to address their entire employee population. And by doing so they had been able to manage their premium increase down to 11%. by 2013. As David Pauer explained, “It’s part of a philosophy of keeping your healthy population healthy. It’s much easier and cheaper to keep healthy people from getting to the point where they have a chronic condition than it is to wait until they have the chronic condition and then try to treat them.”

Employees not diagnosed with a chronic condition are required to participate in a physical activity program in order to receive their premium discount. The program validates activity levels through the use of wearable trackers, along with fitness center visits.

4. Create an environment for success. In addition to the Employee Health Plan, Cleveland Clinic features an employee wellness department that offers programs for every employee, whether they’re on the health plan or not. This is an important factor in creating an environment that makes it easier to achieve wellness goals. For example, they ensure there are healthy food options in all facilities, encourage walking options on campus, and form wellness committees that help with employee communication.

Since 2010, this wellness program approach has created outstanding outcomes for both Cleveland Clinic and their employees:

  • Cleveland Clinic estimates that they’ve saved about $125 million (in cost avoidance) over the course of the program.
  • For 2016, employee premiums were only increased 2%. David clarified, “We would not have had to raise it at all except that our pharmacy costs continue to go up, even though we’re paying for fewer medications”.
  • 60% of plan members, both employees and spouses are currently participating for a discount.
  • This year Cleveland Clinic estimates that every single employee who has the health plan is saving $700 compared to the expected trend line, regardless of whether they receive an incentive.
  • In addition, those meeting the requirements for the 30% premium discount can save an additional $500-$1,400 per plan.

Cleveland Clinic has achieved these dramatic results by using meaningful incentives to engage all employees in appropriate behaviors based on their health status - proving that healthier populations really can make a difference.

If you’d like to gain further insight into Cleveland Clinic’s program you can download the full interview with David Pauer here:

myInertia became wellness partners with Cleveland Clinic in 2015. If you’re interested in learning more about how a myInertia partnership could benefit your organization please feel free to contact one of our wellness representatives here.

Thursday, July 14, 2016

What I Learned at the 41st Annual National Wellness Conference

I recently had the honor of attending and presenting at the 41st annual NWI Conference in St. Paul Minnesota. I thoroughly enjoyed attending this year’s conference. I find when I can minus my outside distractions (home/work/community needs) that I really dive into learning, and want to write down every word / buy every book offered. I walk away with such big aspirations and that is a great thing for all of us to do sometimes!

Let me share some of my favorite takeaways and interactions from this year’s National Wellness Conference:

Thursday, June 16, 2016

6 Ways Wearables are Changing the Wellness Landscape

It was a great experience to attend the Fitbit Captivate 2016 conference this past week and learn more about the powerful impact wearables can have on a wellness program. Much of what was shared aligns exactly with our 8+years of experience in implementing wearables at myInertia. We continue to see high sustained engagement and excitement when wearables are implemented. Why do we see this with wearables more than any other wellness initiative? Here are some of the reasons shared at the Fitbit Captivate conference:

1. Wearables are Consumer focused 
Wearables are built and designed with the end user in mind. In order to capture the interest of potential buyers, device powerhouses like Fitbit are continuously working to provide new ways to make their device experience more fun, engaging and simple to use. Because of this we are starting to see wearables become something that employees engage with and purchase on their own, outside of work. Meaning the hard work has been done for you. Employees already WANT devices, which is in direct contrast to other common workplace wellness initiatives like biometrics, health coaching, or online courses. This “want” can drive adoption and engagement because employees are hearing about wearables, and seeing friends, family and co-workers wearing a device. By offering wearables in your wellness program you offering something employees can identify with and want to be part of.

2. Wearables are on 24/7
Some of the poorest choices for health are made outside the work hours. Wearables are great because they are a reminder that is with a participant 24/7. From evaluating sleep patterns, to giving move reminders throughout the day, and tracking all daily stats, wearables are the wellness initiative that go beyond just the 9-5.

3. Wearables Give Insightful Data 
Activity trackers are offering organizations data that they simply couldn’t have access to previously. Monitoring real-time activity data from wearables can give a company a pulse on the uptake of their wellness program. This data allows for potential adjustments to program design and communication throughout the year, while also offering the ability to recognize and reward employees’ healthy behaviors.

4. Wearables Provide Scalability 
Wellness for the masses is made easier with wearables. Wearing a device is easy for participants and can be less difficult than other wellness initiatives to implement at large, multi-location companies.

5. Wearables Strengthen Social Connections 
When your employees see and know others that are wearing a device it opens up conversations and possible networking through the wearables platform. Challenges can bring together people who haven’t interacted previously driving a noticeable culture shift throughout the organization.

6. Wearables are High Touch 
Too many wellness programs are one and done. Making them insufficient to create behavioral change. A good wearables program will encourage employees to engage throughout the year, providing a constant reminder to make the healthy choice.

If you are looking to build the type of wellness program that employees line up to participate in, consider a strategic wearables program. 

You can download our e-book on developing an engagement strategy that will successfully move the needle on population health.