Despite Union Resistance, Health Engagement Model Gets Under Way in Oregon
November 3, 2011—Public employee unions have raised numerous concerns about the Public Employees’ Benefit Board’s new health engagement model for state employees, a voluntary program designed to improve their health.
This year’s open enrollment for PEBB’s 150,000 members, which began on October 15 and runs through November 15, is the first time members can decide whether to participate in the health engagement model. Thus far, 48 percent of members have enrolled for health plans, and 87 percent of that group have chosen to participate in the health engagement model, said Ingrid Norberg, public information officer.
Participants will complete a health risk assessment, which asks questions about eating and smoking habits, waist circumference and other health-related concerns.
Depending on the health risks identified, employees will take e-lessons or join programs to help them improve their health such as smoking cessation classes or Weight Watchers.
Nobody will be required to lose weight or stop smoking. The hope is that people will develop closer relationships with their providers, and take more responsibility for their health.
Members worry that the health risk assessment they will be required to complete if they choose to participate in the program will violate their patient privacy. They also complain that the program is a top-down, Big-Brother-esque effort to tell state employees how to manage their health.
"I can’t think of an issue that has generated so much member outrage," said Linda Burgin, president of SEIU Local 503, in a statement to PEBB during their August 26 meeting. "Many members have expressed concern over being discriminated against due to their health conditions and questioned the legality of the health engagement model."
It is not clear if the privacy concerns union members have also possibly violate someone’s civil liberties. The ACLU of Oregon did not return a call for comment regarding whether it had received any complaints about the health engagement model.
But plan administrators and public employee unions in other states with similar programs say it’s a pretty natural response in the beginning. What time has shown, they said, is that people are not only satisfied with such programs, but millions of dollars have been saved.
PEBB’s health engagement model is closely modeled after Illinois’ “health improvement plan,” which began in January 2007 and is entirely voluntary. It’s also more robust: in addition to a health risk assessment, participants complete a full biometric screening, a full blood draw and give hip-waist ratios. That information generates a personalized report to help people improve their health.
“There was some concern expressed” in the start-up phase about privacy issues, such as non-medical professionals being given access to the assessments, said Hank Scheff, the plan’s administrator and employee benefits director for the Illinois chapter of the American Federation of State, and Municipal Employees (AFSCME).
However, the union made it quite clear in the very beginning that the information would be kept strictly confidential, said Scheff, and there have been no violations of the Health Insurance Portability and Accountability Act (HIPAA).
Norberg said that the health engagement model will conform to HIPAA privacy laws when it comes to the information in the health risk assessment.
During its first year, the Illinois program attracted 93 percent of the union’s 400 employees. Scheff partially credits that to very clear communication by the union.
Many of the problems Oregon is experiencing come down to poor communication and confusion he said. “The health engagement model says you only have to try, but at the same Oregon is doing that, they’re doing a surcharge for smokers. I would argue that is a mixed message.” He was referring to a new $35 dollar surcharge that PEBB charges to smokers.
Now, close to 97 percent of union members participate, and 66 percent of smokers have quit as a result, Scheff said. Also, claims’ costs have not seen double digit increases.
Strong and effective communication is key, said Brooke Bascom, the communications director for King County’s health reform program. During the year leading up to the implementation of King County’s “healthy incentives program” in 2005, a concerted effort was made to tell employees why the program was being started, how it would work, and that medical information would be kept confidential with a third-party vendor in charge of analyzing the health risk assessments.
“We definitely had resistance from employees in the beginning,” Bascom said. “We did a ton of communication.”
The communication PEBB has made to its members in Oregon about the health engagement model and other changes to state employee health plans, Burgin said, leaves much to be desired. "We are very disappointed in the level of communications from PEBB to members," she said. "We have heard very little directly from PEBB about the changes that are being made."
Thanks to the communication efforts in King County, Bascom said, close to 90 percent of county employees have completed a risk assessment, and around 80 percent take classes and participate in other health-related programs.
High participation is reaping financial rewards: King County saved close to $26 million in healthcare costs between 2005 and 2010. And, the county expects to spend $61 million less for employee health care costs in 2011 and 2012, Bascom said.
Those savings affect how county workers regard the program. “It really helps that they can see how it works,” she said. People who don’t participate can pay up to $1,200 more per year in out-of-pocket expenses.
In Oregon, meanwhile, employees who don’t participate will be charged $20 per month, while dependents will pay $35.
Oregon is by far the cheapest: Illinois charges $50 a month to non-participants, and Connecticut, which has a “health enhancement model” that began October 1, charges $100 a month, plus an extra $350 in its deductible (perhaps unsurprisingly, Connecticut is close to having 100 percent participation).
Scheff thinks the money may have a lot to do with driving people to the program, but less to do with its actual success. “People don’t change because they’re bribed,” he said. “They change because they want to become healthy."