Despite Union Resistance, Health Engagement Model Gets Under Way in Oregon

Similar programs in Illinois and King County, Washington have had measurable success, with high enrollment and decreased medical expenses
The Lund Report

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."

News source: 


When you do not receive a pay increase for several years and then are confronted with the threat of a penalty that would more exceed the tiny cost of living adjustment finally conceded, the extorted response is very clear. Participate or suffer another financial hit. In that environment the rate of participation is clearly not reflective of satisfaction among those on which this has been imposed.

I believe this article omits the fee under PEBB's plan that charges an additional surcharge to men with larger than a 40-inch waist. So it's not just that you "have to try", you're going to pay every month until you get that skinny waist. Nor does it mention the fees if you don't complete online classes on time. This plan is going to get you one way or another. It's not a cost-saver, it's a money generator. "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." Saving $26 million may be the result of reaping fees and surcharges from non-participants, or even participants who don't meet the fee-free criteria. It's not cutting healthcare costs, just transferring the organization's burden onto the employee.

Please read the info more carefully. The charge to opt out of the HEM program per month is $20 for the employee only and $35 if the employee and spouse opt out. The surcharge for smoking is $25.00 per employee and $50 for employee and spouse. I do not believe you mentioned the new Out of pocket deductibles employees will be paying. $250 per person ! New Rx out of pocket $50. per person. Not to mention the Health premiums. Pebb's quoted savings are at our expense. Now, for the Union not getting info is absurd because their people are on the HEM Board and article 31 in the SEIU Union contract agrees to have us participate in the HEM program. They held the info until the contract was ratified, then we heard via the Statesman Journal. An earlier Lund report quoted a Union official regarding members finding out. Amanda! If the Unions were looking out for us they would have told the members BEFORE we voted on the contracts. If members would have known they would be losing $300-$500 per month they might have voted differently. I resent the fact I have to pay to Opt out of the HEM program when I go to my Dr regularly. I have blood work and other tests. I do not smoke or drink. I do not need someone in my business. Ask the HEM Board what awaits us next year and the next. Hopefully they will tell us prior to ONE month before enrollment.

SEIU knew all along about the HEM! It is in the contract, article 31! This is not voluntary, we have to pay! I do not smoke or drink and go to my physician regularly for bloodwork and other tests. I don't need someone else in my business. Amanda you have some errors in this article. To opt out of HEM it is 20 for the employee or 35 for both per month to opt out. Smokers pay 25 per smoker so 50 if employee and spouse smoke. Employees are angry because SEIU knew about all the new charges and copays and did not let us in until the contract was ratified. It will cost most 300 to 500 extra per month and we might have voted differently if we knew. This is something folks need to know! We are not whining, we are wondering how we can manage with this big of a hit. The cost savings is totally on the backs of the workers by copays, deductables and out of pocket and surcharges. No one will say what is coming next year...

This HEM Program provides several benefits for the unhealthy, such as smoking cessation classes and weight watchers. On the other hand, I do not see any incentives for those who already maintain a healthy lifestyle! How about paying for a gym membership for those who do maintain a healthy weight? Lastly, not all state employess are part of this HEM Program.