How Your Patient Engagement Strategies Could Run Afoul of the Law
Is there danger lurking in your patient engagement strategies? Given the recent questions a Senate panel has been asking about how wellness programs conform to anti-discrimination legislation, the answer may be yes. While patient engagement, like initiatives to reduce healthcare costs among health plan members and employees, is a critical component of ACA-driven healthcare reform, organizations need to recognize the potential ramifications of how they segment their target audiences to avoid running afoul of the law.
Are Workplace Wellness Programs Leading to Discrimination?
While it doesn’t happen often, many Republicans and Democrats are on the same page — at least when it comes to the wellness plans that they view as an important tool for reducing healthcare costs. That’s why the uptick in litigation brought by the Equal Employment Opportunity Commission (EEOC) has drawn the attention of the U.S. Senate Committee on Health, Education, Labor & Pensions (HELP).
What seems to be the problem? After all, the Americans with Disabilities Act of 1990 (ADA) allows employers to conduct medical examinations and gather employee medical histories to support wellness programs if participation is voluntary. Moreover, the Affordable Care Act defines an acceptable incentive level of 30 percent of the cost of health coverage, possibly increasing to 50 percent — and the Department of the Treasury, Department of Labor and Department of Health and Human Service all endorse similar standards.
Unfortunately, the EEOC has been waffling when it comes to whether wellness programs are compatible with the Americans with Disabilities Act (ADA). After tacitly endorsing ‘voluntary’ programs that induce participation based on HIPAA standards in 2009, the EEOC rescinded its statement and has since brought several actions against wellness programs while failing to offer any clear guidance on the issue.
Former EEOC member Eric Dreiband, now a partner with Jones Day law firm in Washington D.C. told HELP committee members that “the EEOC’s flip-flopping, ongoing and seemingly never ending ‘examination’ and litigation perpetuate confusion and uncertainty.”
Finding Better Ways to Engage Consumers in Wellness
Another participant in the Senate Hearing, Dr. Gary W. Loveman, testified on behalf of the Business Roundtable, an association for CEOs of major U.S. companies. Loveman, who is also Chairman, CEO and President of Caesars Entertainment, which employs more than 80,000 people, noted that “given the opportunity to lessen or eliminate chronic disease through wellness and prevention programs, it makes sense that the providers of health insurance — from Medicaid to private sector employers — should offer incentives for people to participate in these programs.”
Yet, in the face of on-going uncertainty, if your organization is developing a wellness program — whether for patients, health plan members or employees — you need to craft the initiative with care. The ACA makes it clear that health insurers who service Medicare members, for example, cannot segment members into healthy and unhealthy groups because it would lead to adverse selection.
The psychographic segmentation model developed by PatientBond avoids this hazard by separating people based on their motivations, preferences and beliefs — not by their health status. There are several psychographic segmentation models currently in use by healthcare organizations that group consumers across a continuum of health status, from the very healthy to the very sick… and this could be problematic.
However, when it comes to driving successful patient engagement strategies, a well-designed psychographic segmentation model offers valuable insights that can help you connect with your patients or employees. For example, PatientBond helped one employer address the issue of obesity among its employees — an issue that does have potential ADA ramifications if not handled in the right way.
By breaking down the target audience into five distinct psychographic segments based on attitudes towards health and wellness, the company was able to evaluate the segment composition of its employees and customize the messaging and communication channels used to suit individual segments and drive greater engagement.
PatientBond is also collaborating with AMI (Analytic Marketing Innovations) in conjunction with KBM Group, a leading national data compiler working with health insurance companies and hospitals, to project our psychographic segments across the U.S. population and develop propensity models for various health behaviors.
Moreover, the PatientBond Consumer Diagnostic, a national study of the U.S. healthcare consumer, includes valuable insights on the health behavior incentives that most appeal to the PatientBond Psychographic Segments, as well as for consumer types defined by most any demographic and socioeconomic variables.
Importantly, the PatientBond Consumer Diagnostic study was designed to provide healthcare organizations and employers the insights necessary to motivate healthy behaviors while avoiding adverse selection.