
Workplace Wellness Plans Offer Big Incentives, but May Cost Your Privacy - gnicholas
https://www.npr.org/sections/health-shots/2018/09/22/649664555/workplace-wellness-plans-offer-big-incentives-but-may-cost-your-privacy
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doctorpangloss
> Few expect employers will stop offering wellness programs outright — because
> most hope the programs will hold down health costs by getting workers to
> take steps to improve their well-being. Critics, however, point out that
> studies show little evidence that workplace wellness programs achieve these
> goals.

Insurers like Oscar are very savvy pioneers of what wellness programs actually
do: select for healthier pools.

What difference does it make if your insurance costs $4,700 instead of $6,000
this year, if you're so healthy you don't use a dime of it? Oscar's investment
exit horizon is nearer than the time it takes health 28 year olds to turn 55
and chronically unhealthy.

How does it select for healthier pools? Older people don't like being told
what to do, or to have to use technology like fitness trackers and apps. It's
that simple.

As long as gratuitous technology and wellness selects for healthier pools, an
insurer's bottom line doesn't care if wellness actually improves health
outcomes. At least from an accounting point of view.

Obviously, we should support efforts to make people healthier. But I'm just
trying to point out why insurers do this.

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DamnYuppie
Your comments about Oscar do no make sense. Oscar offers insurance in the
individual marketplace. As such they are not selling to companies but to
individuals directly who don't have insurance through their employer. This
means their members do not partake in these types of wellness plans. Also, as
part of that marketplace, Oscar can't legally use the members previous medical
history to underwrite/rate their policy. This means Oscar has little to no
insight to whom they are offering their products, their goal is to get enough
healthy people to offset the costly ones.

Also an insurance company who offers commercial group insurance, i.e. sells
insurance to companies, does not have their bottom line really impacted as
much as you would think. This is based on the fact that they are currently
acting as middleman in the system and any increase in costs is merely passed
along, hence continually rising cost of healthcare.

~~~
doctorpangloss
> This means their members do not partake in these types of wellness plans.

Oscar members get discounts for walking a certain number of steps a day, and
other somesuch things. They are functionally equivalent to employee wellness
programs, in that consumers (be they individuals or business) are offered
discounts in exchange for fulfilling some behavioural change that intuitively
seems to make people healthier, even though there's little evidence that it
does. I'm speaking to their prevalence in the industry.

I get that it matters from an accounting point of view that they're an
individual marketplace insurer versus a whatever. It doesn't matter from the
point of view of why insurers generally like these programs.

> Oscar can't legally use the members previous medical history to
> underwrite/rate their policy.

Oscar does a lot of things to select for healthier pools. Their marketing is
carefully tuned to a particular kind of healthier customer. You're
underestimating how goddamned savvy they are. That's not illegal, but it's
effective.

There has recently been a rule change that allows insurance pools that are
"guild"/union targeted, like only plumbers or insurance offered for the
Writers Guild of America (WGA). Surely you see that, if that average writer is
28 years old, and the average plumber is 45 years old, I don't need to look at
their medical history or anything to know which pool is healthier?

Even if I pick a pair that's the same age, I bet you the average highly paid
programmer at 28 (for my hypothetical programmer's insurance) is going to
select for a healthier pool than my 28 year old warehouse and teemsters worker
insurance.

> Oscar has little to no insight to whom they are offering their products.

I think when they place an Instagram ad, they're pretty much guaranteed to be
"offering" their products to a younger audience than the average American. I
don't need to look anything up to get that incredibly cost-impacting insight.

Or maybe I'm targeting iPhone versus Android, and iPhone users are just
wealthier on average and therefore just healthier on average.

I get that ANY American can buy their insurance. I'm not going to litigate the
role of marketing, because it's pretty obvious that it matters.

> This is based on the fact that they are currently acting as middleman in the
> system and any increase in costs is merely passed along, hence continually
> rising cost of healthcare.

From the article:

> The Cleveland Clinic's Rogen, who credits the wellness program for holding
> medical costs almost flat for the past five years...

I guess I'm just trying to explain why. Your business specifically is a
middleman in a system, and you're passing costs along. But there are some
actors who, by their accounting have held costs "almost flat," whatever that
means.

I'm speculating as to the mechanism by which costs can remain flat, DESPITE
your accurate picture of a continually rising cost of healthcare.

~~~
chongli
_discounts in exchange for fulfilling some behavioural change that intuitively
seems to make people healthier_

I think Oscar is less concerned with whether walking so many steps makes you
healthier and more concerned with your ability to walk so many steps as a
rough indicator of your health. This is especially useful given the above-
mentioned fact that Oscar isn't allowed to underwrite based on your medical
history.

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rectang
With the ACA's pre-existing condition guarantees under threat, it is in every
individual's interest to keep as much of their medical information private as
possible. The way insurance companies make money is by avoiding elevated risk,
after all.

On a related subject, I wonder whether ISPs are selling browsing history to
insurance companies.

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dba7dba
I was about to get free Fitbit from work program. And then I heard work would
have access to data in Fitbit. Nah, screw that.

~~~
craftyguy
If I got a free one from work, I'd just put it on my dog.

~~~
pmiller2
Wouldn’t work for me. My dog is incredibly lazy. :)

~~~
craftyguy
The trick then is to catch a neighborhood squirrel and attach it to the
animal.

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newscracker
Looks like a case of damned if you do and damned if you don't. Privacy of
health related information is critical, and as with other things, the people
who are relatively poorer would be the worst hit. There's probably no escaping
being further exploited or discriminated against.

