incentives and penalties are two sides of the same coin. how you perceive and experience them comes down to how they’re implemented and communicated. just ask penn state, and CVS before that.
right now penn state (PSU) is splashed across every newspaper, blog, and social channel. what’s brought the media to their doorstep is their “take care of your health initiative,” which, as explained on PSU’s benefits website is designed to help employees and their partners “understand your health risks and to provide you with the resources you need in order to treat disease and maintain or improve your health.”
the initiative involves a $1200 annual charge to any employee who doesn’t take three steps this year: complete an online health assessment, certify they’ve had or will have an annual physical in 2012 or 2013, and register for an on-campus biometric screening. if they cover a spouse, that spouse must also complete the assessment and certify the intention to have a physical. this initiative was announced in conjunction with a tobacco surcharge and a spousal surcharge, but it’s the “take care of your health initiative” that’s garnered the most attention.
if everyone’s doing it, why is PSU getting it?
except for the rather large annual surcharge, this initiative sounds similar to what other companies are doing. so why all the media coverage? i’m going to share my perspective, but i’ll be sticking with the communications lessons and not going into whether PSU’s design will achieve the intended results. it’s not that this question—whether getting thousands of PSU employees and their spouses to complete a health assessment or be pricked by a needle will make a difference in health or health care costs—is unimportant. it’s just that others have covered it. plus, no matter how much i or anyone else gets their panties in a twist over PSU’s design, we’re seeing more employers move here. let’s at least learn how to do it better. (for perspectives on carrots versus sticks, jump to the bottom of the post where i’ve linked to studies and posts on the subject.)
i’m going to begin with why this became the story it is today.
two employees spoke out. loudly. associate professor matthew woessner lit the fire when he spoke out on privacy and ethical issues in a blog post about the initiative. in it, he invited colleagues to join him in an act of civil disobedience by finding alternative ways to satisfy PSU’s requirements. for example, he recommended employees ask their doctors to take the biometric screening instead of using highmark, PSU’s insurer. next, brian curran created a petition on change.org, a crowdsourced platform for social change.
these employees struck a nerve. it’s incredible this type of controversy took so long to happen. that it’s taking place now may speak more to woessner’s and curran’s media smarts than to how few share their feelings. since curran posted his petition, it’s secured more than 2100 signatures. woessner’s blog post has just under 4100 views from 31 countries. while some signers and viewers are certainly fellow PSU professors, many others come from other institutions where they’ve soaked up increases and changes they don’t like for years. they’re ripe and ready to pile on this bandwagon, adding their signatures and stories to the mix.
the media lives for stories like this. when woessner crafted his blog post, his focus was on penn state alone. he had no idea that PSU’s initiative lines up with industry trends. but the media did. they also recognized it as a potent way to discuss the affordable care act. this type of story is catnip as well for those in the wellness industry who have been speaking out against wasteful, ineffective and harmful tactics.
the university initially did itself few favors. while woessner and curran continue to benefit from the media attention, the university got off on a bad foot. one of the first stories on the controversy aired on NPR, where susan basso, PSU’s vp of human resources, referred to woessner’s call for civil disobedience as “unfortunate and sad.” this line has been picked up and reused in multiple stories since. within the college community, PSU has worked to get ahead of the coverage and manage the message. after having matthew woessner on cohealth checkup, my co-host carol and i made a point of reaching out to ms. basso to invite her to record a cohealth checkup show—with or without highmark—and she declined. she did point me to the Q&A available to PSU employees as well as the announcement materials, and a letter from the president, issued after the media coverage began. highmark’s letter to the editor has become a laughingstock.
are there lessons to be learned?
now, let’s step back and look at before the story became national news. that’s where employers instituting similar initiatives or considering them can learn valuable lessons.
change efforts require a long lead time. the university announced the initiative to employees in july, and the first two deadlines for their three required health activities are in october and november. even without those dangling deadlines, large change efforts require a much longer lead time. employees need time to understand what’s at stake and how it affects them. this is true in mergers and acquisitions; it’s true here. by announcing the initiative with such little advance notice, the university left employees insufficient time to grapple with their concerns and make their choices with a cool head. in ways unforeseen by the university, this short-changed communication timeline fueled anger and didn’t quell it.
understanding the big picture doesn’t smooth things over. the available online communications focus largely on information. they do an admirable job of telling employees what they need to do and how. they also outline the significant costs the university absorbs, and they recognize the bite these surcharges will take from employees’ wallets. they take time to explain the choices the university faced: applying an automatic across-the-board premium increase to all or allowing people to choose to opt out and pay the surcharge. but seeing the big picture and understanding it shouldn’t be confused with liking or accepting it—immediately, or ever. on the other hand, building in time and ways for employees to voice their feelings to those making the decisions can go pretty far.
when you seek input, use it. the university’s benefits committee’s march minutes show a rich discussion about what cost increases they’re facing and what was on—and off—the table as far as changes go. the minutes reference the committee’s plan to share changes with faculty for feedback. it’s unclear how this feedback was gathered, but the april minutes show an understanding of the need for well-crafted communications overall and for those communications to address certain issues, like any link to PSU’s NCAA fine, head-on. in the communications i’ve seen, this recognized sticking point is never addressed, and now the question mark about it lives on and has a moniker, the “sandusky tax.” for PSU and its community as well as the rest of us, any connection with sandusky resuscitates widely held negative feelings about PSU and its administration. it calls into question their ability to manage and lead, ethically and with honor.
communication isn’t for times of big change only. woessner has himself admitted he had little understanding about how PSU’s design fit into industry trends before this controversy got in full swing. he did, however, feel universities and for-profit corporations have different ways of tackling rising costs. that’s not the case. according to a 2012 study by inside higher ed, the survey of college and university human resources officers, 73.7% agreed that their institution “should offer wellness policies that ‘reward real outcomes’ (weight loss, quitting smoking, etc.) rather than just participation in these programs.” benefits managers have the long view of what their program can absorb and what changes they must make to keep benefits affordable and available. it’s on them to continuously communicate and prepare employees for what’s ahead.
whether doing things differently would have made a difference at penn state, we’ll never know. woessner, curran, and all the employees out there who feel an unbearable cost burden and an untenable intrusion into their lives might still have expressed their outrage. however, the rules of the game are changing fast with wellness, and penn state university may well be the match that inflames this fire—one that’s been simmering quietly within the industry until now.
studies and commentary on design
this is a limited list. if you’d like to add something to it, please leave the link in the comments.
- kevin volpp and mark pauly critique penn state’s wellness program
- workplace wellness programs (health affairs)
- wellness incentives in the workplace: cost savings through cost shifting to unhealthy workers
- redesigning employee incentives—lessons from behavioral economics
- the danger of wellness programs: don’t become the next penn state
- penn state wellness: fear and loathing in happy valley, pa
- we need to know more about wellness incentives
- carrots vs. sticks: the penn state wellness controversy
- tom emerick and al lewis on cracking health costs
- guidance on outcomes-based wellness