• Public Affairs

  • ACOEM Provides Comments to EEOC on Wellness Programs and Incentives under GINA

    May 23, 2013

    The U.S. Equal Employment Opportunity Commission
    131 M Street, N.E.
    Washington, D.C. 20507

    Re: Wellness Programs and Incentives

    Dear Sir or Madam:

    The American College of Occupational and Environmental Medicine (ACOEM) appreciates this opportunity to provide comments as you consider worksite wellness programs in the context of the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). We are encouraged by your comments recognizing the value of worksite programs and incentives in your recent public meeting.

    Occupational and Environmental Medicine (OEM) is positioned at the crossroads of the employer-employee-health system, making it a logical advocate for health system reform through workplace initiatives. Among all medical specialties, OEM physicians have unique training, expertise and perspective to understand the link between health and productivity as well as how to help injured, ill and aging workers to remain productive and at work. In addition, the OEM community has a high concentration of physicians trained in preventive medicine, epidemiology and public health. Their focus on population-based health issues as well as individual health is critically important to health system reform. Thus, OEM physicians have a distinct and seminal role to play in advocating for prevention-oriented programs that protect and assure the health of employed and productive citizens.

    Why an Emphasis on Workplace Health is Critical to Health Reform
    There is increasing recognition in the United States that the physical and mental health of the workforce is inextricably linked to the economic health of the workplace. Improved employee health equals improved employee performance, engagement and productivity. Unfortunately, the American workforce is not as healthy, nor as productive, as it could or should be. The overall health of Americans is on the decline, with studies showing a dramatic rise in recent years of health risks like obesity and chronic diseases like diabetes, across all age groups.

    At the same time, the aging of the baby boomers — the so called “silver tsunami” — is changing the profile of the workplace and putting new pressure on America’s health care system. In the face of these trends, the United States must find a way to bolster and improve the health and productivity of our national workforce.

    Workplace wellness programs are emerging as a key building block in this new paradigm, helping promote a true culture of health in the workplace. These programs are based on prevention and integrated health management and are aimed at decreasing the burden of illness overall by focusing health management strategies “upstream” from the onset of chronic disease. Rather than simply treating disease, wellness programs seek to keep healthy people healthy and bring people at high risk back from the brink of illness by managing health risk factors and promoting proactive health maintenance strategies.

    Incentives for Voluntary Participation
    Congress made clear when it enacted the Affordable Care Act (ACA) that workplace wellness programs can contribute to improving health nationwide. ACOEM supports the five conditions cited in the ACA that worksite wellness programs must meet if offering outcomes-based incentives. This five-pronged standard codified the HIPAA standard outlined in the 2006 final regulations on Nondiscrimination and Wellness Programs by the Departments of Labor, Treasury, and Health and Human Services. These regulations expressly identify the HIPAA standard as the appropriate metric for evaluating the “voluntary” aspect of worksite medical programs.

    To provide guidance regarding appropriate use of outcomes-based incentives as part of a reasonably designed wellness program designed to improve health and lower cost while protecting employees from discrimination and unaffordable coverage, ACOEM collaborated with the Health Enhancement Research Organization (HERO), the American Cancer Society and American Cancer Action Network, the American Diabetes Association and the American Heart Association to bring together both the views and concerns of employers and employees as represented by our member organizations. Through a collegial process, we published a joint consensus statement entitled Guidance for a Reasonably Designed, Employer-Sponsored Wellness Program Using Outcomes-Based Incentives (Joint Consensus Statement), for the purpose of informing employers either considering or embarking on providing “health-centric” wellness programs of what should be considered in their plan.

    Voluntary Tool/Processes
    A voluntary tool or process, such as a health-risk appraisal and biometric screening, identify opportunities for improvement and interventions at the aggregate and individual levels.

    As outlined in the Joint Consensus Statement, key characteristics of a well-designed worksite screening activity include the following: 

    • Screenings should follow consistent protocols for all participants in a target population.
    • Screenings should adhere to industry standards and scientific/clinical guidelines regarding quality, accuracy,
    • privacy, and safety.
    • Screenings should follow referral protocols based on established national guidelines for individuals whose 
    • results are out of the normal range. 
    • Screenings should have an established process for communicating results to the participant’s physician. 

    Any individually identifiable medical information obtained through the assessment and screening process is considered protected health information and is subject to the same privacy, storage, and security requirements as any other sensitive medical information.

    For screening activities associated with outcomes-based incentives, the Joint Consensus Statement recommends that a well-defined appeals, dispute, and retesting process be in place as some tests vary in their ability to produce reliable and valid results at a single point in time (e.g., blood pressure). To optimize confidentiality and credibility, employers should strongly consider having appeals independently adjudicated by a qualified vendor that specializes in this activity.

    Use of Health Risk Appraisals
    Employers should provide health risk appraisals as part of voluntary wellness plans and as part of employer provided insurance benefits. Voluntary wellness programs, including financial incentives for completing a health risk appraisal can provide significant benefits to the individual. The health risk appraisal is a key entry point into employee health and wellness programs. The health risk appraisal is a widely used, evidence-based tool to identify individuals with, or at risk of developing chronic conditions, and to ensure they receive appropriate and beneficial wellness, prevention and disease management services.

    Many employees need some encouragement to complete a long, detailed health risk appraisal and to start participating in a program of healthy living. As noted earlier, financial incentives are important and can provide a key motivational trigger. Eliminating the employer’s ability to provide a financial incentive to individuals who complete a health risk appraisal or participate in a wellness program would effectively end these programs and the positive results they have produced for workers. We believe that incentives should be used to encourage participation in these programs.

    Enclosed for your reference is a copy of the Joint Consensus Statement, as well as several other studies that document the benefits of workplace wellness programs. As you move forward on this important issue, it is our hope that we can work together to ensure wellness programs operate in the confines of the ADA and GINA. Please do not hesitate to contact me at 847-818-1800 or Pat O’Connor, ACOEM’s Director of Government Affairs, at 202-223-6222, should you have any questions concerning the publication or this matter in general.

    Again, thank you for the opportunity to comment.


    Ronald R. Loeppke, MD, MPH, FACOEM