Wellness & Disease Management

Employer-sponsored Wellness Accounts and Disease Management Program are offered as an incentive to promote employee health and activity-based programs. These accounts are unique to every employer.

Wellness Accounts

Wellness programs can take many forms and may not even be called a “wellness program.” They may cover only employees and/or other family members. A comprehensive employer-sponsored wellness programs might offer a system of coordinated health-related communications, assessments, and incentives intended to raise health awareness and promote positive health behaviors.

 

Wellness programs might also use one, some, or all of the following tools to promote wellness and decrease health plan costs:

  • health-related newsletters and informative material

  • lunch-hour sessions on first aid, self-care, or healthy eating

  • health risk assessments of willing employees

  • personal consultations with case managers regarding nutrition, lifestyle changes, and related issues

  • blood pressure and cholesterol screening

  • optional or compulsory smoking-cessation programs

  • weight-loss programs

  • flu shots or other vaccinations

  • on-site gyms or other exercise facilities

  • payment of health club dues

  • diagnostic testing; and

  • financial incentives to encourage participation or achievement of specific wellness standards

 

Some offer rewards to employees who participate or impose penalties on those who do not. Rewards for participation can take many forms:

  • Cash or cash equivalents (e.g., gift cards or gift certificates)

  • Health benefit plan-related rewards (e.g., reductions or waivers in employee cost-sharing features, such as premiums, co-payments, or deductibles, or additional employer-provided benefits)

  • Other non cash rewards (e.g., employee discounts or merchandise prizes).

 

Penalties of non-participation can take many forms:

  • Financial penalties

  • Refusal to hire

  • Disqualification from the employer’s health plan

  • Termination of employment (note, however, that HIPAA or ADA issues may be raised when a program involves penalties for non-participation).

 

Disease-Management Program

An employer-sponsored disease-management program generally identifies employees and their family members who have, or who are at risk for developing, certain chronic medical conditions. A typical disease-management program will identify these individuals and “coach” them on how to manage their conditions.

Disease-management programs might provide:

  • Evidence-based medical information

  • Disease-specific support

  • Case monitoring

  • Coordination of the care and treatment provided by the employer’s group health plan.

  • Monitor laboratory or other medical test results

  • Provide telephonic, e-mail, or web-based reminders of treatment or appointment schedules

  • Furnish information about minimizing health risks.

Sometimes, these programs offer rewards (such as reductions or waivers of employee cost-sharing items, such as premiums, co-payments, or deductibles) for employees who participate.

How Are Wellness and Disease-Management Programs Alike (and Different)?

In some ways, employer-sponsored wellness and disease-management programs may appear quite similar—both types of programs are intended to help participants lead healthier lives and lower or control health care costs. In fact, sometimes employers combine wellness and disease-management programs into a single program, or coordinate wellness and disease-management programs with each other or with the employer’s other health plans, such as a major medical plan, health FSA, HRA, or HSA.

But wellness and disease-management programs typically differ from one another. Wellness programs generally are designed to help all employees become and stay healthier, while disease-management programs are targeted toward helping only those employees who are at risk for developing, or who have already developed, chronic medical conditions.

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