A Taxonomy of Health Wellness Programs - Part II

A health wellness program is broadly defined as any program of health promotion or disease prevention. My recent article entitled "Taxonomy of Health Wellness Programs - Part I" reviewed the classification of health wellness programs (hereinafter referred to as "Wellness Programs") under the Health Insurance Portability and Accountability Act ("HIPAA"). In this article, I am going to review an alternative way of classifying Wellness Programs that is contained in the "2018 Employer Guide: FINDING FIT: IMPLEMENTING WELLNESS PROGRAMS SUCCESSFULLY" (the "Guide").

In February 2018, the Interdisciplinary Center for Healthy Workplaces at the University of California, Berkeley (in collaboration with the Transamerica Center for Health Studies) released the Guide to assist small and medium organizations in implementing Wellness Programs. The Guide provides a framework for categorizing Wellness Programs based on the level of employer involvement.

Significantly, the Guide recognizes that activities under various Wellness Programs are often aggregated. The Guide addresses this issue by aggregating Wellness Program types as an "inverted pyramid". In other words, Wellness Programs with higher levels of employer involvement will often include elements or activities from Wellness Programs that have been characterized as having a lower level of employer involvement.

For example, under the Guide, education programs are characterized as having the lowest level of employer involvement. Yet, it is common for educational activities to be incorporated into Wellness Programs with higher levels of employer involvement (such as healthy habit development or preventive care programs, described below). Under the Guide, such activities are included and characterized at the Wellness Program with the higher employer involvement level.

The Guide divides Wellness Programs into the following five broad categories: education programs, social community building, healthy habit development, preventive care programs and disease management programs. The Guide further subdivides three of these broad categories into subcategories resulting in a total of eight classes of Wellness Programs.

The following is a summary of the Guide's types of wellness programs in order of increasing employer involvement:

Education Programs. "Educational programs" are programs "pursued by employees on their own outside of work" to learn about health and wellbeing (i.e., classes, reading articles, listening to podcasts or watching videos). "Education programs" are the clearest examples of the Guide's "inverted pyramid' approach. For purposes of the Guide, "education programs" (as a type of Wellness Program) have no employer involvement. Thus, if the employer sponsors a lunch and learn on a health related topic (such as exercise, healthy eating, weight control, etc.) that activity is part of a Wellness Program that would be characterized as "healthy habit development (lite)" (discussed below).

Social Community Building by Employees. These programs involve employees initiating in a grassroots manner social activities which enhance social relationships at work. Examples of these programs include sports-related teams, clubs (cooking, reading, etc.) and interest groups (travel, technology, etc.). Such programs are Wellness Programs because they foster "employees' feelings of social belonging and connection to their coworkers."

Social Community Building by the Organization. These activities are the same as "social community building by employees" (i.e., sports-related teams, clubs or interest groups), but an organizational lender arranges and encourages the participation of employees in these activities.

Preventive Care (Lite). These programs utilize a health care vendor to perform health assessments (or participant completed health risk assessment surveys) and health screenings (i.e., blood pressure, cholesterol, and blood sugar benchmarking) with employee specific information/recommendations provided to participants.

Healthy Habit Development (Lite). These programs include "organization-led interventions in the workplace that encourage healthier eating, greater physical activity, tracking personal mental and physical health, and enjoying restoration." Examples include providing healthier food at work, employer provided on-site classes, gym memberships, health tracking through wearable devices, and local health-related events (i.e., fun runs).

Healthy Habit Development (Enhanced). These programs involve "a much greater investment on the part of leadership in making physical enhancements to the worksite to introduce healthier habits as a part of an employee's workday". Examples include building in-house gym facilities, in-house cafeterias with healthy meals, attractive stairways, gardens and outdoor paths and other workspace enhancements.

Preventive Care (Enhanced). These programs involve a "partnership between health care providers and organizational leadership in an effort to reduce the incidence of serious illness and disease." These programs actively engage health professions in coaching employees on disease prevention and health promotion. Certain targeted programs (such as smoking cessation or weight loss) for high risk employees may also be included in these programs.

Disease Management. These programs are designed to "help employees who already have significant health problems (e.g., pre-diabetes, diabetes, hypertension, cardiovascular disease) to monitor and manage their treatments." These programs can involve "significant investments in the establishment of in-house medical clinics and occupational health programs" and programs offered by health insurance companies.

Unfortunately, the Guide does not discuss the potential application of the HIPAA requirements to the Guide's Wellness Programs. By definition "education programs" and "social community building by employees" (with no employer involvement) should not be subject to any of the HIPAA requirements. On the other end of the employer involvement spectrum, "disease management," "preventive care (both lite and enhanced)" should be subject to the HIPAA privacy rule (described in my earlier article entitled "Health Wellness Programs - An Introduction and a Resource") and the HIPAA nondiscrimination rules (discussed in my earlier article entitled "Taxanomy of Health Wellness Programs - Part I"). Depending on the structure of the programs and the rewards offered under the programs, "social community building by the organization" and "healthy habit development (both lite and enhanced)" may be subject to the HIPAA requirements.

Employers should review the elements of their Wellness Programs to ensure that these programs comply with the applicable HIPAA requirements. Notwithstanding the omission of a HIPAA discussion, the Guide provides valuable assistance to employers in designing Wellness Programs by: (1) applying an employer involvement framework for analyzing Wellness Programs; and (2) recognizing that workplace community building and employer actions and activities with respect to the workplace environment may constitute Wellness Programs.

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