By TOM MURPHY and CATHERINE LUCEY

Associated Press

That little voice nagging you to put down the cake and lace up the running shoes is increasingly coming from your employer and is likely to grow louder with a looming change under the federal health care overhaul.

More companies are starting or expanding wellness programs that aim to reduce their medical costs by improving their employees’ health. They’re asking workers to take physical exams, complete detailed health assessments and focus on controlling conditions such as diabetes. Along with that, many companies also are dangling the threat of higher monthly insurance premiums to prod workers into action.

The Affordable Care Act is one reason the programs are spreading. The federal law calls for a 40 percent tax on expensive benefit plans starting in 2018, and many companies that offer employer-based coverage already have begun looking for ways to lower costs and avoid that tax.

“It is a very powerful … visible wake-up call to all employers,” said Helen Darling, chief executive of the National Business Group on Health, a nonprofit organization that represents large employers on health care issues.

Businesses see wellness programs as a win for themselves and their workers. But studies have shown that the programs have a limited ability to reduce costs. They also raise concerns about privacy and discrimination against older workers or those who are more likely to have chronic conditions.

Penalties also can hit lower-wage workers harder than they would executives because premiums already consume a larger portion of those workers’ paychecks.

“The top-line concern is that it has a huge potential to be discriminatory,” said Lydia Mitts, a health policy analyst with the nonprofit Families USA.

Benefits consultants say federal regulations help guard against that. Companies can be penalized under the overhaul for offering coverage that is considered unaffordable.

Businesses also are required to offer alternatives that help workers avoid penalties like a higher premium because they can’t meet a wellness program goal.

Despite employee concerns, the idea of prevention as a way to reduce health care costs has been largely embraced by employers, who provide the most common form of health insurance in the U.S.

For years, they have offered gift cards, cash and other rewards to employees who agree to get physical exams, fill out health assessments or take other steps to monitor their health. The goal is to at least make workers more aware of their health, and it worked for Roy Simmons, a 55-year-old nuclear power plant manager for energy provider Dominion Resources Inc.

Dominion started offering a $400 premium credit a couple of years ago for employees who agreed to have a health assessment, so Simmons had basics such as his weight and cholesterol measured. He then forgot about the numbers until a reminder arrived last year. Another physical told him he had gained 40 pounds and his cholesterol was up.

“That was a bit of a wake-up call for me,” said Simmons, who manages a Dominion plant near Williamsburg, Va. “I didn’t know it had happened to me. I know that sounds stupid, but I wasn’t paying attention to it, and it just snuck up on me.”

Simmons cut junk food from his diet and asked his college football-playing son to become a workout partner over the summer. He has since dropped the weight.

Benefits experts say companies haven’t seen enough cases like Simmons’, in which an incentive helps nudge an employee to participate in a wellness program, so some employers have started using penalties.

These penalties most often stick employees who do not participate with larger premiums or deductibles, but they also can come in the form of a straight monthly surcharge, deducted from paychecks.

A survey of nearly 600 large U.S. companies by benefits consultant Towers Watson found that 22 percent of companies that use financial incentives to encourage wellness program participation structured them as penalties. That’s up from 18 percent last year.

“There’s going to be more of your skin in the game,” said Michael Wood, a Towers Watson senior consultant. “If you help us control costs, uses the system wisely, you will be rewarded.”

Companies also are moving beyond rewarding or penalizing employees simply for participating. More are requiring workers to reach a health goal such as improved blood pressure, said Beth Umland, director of health and benefits research for the benefits consultant Mercer.

Whether the various versions of wellness programs are achieving their intended effect _ reducing a company’s health costs _ is a matter of debate.

The average annual premium for employer-sponsored family health coverage topped $16,000 last year, according to the nonprofit Kaiser Family Foundation, which studies health care issues. Employers, who pay most of that bill, have watched that figure climb faster than inflation for years, and it has more than doubled since 2002.

Rand Corp. researchers studied several years of data from a PepsiCo wellness program to determine how it affected health care costs. They reported in the January issue of Health Affairs that disease management programs, which helped people with chronic conditions, reduced hospital admissions and lowered costs.

But programs that simply tried to make employees live a healthier lifestyle did not, and the researchers said companies should not assume those programs will lower costs.

At the same time, the programs have begun generating a backlash from employees.

Last fall, faculty and staff at Penn State University objected to new wellness requirements that the university was eventually forced to modify. After significant pushback, the university said it would not institute a $100 monthly charge for people who failed to complete a series of activities, including a detailed online questionnaire.

“They asked about pregnancy, they asked if men were doing testicular exams, they asked about depression, they asked about violence in the home,” said Matthew Woessner, a professor of political science at the Harrisburg campus. “It was an incredible invasion of privacy.”

CVS Caremark Corp. employee Roberta Watterson has filed a lawsuit in California against her company over a wellness program that offers a $600 annual premium break for participants.

The cashier’s lawsuit accuses the company of asking personal questions in its survey, including whether its employees are sexually active. Watterson also alleged that blood work performed in the exam is used to flag employees who are at risk for certain conditions. She declined to comment on her case.

CVS spokeswoman Carolyn Castel said the company offers a lower premium for employees who complete a health assessment and screening. She said an outside company designed the questionnaire her company uses, and CVS had asked it to “remove certain questions” before Watterson filed her complaint.

She also said CVS management cannot see employee-specific information compiled in the wellness exams.

Having an outside business run the wellness program is a common way for companies to counter privacy concerns. The vendor can tell a company about trends, such as whether it has a lot of employees with high blood pressure, so the employer can implement programs to address that. But it is not supposed to share details about individual employees.

State and federal laws are designed to prevent employers from seeing employees’ specific responses or health statistics.

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