Table 1.

Illuminating quotes within key themes and best practices.

Reward healthy behavior regardless of biometric outcomes (Culture of health or wellness)

“You know, I think that in life in general, you need skin in the game of whatever. And so, I think that there needs to be incentives and—but people are going to have to have responsibility as well. So, it depends on program-to-program. To speak as a whole, you can’t do that. But I generally believe that you should be rewarded for good behavior.”

“Well, regardless of the evidence, I still think it’s a good thing to do to encourage people to take better care of themselves, and maybe it doesn’t save the company any money to develop these programs, but I still think, again, just for the individual that it’s a good thing to do, because hopefully people will be healthier, and of course you can’t argue with that. That’s better for the individual and their families and those kind of things. So, I mean, I wasn’t aware that there was very little evidence, but I still think it’s a good thing for the person, and it’s a nice thing for the company to offer. You can’t always give more money, but there’s other things you can do like wellness programs or a extra holiday, that kind of thing, so I still think it’s good for the culture of the organization when they talk about what are great places to work.”

Make program benefits accessible, regardless of personal status (Culture of health or wellness)

“If you have insurance through your employer, and many people do, a lot of people don’t, so if your employer is providing insurance that’s wonderful. I hope we get to a place where we’re no longer employer-based insurance, but the reality we live in is a lot of people have employer-based insurance. The insurance should be offered, and that’s it. The door closes. The cost match of the insurance is the cost match of the insurance. Then you get into pregnancy, you get into people recovering from surgery. All those things start affecting your ability to participate in a wellness program. You click in, you click off. Who’s going to measure that? What are you going to do? So, the cost of your health insurance should be across the board the same for all employees, and employers should never be able to look into your mental health records, your physical health records.”

“I can see the thing about employees wanting to participate and needing to participate because of the incentive, but I could also see a lot of employees that might work a second job and might have childcare issues and might have a 100 and so reasons why they can’t if it’s after work or if it’s during work. Their jobs might not be good, so, I mean, I think that the best way to do it is to have a wellness program in a workplace that is free, accessible to everybody without going through all of that.”

“I think the employer should provide both the time and the means to participate in the wellness programs. I don’t think they should be required to be completed outside of the work areas-- hours or outside of the work areas so if it involves going to a gym, the gym should be on site and it should be during work hours. I don’t think it should be a burden on the employee.”

“I think that if employers are going to offer a wellness program, then it should be conducive to the workplace and where their employees are. It should not be a burden to employees, and I believe many people probably feel similarly in that respect… So really trying to make it seamless and truly integrated within the workplace would be ideal for a wellness program. Something that could be accomplished in the office or wherever the workplace is and that there’s an understanding between employer and employee that the facilities or the whatever the activities are associated with the program can be done during work hours.”

Remove penalties associated with biometric outcomes and nondisclosure of sensitive health information (Culture of trust)

“I think you probably hit it spot-on in terms of running the risk of coercion… obviously employers have a justification for being invested in their employees’ wellness. It makes sense, especially if they’re providing healthcare. At the same time, you really need to ensure through the incentives you’re crafting around these that it truly is a voluntary program and that the employees are protected so that the incentives are not so great that then it flips to be almost punitive if they are not participating, and so it’s definitely finding that balance and attenuating the program to ensure that there are the right guardrails around the program and the employees.”

“Well, I mean, I do think people are responsible for their health, but I think it’s their personal choice, so, again, going back to how wellness programs are set-up, I think it should be set-up in an incentive-type way to encourage people to do it, but if people choose not to do it, I mean, that’s their choice. I don’t think you should make people do it. I think about myself, how I gain and lose the same 10 to 15 pounds every year, and I only lose the weight, but I have my mind really set toward it, and I’m really determined that even if someone pushes me into it if I’m not determined it’s not going to happen, just like people who have a drinking problem or smoking, trying to quit smoking, that they have to first want to do it, and then it’s still hard. And I think someone that’s pregnant, I mean, even though some people that are pregnant still exercise or whatever, but it’s still a choice, so I don’t think people should be penalized.”

Uphold employee privacy and nondiscrimination standards (Culture of trust)

“So I think that there’s a careful line that we have to ensure that at a policy level when we look at regulations around employee wellness programs that we don’t cross a line into essentially what would be medical underwriting from an employer standpoint, and, you know, the ACA did a lot in terms of progress for medical underwriting, but now that we’re in this new era of employee wellness and more open data and more accessible data, I think we really need to be mindful that it is being used in the right way and wouldn’t be used in a discriminatory fashion, wouldn’t be used to cherry pick employees in hiring process potentially or promotional process, and that it isn’t, you know, it isn’t used, again, against employees. That it wouldn’t be turned into a punitive measure.”

“You know, of course I believe in respecting one’s privacy, and I think that’s a true balance somewhere in between so that employees are able to keep their privacy but be able to participate in the wellness programs. What the answer is to get there, I think that’s where you have so much debate within the agencies and also within Congress. So-- but I think… for the most part, I believe that you need to have a balance of respecting employees’ privacy and still be able to utilize the programs.”

“…I think that’s a difficult one. I mean, if you have a large pool of employees, potentially if you’re not giving the names of employees but just giving statistics, it might be easier, but, you know, in smaller workplaces, it might become very evident which employee you’re talking about when you’re looking at some of those metrics. Yeah, I think that’s something that the workarounds on that might be a little more difficult.”

Have transparent and prominent data standards and practices (Culture of trust)

“…To whom does the health data belong? Is it the company who’s making the assessment or does it belong to the employee or the employer? Is it shared? So, making all of those elements clear, that’s not a very straightforward process right now. I mean, companies don’t have standards that cross across each company, or what have you.”

“Well, I definitely think before an employee gets involved in a wellness program there has to be some type of contractual agreement around the issue of privacy and how the information gets used. Now, of course because of hackings, cybersecurity and those kind of things there’s always a chance that your information can get out, but when you get a credit card there’s that chance also, but I think there has to be agreements set-up in the beginning about how and why that information can be used in the privacy document.”