I commend Mort Kondracke for his Nov. 23 Roll Call commentary, “Is Congress Serious About Fighting Chronic Diseases?” He gets to the heart of the issue of what health reform should be about – improving health and helping Americans fight obesity and other chronic conditions.

I appreciate him sharing his views on what has become a very sticky discussion around how far to go with “incentivizing” good choices in health – as this is certainly a question that we should be discussing more.

As Mort said, chronic disease—often complicated by unhealthy lifestyle choices— is the leading cause of death and accounts for more than 75 percent of health care spending in the U.S. Clearly, something must be done to help stem this crisis.

Most agree—and it’s hard to ignore the growing body of evidence—that workplace wellness programs are effective interventions that help employees improve their health and reduce health care costs for employees and employers alike. The question is how best to encourage employee participation and engage participants in the program.

The PFCD strongly supports workplace wellness programs like those mentioned in the article that reduce costs and improve health outcomes, and as stated in the PFCD platform, our members believe that re-aligning incentives for all of those with a stake in the health care system – payers, providers and individuals, alike – is an important component of reform and should rely on evidence-based practices that protect individuals.

As Congress has debated health care reform they have begun to address this issue, though not yet as completely as we would like.  In particular we have applauded the work of the Senate and hope they continue down this road.

Regarding the specific issue of allowing premium variation in wellness programs, there is disagreement about whether this variation should go beyond the 20 percent allowed in current law.  Congress has not yet settled on whether current law should be changed and I expect debate to continue on this issue.

However, as Congress continues its deliberations, there are a few things I think we should keep in mind to guide the debate:

Participation is key and should be the metric for “reward.”  We know from the literature, when wellness programs are done right, improved health outcomes – and sometimes even lower costs – will follow from participation.

Participation is up to the individual. Not all employees may be in a position to, or want, to take advantage of wellness benefits either because of an underlying illness or condition. For those who have an underlying condition, they should not be penalized for not participating.

The rewards of participation are shared over time. Even those that choose not to participate may see benefit from lower health costs as others’ participation leads to better health outcomes and lower claims on health benefits. Any savings associated with participation in wellness programs thus accrue to everyone – and this should be recognized.