De Blasio wants to slim city employees to trim health care costs
Mayor Bill de Blasio, looking for ways to lower health care costs, wants city employees to trim their waistlines.
The de Blasio administration is willing to pay up to $6.6 million for weight-management services for the city's 340,000 employees as part of an effort to find more than $3 billion in health care savings.
"We are working to fundamentally bend the health care cost curve through initiatives that improve employees’ health and save New York City taxpayers,” de Blasio spokeswoman Amy Spitalnick said in an email.
The theory — that a skinnier workforce will spend less on health care — sounds logical, but there isn't much evidence to show that these programs help employees lose weight, or that losing weight saves money. That's why the administration wants to evaluate the effort before making a long-term commitment.
“Weight management services are not currently available as a benefit to New York City employees and the short term contract awarded as a result of this demonstration project procurement is designed to test and evaluate the feasibility of offering weight management services to New York City employees,” a listing in the City Record said.
As part of a labor deal signed in 2014, the de Blasio administration and the municipal labor committee promised to find a total of $3.4 billion in health care savings over four years, and $1.3 billion in recurring savings every year thereafter. The health savings achieved between 2014 and 2018 were supposed to help cover the cost of higher wages.
If the savings are not achieved through negotiations, an outside arbitrator can force the unions to give up an equivalent amount of money, which could mean health insurance premium increases.
Bob Linn, the city's labor relations commissioner, has previously mentioned several cost-saving measures that the administration and unions had discussed, including auditing the rolls of health care recipients to remove dependents who are no longer eligible, renegotiating a city contract with drug provider Express Scripts and changing care management programs.
Linn has also hinted at his desire to change employee behavior.
"Typically 75 percent of health care costs are related to chronic diseases, much of which can be prevented and controlled with better lifestyle choices," Linn wrote in 2015.
The challenge with weight-management programs is that they require active and continued participation from employees, and they tend not to pay dividends for years.
“There is no published evidence that large-scale corporate attempts to control employee body weight through financial incentives and penalties have generated savings from long-term weight loss, or a reduction in inpatient admissions associated with obesity or even long-term weight loss itself,” an article last year in the American Journal of Managed Care said. “[O]verscreening and crash dieting can impact employee morale and even harm employee health.”
Arthur Caplan, a medical ethicist at NYU Langone Medical Center, said weight-loss management is a useful goal, but "unfortunately, I'm not sure we've got any real programs that work well."
Instead, Caplan suggested pushing smoking cessation and colonoscopy screenings, which have a more proven track record. "Those two save money and improve health," he said.
The administration is looking for a one-year contract that would begin May 1, with two one-year options to renew. The money to pay for the project comes from the joint-stabilization fund, which is controlled by the mayor and the unions.