Should New Blood Pressure Guidelines Alter Wellness Incentives?

Medication may not be warranted for all who are now diagnosed with hypertension

By Greg Goth January 24, 2018
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Stricter guidelines from the American Heart Association and the American College of Cardiology have sharply increased the number of Americans classified as having high blood pressure, but corporate wellness program managers are not rushing to make things tougher for workers or their family members to meet health incentive targets for keeping hypertension under control.

The new guidelines classify blood pressure rates higher than 130/80 as hypertension. They replace guidelines released in 2003, which set a 140/90 benchmark as the onset of hypertension. One result of the revised blood pressure target has been to increase the percentage of Americans classified as hypertensive to 46 percent, up from 32 percent under the old metrics.

Carrie Alexander, SHRM-CP, a managing consultant at HR advisory firm Findley Davies/BPS&M, said the timing of the guidelines' release—in mid-November 2017—meant that most of her clients' firms had already done health screenings for the 2018 benefits year, so any big changes in hypertension incentives won't come until 2019, if at all.

"We're starting to talk incentive designs now and into the spring to be communicated in the summer and fall," Alexander said. "That's when those conversations will happen."

Drug Regimen Considerations

According to both the American College of Cardiology and the American Hospital Association (AHA), only a small percentage of those newly classified with hypertension due to the revised guidelines should be prescribed medication as the first-line approach to bringing their blood pressure down. Of the estimated 14 percent more adults to be classified with high blood pressure, about 1 in 5 will need medication, said Dr. Paul Whelton, who chaired the guideline writing committee, in an interview with AHA News.

"I suspect many primary-care practitioners will want to ignore this new target," Dartmouth College professor of medicine Dr. H. Gilbert Welch wrote in an opinion article in the New York Times shortly after the guidelines were published. "They understand the downsides of the relentless expansion of medical care into the lives of more people."

At the same time, however, Welch said that he feared that the new blood pressure guidelines "will push doctors to meet the target using whatever means necessary—and that usually means more medications."

[SHRM members-only toolkit: Designing and Managing Wellness Programs]

Education Before Medication

Managers of nationally recognized corporate wellness programs say the new guidelines are not signals to compel their employees to begin stricter treatment regimens. They will, however, take advantage of the new guidelines to educate their workforces about consistent pursuit of better health rather than arbitrarily enforcing new numbers.

"These guidelines just came out," said Stephanie Harvie, manager of wellness operations at L.L. Bean in Freeport, Maine, "and 140/90 is still considered high blood pressure. We will remain at that target until we can truly strategize, consult and look at the guidelines that are available before we make any significant changes to a program we have had in place for a very long time."

While not changing her wellness program's recommendations on when to begin taking blood pressure medication, Harvie said she is planning to provide additional information to L.L. Bean's employees. "We want to reinforce that this is important information and that employees should learn what their numbers are by getting screened, and then talk to their physician about them."

*We're not changing the criteria for our screening program to offer incentives" for bringing blood pressure readings under control, said Sheri Snow, wellness manager at American Cast Iron Pipe Co. in Birmingham, Ala. Even if employers were to incorporate the new blood pressure targets into their wellness incentives, "we would still need a period of time to educate and coach and help people get there."

Use Data to Spur Outreach

Employers should ask their wellness vendors for some vital data, advised Rob Davidson, vice president of insurance advisory services for the Kansas City-based Children's Hospital Association. Among the questions he recommends posing:

  • How many of our employees have high blood pressure under the old regimen, and how many have it under the new regimen?
  • What is our plan for dealing with these people, and how many of them are taking medication?
  • How many of them have enough medication that it could be effective? How has that changed year over year?
  • How are health risks changing over time?

Davidson cautioned against reading too much into any discrete data element, however, echoing a sentiment Welch stated in his New York Times column when he wrote, "Let me be clear: Using medications to lower very high blood pressure is the most important preventive intervention we doctors do. But more medications and lower blood pressures are not always better for everyone."

It might be more beneficial to target hypertensive employees who also have other chronic conditions (or "co-morbidities") for care management outreach—to help ensure that prescribed medication is being taken, for instance, Davidson noted, because "when they are co-morbid, there is a multiplier effect."

"Being hypertensive and diabetic makes you about 50 percent more expensive than being hypertensive alone," he said. "So maybe the more strategic focus is renewed emphasis on helping diabetics to manage hypertension rather than going after hypertension in everybody."

Greg Goth is a freelance health and technology writer based in Oakville, Conn.

Related SHRM Article:

Time to Set Limits on Wellness Screenings?, SHRM Online Benefits, January 2016

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