Med thumb sleeping main aetna

Good habits pay. Literally. 

A growing number of companies are offering employees wellness incentive programs as part of their healthcare benefits packages. The basic idea: Encourage people to maintain thrice-weekly gym sessions and various other healthy habits through financial rewards. Employees who participate can earn, say, three dollars each time they check in at their gym or 50 cents when they log a mile on their activity tracker. Sync up devices and memberships, and watch the money (slowly) roll in.

Last week, Aetna CEO Mark Bertolini said in a CNN interview that his insurance company offers sleep incentives (sleep-centives?) as a part of its own Healthy Lifestyles program. Aetna employees who take advantage of the shuteye bonus can earn up to $300 per year. Over at Slate, L.V. Anderson argued that Aetna's sleep-centivization is well-intentioned but flawed. Among other issues, she contends that reliance on self-reported data lets employees fudge their sleep stats. And that employers concerned about employees' sleep and wellbeing should focus on helping them chill out and unplug before handing them dollars for dozing. 

The first point isn't persuasive, but the second hints at the more interesting discussion underlying Aetna's sleep-centives. Telling workers to "get rest!" without also encouraging work-life balance is, in some sense, putting the cart before the horse. But more than that, Aetna employs 47,000 people whose annual salaries range from roughly $25,000 to well over six figures (not including Bertolini, of course). Sleep-centives potentially work for people who otherwise have the time, ability and resources to get enough quality sleep. A sizeable chunk of Aetna employees don't need incentives as much as they need money, access to medical providers and a consistent schedule. To its credit, Aetna has implemented (or announced plans to implement) policies geared towards higher pay and better healthcare for employees at the low end of the income scale. And those policies may not incentivize sleep, but they almost certainly help enable it. 

Less-scrupulous employees, Anderson points out, can easily report more sleep than they get.

Per Slate, participating Aetna employees can earn "earn $25 for every 20 nights in which they sleep seven hours or more, with a cap of $300 per year...If they sleep seven hours or more on 240 days per year, they’ll get the full $300...Neither the sleep nor the streaks have to be continuous — you don’t get disqualified if you get up to go to the bathroom in the middle of the night, nor do your 20 nights of sleep need to occur consecutively."

While employees can use fitbit activity trackers to show proof of rest, they can also log their sleep the old-fashioned way — through self-report, i.e.: "I fell asleep before someone texted me at midnight. I woke up to my "The Dope Show" ringtone at 7:15. That's seven hours."

Less-scrupulous employees, Anderson points out, can easily report more sleep than they get. That's true. As a method of collecting data, self-report is, of course, somewhat unreliable — or at least, not consistently reliable. Still, people's assessments of how they behave and feel informs most of we know about national public health trends. Some employees may stretch the truth, because, well, money is involved. But, how many will bother to sign up and lie about their nightly sleep to receive $25 every three weeks (roughly)? Aetna is making $300 easily available to employees for doing something they should be doing anyway. And, isn't the program a success if someone who's severely underslept gets more sleep, even if they don't hit their #hardseven for 240 nights? 

For those 5,700 employees, more money (earned through work, not through sleep) and better, cheaper healthcare are better than sleep-centives.

Anderson also suggests that employers should encourage employees to ditch the late-night emails and r-e-l-a-x, rather than pay them to hit the sack: "It’s all well and good to tell employees you want them to get enough sleep, but if that message is paired with late-night memos and requirements that employees check their work email from their mobile devices, it won’t make much of a difference." 

She's right that sleep-centives don't go far if people don't have the choice to sleep. It would be twisted to pay first-year investment banking analysts to get eight hours of sleep a night, take more vacation and honor all of their social commitments. But, let's put employees who can't "unplug" in the category of those who have the choice to sleep. By that, I mean, they don't need to refresh their inboxes at 2 a.m. And, if that's an issue, any employer that emphasizes sleep health should, absolutely, do its part to help Carl in marketing back away from the iCal. 

Sleep-centives are geared towards compulsively productive Carl and his ilk. For thousands of other Aetna employees, however, sleep-centives hardly get at the heart of the likeliest barriers to rest. But other recent Aetna policies do. Last year, the company raised wages for its lowest-paid employees to $16 per hour. The policy, implemented in April 2015, affected about 12 percent of employees — that's roughly 5,700 people, the Wall Street Journal reported. At the same time, Bertolini announced plans to "let workers with household income below a certain threshold choose health coverage with lower out-of-pocket charges without paying more in monthly premiums, a shift it said could save a worker with a family as much as $4,000 a year." (The healthcare boost was supposed to happen this year.)

For those 5,700 employees, more money (earned through work, not through sleep) and better, cheaper healthcare facilitates Zzzs are better than sleep-centives. Sleep struggles and associated health conditions disproportionately plague Americans with low incomes and irregular work schedules. It's not the paycheck itself that predicts sleep quality, researchers have found, but the benefits associated with high income, including access to private healthcare. In other words? It's not that income alone leads to better sleep, but rather what income buys. 

Isn't the program a success if someone who's severely underslept gets more sleep, even if they don't hit their #hardseven for 240 nights?

And healthcare access is crucial to sleep health for a number of reasons. For starters, sleeping issues can be both a symptom of underlying diseases as well as a contributing factor to conditions including heart disease and depression. Diagnosing and treating sleeping disorders, and related health problems, hinges on access to general practitioners, sleep medicine specialists, psychiatrists and behavioral therapists. Together, these healthcare providers supply vital sleep-health services, such as wellness assistance (weight, cholesterol), at-home and in-clinic sleep testing (polysomnography), drug treatment (Ambien) and non-drug treatment (Cognitive Behavioral Therapy). Try affording any or all of that with a high-deductible plan on a $25,000 annual salary. 

Not to mention, those 5,700 employees primarily work in customer service and billing-related jobs, which are both areas heavy on shift-work. Nothing screws up internal sleep-and-wake rhythms like a wonky schedule. And, circadian-rhythm disorders, research has found, comes with fun perks such as a heightened risk of developing diabetes and other cardiometabolic diseases. 

Had Aetna not recognized the need to raise wages for least-paid workers, a sleep-centive program feels a little icky: Offer $300 to a huge group of people, some of whom don't need the money and have the means and time to sleep, while others desperately need the money but can't get their seven hours thanks to a shift-work schedule and untreated sleep apnea. 

At least they can fudge the data. Cha-ching.