How far is too far for work wellness programs to go?

As companies rapidly embrace employee wellness programs, some employers say regulators are stymieing their efforts to help workers improve their health.

Companies are increasingly cutting workers' health insurance premiums if they improve their scores on health screening tests for blood pressure, diabetes and other chronic illnesses.

The Affordable Care Act doesn't let insurers or employers charge people more for insurance based on their pre-existing conditions, but it does encourage them to offer wellness programs by allowing healthcare premium cuts or other incentives if workers participate and show improvement on screening tests.

Companies risk running afoul of the Americans with Disabilities Act if they don't offer other options for employees who are physically or mentally unable to participate. But federal rules under the ACA also require businesses to offer alternative ways to comply for those who simply don't want to do what it takes to, say, reduce their cholesterol. And these employees can also go to their doctor and get another option -- perhaps to take a class -- that the company has no say in.

Some employers, including Caesars Entertainment CEO Gary Loveman, say these rules let workers off too easy. Loveman, co-chairman of the health and retirement committee for the CEO association Business Roundtable, says members of the group believe the Obama Administration "made it very difficult to provide any sort of tangible motivation" to employees to improve scores on tests including blood pressure and cholesterol.

"I hate to sound skeptical about human motivation -- but a lot of people will just not read the book, they'll read the Cliffs Notes about the book about getting your (diabetes blood test score) down by 5%," Loveman says.

Advocates for workers say some programs already go too far.

There are "whole demographics" that the programs can discriminate against, says Judith Lichtman, a senior adviser with the National Partnership for Women & Families. These include women, minorities and low wage workers who are disproportionately afflicted with chronic illnesses, she says.

Problems include wellness programs that require attendance at events that fall outside of normal business hours, which would make it difficult for single mothers and others to attend if they have to pay extra for day care. Besides, she says, incentives are often made out to be carrots "when it is really a stick."

The Equal Employment Opportunity Commission, which held hearings on possible discriminatory aspects of wellness programs last year, is expected to issue rules or guidance soon to help companies address possible labor law issues with the programs.

Although Lichtman questions whether there's "hard research" linking wellness programs to good health outcomes, companies report they are making a difference.

A peer-reviewed study conducted for Interactive Health, which administers wellness programs for about 2,000 companies, found 85% of 15,550 employees and spouses improved or maintained their level of health risk and companies' health care costs rose 6% more slowly.

"We know we save people's lives," says Cathy Kenworthy, CEO of Interactive Health.

Along with incentives for surveys and screening, wellness programs can include gym membership reimbursement, online and telephone coaching for weight management and health trackers, says Tracey Lempner, spokeswoman for United Healthcare, which administers programs for insurance clients.

A survey by benefits consulting firm Towers Watson found nearly half of companies will offer wellness programs next year that cut insurance premiums for those who improve health screening scores. That's up from 22% this year.

Despite the federal roadblocks, companies are increasingly telling employees, "We want you to do more than show up and listen; we want you to actually take action and try to achieve a result," says Randy Abbott, a senior consultant at employee benefits consulting firm Towers Watson

CVS hasn't adopted them yet, but chief human resources officer Lisa Bisaccia says these outcome-based wellness programs are a "natural successor" to those that ask or require workers to be tested.

"You have to get people to understand what their numbers are and only then can you move on to something that improves them," says Bisaccia. "You have to take it step by step."