| Potential Downside to Insurance Company Sponsored | | | | nurse lines to assist with self-diagnosis, discounted gym |
| Wellness Programs | | | | memberships, discounted access to complimentary |
| Employers struggling with the ever-increasing costs for | | | | and alternative medicine and advertising incentives that |
| healthcare are wisely turning to worksite wellness | | | | reward people for tracking activities. |
| programs in search of a solution. For convenience, | | | | Most insurance companies, however, fail to offer |
| many employers are looking to their health insurance | | | | simple and effective programs that could have a |
| carrier to provide the appropriate wellness program. | | | | greater impact on improving member health. For |
| However, the convenience of a health insurance | | | | example, there are highly effective online nutrition |
| provided program may not outweigh the risks. That | | | | programs that can be offered for pennies per eligible |
| decision could come back to haunt them. | | | | member per month. Instead insurance carriers are |
| At issue is an insurance carriers ability to use | | | | opting to increase claims cost, and ultimately premiums, |
| information gathered during a wellness program as | | | | by covering visits to a Registered Dietician. |
| justification for increasing an employers rates at | | | | Though most health insurance carriers actively |
| renewal. Since no laws prevent an insurance company | | | | encourage members to complete an HRA, few |
| from using voluntarily provided information for rating | | | | insurance carriers share the group-level risk profile with |
| purposes, employers should be cautious about the | | | | the employer and even fewer provide group-based, |
| information they provide. | | | | onsite wellness programs. How is an employer using |
| Employers should be particularly concerned with how | | | | an insurance company sponsored wellness program |
| their insurance company uses data collected during a | | | | able to objectively determine the best way to assist |
| Health Risk Assessment (HRA). | | | | their employees without this crucial information? |
| Health Risk Assessments | | | | So, why do insurance carriers encourage HRA |
| Health Risk Assessments are sophisticated survey | | | | completion among their members? Insurance carriers |
| tools designed to identify preventable health risks on | | | | generally contend that collecting HRA data allows |
| both an individual and a group level. | | | | them to more quickly identify candidates for Disease |
| Individual participants who complete the survey receive | | | | Management (DM) services. |
| a custom health profile that outlines specific health risks | | | | Health Risk Assessments are not completed at initial |
| and makes recommendations for modifying high-risk | | | | enrollment and therefore it is highly unlikely that many, if |
| behaviors. This information can serve as a catalyst for | | | | any, candidates for DM will first be identified through |
| individual change, but more often than not it takes | | | | HRA data analysis. Instead, most will be identified when |
| incentives and customized, individual and/or | | | | they incur claims related to that disease. For example, |
| group-based intervention to encourage people to | | | | candidates for a diabetes management program are |
| modify these high-risk behaviors. | | | | easily identified when they purchase insulin, test strips |
| Data gathered from individual participants HRAs is | | | | or any other diabetes-related products. |
| compiled into aggregate or group-level, health risk | | | | Health Risk Assessments are backed by years of |
| profile. This information then provides benchmarks for | | | | research and can be highly predictive of future |
| ongoing measurement, assesses wellness program | | | | healthcare costs. As the cornerstone of most |
| effectiveness, and forecasts future healthcare costs. | | | | worksite wellness programs the value of an HRA is |
| HRA data also serves as a roadmap for intervention | | | | not at issue. Instead, the issues surround the use and |
| on both an individual and a group level. | | | | control of HRA data. |
| By way of example, assume that a companys | | | | Without laws to prevent an insurance carrier from |
| group-level risk profile reveals that few employees | | | | using voluntarily provided information for rating |
| exercise on a regular basis. Using this information, an | | | | purposes employers would be well served to confirm |
| independent (non-insurance) wellness vendor could | | | | in writing exactly how HRA data will be used. At |
| customize an effective workout that does not require | | | | minimum employers should confirm that HRA data will |
| a gym membership. | | | | not be used for rating their individual company or for |
| To further enhance results the wellness vendor might | | | | rating the insurance carriers overall block of business, |
| also provide a group-based seminar about starting and | | | | because that also indirectly impacts an employers rate. |
| maintaining an exercise program. By offering an | | | | To eliminate any possible conflict of interest, many |
| incentive for exercising and/or attending the seminar | | | | employers are avoiding insurance company sponsored |
| the level of participation should increase, thereby | | | | wellness programs and are opting to utilize the |
| increasing the overall effectiveness of the program. | | | | services of independent wellness vendors instead. This |
| Often a wellness vendor will assign a health coach to | | | | decision easily prevents wellness data from being |
| each individual to assist them in setting and maintaining | | | | used against an employer by an insurance company. |
| their goals. The health coach also increases the | | | | Employers should remember that Health Risk |
| effectiveness of the program. | | | | Assessments are tools designed to measure risk, plan |
| Insurance carriers, however, take a different and | | | | interventions and measure results. Health Risk |
| varying approach to providing a wellness program. | | | | Assessments do not improve employee health; it is the |
| Many health insurance carriers offer a limited number | | | | programming that results from the assessment that |
| of individual level interventions including; Employee | | | | makes the difference. |
| Assistance Programs, online health information, toll free | | | | |