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