Potential Downside to Insurance Company Sponsored Wellness Programs

Employers struggling with the ever-increasing costsfor healthcare are wisely turning to worksite wellness programs in search of asolution. For convenience, many employers are looking to their health insurancecarrier to provide the appropriate wellness program. However, the convenienceof a health insurance provided program may not outweigh the risks. Thatdecision could come back to haunt them.

At issue is an insurance carrier’s ability to useinformation gathered during a wellness program as justification for increasingan employer’s rates at renewal. Since no laws prevent an insurance company fromusing voluntarily provided information for rating purposes, employers should becautious about the information they provide.

Employers should be particularly concerned with howtheir insurance company uses data collected during a Health Risk Assessment(HRA).

Health Risk Assessments

Health Risk Assessments are sophisticated survey toolsdesigned to identify preventable health risks on both an individual and a grouplevel.

Individual participants who complete the surveyreceive a custom health profile that outlines specific health risks and makesrecommendations for modifying high-risk behaviors. This information can serveas a catalyst for individual change, but more often than not it takesincentives and customized, individual and/or group-based intervention toencourage people to modify these high-risk behaviors.

Data gathered from individual participants’ HRAs iscompiled into aggregate or group-level, health risk profile. This informationthen provides benchmarks for ongoing measurement, assesses wellness programeffectiveness, and forecasts future healthcare costs. HRA data also serves as aroadmap for intervention on both an individual and a group level.

By way of example, assume that a company’sgroup-level risk profile reveals that few employees exercise on a regularbasis. Using this information, an independent (non-insurance) wellness vendorcould customize an effective workout that does not require a gym membership.

To further enhance results the wellness vendormight also provide a group-based seminar about starting and maintaining anexercise program. By offering an incentive for exercising and/or attending theseminar the level of participation should increase, thereby increasing theoverall effectiveness of the program.

Often a wellness vendor will assign a health“coach” to each individual to assist them in setting and maintaining theirgoals. The health coach also increases the effectiveness of the program.

Insurance carriers, however, take a different andvarying approach to providing a wellness program. Many health insurancecarriers offer a limited number of individual level interventions including;Employee Assistance Programs, online health information, toll free “nurselines” to assist with self-diagnosis, discounted gym memberships, discountedaccess to complimentary and alternative medicine and advertising incentivesthat reward people for tracking activities.

Most insurance companies, however, fail to offersimple and effective programs that could have a greater impact on improvingmember health. For example, there are highly effective online nutrition programsthat can be offered for pennies per eligible member per month. Insteadinsurance carriers are opting to increase claims cost, and ultimately premiums,by covering visits to a Registered Dietician.

Though most health insurance carriers actively encouragemembers to complete an HRA, few insurance carriers share the group-level riskprofile with the employer and even fewer provide group-based, onsite wellnessprograms. How is an employer using an insurance company sponsored wellnessprogram able to objectively determine the best way to assist their employeeswithout this crucial information?

So, why do insurance carriers encourage HRAcompletion among their members? Insurance carriers generally contend thatcollecting HRA data allows them to more quickly identify candidates for DiseaseManagement (DM) services.

Health Risk Assessments are not completed atinitial enrollment and therefore it is highly unlikely that many, if any,candidates for DM will first be identified through HRA data analysis. Instead,most will be identified when they incur claims related to that disease. Forexample, candidates for a diabetes management program are easily identifiedwhen they purchase insulin, test strips or any other diabetes-related products.

Health Risk Assessments are backed by years ofresearch and can be highly predictive of future healthcare costs. As thecornerstone of most worksite wellness programs the value of an HRA is not atissue. Instead, the issues surround the use and control of HRA data.

Without laws to prevent an insurance carrier fromusing voluntarily provided information for rating purposes employers would bewell served to confirm in writing exactly how HRA data will be used. At minimumemployers should confirm that HRA data will not be used for rating theirindividual company or for rating the insurance carriers overall block ofbusiness, because that also indirectly impacts an employers rate.

To eliminate any possible conflict of interest,many employers are avoiding insurance company sponsored wellness programs andare opting to utilize the services of independent wellness vendors instead.This decision easily prevents wellness data from being used against an employerby an insurance company.

Employers should remember that Health RiskAssessment’s are tools designed to measure risk, plan interventions and measureresults. Health Risk Assessments do not improve employee health; it is theprogramming that results from the assessment that makes the difference.