[T453]The First Insurance Company

Employers struggling with the ever-increasing costs for healthcare are wisely turning to worksite wellness programs in search of a solution. For convenience, many employers are looking to their health insurance carrier to provide the appropriate wellness program. However, the convenience of a health insurance provided program may not outweigh the risks. That decision could come back to haunt them.

At issue is an insurance carrier's ability to use information gathered during a wellness program as justification for increasing an employer's rates at renewal. Since no laws prevent an insurance company from using voluntarily provided information for rating purposes, employers should be cautious about the information they provide.

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

Health Risk Assessments

Health Risk Assessments are sophisticated survey tools designed to identify preventable health risks on both an individual and a group level.

Individual participants who complete the survey receive a custom health profile that outlines specific health risks and makes recommendations for modifying high-risk behaviors. This information can serve as a catalyst for individual change, but more often than not it takes incentives and customized, individual and/or group-based intervention to encourage people to modify these high-risk behaviors.

Data gathered from individual participants' HRAs is compiled into aggregate or group-level, health risk profile. This information then provides benchmarks for ongoing measurement, assesses wellness program effectiveness, and forecasts future healthcare costs. HRA data also serves as a roadmap for intervention on both an individual and a group level.

By way of example, assume that a company's group-level risk profile reveals that few employees exercise on a regular basis. Using this information, an independent (non-insurance) wellness vendor could customize an effective workout that does not require a gym membership.

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

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

Insurance carriers, however, take a different and varying approach to providing a wellness program. Many health insurance carriers offer a limited number of individual level interventions including; Employee Assistance Programs, online health information, toll free "nurse lines" to assist with self-diagnosis, discounted gym memberships, discounted access to complimentary and alternative medicine and advertising incentives that reward people for tracking activities.

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

Though most health insurance carriers actively encourage members to complete an HRA, few insurance carriers share the group-level risk profile with the employer and even fewer provide group-based, onsite wellness programs. How is an employer using an insurance company sponsored wellness program able to objectively determine the best way to assist their employees without this crucial information?

So, why do insurance carriers encourage HRA completion among their members? Insurance carriers generally contend that collecting HRA data allows them to more quickly identify candidates for Disease Management (DM) services.

Health Risk Assessments are not completed at initial 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. For example, candidates for a diabetes management program are easily identified when they purchase insulin, test strips or any other diabetes-related products.

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

Without laws to prevent an insurance carrier from using voluntarily provided information for rating purposes employers would be well served to confirm in writing exactly how HRA data will be used. At minimum employers should confirm that HRA data will not be used for rating their individual company or for rating the insurance carriers overall block of business, because that also indirectly impacts an employers rate.

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

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