Historical Health Hindrance
The Genetic Information Nondiscrimination Act, which goes into effect on Dec. 7, will bar organizations from asking about an employee's family-health history. That may impact the effectiveness of wellness initiatives or disease-management programs.
By Andrew R. McIlvaine
Does your organization offer employees incentives for completing health-risk assessments that include questions about family-medical history? Thanks to the Genetic Information Nondiscrimination Act, doing so will soon be a thing of the past.
GINA, which bars employers and health insurers from discriminating against individuals based on their genetic information, prohibits health plans and employers from offering financial incentives --such as reductions in healthcare premiums or cash awards -- to those who complete HRAs that request genetic information such as family-health history.
The new rules apply to plan years beginning on or after Dec. 7.
Experts disagree on the extent to which the new rules will affect the usefulness of HRAs, which are typically used in conjunction with wellness initiatives or disease-management programs to help identify people with manageable medical conditions and, ultimately, help employers reduce their healthcare costs.
"This will be a setback for wellness efforts in the long term," says Randall Abbott, a senior healthcare consultant based in HR consultancy, Watson Wyatt's Boston office.
John Hennessy, a senior consultant in the Dallas office of the Hay Group, an HR consulting firm, agrees.
"In order to ensure good outcomes, we need good information on people and this diminishes our ability to collect that information," he says. "The reaction I've seen from employers so far is that they can live with the changes, but it doesn't make these programs stronger. It undermines the larger strategy of what they're trying to accomplish."
However, Geoff Alexander, chief science officer at Gordian Health Solutions, a Nashville, Tenn.-based health-consulting firm that administers HRAs, estimates GINA's impact on the tool at "less than 1 percent."
Although family history can be important in some cases, other precursors -- such as smoking, obesity, high blood pressure and heavy alcohol use -- are far more important, he says.
With respect to diseases for which family history can be a clear precursor, such as breast cancer, the company already has a system in place to alert employees who choose not to answer family-history questions, he says.
"Women who choose not to profile their family history of breast cancer are sent a message along the lines of 'If you do have a history of breast cancer within your family, here is what you need to be aware of,' " says Alexander, adding that Gordian has already removed questions pertaining to family history from its online HRAs.
GINA's effect on HRAs would have been considerably greater were it not for one thing -- that health and wellness vendors were failing to put family-history data to good use in the first place, says Abbott.
"We did an informal survey with eight health-and-wellness vendors that, collectively, provide about 75 percent of such services in the country, and we were quite surprised to see that most of them ascribed very little value to family-health history," he says.
Family medical history is "extremely important," he says. "Yet the various algorithms HRA vendors apply to measure the risk an individual faces actually take very little family-history information into account.
"Now the vendors are telling employers that GINA will have little to no effect on how they use HRAs, but that's really a sad commentary on how little they've been using this information," Alexander says.
HR leaders who champion wellness initiatives and disease-management programs will need to find a way to compensate for the new rules, he says.
"GINA is real, it's here and we have to deal with it," he says. "So how do we work around it?"
One potential solution is to stress to employees the importance of primary-care physician relationships, Abbott says.
"Many folks believe going to a specialist is better than going to a general practitioner," he says. "But what individuals really need is an ongoing relationship with a doctor who knows their family history and knows all aspects of the medical care they're receiving.
"During open enrollment, HR should stress that people with good primary-care relationships are healthier, have lower mortality rates and have better outcomes than people managed primarily by specialists," he says.
Another strategy is to educate employees on the importance of understanding and taking on the responsibility of documenting their family's medical history, he says. The American Medical Association has developed a set of free tools on its
Web site
to help in this regard.
Hennessy says that many employers have already begun de-emphasizing HRA-based incentives in favor of programs that reward employees for participating in biometric health screenings. GINA will only increase this trend, he says.
"Rather than offering someone fifty bucks to complete an HRA, a more meaningful incentive is getting them to take a blood test, get a body-mass index, then offer them $300 for showing improvement in those areas," he says.
November 17, 2009 Copyright 2009© LRP Publications
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