[ Tuesday, November 13, 2007 ]


HIPAA, but not privacy or security: I've been involved in a couple of client projects where an employer wanted to impose a wellness plan to prod employees into abandoning unhealthy behaviors like smoking or tending to unhealthy conditions like obesity, diabetes and high blood pressure. The goals are to reduce absenteeism due to sickness, lower healthcare costs, and improve employee moral (a healthier worker is a happier worker, in theory). It seems that some employers are moving from the "carrot" method to the "stick" method, though.

These things are doable, but can be tricky. In addition to the issues raised in the article (ADA and state antidiscrimination laws), there's a HIPAA provision that prevents a health plan from discriminating against an individual for a health condition (under the theory that health insurers should cover a general population, not cherry-pick healthy [low-cost] patients and exclude unhealthy [espensive] ones); however, "wellness plans" are allowed, as long as they meet certain requirements. Mainly, the carrot/stick can't exceed 20% of the cost of coverage, must be reasonably designed to promote health or prevent disease (including not being overburdensome or a subterfuge for discrimination), has to be available for entry at least once per year, and must be available to all similarly-situated individuals, with reasonable alternative arrangements (i.e., a "get-around") for someone who can't reasonably meet the standards due to medical conditions or the fact that participation is medically inadvisable. The wellness program must also be described in the benefit plan materials, including a description of the get-around.

Expect to see more of these. It's not just the government that wants to be your momma, your employer wants to nanny you too. The government does it because it thinks it knows best for you, your employer because it knows what's best for it (i.e., saving money).

Jeff [11:16 AM]

What about Wellness Programs being able to access your insurance claims and prescription information. My companies wellness program monitors all claims. The prescription plan sends a weekly list of our medications to our Employee assistance program. If youre on any antidepressants or other they call you to schedule an appointment for counseling.
That doesn't sound right. Unless the employee agreed to it, that sounds like a clear HIPAA violation if the prescription information is part of the regular health plan. Perhaps there could be some argument that the disclosure is for treatment purposes as part of a disease management program, but I'd still think a plan would be wise to get patient consent before making that disclosure. Counseling in the mental health area is a far cry from what most of us think of when we think of disease management.
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