Official says most removing questions; decision 'short-sighted'

[caption id="attachment_17155" align="alignright" width="209" caption="Geoff Alexander"][/caption]

The chief science officer for one of the nation’s largest employer wellness program providers, Gordian Health Solutions Inc., described in an interview with the Business Journal last week the potential impacts of recently released regulations for the Genetic Information Nondiscrimination Act of 2008, or GINA.

Effective a week from today, employers that offer incentives for completing health-risk assessments that include questions about family history or other genetic information will be forced to adjust wellness plans, regardless of whether or not the incentive is linked to the result of that survey. To read the full text of the final rules released Oct. 7, visit http://edocket.access.gpo.gov/2009/pdf/E9-22504.pdf.

Geoff Alexander of Gordian answered the following questions:

Q. How common are health-risk assessments in wellness programs and how big of a part do family history and genetic information questions play in those surveys?

A. We have asked family history questions for more than 20 years, and I would say almost all in the corporate market include some kind of incentive. The new regulations are very clear that if an employee is being offered an incentive, they would be in violation of GINA, and it doesn’t matter if that comes in the form of a premium reduction or wellness dollars that can be spent on things that benefit health like a pedometer or smoking cessation.

It was also clear that the drafters of these regulations heard the shrieks from the wellness industry but decided it would be OK to keep them as is anyway.

Q. So what happens to these wellness programs?

A. Typically, the risk assessment is the initial communication between the participant and the program, and the self-reported data allows several things to take place. First, it creates a tailored health information report, and second, it makes recommendations based on that information, like recommending a mammogram, for example.

Third, the HRA allows the organization to assess its overall health and choose programs that provide the greatest benefit to its employee population. ... At this point we have removed all the family history questions from the HRA and the assessment is still intact, but the bigger impact of the GINA isn’t on the HRA itself, but on the overall wellness program.

Q. In what way does it impact programs as whole?

A. For example if an individual is exploring whether to participate in a blood pressure program, knowing that that person has high blood pressure in the family and offering an incentive for them to participate is a really powerful tool for improving someone’s health. ...

There are quite a few conditions where knowing personal history can improve health outcomes, and I think implementing this restriction was a really short-sighted decision.

What have your clients' reactions been like?

Right after the Oct. 7 announcement, we hit the streets and the feedback was clear. No one is interested in gutting their program, but they were interested in playing it safe.