When Biometric Screenings Aren’t Enough
Giving blood at work may soon take on a whole new meaning. Rather than referring to community-minded employees donating a pint as part of a corporate blood drive, it may describe submitting a vial as part of a workplace wellness program that relies on genetic screening to assess workers’ health risks.
The Equal Employment Opportunity Commission gave employers a little more wiggle room to offer genetic screening to their employees via proposed amendments to Title II of the Genetic Information Nondiscrimination Act of 2008. That provision of the law prohibits employers from discriminating against job applicants and current and former employees based on their genetic composition.
Regulations implementing Title II took effect in 2011. The 35-page set of new regulations proposed by the EEOC would amend the 2011 regulations (bit.ly/1NaCtpX). The EEOC says the proposed regulations set parameters on how employers may legally incent their covered employees to cough up their DNA profiles.
Under current law, an employee voluntarily can accept genetic screening offered as part of a workplace wellness program. Any financial incentive offered to an employee to participate in a wellness program can’t make genetic screening a requirement of receiving that financial incentive.
Under the proposed regs, employers could install “limited” financial incentives or penalties for spouses of employees (and, by extension, employees themselves) to undergo genetic screening as part of group health plan workplace wellness programs. The regs define “limited” as 30 percent of the total cost of individual or family coverage, whichever applies. That mirrors the limit on incentives and penalties for participation in workplace wellness programs that employers must follow to avoid violating the Americans with Disabilities Act, as outlined by the EEOC in draft legal guidance (bit.ly/1Wxjs70).
“EEOC is mindful that this change creates an exception to the general rule that no incentives may be provided for an employee’s genetic information,” the agency said in its answers to frequently asked questions. “Therefore, we have interpreted the exception as narrowly as possible.”
My frequently asked question would be how many employers are willing to turn up the dial on their workplace wellness programs by incenting employees and their significant others to be screened for genetically linked diseases and medical conditions? At this point, it’s unknown how many employers are taking workplace wellness that far. The latest annual employer health benefits survey by the Kaiser Family Foundation stops at biometric screening (see “Invasive Procedures,” on right).
Yet for employees, genetic screening is an opportunity to benefit from personalized versus generic wellness regimens that rely on less invasive programs to identify health risks. For employers, it’s an opportunity to focus wellness dollars on interventions that promise the best results and the greatest savings from reducing employees’ use of costly health care services.
A study published last October in the Journal of Occupational and Environmental Medicine concluded that workplace wellness programs that included genetic screenings “would be expected to lead to significant downstream reduction in major clinical events and costs.”
The study was authored by Aetna, which screened 445 of its employees to identify those genetically predisposed to metabolic syndrome. Metabolic syndrome is a mix of conditions—including high blood pressure, high blood sugar and high cholesterol—that increase a person’s risk for heart disease, stroke and diabetes. Per the study, Aetna put the workers on one-year, personalized wellness plans that reduced each participant’s health care costs by an average of $122 per month.
Despite the big dollar signs, for both employers and employees it’s still a huge leap of faith to assume that workers’ DNA profiles will remain confidential, won’t fall victim to an accidental or deliberate data breach, and will be used solely for the purposes intended.
The EEOC’s proposed regulations are a sign that it thinks workplace wellness programs that feature genetic screening are inevitable, and the agency wants to steer the inevitable in the right direction. And if the EEOC is thinking about how to handle it, so should your business or company.
Accountable care organizations in Minnesota are like millennials—they show promise but need to prove themselves to their managers. That’s my analogy for the findings of an analysis of the ACO market by the Minnesota Department of Health (bit.ly/1ktTKPr). ACOs are hospitals, doctors and insurers in various combinations that care for specific groups of patients for a fixed dollar amount per patient.
ACOs assume the clinical and financial risk for medical care. The analysis is based on a survey of 65 providers and eight insurers. Of the 65 providers, 22, or about 30 percent, participate in ACOs and provide care to 288,000 commercial lives. Six of the insurers offer ACO insurance plans covering about 750,000 commercial lives.
The researchers asked the insurers to rate on a scale of one to 10 the willingness of employers to offer ACOs to workers. The average was six. They also asked insurers to rate the willingness of employers to incent workers to choose ACOs. The average was five. If you’re seriously interested in the analysis, skip the 47-page report and read the 52-page appendix with the survey findings. That’s where you’ll find all the good stuff you want to know.
In the first Explanation of Benefits column, published way back in February 2014, we talked about new medical technologies under development that sooner rather than later will appear as costly line items on patient bills footed by insurers and, ultimately, employers (bit.ly/1ipnN57). I was pessimistic but realistic. New drugs, procedures and devices to make sick people well again are expensive. (When was the last time your new set of golf clubs scientifically engineered to correct your slice cost less than your old set?) Two years later, I’m changing my mood to optimistic yet reserved. The cause of my mood swing was the annual top 10 medical innovations list from the Cleveland Clinic (cle.clinic/1kRJW1Y). Taken as a whole, the top 10 medical innovations for 2016, as decided by a panel of 75 Cleveland Clinic physicians and scientists, tilted toward prevention and away from intervention. Most are designed to keep healthy people healthy and people with chronic medical conditions as healthy as possible. That’s much cheaper than letting everyone get sick or sicker and fixing them later with expensive treatments. Among the prevention and detection items on the list are:
- Epidemic-battling vaccines
- Genomics-based clinical trials
- Gene editing
- Water purification systems
- Biomarker cancer screenings
- Passive remote monitoring of vital signs
If it all works, fewer people will get sick, people preprogrammed to get sick will get rebooted and people already sick won’t get any sicker. That works for everyone on every level—and line item.
David Burda (@davidrburda, firstname.lastname@example.org) is editorial director, health care strategies, for MSP-C, where he serves as the chief health care content strategist and health care subject matter expert.