Friday, March 22, 2013

CVS requirement for employees to turn over health info part of greater trend in health insurance

A plan by a major drug store chain to penalize employees who don't turn over health information may be new, but the trend to get unhealthy people to pay - and pay more - for their health insurance is not.

CVS Caremark Inc., which operates dozens of drug stores in the region and a pharmacy fulfillment center in Hanover Township, will require employees under its health insurance plan get an annual checkup and disclose to the company health statistics such as weight, body mass index and blood sugar or face a $50 per month surcharge for health care.

A statement issued by the Woonsocket, R.I.-based company said the program "is evolving to help our colleagues take more responsibility for improving their health and managing health-associated costs."

This is not the eve of a new era of premium differentials and risk ratings, said Nate Kaufman, managing director of Kaufman Strategic Advisors. That era is already here.

Hospitals are refusing to hire smokers, group insurance plans have long offered financial incentives to those who get regular health assessments or even those who go the gym. The federal Affordable Care Act will cost smokers more, he noted. Whether a company is charging the healthy less or the unhealthy more, it's the other side of the same coin.

"Those are precursors to what we are seeing now - follow health advice or there will be a differential," said Kaufman, who spoke at Misericordia University last year about health care costs.

Those buying individual insurance have long been subjected to more probing scrutiny, he noted, with an insurer assessing not just an individual's use of tobacco, weight, blood pressure, but also every visit to a health care provider going back years, which sometimes veers into more sensitive areas.

"If you've ever visited a psychologist, for example, you may end up with a higher risk ranking and a higher premium," he said.

Those same risk rankings and differentials are coming to group plans, where the unhealthy or those who used lots of services were blended with a larger group. An employer offering group insurance to employees negotiates premiums with insurance companies. Adopting wellness incentives usually results in a lower-cost insurance plan for all.

Health insurers say the terms of the wellness incentives come from the employer, in consultation with the insurance companies. Both Geisinger and Blue Cross of Northeastern Pennsylvania offer wellness plans that includes health planning and coaching connected to incentives from discounts and refunds to gift cards.

"There is nothing unusual about what CVS is doing," said Mark Ungvarsky, vice president of informatics for Blue Cross of Northeastern Pennsylvania. "The reality is that we see more and more groups telling us 'we want our insured employees to have some accountability.'"

Blue Cross wellness programs are based on incentives rather than penalties, because that's how employer groups request it. Ungvarsky said the perception of those plans has much to do with how the program packaged, but in the end, some pay less or get a benefit and others don't.

Among the 400,000 people covered by Geisinger Health Plan, 50,000 in 40 employer group are in some form of Geisinger's wellness plan often called Smart Steps, said Amy Bowen, public relations specialist for Geisinger Health Plan. Thirteen other groups are considering it.