Written by Larry Sobal, CEO, Appleton Cardiology Associates

A growing number of companies are realizing that simply offering wellness programs is not enough to reduce or slow the rate of health care expenses.

As a result, wellness programs are evolving toward models that look to reward participants who make healthy lifestyle choices and provide greater incentives and financial accountability for those who don't.

What is emerging is the use of biometric measures of health to determine how much employees should pay toward health insurance. The basic theory behind a biometric-results based plan is that healthy participants will have fewer claims and therefore lower costs since there is repeated evidence that more than 70 percent of health care expenditures are spent on treating conditions that are lifestyle related and can potentially be reduced by more healthful lifestyle changes.

For example, Indianapolis-based Clarian Health, a multi-hospital system, is implementing a biometric health plan with the following components. The program will assess $5-$10 per paycheck fees on employees who violate standards for each of these conditions or behaviors:

• Body mass index over 29.9.
• Blood pressure over 140/90.
• Blood glucose over 120.
• LDL cholesterol over 130.
• Use of tobacco.

As a result, an employee who does not meet any of the measures will pay an additional $760 per year.

The first reaction when people hear about this plan is to ask what right does Clarian have to meddle in such private matters? It's an interesting cultural question but they do have a legal right to design an insurance plan using biometrics.

Under the HIPAA rules issued in December, employers may vary the amount of premium contributions required from employees as long as the program meets the following criteria:

·  The reward or penalty must not exceed 20 percent of the cost of employee-only coverage under the plan.

·  The program must be reasonably designed to promote health or prevent disease.

·  Employees must be eligible to qualify for the reward at least annually.

·  The reward must be available to all similarly situated individuals.

·  A reasonable alternative standard or waiver must be available to individuals for whom it is unreasonably difficult to satisfy the otherwise applicable standard due to a medical condition.

Will employees accept this concept? The answer is a "maybe." In a recent survey by the National Business Group on Health, 65 percent of 1,619 employees at large companies said they believe smokers should be charged more for health care than nonsmokers. About 49 percent surveyed said they would support higher premiums for obese workers.

Employers need to assess their culture and where biometrics fit related to their business strategy. For some, the carrot approach may be effective but biometrics may be what it takes to finally change behaviors.