When it comes to obtaining and using employees’ health info, your firm’s health plan has more HIPAA rights than you may think.

Under HIPAA, your plan is allowed – without employees’ consent – to obtain individual health info (not just aggregate data) for the purpose of improving the quality of care. And there are a host of legal ways to use health data for this purpose.

Questions you can answer

Your plan’s TPA  is entitled to obtain and review a sampling of people’s personal health info to answer all of the following plan cost-related questions:

• What employees are and aren’t getting the right treatment?
• Which network doctors aren’t communicating treatments with
  each other, wasting resources?
• Which folks are and aren’t compliant with their prescription drugs?
•  Are the current health issues of your at-risk employees likely to be ones of concern a few years from now?

In short, you’re allowed to use the info to more accurately predict upcoming claims (and costs) in the short-term future.

What you can’t do with the info is make any employment-related decisions from your findings.  Legal experts debate if the prohibition includes charging smokers or other at-risk populations higher premiums.

But you can always use it when comparing the cost-effectiveness of different health plans or for making your wellness program even stronger.

Wellness program implications

Under HIPAA and ERISA, you’re allowed to use personal data as the starting point for having employees contacted regarding their health issues.
Based on the info you obtain, you can hand-pick people for educational mailings about specific health issues.

You’re even allowed to have a third party tell you if your employees have certain health problems (such as asthma or diabetes) and haven’t sought programs to treat the condition.

If you offer financial incentives as part of your wellness program, be aware that HIPAA’s non-discrimination rules require you to wipe the slate clean each plan year.

Legally, it’s still the safest policy to consult with an attorney before using health info apart from routine FMLA certifications or accommodating ADA.

But it’s good to know HIPAA is usually on your side in the battle to control health costs.

Tags: ada, employee privacy, FMLA, hipaa, wellness