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Use genetic testing of workers with caution

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Use genetic testing of workers with caution

Testing for genetic indicators of chronic diseases can help employers offer workplace wellness programs that more closely fit the needs of at-risk employees, but it also can invite a host of legal exposures if not executed carefully, experts say.

Earlier this year, Hartford, Connecticut-based health insurer Aetna Inc. and Toronto-based health management company Newtopia Inc. launched a wellness engagement platform that includes voluntary diagnostic testing to identify genes linked to metabolic syndrome.

Defined by the American Heart Association as a combination of high blood pressure, high fasting glucose levels and fat around the waist, metabolic syndrome is a common predictor of diabetes, heart and liver disease and other weight-related disorders.

The early application of genetic testing in a workplace wellness program is available to Aetna's corporate clients. It compares the results of the genetic testing with other information, such as self-reported lifestyle and personality assessments, to identify wellness programs and activities most likely to resonate with employees.

“What the program does is help employees understand what they've inherited from their parents that may have an impact on their weight and lifestyle, so they can stop blaming themselves and so we can shape the recommendations we make based on that genetic understanding,” said Jeffrey Ruby, Newtopia's founder and CEO.

Preliminary results of a voluntary pilot program Aetna offered to its employees last year found that most did lose weight.

“There was also some measurable benefit with respect to cost,” said Dr. Gregory Steinberg, Aetna's New York-based head of clinical innovation.

“We're in the process of rolling it out with a handful of employers this year and, hopefully, on an even wider scale next year,” Dr. Steinberg said. “We've seen a lot of interest, based on the preliminary results.”

While such approaches may improve employee wellness, legal experts warn that collecting employee genetic information could violate privacy and nondiscrimination laws.

Though the 2008 Genetic Information Nondiscrimination Act generally prohibits employers from collecting information about employees' genetics or family medical history — as well as taking any adverse employment action based on that information — the law does allow asking for genetic information in health risk assessments, biometric screenings and other wellness-related activities.

But requests must be optional, and any protected information employees volunteer must be used solely for health management purposes, experts say.

“The regulations say that employers can make those kinds of requests as long as they're not financially inducing employees to provide their genetic information,” said Ilyse Schuman, a Washington-based partner at Littler Mendelson L.P.

Employers must also be careful if they use financial penalties or rewards to motivate employees toward completing health risk assessments or biometric screenings that include questions about genetics.

“Employers may still provide those incentives, but they have to make clear in writing that the incentives are available even if they don't answer any questions pertaining to genetic information,” said Esther Lander, a Washington-based partner at Akin, Gump, Strauss Hauer & Feld L.L.P.

Additionally, GINA requires employers to provide a written explanation about the types of information being collected and its intended use in the wellness program, experts said.

Further, employers may not view individual genetic testing results.

“(Protecting employees' genetic information) is something we take extraordinarily seriously,” Newtopia's Mr. Ruby said. “We make it very clear to potential participants that at no time will their genetic information ever be shared with their employer or insurer.”

Additionally, Mr. Ruby said, “the genetic data that we do collect is actually quite narrow, and we don't bank any of the DNA samples. I think the combination of those efforts has been the key to our success in providing employees with confidence that their information won't be used for any improper purposes.”

Whether genetic testing becomes a staple of workplace wellness programming on a large scale remains to be seen, experts said, as more evidence of the testing's effect on health behaviors and choices becomes available.

“The paradox is that employees who are at the greatest risk might not necessarily be given a leg up by something like this,” said Dr. Ron Leopold, the Atlanta-based national practice leader for health outcomes at Willis North America Inc. “If an employee opts into a program like this and then finds out that they do have one or more of these genetic markers, it could actually wind up being a deterrent to effective weight loss in that it becomes an excuse.”

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    After a yearlong pilot program with its employees, health insurer Aetna Inc. is offering employers a wellness engagement platform that includes voluntary genetic testing for metabolic syndrome, a common predictor of diabetes, heart and liver disease and other weight-related disorders.