Employee Health Promotion in Massachusetts: Federal and State Regulatory Landscape Tom Hubbard...
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Employee Health Promotion in Massachusetts: Federal and State Regulatory Landscape Tom Hubbard Senior Program Director, NEHI April 30, 2010 ● Waltham, MA
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Transcript of Employee Health Promotion in Massachusetts: Federal and State Regulatory Landscape Tom Hubbard...
Employee Health Promotion in Massachusetts:
Federal and State Regulatory Landscape
Tom HubbardSenior Program Director, NEHI
April 30, 2010 ● Waltham, MA
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For Discussion
• Employee Health Promotion – Why Now?
• The Regulatory Landscape – Federal and State
• Key Questions
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Employee Health Promotion: Why Now?
Source: Trust for America’s Health; MassINC and Northeastern University Center for Labor Market Studies, Mass Economy: The Labor Supply and Our Economic Future, December 2006
-200,000
-150,000
-100,000
-50,000
0
50,000
100,000
150,000
200,000
16-19 20-24 25-29 30-34 35-44 45-54 55-64 65+
Number of people
Projected Changes in MA Working Age Population, 2005 – 2015
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Where Are the Employees Located?
Source: Medical Expenditure Panel Survey, 2008
9.9 8.5
13.7
19.6
48.3
56.9
13.4
8.6 8.1
13.1
0
10
20
30
40
50
60
<10 11 to 24 25 to 99 100 to 999 1000+
Employees
%
% of Employees
% of Employers
MA Employers and Employees by Firm Size
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The Regulatory Landscape – Federal and State
Self-Insured Fully-Insured
Fundamental Concern:Non-discrimination on the basis of health status
and pre-existing conditions
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The Regulatory Landscape – Federal and State
Self-Insured Fully-Insured Incentives allowed for employee
participation in wellness/prevention programs AND for health status
Value of incentives capped at 20 percent of cost of coverage
Other conditions apply – to protect against discrimination on basis of health status
Premium discounts for small employers allowed based on employee ‘usage’ of wellness programs
Employers (small and mid-sized) may grant employees premium discounts, based on usage of wellness programs
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The Regulatory Landscape – Federal
Self-Insured
5-year grants to small employers
Increase value of employee incentives to 30 percent of overall premiums per employee
10 state pilot projects
Federal Health Care Reform Incentives allowed for employee participation in wellness/prevention programs AND for health status
Value of incentives capped at 20 percent of cost of coverage
Other conditions apply – to protect against discrimination on basis of health status
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Key Questions
• How do we expand adoption among both self-insured and fully-insured employers?
• How should we incorporate the use of incentives? – Among self-insured employers
– Among (state regulated) fully-insured employers
Employee Health Promotion:
Opportunity and Challenge for Massachusetts
www.nehi.net
April 30, 2010 Waltham, MA
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Panelists
Phyllis YalePartner, Bain & Company Director, Employers Action Coalition on Healthcare (EACH)
Dena Broderick, RNVP of Clinical Programs & Development,Tufts Health Plan
Marie ChalmersPrincipal, Advisory Enterprise Market Leader,Mercer Health & Benefits
Judith Frampton, RN, MBAVP of Medical Management, Harvard Pilgrim Health Care
Thomas Hawkins, MD, SMMedical Director for Health Informatics, Blue Cross Blue Shield of Massachusetts
Alan G. MacdonaldExecutive Director, Massachusetts Business Roundtable
Eileen P. McAnnenySenior VP of Government Affairs,Associated Industries of Massachusetts
Lynn Nicholas, FACHEPresident and CEO,Massachusetts Hospital Association
Kerry HandsVice President, Small Business Solutions,The Bostonian Group
Employee Health Promotion:
Opportunity and Challenge for Massachusetts
www.nehi.net
April 30, 2010 Waltham, MA
