Wellness Programs Blum

7/31/2019 Wellness Programs Blum

1/19

Is an ounce of prevention really wortha pound of cure?


2/19

Research suggests that two-thirds of the growth inhealth spending in the United States is caused byAmericans increasingly bad health habits, such assmoking, obesity, failure to follow medical

directives, and alcohol abuse. Additionally, it is estimated that 74% of health care

costs are confined to four chronic conditions:cardiovascular disease, cancer, diabetes, and

obesity, a large portion of which are preventable: 80% of cardiovascular disease and diabetes

60% of cancers

90% of obesity


3/19

Employers benefit from healthy employeethrough: Lower medical costs

Fewer unplanned absence hours Lower disability claims

Higher workplace moral and productivity


4/19

Early employer sponsored HMO-likeorganizations

Healthy workplace initiatives of the 1970s

Beginning in the 1990s, rise in workplace

wellness programs with a focus employeelifestyle


5/19

Balance between personal autonomy and thepublic good

Concerns about employment discrimination

In any case, wellness programs are becomingmore pervasive 77% of employers have a wellness program

Wellness programs are already being offered byinsurance carriers

Government incentives for employer sponsored wellnessprograms

If successful, wellness programs will be incorporated intothe state-sponsored health exchanges


6/19

Workplace wellness programs is one of the fewarea of PPACA with strong bipartisan support

Employersponsored group health plans and

health insurance issuers are now prohibitedfrom requiring copays for all preventativeservices recommended by the USPSTF Recommended services are those with an A or B

rating from the USTSTF

However, this requirement does not apply tograndfathered health plans


7/19

Grade Definition Suggestions for PracticeA The USPSTF recommends the service. There is high

certainty that the net benefit is substantial.

Offer or provide this service.

B The USPSTF recommends the service. There is high

certainty that the net benefit is moderate or there is

moderate certainty that the net benefit is moderate to

substantial.

Offer or provide this service.

C Clinicians may provide this service to selected patients

depending on individual circumstances. However, for

most individuals without signs or symptoms there is

likely to be only a small benefit from this service.

Offer or provide this service only if other

considerations support the offering or

providing the service in an individual

patient.

D The USPSTF recommends against the service. There

is moderate or high certainty that the service has nonet benefit or that the harms outweigh the benefits.

Discourage the use of this service.

I Statement The USPSTF concludes that the current evidence is

insufficient to assess the balance of benefits and

harms of the service. Evidence is lacking, of poor

quality, or conflicting, and the balance of benefits and

harms cannot be determined.

Read the clinical considerations section

of USPSTF Recommendation

Statement. If the service is offered,

patients should understand the

uncertainty about the balance of

benefits and harms.


8/19

Co-pays for qualified preventative services forMedicare and Medicaid recipients have alsobeen eliminated

Medicare and Medicaid recipients are alsoeligible for an annual wellness visit


9/19

Prior to PPACA, HIPAA permitted employersto reduce the cost of health insurancepremiums for employees practicing healthy

behaviors. The discounts allowed employers to reward

workers who met certain criteria reasonablydesigned to promote health and prevent

disease However, discount were limited to 20% of the

employees regular premium cost


10/19

PPACA expands that limit to 30% in 2014 Also give the Secretary of HHS the discretion to raise

the cap to 50%

Follows the same model as auto-insurance,where evidence of good or bad behavior wouldbe reflected in insurance premiums

A survey of Chicago employers found that 60%are likely or very likely to create or expandtheir wellness programs as a result of the newprovisions in PPACA.


11/19

A discount cannot be a means fordiscriminating based on health status The program must provide reasonable alternative

standards for obtaining the reward

The employer must give employees an annualopportunity to qualify for the discount.

The program must be voluntary

Employers may conduct voluntary medicalexaminations, as long as information acquiredis kept confidential and separate frompersonnel records.


12/19

GINA prohibits an employer from offering afinancial inducement to provide geneticinformation as part of a wellness program

Any voluntarily offered genetic informationcan be used by a health care provider, but isonly available to the employer in the aggregate


13/19

Safeway utilizes a wellness program that testsemployees on four health measures: Tobacco use

Weight Blood pressure

Cholesterol level

For each test an employee passes, Safewaygives the employee a discount off the base levelpremium, a maximum of $780 per individualor $1,560 per family


14/19

All data collection and test are done by anindependent third-party and not shared withSafeway management

The program has a 74% enrollment This wellness discount program kept Safeways

per-capital health care costs flat during a four-year period, during which other Americancompanies health per-capital health care costsrose by an an average of 38%.


15/19

The City of Chicago estimates that a wellnessprogram would save the city $20 million

Wellness Counsel of America estimates a

return of 3:1 for investments made byemployers into wellness program

Johnson and Johnson reported an ROI of $2.71for every dollar spent, saving $250 million overthe past ten years

Several clinical demonstration programs havereported ROIs as high as 6:1


16/19

Regence BCBS studied the effect an employerswellness program from 2005 to 2009 and founda savings of approximately $9 million, with a

return of $1.78 per dollar spent on the wellnessprogram Regence also noted that over two years the average

number of risk factor from 2.60/person to

2.41/person Significant decrease in physical inactivity, fatty diet,

and tobacco use


17/19


18/19

Qualified employers will be eligible for federalgrant monies to help launch programs from2011 to 2015

CDC will provide employers with technicalassistance , consultation, and other services toevaluate employer sponsored wellnessprograms

PPACA creates a Prevention and PublicHealth Fund to be administered by HHS tosupport prevention and public healthprograms.


19/19

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