Changing the Conversation: Health vs. Healthcare

The statistics are foreboding: since 1980, growth in healthcare spending has outpaced all other consumer spending by a factor of nearly three, while increasing from 5% to 18% of GDP. Looking just 3 years ahead, this figure is projected to reach at least 22%.  Despite so much of the national conversation focused on managing “healthcare”, employers remain confronted with:

  • Healthcare renewal costs that are unsustainable
  • Plan design changes that have reduced benefits
  • Employee dissatisfaction with reduced benefits and increased costs

To understand why a shift in the national conversation from healthcare to health is necessary, one needs only to consider the implications of the data provided by our medical professionals:

  • Nearly 75% of Americans are overweight, and 33%  qualify as obese
  • Cardiovascular disease and stroke are now the leading cause of death
  • 17.5 million Americans will be afflicted with diabetes, and 25.1 million with cardiovascular disease
  • 1 in 3 children born after 2000 will develop diabetes by age 50
  • 29% of adults with high blood pressure are undiagnosed
  • 70% of all claim costs are the direct results of behavior
  • 74% of all claims are confined to four chronic conditions: cardiovascular disease, diabetes, cancer and obesity

For those business owners seeking real solutions to rising healthcare costs, we propose the need to change the conversation on how to improve the health of those who are employed.

Understanding that the cost of improving health is far lower than the healthcare costs associated with combating increased disease, companies must learn how to build a culture of health improvement and engage employees and families in order to achieve sustainability in healthcare costs. To do so, employers can take a “measures-based approach” to identify risk within the employee population, develop strategies to facilitate positive change among high risk individuals, and strategies to keep the healthy population healthy.

By learning and adopting new strategies that emphasize and reward employees and their families to embrace healthy lifestyle choices, employers can help employees and their families become far more efficient healthcare consumers, and move towards a zero trend health plan (for our next discussion).

Thomson Reuters Health Care Spending Index: Insurance Costs Climb 4.0% for Q3 2011 

Is Obesity an Infectious Disease?

Changing the Conversation: Health vs. Healthcare, is an editorial series designed to advance the health improvement model as a business strategy, supported by medical research, academic and corporate case studies. Scott Bradley is a Sr. Vice President with Cook, Hall & Hyde, Inc., a health and welfare advocate supporting middle market employers to design, implement and manage employee health improvement and insurance programs.     

Expanding Access to Preventive Services for Women

Affordable Care Act Rules on Expanding Access to Preventive Services for Women

New private health plans must cover the guidelines on women’s preventive services with no cost sharing in plan years starting on or after August 1, 2012.

Additional women’s preventive services that will be covered without cost sharing requirements include:           

  • Well-woman visits: This would include an annual well-woman preventive care visit for adult women to obtain the recommended preventive services, and additional visits if women and their providers determine they are necessary. These visits will help women and their doctors determine what preventive services are appropriate, and set up a plan to help women get the care they need to be healthy.
  • Gestational diabetes screening: This screening is for women 24 to 28 weeks pregnant, and those at high risk of developing gestational diabetes. It will help improve the health of mothers and babies because women who have gestational diabetes have an increased risk of developing type 2 diabetes in the future. In addition, the children of women with gestational diabetes are at significantly increased risk of being overweight and insulin-resistant throughout childhood.
  • HPV DNA testing: Women who are 30 or older will have access to high-risk human papillomavirus (HPV) DNA testing every three years, regardless of pap smear results.  Early screening, detection, and treatment have been shown to help reduce the prevalence of cervical cancer.
  • STI counseling, and HIV screening and counseling: Sexually-active women will have access to annual counseling on HIV and sexually transmitted infections (STIs). These sessions have been shown to reduce risky behavior in patients, yet only 28% of women aged 18 to 44 years reported that they had discussed STIs with a doctor or nurse. In addition, women are at increased risk of contracting HIV/AIDS. From 1999 to 2003, the CDC reported a 15% increase in AIDS cases among women, and a 1% increase among men. 
  • Contraception and contraceptive counseling: Women will have access to all Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling. These recommendations do not include abortifacient drugs. Most workers in employer-sponsored plans are currently covered for contraceptives. Family planning services are an essential preventive service for women and critical to appropriately spacing and ensuring intended pregnancies, which results in improved maternal health and better birth outcomes.
  • Breastfeeding support, supplies, and counseling: Pregnant and postpartum women will have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment. Breastfeeding is one of the most effective preventive measures mothers can take to protect their children’s and their own health. One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies.
  • Domestic violence screening: Screening and counseling for interpersonal and domestic violence should be provided for all women. An estimated 25% of women in the U.S. report being targets of intimate partner violence during their lifetimes. Screening is effective in the early detection and effectiveness of interventions to increase the safety of abused women. 

Corporate Wellness Programs: Are They a Wise Investment for Employers?

With the permission of TLNT and Jeremy Sharp I am reposting a terrific article that lends clarification regarding the new GINA regulations issued in November 2010, ADA and HIPAA compliance for wellness programs. TLNT is a HR blog about “The Business of HR,” with news, insight, and topical information from experts and thought leaders in HR, talent management, and all areas related to HR and managing a workforce. Jeremy Sharp, a partner at Walter & Haverfield in Cleveland, concentrates his practice primarily in the field of employee benefits and executive compensation. He also has experience handling related legal issues involving taxation, labor and employment law, school law and health care reform. You can contact him at jsharp@walterhav.com.

 Corporate Wellness Programs: Are They a Wise Investment for Employers?

IBM Plans to Cover Its Employees’ Deductibles, Copays for Primary Care Services

As reported by the American Academy of Family Physicians, IBM plans to eliminate copays and deductibles for primary care physician services for most of its employees in January, a move that could prompt other large companies and employers to eliminate financial barriers for primary care services as well, according to analysts interviewed by AAFP News Now.

“IBM is doing this because we think it is the right thing to do,” said Paul Grundy, M.D., M.P.H., IBM’s global director of health care transformation. “We have really listened to our patients. They want a meaningful relationship with their doctor. They want to have a healing relationship, and they want us to support them in having better access and more convenience around their care.”

IBM is one of the nation’s largest employers, employing about 115,000 people who reside in nearly every part of the country. The new ‘first dollar’ for primary care program essentially will make primary care services free for 80 percent of the 328,888 employees and dependents who are enrolled in IBM’s self-insured plans. It does not apply to the 20 percent of employees and their dependents who are enrolled in the company’s HMO.

Grundy expects that the elimination of copays and deductibles for primary care services will “create much better value for our employees and for IBM.” The company spent $79 million on a series of wellness programs between 2005 and 2007, which helped the company save $191 million, said Grundy.

“We feel if we can get much more robust prevention, if we can focus on an early diagnosis, it will save on expenses like hospitalizations, (sub) specialist care and emergency room care,” said Grundy. In turn, this should lead to increased productivity among the company’s employees — perhaps the greatest benefit for IBM, according to Grundy.

Is your Company Prepared for the H1N1 Virus

The Harvard School of Public Health study released several weeks ago found that two out of three U.S. businesses are unprepared to deal with the effects of a flu pandemic, when employee absences can be a major disruption.

The Kineo Group’s Crisis Practice has created a H1N1 Readiness Check List that leverages its principals’ expertise from work at the American Red Cross and other global organizations to help leaders manage their workforce effectively.

  • Don’t be taken off guard. Those companies with no crisis plan will be surprised by the extent of employee absences and other disruptions, forcing them to be reactive and accept higher losses;
  • Review your existing plan, if you have one. Firms with existing crisis communications plans should review and update their plans for H1N1 flu, referencing the latest government guidance, including visiting www.flu.gov. This effort should start immediately and be reviewed monthly;
  • Develop a plan now if you don’t. Organizations without existing crisis plans should immediately formulate a basic H1N1 response plan relying heavily upon published guidance from government agencies and medical associations;
  • Form an assessment team. Firms should form a team to quickly assess those recommendations, identify issues unique to their industry and develop an action plan;
  • Communicate regularly. All companies should communicate regularly to key stakeholders, particularly employees, about what the company is doing, and provide them clear information on what they need to do to sustain the enterprise.
  • H1N1  douments:  H1N1 Legislative Brief, H1N1 Employee Awareness Poster, H1N1 Flu Vaccine Poster. For more detailed flu pandemic planning guides please contact me at jsbradley@chhins.com or 631-329-7268.

Swine Flu Employee Education

Below are links to a variety of swine flu educational resources that will help you stay on top of the situation. They include:

The CDC has offered recommendations for everyday actions people can take to protect themselves from this new strain of flu.

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
  • Avoid touching your eyes, nose or mouth. Germs spread that way.
  • Try to avoid close contact with sick people.
    • Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
    • If you get sick, the CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008

On October 3, 2008, as part if the economic bail out bill, President Bush signed into law the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 – Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to require a group health plan that provides both medical and surgical benefits and mental health or substance use disorder benefits to ensure that: (1) the financial requirements, such as deductibles and copayments, applicable to such mental health or substance use disorder benefits are no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits covered by the plan; (2) there are no separate cost sharing requirements that are applicable only with respect to mental health or substance use disorder benefits; (3) the treatment limitations applicable to such mental health or substance use disorder benefits are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan; and (4) there are no separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits.

Requires the criteria for medical necessity determinations and the reason for any denial of reimbursement or payment for services made under the plan with respect to mental health or substance use disorder benefits to be made available by the plan administrator.

Requires the plan to provide out-of network coverage for mental health or substance use disorder benefits if the plan provides coverage for medical or surgical benefits provided by out-of network providers.

Exempts from the requirements of this Act a group health plan if the application of this Act results in an increase for the plan year of the actual total costs of coverage with respect to medical and surgical benefits and mental health and substance use disorder benefits by an amount that exceeds 2% for the first plan year and 1% for each subsequent plan year. Requires determinations as to increases in actual costs under a plan to be made and certified by a qualified and licensed actuary.

Summary of Mental Health Parity and Addiction Equity Act of 2008

 

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