Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of 10 deaths among Americans each year and account for 75 % of the nation’s health spending – and often are preventable.
High-quality preventive care helps Americans stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce costs. And yet, despite the proven benefits of preventive health services, too many Americans go without needed preventive care because of financial barriers.
Preventive services with a “grade” of A or B, like screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure, and tobacco cessation counseling will be covered under these rules.
An estimated 31 million people in new employer plans and 10 million people in new individual plans will benefit from the new prevention provisions under the Affordable Care Act. The number of individuals in employer plans who will benefit from the prevention provisions is expected to rise to 78 million by 2013, for a total potential of 88 million Americans whose prevention coverage will improve due to the new policy.
Policy Promoting Prevention: What are some of the key ways in which public policy is focusing on Prevention?
ü Prevention and Public Health Fund: The Affordable Care Act makes an unprecedented investment – $15 billion over 10 years – in health care programs and providers to prevent disease, detect it early, and manage conditions before they become severe.
ü Prevention and Wellness in Medicare and Medicaid: The Affordable Care Act also provides for prevention without cost-sharing under Medicare. The new law will also provide enhanced Federal Medicaid matching funds to States that offer evidence-based prevention services.
ü Prevention and Public Health Council: The Affordable Care Act creates a National Prevention, Health Promotion, and Public Health Council, composed of senior government officials, to coordinate Federal prevention activities and design a National Prevention and Health Promotion Strategy with input from stakeholders and communities across the country to promote the nation’s health.
ü Recovery Act: Provides $1 billion for community-based initiatives, tobacco cessation activities, chronic disease reduction program, and efforts to reduce health-care-acquired infections.
Employers commitment to wellness: Is incentivizing the way?
In addition to the trends in public health policy the Private sector has been focusing on wellness as well. Many employers are taking measures to combat rising health care costs, in some cases by providing access to employee assistance programs and wellness benefits, both of which attempt to help people adopt preventive health measures and more healthful habits. Data from the National Compensation Survey show that a relatively small percentage of workers have access to these kinds of benefits, but the trends suggest that the proportion is increasing over time.
Data from the National Compensation Survey (NCS) for March 2010 show that three-fifths of private employers made health care benefits available to their workers. Some employers, perhaps heeding the wisdom of Benjamin Franklin that “an ounce of prevention is worth a pound of cure,” elect to do more for their employees. Employer-sponsored wellness programs that include help with nutrition, incentives to exercise, or smoking cessation are available to a third of private sector workers.
There was widespread agreement among wellness companies, benefits consultants and employers that financial incentives dramatically increase wellness participation—for example, boosting HRA completion from 20 percent to between 50 percent and 90 percent. Cash incentives and insurance premium contribution reductions are the most common form of financial incentive; gift cards and contributions to health savings accounts or health reimbursement arrangements also are used by some employers.
Most benefits consultants and wellness vendors believed that $100 is the “sweet spot” for an incentive for a “single instance of behavior,” such as HRA completion or participation in a specific wellness activity. There was consensus that the incentive should be paid soon after the activity is completed, so that the reward is strongly linked to successful activity completion in participants’ minds. There was also common agreement that offering incremental incentives adding up to a substantial total incentive over the course of the year is preferable to offering a large lump sum for satisfying many requirements, because the latter may be perceived as too insurmountable a barrier to generate much enthusiasm or participation among employees.
While focusing on prevention is key to embracing wellness, and incentivizing is key to adoption, ensuring HIPAA compliance is critical.
HIPAA Nondiscrimination Requirements: What are the five requirements for wellness programs which base a reward on satisfying a standard related to a health factor?
ü The total reward for all the plan’s wellness programs that require satisfaction of a standard related to a health factor is limited–generally, it must not exceed 20 percent of the cost of employee-only coverage under the plan. If dependents (such as spouses and/or dependent children) may participate in the wellness program, the reward must not exceed 20 percent of the cost of the coverage in which an employee and any dependents are enrolled.
ü The program must be reasonably designed to promote health and prevent disease.
ü The program must give individuals eligible to participate the opportunity to qualify for the reward at least once per year.
ü The reward must be available to all similarly situated individuals. The program must allow a reasonable alternative standard (or waiver of initial standard) for obtaining the reward to any individual for whom it is unreasonably difficult due to a medical condition, or medically inadvisable, to satisfy the initial standard.
ü The plan must disclose in all materials describing the terms of the program the availability of a reasonable alternative standard (or the possibility of a waiver of the initial standard).
Bottom Line: What does this mean for you?
Ø Visit http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html to find out more on how you can take advantage of upcoming changes
Ø Talk to your primary health care provider to make sure you are getting the tests and screening that apply to your individual needs
Ø Reach out to your HR partner at work to see what incentives are available at work. You benefit from making these changes as much as your employers
Ø Visit your health insurance companies website to better understand all benefits and tools
