The 4-Minute Workout
Originally published by Gretchen Reynolds on The New York Times health blog.
Thanks to an ingratiating new study, we may finally be closer to answering that ever-popular question regarding our health and fitness: How little exercise can I get away with?
The answer, it seems, may be four minutes.
For the study, which was published last month in the journal PLoS One, researchers from the Norwegian University of Science and Technology in Trondheim, Norway, and other institutions attempted to delineate the minimum amount of exercise required to develop appreciable endurance and health gains. They began by reconsidering their own past work, which had examined the effects of a relatively large dose of high-intensity intervals on various measures of health and fitness.
For those unfamiliar with the term, high-intensity intervals are just that: bursts of strenuous exercise lasting anywhere from 30 seconds to several minutes, interspersed with periods of rest. In recent years, a wealth of studies have established that sessions of high-intensity exercises can be as potent, physiologically, as much longer bouts of sustained endurance exercise.
In a representative study from 2010, for instance, Canadian researchers showed that 10 one-minute intervals — essentially, 10 minutes of strenuous exercise braided with one-minute rest periods between — led to the same changes within muscle cells as about 90 minutes of moderate bike riding.
Similarly, the Norwegian scientists for some years have been studying the effects of intense intervals lasting for four minutes, performed at about 90 percent of each volunteer’s maximum heart rate and repeated four times, with a three-minute rest between each interval. The total meaningful exercise time in these sessions, then, is 16 minutes.
Which, the researchers thought, might just be too much.
“One of the main reasons people give” for not exercising is that they don’t have time, says Arnt Erik Tjonna, a postdoctoral fellow at the Norwegian University of Science and Technology, who led the study.
So he and his colleagues decided to slim down the regimen and determine whether a single, strenuous four-minute workout would effectively improve health and fitness.
To do so, they gathered 26 overweight and sedentary but otherwise healthy middle-aged men, determined their baseline endurance and cardiovascular and metabolic health, and randomly assigned them to one of two groups.
Half began a supervised exercise program that reiterated the Norwegian researchers’ former routine. After briefly warming up, these volunteers ran on a treadmill at 90 percent of their maximal heart rate — a tiring pace, says Dr. Tjonna, at which “you cannot talk in full sentences, but can use single words” — for four four-minute intervals, with three minutes of slow walking between, followed by a brief cool-down. The entire session was repeated three times a week for 10 weeks.
The second group, however, completed only one four-minute strenuous run. They, too, exercised three times a week for 10 weeks.
At the end of the program, the men had increased their maximal oxygen uptake, or endurance capacity, by an average of 10 percent or more, with no significant differences in the gains between the two groups.
Metabolic and cardiovascular health likewise had improved in both groups, with almost all of the men now displaying better blood sugar control and blood pressure profiles, whether they had exercised vigorously for 16 minutes per session, or four minutes per session, and despite the fact that few of the men had lost much body fat.
“This is not a weight-loss program,” Dr. Tjonna says. It is, instead, he says, “a suggestion for how people can make a kick-start for better fitness,” or maintain fitness already gained, when other obligations press on your time.
The results, Dr. Tjonna says, persuasively suggest that “getting in shape does not demand a big effort” in terms of time.
That finding, though, inevitably raises the question of whether the bar could drop even lower. Could, for instance, a mere two minutes of strenuous training effectively improve health and fitness?
Dr. Tjonna, the killjoy, doubts it. There are other groups of scientists looking at even shorter bouts of exercise, he says, “but it seems like they don’t get the same results regarding the maximal oxygen uptake” as the four-minute sessions used in his experiment. Since improved maximal oxygen uptake can reliably indicate better overall cardiovascular health, he suspects that “we need a certain length of the interval to trigger” such health and fitness benefits.
Thankfully, for those worried that a trip to the gym is an inefficient means of completing four minutes of exercise, the workout can effectively be practiced anywhere, Dr. Tjonna says. Sprint uphill for four minutes or race up multiple flights of steps. Bicycle, swim or even walk briskly, as long as you raise your heart rate sufficiently for four minutes. (Obviously, consult your doctor first if you haven’t been active in the past.)
“Everyone, we think,” Dr. Tjonna says, “has time for this kind of exercise three times a week.”
Special thanks to the Reduced Shakespeare Company and Christopher McDougall for their contributions to the Well 4-Minute Workout playlist.
Now What? Employer Benefits Obligations Post-DOMA
Originally posted by Stephen Miller on https://www.shrm.org
On June 26, 2013, the U.S. Supreme Court, in United States v. Windsor, found unconstitutional Section 3 of the federal Defense of Marriage Act (DOMA), which had prohibited the federal government from acknowledging marriages between same-sex couples. Same-sex marriages were recognized as legal by 12 states and the District of Columbia at the time of the ruling. In a related case, Hollingsworth v. Perry, the court ruled that those challenging a California state court decision that made same-sex marriage legal in California (by overturning a state ballot initiative known as Proposition 9) lacked standing to do so—a finding that will restore legal same-sex marriage in the state.
“The Windsor decision is as many expected," Roberta Chevlowe, senior counsel in law firm Proskauer's employee benefits practice center in New York, told SHRM Online. "While the court held that Section 3 of DOMA (which defines 'marriage' and 'spouse' as excluding same-sex partners) is unconstitutional on equal-protection grounds, the decision does not force same-sex marriage on the states, which appear to continue to be free to define marriage as they wish and not recognize same-sex marriage."
For employers, "the Windsor decision means that there is much work to do with regard to the employer's benefit plans, even for employers who do not operate in states that recognize same-sex marriage," Chevlowe added. "On the health benefits side, among other things, employers will need to revisit the definition of 'spouse' in their plans to ensure that the definition is consistent with the employer's intent, in light of the decision. Employers may also need to cease imputing income to employees for the value of the health benefits they provide to same-sex spouses. With regard to qualified pensions, plan language and procedures will need to be considered because same-sex spouses have additional rights to federally protected benefits."
In addition, "Employers should expect that employees will immediately start asking questions about their rights with regard to various employee benefits, and employers will need to consider carefully the scope of the decision and various issues relating to the implementation and effective date of the decision with regard to these issues,” Chevlowe said.
Expanded Obligations
In an e-mail, Todd Solomon, an employee benefits partner at law firm McDermott Will & Emery LLP in Chicago, identified the following as key benefits implications for private-sector organizations (but not necessarily state government and church employers) now that Section 3 of DOMA has been struck down.
For a legally married couple who live in a state where same-sex marriage is recognized:
- Federal laws governing employee benefit plans will require companies to treat employees’ same-sex and opposite-sex spouses equally for purposes of the benefits extended to spouses.
- Employers with self-insured welfare plans (meaning benefits are paid out of the company’s general assets) may not have to extend spousal-benefit coverage to same-sex spouses, because federal law does not require spousal welfare-benefit coverage and because state insurance law mandates do not apply to self-insured plans. However, employers that continue to provide benefit coverage only to opposite-sex spouses "are almost certain to face legal challenges under federal discrimination law," Solomon advised.
- Employees will no longer have to pay federal income taxes on the income imputed for an employer’s contribution to a same-sex spouse’s medical, dental or vision coverage. And workers can pay for same-sex spouses’ coverage on a pretax basis under a Section 125 plan.
- Businesses will have to offer COBRA continuation coverage to same-sex spouses.
- Employers with pension plans will be required to recognize same-sex spouses for purposes of determining surviving-spouse annuities. Same-sex spouses must also agree to receive payment of their deceased spouse’s pension benefits in a form other than a 50 percent joint and survivor annuity, with the same-sex spouse as the beneficiary.
- Organizations with 401(k) plans will have to recognize same-sex spouses for purposes of determining death benefits, and same-sex spouses must consent to beneficiary designations.
- Employees must be permitted to take family and medical leave to care for an ill same-sex spouse.
"The above rules only apply to same-sex spouses who were married in and live in a state where same-sex marriage is legal,” Solomon clarified. “The big open question is what happens to same-sex spouses who live in states such as Florida or Texas," which don't recognize same-sex marriages. "No one can answer the question until additional guidance is issued. It is possible that the answer can vary for different purposes—for example, state of residence will likely carry the day for tax filing and imputed income purposes, but it is possible the IRS could say that 'state of celebration' governs for pension plan purposes. In the meantime, it appears that employers can choose either approach, but it will be imperative to amend plans to add clear plan language to document the employer's approach."
The decision "will affect retirement plan administration because plans will have to obtain the consent of the same-sex spouse to permit a waiver of the qualified joint and survivor annuity (QJSA) form of benefit or for any other purposes for which the consent of an opposite-sex spouse is required," in states that recognize same-sex marriages, concurred Leslye Laderman and Marjorie Martin, principals at Buck Consultants LLC. "It is unclear from theWindsor ruling whether employers will be required, or permitted in the case of the QJSA, to recognize same-sex spouses of employees living in states that do not recognize same-sex marriages as spouses for purposes of these laws. Additional guidance is needed."
Retroactive Benefits
Another question is whether employees can claim benefits retroactively—for instance, seeking past tax relief for spousal health care benefits—if they've been married to their same-sex spouse in a state that recognizes same-sex marriage. Solomon observed: "It is certainly not clear yet, but I would think employees should be able to amend tax returns for open years to claim refunds. And employers should be able to get refunds of FICA taxes for prior open years."
Retroactivity “is one of the most important practical questions facing employers and plan sponsors" following the DOMA ruling, added Joanne Youn, an ERISA and benefits law attorney at Caplin & Drysdale in Washington, D.C. "While the court did not specifically address retroactivity broadly, the decision arose out of a claim for refund of estate taxes paid by a same sex-spouse in a prior tax year. The IRS has authority under existing law to grant relief from retroactivity; however, even if it were to do so, its authority would not extend to other statutes affecting employee benefits, such as ERISA. The decision itself references the fact that over 1,000 federal laws contain provisions specifically applicable to spouses that may be affected and should be coordinated. Therefore, I would expect that additional guidance will be issued in the coming months.”
Deferring to State Law
Rita F. Lin, a partner at Morrison Foerster in San Francisco, said that many federal laws governing spousal benefits do not contain a statutory definition indicating which law governs whether an individual is “married.”
"Typically, federal laws defer to state law on this issue,” Lin explained, “but it will often be an open question under choice-of-law principles whether the applicable state law is the law of the state in which the couple was married or the state in which the couple currently resides. Some federal statutes (e.g., Social Security) look to whether a couple is married at the time that benefits are sought, which may suggest that the law of the state of current residence will apply. Others (in the immigration context) look to the state where the couple was married."
Lin revealed that there are "rumors that the administration may be considering an executive order that directs federal agencies, in interpreting federal statutes, to treat the state where the marriage celebration occurred as the governing state for purposes of determining whether couples are married.” She added: “I would note that, though there may be some short-term confusion, this is not technically a new issue. The states vary in their definitions of marriage on issues like common-law marriage, first-cousin marriage and age of eligibility, so this could always be an issue when married couples move to a new state that does not recognize their marriage. Of course, the issue is now going to be presented on a much larger scale than before, so we may see an attempt to resolve this in a more uniform fashion."
Presidential Action
Similarly, Hunter T. Carter, a litigation partner at Arent Fox in New York and Washington, D.C., said: "The president is crucial to implement the Supreme Court decision overturning DOMA, and employers will be watching to see what the president does. Everywhere he can do so, President Obama is expected to approve regulations and interpretations that apply the term 'spouse' to same-sex couples who were legally married, regardless where the couple was from or has moved."
Changing regulations that define "spouse" may take longer than an executive order, Carter said, "but again, President Obama will be crucial. Currently, the IRS and Social Security determine marriage status by where the couple lives, not where they married, so anyone in the 38 states that don't yet recognize or allow same-sex marriage will be unmarried for IRS and Social Security purposes until regulations can be changed. This is true even though they are otherwise identical to their neighbors who may have married in another state, like New York, which also allows same-sex marriage. Other agencies will not need to change, like the Defense Department, which interprets marital status based on where the couple was married."
Volunteering linked to better physical, mental health
Originally posted by Andrea Davis on the Employee Benefit News website.
Three-quarters of volunteers say volunteering has made them feel physically healthier and lowered their stress levels, according to a new study released today by UnitedHealth Group and the Optum Institute. The study also illustrates that employers benefit from employees who volunteer in terms of better employee health and in professional skills development that employees use in the workplace.
Volunteers are also more engaged in their health than non-volunteers, with 80% of the people who’ve volunteered in the past 12 months saying they feel they have control over their health. Moreover, about one-quarter of the people who’ve volunteered in the past month say that volunteering has helped them to manage a chronic illness.
In addition to physical and mental health benefits, employees who volunteer say doing so has helped them learn valuable business skills. Sixty-four percent of employees who currently volunteer said that volunteering with work colleagues has strengthened their relationships, while three-quarters of people who say that volunteering helped their career report that volunteering has helped them refine existing professional skills and build new ones.
“Employers enjoy the benefits of physically and mentally healthier employees; those that support volunteering programs in the workplace see added benefits that drive directly to their bottom line,” said Kate Rubin, vice president of social responsibility with UnitedHealth Group.
The findings are based on a national survey of 3,351 adults conducted by Harris Interactive.
Four tips for better benefit plan communications
Originally posted by Dani McCauley on the EBN blog.
It’s make it or break it time for employee benefit plans, suggests guest blogger Dani McCauley. She has four suggestions for better communication. Do you agree? Share your thoughts in the comments. —Andrea Davis, Managing Editor
Not to be an alarmist, but there is a convergence of events and trends that will make or break the success of many employers’ benefit plans this year. However, a spot-on communications plan will smooth the road ahead, and can even turn risks into opportunities.
Position changes properly
With the biggest health care reform provisions coming into effect in 2014, many employers are making an array of not-so-subtle changes to their benefit offerings. Such changes could range from streamlining down to fewer plan options, to significant premium differentials for wellness participation.
Whether the changes are seen as positive, negative or neutral depends on how well they’re communicated. After all, employees who are satisfied with their company benefits are more likely to be loyal to their employer, according to a recent study by MetLife. The study found that while only 42% of employees in the U.S. would strongly recommend their employer, those who do feel this way are three times more likely to be satisfied with their benefits.
Key takeaway: Taking the time to think through tough benefit messages and position changes in the best possible light will pay dividends.
Wellness
An effective wellness program represents the holy grail for group health plan sponsors seeking to actually change the health risks in their employee populations (thus mitigating costs and increasing worker productivity). Notice I said an “effective” wellness program. In order for such programs to be effective, they must be communicated in a way that helps employees to internalize the lifestyle changes they are expected to make.
For example, sending a quarterly newsletter with diet and exercise tips is likely insufficient to spark meaningful behavioral changes. Such a program is likely to succeed best if kicked-off with in-person meetings and frequent communications, possibly through a company intranet or in some other medium that keeps guidance, goals and incentives front and center for employees on a daily basis.
Key takeaway: Don’t invest in a wellness program unless you’re willing to back it up with an intensive communications plan.
Compliance confusion
Health care reform brings with it a host of new communication requirements designed to ensure that employees have equal access to benefits information, know their opt-out rights, understand the plans being offered, and more.
To take one example, the Summary of Benefits and Coveragerequirement just made benefit communications a little more complicated. While the SBC format is rigid and proscribed, employers must comply with the form’s required phrasing. But don’t rely on the SBC as your primary benefit communication document. Employers still need to communicate their overall benefits offering in a cohesive fashion. From health to retirement, your company benefits need to be explained in a way that resonates with your corporate culture, ideally unifying the entire plan behind a meaningful and relevant theme.
Key takeaway: Don’t abandon your traditional benefit communications materials. The SBC requirement is strictly an add-on.
Multi, Multi-Media
With so many options for communicating with employees, it’s important to consider what will work best for your corporate culture. If employees are spread far and wide at multiple locations, video tutorials can be a great way to reach out and educate employees who might otherwise feel disconnected at open enrollment time and year-round. Companies that are really tech-savvy might also consider social media or mass text messaging to bolster their efforts. But for other organizations where employees have limited access to the Internet throughout the day, call-center assistance might still be the best way to keep from placing certain groups of employees at a disadvantage.
Key takeaway: When it comes to communications logistics, let practicality be your guide.
Dani McCauley is senior vice president of marketing with Univers Workplace Solutions.
What methods are you using to communicate your benefits plan? Are the messages any different than in past years? Share your thoughts in the comments.
Employers Push for Better Health Pricing
Originally published by Dan Cook on the BenefitsPro website.
Catalyst for Payment Reform told lawmakers this week that efforts to elicit better value for employer-sponsored health plans take a flawed approach to solving the pay-for-value problem.
The crux of the issue: health plans are being evaluated by the simplest measures rather than ones that dig deeper. For most purchasers of the plans, this only frustrates efforts to control costs and facilitate better outcomes for those covered.
“One of today’s biggest shortcomings is the separation of price and quality information,” Dr. Suzanne Delbanco, executive director of the group, said in an appearance before the U.S. Senate Committee on Finance.
“I think we have probably too many [quality metrics] now and not enough that focus on exactly those points where there’s the greatest opportunity for reducing harm and where there’s the greatest variation in performance. We tend to measure things that are easy to collect data on and that show very little difference between providers.”
Catalyst for Payment Reform represents major employers dedicated to finding better ways to evaluate their health plans to achieve greater efficiencies and better outcomes. Among the members: Safeway, Dow Chemical, 3M and CALPERS, the mammoth California employee pension fund.
Delbanco said her organization is promoting reference-based pricing, where purchasers establish the price of a particular service, and the patient pays any additional costs beyond that. CALPERS uses this approach in hip and knee surgeries.
Others who testified at the hearing on high prices and low transparency in healthcare included Giovanni Colella, CEO and co-founder of Castlight Health; TIME magazine contributing editor Steven Brill; and Dr. Paul Ginsburg, president of the Center for Studying Health System Change.
SHRM Research Spotlights Health Care Reform Strategies
Originally posted by Stephen Miller on the SHRM website.
New survey reports detailing how U.S. employers are responding to health care reform were released by the Society for Human Resource Management on June 16, 2013, in conjunction with its Annual Conference & Exposition.
Part one, Health Care Reform—Challenges and Strategies, examines the difficulties that HR professionals are facing and the strategies they are using to handle the new regulations. Part two, Health Care Reform—Impact of Health Care Coverage and Costs, focuses on future health care coverage benefits and expected costs.
In addition, a two-page summary of the survey findings is presented in SHRM Research Spotlight: Health Care Reform—Challenges and Costs.
The research was conducted in May 2013, using a randomly selected sample of SHRM members. The Society received 818 responses, half from members with the job function of benefits and compensation and half with the job title of HR manager or higher.
Increased Costs, Cost-Sharing Expected
A large majority of those surveyed (84 percent) expect their health care coverage costs to increase in 2014. Among these respondents, more than half (55 percent) predicted an increase of up to 10 percent, 19 percent forecast a 10 percent to 15 percent increase, and one-quarter (26 percent) expected an increase of 16 percent or more. Generally, small organizations expect greater jumps in costs.
Most responding organizations (83 percent) are likely or highly likely to pass on higher costs to their employees.
When asked what actions their companies are taking as a result of the Patient Protection and Affordable Care Act (PPACA), respondents mentioned the following:
- HR staff education. Nearly three-quarters of organizations are educating HR staff members through classes (74 percent) or working with legal/benefits counsel (73 percent) to help them understand the health care law.
- Redesigned plans. More than one-half are working with their benefits provider to design a compliant health care plan for 2014 (61 percent) or analyzing the short-term financial impact of the law (60 percent).
- Alternative plan options. More than one-half (56 percent) already offer (37 percent) or plan to offer (19 percent) their employees alternative, lower-premium coverage, including high-deductible plans with health savings accounts or health reimbursement arrangements.
- Self-insurance. Just over half of organizations (52 percent) have fully insured medical benefits. Larger businesses are more likely to be self-insured, as are publicly owned, for-profit companies.
- Spousal coverage. Thirteen percent of organizations have provisions to limit coverage for employees' working spouses, such as applying surcharges or exclusions, and 9 percent plan to implement them in 2014.
- Grandfathered status. About one-quarter (26 percent) indicated they will try to keep a grandfathered health plan, which is exempt from certain PPACA provisions. Fifty-five percent will not maintain grandfathered status, and 19 percent are unsure.
- Staff and hour reductions. Few organizations (3 percent) have reduced or plan to reduce their staff. However, 9 percent have already limited part-time workers to less than 30 hours per week, and another 12 percent plan to do so.
- Resources. To help them comply with reform provisions, employers are turning to their insurance brokers (78 percent), SHRM resources (62 percent), legal counsel (48 percent), consultants (34 percent) and internal experts (20 percent).
How analytics can help employers measure and manage risks
Original article from https://ebn.benefitnews.com
By Jan Peter Ozga
“If it can’t be measured, it can’t be managed” is rapidly becoming the operating philosophy of the health care industry, aided in large part by more extensive use of electronic health care records, mobile applications and the growth of population health management. Using health care analytics — sometimes called business intelligence — researchers and consultants are mining clinical and claims data to discover gold standards and establish best practices for prevention, treatment and self care and, ideally, help reduce waste, abuse and fraud.
The goals are simple but have remained elusive: Identify what works, what should be charged, and how the cost should be shared, so maximum value can be derived from the $2.7 trillion being spent on health care. Potential beneficiaries include all of the five P stakeholders: providers, patients, payers (insurers), policymakers (legislators and regulators), and, of course, purchasers (employers), whose health plans cover nearly six out of ten employees and their dependents.
Population health management — historically confined to public health practitioners — seeks to provide positive health outcomes for a group of individuals, including the distribution of such outcomes within the group, as well reducing health inequities among high risk/vulnerable populations. As such, population health management goes beyond the individual-level focus of mainstream medicine and public health by addressing factors such as environment, social structure, and resource distribution. PHM has proved especially effective for wellness and disease management programs.
An essential element in population health management is the role social determinants play in achieving and sustaining good health. Social determinants of health are the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness.
Health care analytics comes in two basic forms. One is real-time analytics, which examine clinical information at the point of care and support health providers as they make prescriptive decisions during a patient encounter. These real-time systems typically use two or more items of patient data to generate case-specific advice. The other form is batch analytics that retrospectively evaluate population data sets, i.e., records of patients in a large medical system, or claims data from an insured population.
Batch health care analytics, in turn, supports predictive modeling, which is used on multiple clinical conditions. This process can identify undiagnosed conditions for patients within an insurer’s patient population or suggest interventions to prevent conditions from developing. Such modeling uses historical data to anticipate with greater accuracy future events. By contrast, explanatory modeling documents how and why certain empirical phenomena occur.
Within the context of health care, predictive and explanatory modeling use patient health information to drive medical decision-making. Data are derived from a variety of sources, including point-of-care encounters, medical claims, pharmacy claims, lab values, health risk assessments, genetic markers, and biometrics. These data are combined with medical guidelines and patient profiles to reveal contraindicated care, gaps in care, and opportunities for cost savings.
“Health care analytics applies an additional level of science to the art of medicine, thereby validating the value proposition. When such assessments are performed by a qualified third-party, providers and insurers can devote more time to their core competencies — and the data are rendered more credible,” says Yvonne Wasilewski, senior research scientist with SciMetrika in Durham, N.C.
According to LiveHealthier founder and CEO, Mary Moslander, understanding how health care analytics supports PHM is fundamental to delivering a work place wellness program that provides measurable results.”
“Empathizing with employees and leveraging their behaviors, barriers to change, fears and motivations are as important as predictive modeling and biometric outcomes,” she says.
And all of this translates to a healthier bottom line. For example, according to the consulting firm Aon Hewitt, population health management can help employers save as much as $700 per employee per year when they focus on any three of these eight major health care behaviors (which contribute to 80 percent of the cases of chronic illness): poor diet, physical inactivity, smoking, lack of health screening, poor standard of care, insufficient sleep, excess alcohol intake, and, poor stress management.
Experts predict that more employers will embrace a more quantified, analytic approach to health care because of its potential to contribute to value-based purchasing of health services and to increase accountability and transparency. Helen Darling, CEO of the National Business Group on Health says that “health care analytics have become as essential to effective management as financial data are to business.”
Leading the type of health plans that are embracing population health management and health care analytics are accountable care organizations and medical homes, encouraged by the Patient Protection and Affordable Care Action. A hallmark of ACOs is that providers agree to accept a flat payment for a given treatment plan for a disease or condition, in exchange for sharing in the savings they may produce.
The analyses associated with the medical home and ACO “exemplify how the population’s health needs have changed and how the marketplace must respond to this change," says Marci Nielsen, PhD, MPH, the chief executive officer of the Patient-Centered Primary Care Collaborative. “The success and impact of the medical home and medical neighborhood are critically dependent on gathering and analyzing health data from patient populations that will prevent leading causes of illness, manage and treat illness more effectively, and reduce costs to the system.”
The PHM movement is still a work in progress and its results need to be further documented. Consulting firm Mathematica has found that not all PHM programs are equal, referencing surveys that showed employers gave vendors mixed reviews on their ability to help employees make healthy lifestyle decisions and comply with preventive care guidelines. Thus, due diligence should be conducted before selecting a PHM provider.
Employers up estimated costs of health care reform law
Original article from https://www.businessinsurance.com
By Jerry Geisel
Employers are upping their estimates of how much the health care reform law will increase costs, according to a Mercer L.L.C. survey released June 12.
Two years ago, 25% of employers thought that complying with the Patient Protection and Affordable Care Act would increase their health care plan costs by less than 1%. But now, just 9% of nearly 900 employers surveyed by Mercer expect a cost increase that small.
Similarly, 15% of employers in 2011 expected the health care reform law to increase costs by at least 5%. Now, 19% of employers expect cost increases of at least 5%. In addition, 21% are projecting 2014 health care reform law related cost increases of 1% to 2%, while 18% expect cost increases of 3% to 4%; 32% of respondents said they didn't know the cost impact.
Mercer executives said there are several reasons why more employers are increasing their cost estimates.
“As employers get closer to implementation, they have a better idea of how many additional employees will become eligible for coverage. Some that thought they would cut hours have changed their position on that,” Beth Umland, Mercer's director of research for health and benefits in New York, said in an email.
Under PPACA, employers will be liable for a $2,000-per-employee penalty if they do not provide coverage starting next year to full-time employees, or those working an average of 30 hours a week.
In addition, Ms. Umland said, some employers in 2011 didn't know about the various fees that the health care reform law imposes. For example, employers will have to pay a fee of $63 per health care plan participant in 2014 to fund a program that will partially reimburse health insurers for providing coverage to high-cost individuals. While there was some awareness of the Transitional Reinsurance Program, it wasn't until last year that regulators announced the size of the fee employers would have to pay.
Check out our HCR Central for FREE PPACA Downloads, FAQ's, and compliance news to help you and your company prepare for PPACA requirements that take effect later this year and in 2014.
Health Care Law Remains Deeply Divisive
Original article from https://triblive.com
By Dayton Daily News
David Peabody is apprehensive about the new health care law. Ericka Haverkos is hopeful about it.
These Ohio residents — one the owner of a small landscaping business in Columbus and the other a college student who works part time as a cashier — are emblematic of millions of Americans who next year will have to adapt to the most sweeping changes in the delivery of health care since the establishment of Medicare and Medicaid in 1965.
To Peabody, the law will impose steep costs on his company and force him to decide whether to insure his 65 workers or pay a fine to the federal government. To Haverkos, who says she has a learning disability, it could mean access to a doctor who could prescribe the medication she needs.
All across the nation, millions of people are facing the reality of a new era in health care. Signed into law in 2010 by President Obama and known as the Affordable Care Act, the law will extend health care coverage to more than 20 million of the 47 million Americans without insurance.
“For people who haven't been able to find affordable insurance, they are going to love it,” said Elise Gould, a health insurance analyst at the Economic Policy Institute, a left-leaning nonprofit organization in Washington.
The law's critics contend it's going to frustrate Americans with its complexities, new regulations and blizzard of fees and taxes that they claim will deal a major blow to a fragile economy still recovering from the 2008 financial crash.
When asked to describe how efficiently the law is being implemented, Thomas Miller, a health policy analyst at the conservative oriented American Enterprise Institute in Washington joked: “Coming along just fine. Steady as she goes right into the cliff. Don't mind that iceberg. The Titanic got past it.”
A Kaiser Family Foundation survey in April found that 49 percent of Americans lack the information to understand how the law works. More alarming to the Obama administration, a recent Wall Street Journal/NBC News poll showed that 49 percent of Americans believe the law is a bad idea while just 37 percent call it a good one.
The law extends coverage in two ways. It expands the eligibility for Medicaid, which provides health coverage to low-income people. For those making too much money to qualify for Medicaid, the law offers federal subsidies for families of four earning $33,000 to $94,000 a year so that they can buy their plans through exchanges operated by the federal government or their state.
“I do believe folks underestimated the enormity of this law,” said Kevin Kuhlman, a Washington lobbyist for the National Federation of Independent Businesses. “In order for it to be a success, not only does the government have a massive project ahead of it managing and operating these exchanges, but private businesses also will have to come along and make a lot of drastic changes.”
Haverkos, a student at the Columbus College of Art and Design, said she lost her health insurance more than two years ago when her mother's term on the state Board of Education ended. The health law lets adult children remain on their parents' health plan until age 26, but Haverkos said that's not an option for her.
She said her employer doesn't offer insurance to part-time employees like her. She said she has emergency coverage through the college. Under the law, her insurance through the college will be upgraded if she remains enrolled there.
Supporters of the health care law say people like Haverkos can get access to coverage because government subsidies make the coverage more affordable. Comprehensive coverage would help relieve the symptoms of her persistent allergies and, she said, give her security - a sense of comfort knowing that it's there.”
For some people, the subsidies would amount to considerable savings. According to the Kaiser Family Foundation, a single 45-year-old earning $28,735 a year would pay $5,733 a year in premiums under a typical plan. Using the ACA's graduated scale, which calls for more subsidies for lower-income people, that person would have $3,420 of the premium paid for by the government.
“Those people who have found it very difficult to have access to coverage will find it a good deal,” said Kenneth Thorpe, a one-time senior health official under former President Bill Clinton.
Others are scrambling to determine what the law will cost them.
Many small companies that have not been offering insurance will have to under the new law. That will force some into a choice between providing insurance for their workers or paying thousands of dollars in federal taxes.
The ACA will require a company with 50 or more full-time workers to provide insurance or pay a $2,000 per-person fine for every uninsured worker. The only exception is the first 30 workers in the company are excluded from the fine.
Peabody, who years ago took pride in covering the entire cost of his employees' health coverage, said he now has to calculate what he can afford.
Last year, his company paid $48,000 of the $119,000 in premiums charged by his insurer, with the workers picking up the rest.
Not all of his workers accept the company-provided insurance, Peabody said.
“A lot of people can't afford health insurance,” he said. “That's why they choose not to take it.”
Other businesses are facing similar choices. Jamie Richardson, vice president of White Castle, which has 406 hamburger shops across the country, said his company spent $36 million last year on health coverage for its 5,000 full-time workers. All told, the chain employs about 10,000 people.
Under the new law, White Castle must offer its full-time workers (or anyone working 30 hours or more a week) insurance within 90 days of their hire date. That's a change from current White Castle policy, which offers health insurance to workers six months after they are hired. The company could reduce the number of hours for some workers — as a few companies have said they would do — but the chain said it does not want to do that.
“If someone's full time, we want them to stay full time,” Richardson said. “We don't want people to lose benefits.” He did say the additional costs could mean fewer people are hired.
Opponents argue that adding 20 million into the health care system along with requirements for minimum federal coverage is likely to cause premiums to rise for everyone insured in the United States. By contrast, supporters say the new law will restrain the growth rate of health care because insured people will not be flooding emergency rooms for care.
Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation, said the true costs of the new law will be difficult to calculate.
“For most people with employer-sponsored coverage, the cost of that coverage has been increasing over the past decade,” she said. Determining how much of those costs are due to general trends as opposed to the new law will be “hard to disentangle.”
HHS Issues Final Rule on SHOP Exchange Program
This content was originally published on the IFEBP.org website.
The Department of Health and Human Services (HHS) released a final rule implementing Affordable Care Act provisions relating to the Small Business Health Options Program (SHOP). This rule finalizes the amendments in the proposed rule of March 11, 2013, regarding triggering events and special enrollment periods. It implements a transitional policy regarding employees' choice of qualified health plans (QHPs) in the SHOP.
- The final rule changes the special enrollment period from 60 days to 30 days in most instances.
- If an employee or dependent becomes eligible for premium assistance under CHIP or loses eligibility for Medicaid or CHIP, the employee or dependent would have a 60-day special enrollment period to select a Qualified Health Plan.
- There is a transitional rule regarding what QHPs an employer may choose to offer.
The regulations are effective July 1, 2013.
HHS also published a