Wellness programs adopt outside-the-box solutions
Originally posted December 15, 2014 by Mike Nesper on Employee Benefit Advisor
Increasing participation in a particular activity can be done with incentives, “but you can’t buy commitment to health,” says Alexander Domaszewicz, a principal and senior consultant with Mercer. “Getting people committed to health takes other influencers and motivators.”
That’s the state of wellness programs in the workplace, Domaszewicz says, trying to make a program as valuable as possible and doing so in a meaningful way. “We’re enhancing and refining as we go,” he says.
More employers are using outcomes-based incentives, says Beena Thomas, Optum’s vice president of health and wellness. “It increases personal responsibility,” she says. Financial incentives, like premium reductions for employees who meet biometric thresholds, are widely used, but there are other strong motivators, Domaszewicz says. People are more likely to participate if an activity is easy and accessible, he says. Participation is less likely if an activity is difficult, he says, even if there is money attached to it.
Wellness programs have moved past a one-size-fits-all mentality, Domaszewicz says, and employers are now focused on employee health both at work and at home. The latter is even being recognized — such as rewarding someone who plays in an adult soccer league.
Employees prefer face-to-face interaction
There’s also more focus on one-on-one interaction, Domaszewicz says. “We tried to make everything so digital in the last decade,” he says, but employees prefer in-person communication. Employers are bringing professionals, like dieticians, to the workplace, Thomas says. “Employees like to see someone face-to-face,” she says.
Social media has helped increase participation, too, Thomas says. “Social media has played and will play a larger, more defined role in driving employee engagement,” she says.
Wellness programs have evolved rapidly in the past five years, Domaszewicz says, just look at all the wearable devices available today. “There’s a lot to be said for the groundswell of support we’ve seen,” he says. Wellness should continue to accelerate and be more successful in the future, he adds.
Wearables are evidence that employers are focusing on outcomes rather than return on investment, says Robin Widdis, business unit president and interim wellness director at CBIZ. “It’s about encouraging employees to take their health more seriously,” she says, “and employers have shown greater interest in healthy outcomes rather than dollars spent.”
Integrated approach
An integrated health strategy is an approach many employers are taking, Thomas says, and using one vendor for all benefits. “Affordability still continues to remain paramount for employers,” she says.
Regardless of any new legislation, Thomas says wellness programs will keep progressing and employers will continue to emphasize wellness as a core piece to their business strategy. “It’s not something that just sits siloed in the HR department,” she says.
Perry Braun, executive director of Benefit Advisors Network, isn’t so sure. “Intuitively, it is a sound business strategy to invest in these programs, however, businesses are cautious about making investments until the regulatory environment and tax policies have greater certainty or predictability to them,” he says. “Wellness programs require a long-term view and investment from the business community, and unfortunately, the overall business climate is short-term focused at present.”
Ensuring compliance
Advisers got a reminder this year to make certain wellness plans are compliant with the Affordable Care Act after the EEOC sued Wisconsin-based Orion Energy Systems, claiming the employer imposed too harsh a penalty for opting out of the program. Employees who participated had 100% of their premiums covered by the employer, while those who didn’t participate had to pay 100% on their own.
“For a lot of employers it was frustrating to see these lawsuits because they’ve been asking for clarity — not legal action — for many years,” says Karen Marlo, vice president at the National Business on Group Health. “I think there’s a lot of concern. There’s certainly been a lot of going back and reviewing the programs they’ve put in place.”
It’s difficult navigating the various regulations surrounding health care, Marlo says, making it crucial advisers ensure programs are compliant with the ACA, GINA, ADA and HIPAA to avoid lawsuits.
What to expect in 2015
In 2015, employers will continue to shift the rising cost of health care to employees, Widdis says, which will create “an emphasis on healthier lifestyles. There will also be more of a focus on taking action versus pushing information.” Gone are the days of handing out booklets on the dangers of smoking, Widdis says, and employers are now taking action such as charging smokers higher premiums.
Vinnie Daboul, partner at Sage Benefit Advisers, agrees, saying “the successful wellness programs are not going to be the status quo.” Effective programs will be ones that take action based on biometric data and reduce claims, he says. “When you start talking to some of the organizations that are tied to wellness, they’re starting to look at changing the claim curve,” Daboul says.
That includes involving family members, Widdis says. “Employers are also encouraging employees’ spouses and families to become more involved in their wellness programs,” she says. “Moving forward, employers are making wellness less about ROI, and more about improving health, productivity and morale.”
Most Consumers Value Integrated Benefits for Time and Cost Savings
Originally posted December 11, 2014 on Insurance Broadcasting
Whether it’s dental insurance or the smartphone, consumers want products that offer simplification and savings. In a new survey, Anthem Blue Cross and Blue Shield asked Americans what products make their lives easier and the findings revealed that integrated products and services are highly valued – for example, the smartphone (74 percent), printer/copier/scanner (64 percent) and the toaster oven (36 percent). And, when it comes to insurance, consumers overwhelmingly (81 percent) said it would be extremely helpful to trust the same carrier to provide their dental, vision and health coverage.
“We’re meeting the needs of both employer and employee by providing affordable and comprehensive coverage benefits, which helps save time and money every step of the way.”
So, what specifically are consumers looking for when it comes to selecting an insurance plan? Survey respondents said a range of factors are important to consider, but they most frequently point to cost as being an extremely important aspect (67 percent), followed by comprehensiveness of coverage (61 percent), customer service (60 percent) and ease of use (58 percent). Additionally, 86 percent would expect to save time, save money or receive improved care if they had the same carrier integrate dental with their vision and medical benefits.
In the current health care environment, employers are looking for products that offer their employees exceptional valuei. The good news is that simpler processes, vast networks and deep discounts offered by multiline carriers like Anthem can provide employers and employees with the exceptional value they are seeking.
“For example, we offer a vast choice of dental benefits that employees want, along with large, reliable provider networks that make it easy and affordable for consumers to maintain good oral health,” said Erin Hoeflinger, President of Anthem in Ohio. “We’ve built strong relationships with the dentists in our network and we have negotiated rates, which saves members on average 25 to 32 percent on their covered dental services.”
In addition to seeing a cost savings, consumers can expect to save time when they select a multiline carrier. Half of the consumers surveyed (50 percent) say that figuring out costs is the most time consuming aspect of health management. Two-in-five also say it’s time-consuming to find health care providers that accept their insurance (41 percent) and to get their doctors to talk with each other to coordinate care (39 percent).
“With all of the advantages available to consumers and employers who get their benefits from a multiline carrier, there’s no reason to settle for the inefficiencies of having multiple benefit providers," said Hoeflinger. “We’re meeting the needs of both employer and employee by providing affordable and comprehensive coverage benefits, which helps save time and money every step of the way.”
This report presents the findings of a telephone survey conducted among 1,005 adults, 503 men and 502 women 18 years of age and older, living in the continental United States. Interviewing for this ORC International CARAVAN® Survey was completed on July 10-13, 2014. 605 interviews were from the landline sample and 400 interviews from the cell phone sample.
The margin of error for the total sample is ±3.0 percent at the 95% confidence level. This means that if we were to replicate the study, we would expect to get the same results within 3.0 percentage points 95 times out of 100.
Dental gap: Coverage slips through reform's cracks
Originally post December 9, 2014 by Bob Herman on www.businessinsider.com.
Dental care is a peculiar niche of the U.S. healthcare system. Even though teeth and gums are just as much part of the human body as kidneys or elbows, they are insured differently — a lot differently.
When the Patient Protection and Affordable Care Act was written and debated, comprehensive dental insurance never really became a focal point. Lawmakers ultimately created a few provisions that may boost access to oral care, but dental coverage still escapes the grasp of millions of Americans.
Dental plans garnered national attention after it was discovered that HHS overstated 2014 enrollment figures in the ACA's insurance exchanges. The government included almost 400,000 stand-alone dental plans, which are much cheaper and separate from standard health plans. After accounting for those, the number of people who were enrolled in full-service medical plans was 6.7 million. A House committee plans to grill CMS Administrator Marilyn Tavenner on the numbers Tuesday.
Lost in that discussion, however, is the question of how much the law has done to advance dental care. Not enough, advocates argue.
The Affordable Care Act mandated pediatric dental services as one of the 10 essential health benefits for health plans, but adult dental services were excluded. In addition, all health plans must cover oral health risk assessments for children up to 10 years old with no copayment, coinsurance or deductible. The law also allowed states to expand Medicaid and its related dental benefits to more low-income children and adults.
But large gaps in coverage remain, primarily for adults who don't qualify for Medicaid. “More children have been enrolled (in dental plans) through the Affordable Care Act,” said Maxine Feinberg, president of the American Dental Association. “However, it really only helped adults in a minimal way.”
About 187 million people have some form of dental insurance, according to the National Association of Dental Plans. Coverage is provided through two main outlets: employers or public programs like Medicaid and the Children's Health Insurance Program.
A majority of people who have dental insurance get it through their employer. Almost nine in 10 employers with 200 or more workers and about half of all companies offer dental benefits, according to the Kaiser Family Foundation. The most common forms of coverage are like “prepaid gift cards,” Feinberg said. Routine cleanings and other preventive services are completely covered, and all other dental care needs are covered up to a yearly maximum figure.
But that leaves about 130 million Americans who have to pay for their dental care completely out of pocket or rely on supplemental dental policies. That figure includes millions of Medicare beneficiaries. Traditional Medicare does not cover dental care unless it's an emergency procedure during a hospital stay.
Medicare, Medicaid pitfalls
Cost and a lack of dental providers are cited as the key barriers for obtaining care. In some instances, the results have been lethal. The most famous case was Deamonte Driver, a 12-year-old boy in Maryland who died in 2007 after bacteria from an infected tooth spread to his brain. Deamonte's family lost its Medicaid coverage. More recently, in 2011, Kyle Willis, 24, died in Ohio after a wisdom tooth infection forced him to the emergency department. Mr. Willis had no insurance and couldn't afford antibiotics.
Ultimately, the Affordable Care Act is expected to bring some kind of dental coverage to 8.7 million kids and 17.7 million adults by 2018, according to an ADA-commissioned analysis conducted by actuarial consulting firm Milliman. A vast majority of those gains will be through Medicaid expansion, and some asterisks apply.
Medicaid dental benefits for adults vary widely in each state. Some states like Connecticut and New York offer extensive coverage that includes preventive cleanings and restorative services like fillings and crowns. But others offer zero dental coverage, or only cover emergency services that relieve tooth pain and infection. That means many people who live in states expanding Medicaid eligibility may only benefit marginally, and some others in non-expansion states won't benefit at all. The ADA study said of the 26 states expanding Medicaid, nine provide “extensive” adult dental benefits.
The scenario also assumes patients can find dentists accepting Medicaid. Only one-third of practicing dentists take Medicaid patients due to lower reimbursement rates.
Dr. Richard Manski, a dentistry professor at the University of Maryland who has studied dental insurance said the state programs that prioritize dental care actually offer “robust” coverage. But “the problem with the Medicaid plans is there's always a fixed pot of money,” he said.
Dental benefits are often the first to get cut when states need to get their Medicaid budgets in order. Even the federal government has encouraged state Medicaid programs to tinker with their dental care benefits when money gets thin. In 2011, then-HHS Secretary Kathleen Sebelius wrote letters to governors saying that limiting or eliminating dental care benefits is an effective way to save Medicaid funds.
The impact of the ACA's exchanges on dental care is similarly cloudy. Although dental benefits for children up to age 19 are required for all health plans sold on the individual and small-group markets, each exchange can take a different approach, said Colin Reusch, senior policy analyst at the Children's Dental Health Project. Some exchanges require health insurers to embed pediatric dental coverage. Others allow the benefits to be sold in stand-alone policies, requiring people to pay a separate premium.
The average cost differential between a medical policy with embedded dental coverage and a medical policy without dental coverage on the federally run exchanges ranges from $33.45 per month for a family with one child to $70.05 for a family with three or more children, said Evelyn Ireland, executive director of the National Association of Dental Plans.
Mr. Reusch said he's hopeful the gap between dental and medical care can be bridged, even though the ACA will leave many without dental insurance and nothing has changed with Medicare. Providers in accountable care organizations or patient-centered medical homes are now somewhat responsible for the oral health of patients, especially if dental issues ultimately lead to more complex health problems.
“In the long term, that's really beneficial in terms of shifting the oral healthcare delivery system towards integration, which is where we want to go,” Mr. Reusch said.
2015 HSA and FSA Cheat Sheet
Source: BenefitsPro.com
Health savings accounts
What they are
A health savings account is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in an HSA-qualified high-deductible health plan.
HSAs can grow tax-deferred in your account for later use. There’s no deadline for making a withdrawal: Consumers can reimburse themselves in future years for medical costs incurred now.
Individuals (self-only coverage) - $3,350 (up $50 from 2014)
Family coverage - $6,650 (up $100 from 2014)
The annual limitation on deductions for an individual with family coverage under a high-deductible health plan will be $6,650 for 2015.
The maximum out-of-pocket employee expense will increase next year to $6,450 for single coverage from $6,350, and to $12,900, from $12,700, for family coverage.
What’s new
The out-of-pocket limits include deductibles, coinsurance and copays, but not premiums. But starting in 2015, prescription-drug costs must count toward the out-of-pocket maximum
Account numbers — and exploding growth
Health savings accounts have grown to an estimated $22.8 billion in assets and roughly 11.8 million accounts as of the end of June, according to the latest figures from Devenir. The investment consulting firm said that’s a year-over-year increase of 26 percent for HSA assets and 29 percent for accounts.
Projections
Devenir projected that the HSA market will exceed $24 billion in HSA assets covering more than 13 million accounts by the end of 2014. Longer-term predictions are far greater: The Institute for HealthCare Consumerism, for one, estimates that 50 million Americans will be covered by HSA-qualified health plans by Jan. 1, 2019, and that HSA adoption will grow to 37 million.
Who’s using them
Both men than women. The gender distribution of people covered by an HSA/HDHP as of January 2014 was evenly split — 50 percent male and 50 percent female. But males have more money in their accounts. At the end of 2013, men had an average of $2,326 in their account, while women had $1,526, according to the Employee Benefit Research Institute. EBRI reported that older individuals have considerably more money in their accounts than do younger HSA users: Those under 25 had an average of $697, while those ages 55-64 had an average of $3,780, and those 65 or older had an average account balance of $4,460.
Other things of note
People are becoming more active and better managers of their HSA dollars. In 2012, 52 percent of HSA account holders spent in excess of 80 percent of their dollars on health care expenses, according to research by the HSA Council of the American Bankers' Association and America’s Health Insurance Plans.
Flexible spending accounts
What they are
FSAs allow employees to contribute pre-tax dollars to pay for out-of-pocket health care expenses — including deductibles, copayments and other qualified medical, dental or vision expenses not covered by the individual’s health insurance plan.
They’re also known as flexible spending arrangements, and they’re more commonly offered with traditional medical plans.
Limits
On Oct. 30, the IRS announced the FSA contribution limit for 2015 would increase $50 to $2,550 under the Patient Protection and Affordable Care Act.
What’s new
Last fall the U.S. Treasury Department issued new rules that let employers offer employees the $500 carryover. Previously, unused employee FSA contributions were forfeited to the employer at the end of the plan year or grace period, which industry insiders say were a barrier to adoption. The rule went into effect in 2014.
Double-digit growth
Alegeus Technologies said that clients who have actively promoted the FSA rollover allowance to their employer groups and eligible employees are seeing 11 percent incremental growth in FSA enrollment and 9 percent growth in FSA elections — compared to a flat overall FSA market growth.
Projections
The change to the FSA use-it-or-lose-it rule was greeted enthusiastically by employers, consumers and industry insiders. Many believe adoption will grow with that amendment.
Who’s using them
An estimated 35 million Americans use FSAs.
Other things of note
A survey from Alegeus Technologies says most consumers, and even account holders specifically, do not fully understand account-based health plans, including HSAs, FSAs and health reimbursement accounts. Only 50 percent of FSA holders passed a FSA proficiency quiz.
Join the January 13 Event
Originally posted on https://www.rwjf.org
Building on its original work from 2009—which helped advance a national movement to address non-medical factors that affect our health—the RWJF Commission to Build a Healthier America will release new recommendations on Monday, January 13, 2014, at 2:30 p.m. ET, during a live online event.
Watch the YouTube video on Creating a Culture of Health: https://youtu.be/XeIfRaKqDnw
During the event featuring Commission Co-Chairs Mark McClellan and Alice Rivlin, Commissioners will offer recommendations covering three key areas:
- Prioritizing investments in America’s youngest children
- Encouraging leaders in different sectors to work together to create communities where healthy decisions are possible
- Challenging health professionals and health care institutions to expand their focus from treating illness to helping people live healthy lives
Weight Loss Is Employees’ Top New Year’s Resolution
Source: https://www.compsych.com
Thirty-nine percent of employees say losing weight is their top health concern while 26 percent say stress has them most worried, according to a ComPsych Tell It Now poll released today. ComPsych is the world’s largest provider of employee assistance programs and is the pioneer and leading provider of fully integrated EAP, behavioral health, wellness, work-life, HR and FMLA administration services under the GuidanceResources brand.
“Weight loss is, not surprisingly, the number one health concern this year,” said Dr. Richard A. Chaifetz, Chairman and CEO of ComPsych. “What is significant is that many more employees are aware of stress as a major contributor to health problems. Corporate wellness programs that address both physical and emotional health are uniquely suited to help employees make lasting lifestyle changes, which will ultimately reduce health and disability costs while improving productivity.”
Employees were asked: Which health issue are you most trying to stay ahead of this year?
39 percent said “weight loss”
26 percent said “stress”
17 percent said “exercise”
9 percent said “diet improvement”
6 percent said “quitting smoking”
3 percent said “other”
ComPsych’s build-to-suit health and wellness program – HealthyGuidance® -- targets employee behavior and lifestyle issues before they become significant health risks. Drawing upon more than 25 years of behavioral health experience, HealthyGuidance uses a consultative, high-touch approach, empowering employees to make healthy lifestyle changes through expert guidance. The program offers:
• Comprehensive health risk assessments and screenings
• Live, telephonic wellness coaching with behavioral, health and nutrition experts
• Online health management tools including diet and exercise programs and incentive tracking
• Action-oriented wellness seminars, turn-key wellness challenges and award-winning communications
• Targeted programs such as tobacco cessation, weight management, stress reduction and more
Large gaps seen in health perceptions vs. reality
Source: https://eba.benefitnews.com
By Tristan Lejeune
A new survey from Aon Hewitt, the National Business Group on Health and The Futures Company indicates that many American workers and their families — even those who know what it takes to get and stay healthy — have inaccurate perceptions about their own weight, condition and the cost of their health care. The survey results, released this month by Aon Hewitt, further indicate satisfaction and claims of positive behavior changes associated with participation in consumer-driven health plans.
More than 2,800 employees and their dependents covered by employer-sponsored health plans were surveyed about their thoughts, attitudes and behaviors toward health and wellness. Eighty-seven percent of respondents reported being in good health, yet more than half of those (53%) gave height and weight combinations that categorize them as having a body mass index in the overweight or obese categories. Only 23% of all respondents believe they are actually overweight or obese, when in reality that number is 34%.
“Employees want to be healthy, but many have an overly rosy perception of their health and may not see an urgent need to take action,” says Joann Hall Swenson, Aon Hewitt’s health engagement leader. “For others, the activities and stresses of daily life take priority over good health, and many consumers are unwilling to make sacrifices to improve their health.”
She says employers need to offer workers and their families “the necessary tools and resources that give them a realistic picture of their health,” then follow up by encouraging healthy decision making.
Consumers’ incorrect perceptions extend to cost, the survey finds. Total health care costs per employee were $10,522 last year, according to an analysis, of which employers paid $8,318. When asked, however, how much of their bill their employer pays, the average respondent guessed around half that amount.
“These survey results,” says Helen Darling, president and CEO of the National Business Group on Health, “underscore the challenges employers face as they seek to engage employees and their families in health improvement as a means to better managing rising health care costs. It is critical for employers to bridge the knowledge gap evident in this survey.”
It seems one way to do that is by offering a consumer-driven health plan, the survey reveals, as 60% of those in a CDHP say they have made positive behavior changes in regards to their health, including more preventive care (28%), seeking lower-cost options (23%) and more frequent research of health costs (19%). In addition, 63% of respondents say they would complete a health risk questionnaire for a monetary reward, and just under that would engage in a healthy eating or weight management program.
“Consumers are looking for solutions that address their specific health needs and concerns,” says Christine Baskin, senior vice president at the Futures Company. “Tailored, targeted feedback such as that given in the HRQ process, along with understanding individual consumer's attitudes towards health, are essential ingredients to having employees take actions to improve their health and their lifestyle.”
Obesity declining...Fat Chance!
Number of U.S. adults who are obese to increase by 9 percent by 2030, according to forecast.
LAURAN NEERGAARD, AP Medical Writer
Source: Timesleader.com
WASHINGTON — The obesity epidemic may be slowing, but don’t take in those pants yet.
Today, just over a third of U.S. adults are obese. By 2030, 42 percent will be, says a forecast released Monday.
That’s not nearly as many as experts had predicted before the once-rapid rises in obesity rates began leveling off. But the new forecast suggests even small continuing increases will add up.
“We still have a very serious problem,” said obesity specialist Dr. William Dietz of the Centers for Disease Control and Prevention.
Worse, the already obese are getting fatter. Severe obesity will double by 2030, when 11 percent of adults will be nearly 100 pounds overweight, or more, concluded the research led by Duke University.
That could be an ominous consequence of childhood obesity. Half of severely obese adults were obese as children, and they put on more pounds as they grew up, said CDC’s Dietz.
While being overweight increases anyone’s risk of diabetes, heart disease and a host of other ailments, the severely obese are most at risk — and the most expensive to treat. Already, conservative estimates suggest obesity-related problems account for at least 9 percent of the nation’s yearly health spending, or $150 billion a year.
Data presented Monday at a major CDC meeting paint something of a mixed picture of the obesity battle. There’s some progress: Clearly, the skyrocketing rises in obesity rates of the 1980s and ’90s have ended. But Americans aren’t getting thinner.
Over the past decade, obesity rates stayed about the same in women, while men experienced a small rise, said CDC’s Cynthia Ogden. That increase occurred mostly in higher-income men, for reasons researchers couldn’t explain.
About 17 percent of the nation’s children and teens were obese in 2009 and 2010, the latest available data. That’s about the same as at the beginning of the decade, although a closer look by Ogden shows continued small increases in boys, especially African-American boys.
Does that mean obesity has plateaued? Well, some larger CDC databases show continued upticks, said Duke University health economist Eric Finkelstein, who led the new CDC-funded forecast. His study used that information along with other factors that influence obesity rates — including food prices, prevalence of fast-food restaurants, unemployment — to come up with what he called “very reasonable estimates” for the next two decades.
Part of the reason for the continuing rise is that the population is growing and aging. People ages 45 to 64 are most likely to be obese, Finkelstein said.
Today, more than 78 million U.S. adults are obese, defined as having a body-mass index of 30 or more. BMI is a measure of weight for height. Someone who’s 5-feet-5 would be termed obese at 180 pounds, and severely obese with a BMI of 40 — 240 pounds.
The new forecast suggests 32 million more people could be obese in 2030 — adding $550 billion in health spending over that time span, Finkelstein said.
“If nothing is done, this is going to really hinder efforts to control health care costs,” added study co-author Justin Trogdon of RTI International.
Sleep Deprivation Has Same Impact as Binge Drinking
Although drink driving is socially unacceptable sleep deprivation is so extreme in the UK that one million people are doing the equivalent of getting behind the wheel intoxicated every day, without alcohol passing their lips, having a profound impact on their employer and workplace.
The data, from Vielife's online health & wellbeing assessment, also shows that one in three (approximately 100 million European working adults) suffer from 'poor sleep'. These people are living in danger of a semi-conscious existence equal to repeatedly driving their car well over the alcohol limit.
Women are more at risk than men - 35% have poor sleep compared to 31% of men. Depression has a profound correlation with poor sleep.
The survey found people working a five day week generally have better sleep than people working more or less than five days.
Being 'sleep drunk' is caused by the tiredness felt after prolonged waking hours which has the equivalent effect as a raised blood alcohol level above the legal limit to drive.
Tony Massey, Vielife's chief medical officer, said: "Being 'sleep drunk' is a common issue that causes personal and work life issues and a healthy lifestyle is at the heart of solving it."
The data is based on 'sleep scores' recorded by users of Vielife's online health & wellbeing platform. A sleep score indicates the overall quality and satisfaction of a person's sleep as part of a wider 'wellbeing score' used to help people identify and work to improve their health issues.
This research was based on 38,784 assessments of people employed in the UK taken between 2009 and 2011.
By David Woods