The Wellness Equation

Recent laws and regulations have propelled employee health and wellness into the national spotlight.

By Anthony Bucci, Assistant Editor  On Jan 15, 2016

Rising healthcare costs coupled with growing rates of chronic disease have sparked an increasing interest in workplace wellness programs. And, with the implementation of new regulations due to the Affordable Care Act (ACA) and the Health Insurance Portability and Accountability Act (HIPAA), among others regarding employer wellness programs, the focus on employee health and wellness has been pushed into the national limelight.

Generally, the ACA and HIPAA prevent discrimination in providing individuals health insurance or charging higher rates due to pre-existing conditions, health status or gender. Due to that fact, many health insurance premiums have been on the rise for all individuals. According to a July 2015 report by The New York Times, “Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the ACA turned out to be sicker than expected.” That is not to say all insurance companies across all states will drastically increase premiums. However, because of this reality, the nation has shifted from a focus on sickness and disease, to one based on prevention and wellness.

“The ACA has helped create a greater awareness in the importance of keeping people healthy in our society,” says Alfred Campanella, executive vice president of strategic business growth and analytics at Virtua, a South Jersey health system that operates hospitals located in Berlin, Mount Holly, Marlton and Voorhees. “Healthcare premiums have been increasing steadily over the years and for many larger employers, that are required to provide health insurance to their employees under the ACA, this comes as a concern. So in turn, everyone is looking into how these costs can be lowered. One of the ways to do that is to make sure individuals and employees are as healthy as possible.”

In January 2014, The US Departments of Labor, Health and Human Services and the Treasury enacted final regulations to existing wellness provisions made by the ACA in order “to encourage appropriately designed, consumer-protective wellness programs in group health coverage.” The regulations support two different types of employer wellness programs: participatory and health-contingent wellness programs, each of which can provide various incentives for employees.

“Participatory programs are open to all employees with no regard to their current health status,” says Mary Beaumont, vice president of health and legal affairs at the New Jersey Business & Industry Association. “In this program, for example, companies can give employees $50 towards a gym membership or reward them in certain ways if they attend healthcare seminars or have a health risk assessment. … For health-contingent programs, individuals have to meet a certain health standard. For instance, if employees take smoking cessation classes to help them reduce or stop smoking all together, or, if they reduce their cholesterol and hit a certain goal, there are certain rewards that can go with that.”

Ultimately, Beaumont says the ACA has helped employers build on existing wellness programs and implement new incentives, with “the hope that rewards will get more employees to focus on their health.”

“Studies have shown that not many employees will necessarily participate or enroll in a wellness program unless there is an incentive,” she says. “According to a Kaiser Family Foundation Survey, to encourage employee participation, about one in five workplace wellness programs use incentives while larger firms (200-plus workers) are more likely to use financial incentives than smaller firms, in the form of cash, gift cards or other merchandise.”

Health-contingent programs have additional “rules” in order to protect consumers from unfair practices. A health-contingent program must: give eligible individuals the opportunity to qualify for the reward annually; the program must be reasonably designed to promote health and prevent disease; the full reward must be available to all similarly situated individuals, requiring reasonable alternatives that provide employees identical benefits as the original program; and individuals must be given notice of the opportunity to qualify for the same reward through other means.

The rules also implement changes in the ACA that increases the maximum reward under a “health-contingent wellness program offered in connection with an employer group health plan.” The maximum reward offered to individuals must be no more than 30 percent of the cost of health coverage, an increase from the previous 20 percent. However, the reward can increase to as much as 50 percent for individuals enrolled in smoking cessation programs.

“The mere fact that the ACA has created guidelines like [this] was because legislators were well aware that wellness programs had to be an important part of future healthcare offerings,” Virtua’s Campanella says. “But what we see is companies that are mostly into the participatory programs. They are easier to implement, the employee acceptance is generally more open and I think you achieve the same goals in the long run as health-contingent plans.”

New Jersey healthcare and insurance providers have been playing a role in the wellness realm well before laws and regulations placed more of an emphasis on it.

“Approximately 10 to 12 years ago, Virtua embarked on a strategy to move beyond sick care and into the whole arena of wellness,” Campanella says. “We have three fitness centers with upwards of 12,000 members and that was the first step in that wellness equation for us. We also offer wellness education, cooking, stress reduction and other classes.”

Keeping people healthy and well has “always been part of HackensackUMC’s DNA,” according to Paulette Wright, the hospital’s director of employee population health & pension strategies. And, with the recent introduction of its new Campus Health Center, the focus on keeping its own employees healthy has never been more prominent.

“The focus of our Campus Health Center is to provide our employees and their families with the right care, at the right time, in the right setting and with the right doctor,” Wright says. “It means employees don’t have to wait in the emergency room to get care, and it gives them the opportunity to connect with their primary care physician, so it can help them stay well.

“As a healthcare provider, I feel that it is important to set an example,” she continues. “Not only is it part of our mission to keep all people well and healthy, but because our employees take care of patients, we want them to be as healthy as they can so they can perform to the best of their ability. … Additionally, not only is it important for us to take care of our employees, but it is really important for every employer to partner and engage with their employees in developing a healthy lifestyle.”

Furthermore, healthcare and insurance providers have been working with employers in developing programs for employees in an effort to keep them healthy.

Horizon Blue Cross Blue Shield of New Jersey plays a “key role in helping employers find the right wellness strategy and plan to suit their needs,” according to Eduardo Lara, vice president of marketing and product development for Horizon BCBSNJ. “The business community recognizes the importance of workplace wellness programs, as they can help to improve productivity, boost morale, reduce absenteeism and control healthcare costs. Horizon representatives work closely with businesses and brokers to develop wellness strategies that are appropriate for the [employee] population. These strategies include onsite visits for health education seminars and benefit fairs, as well as webinars to present our programs and tools. We offer a WebMd tool, for example, that helps employers manage wellness activities and features telephonic coaching.”

Virtua’s Campanella stresses that employee wellness programs should be implemented with regards to the needs of employees rather than the needs and wants of the employer.

“It is important that wellness programs are not dictated from company management,” he says. “The senior leaders of companies should help set the tone that wellness is important, but it is the employees who should have the final say. For instance, if one department wants to focus on Yoga and another department wants to focus on healthy eating classes, giving today’s employees a voice as to what is offered will make them more apt to engage and take part.”

Virtua is a “wellness partner” to the Burlington County government and provides wellness and care services to approximately 1,500 of the county’s employees.

“We work with Burlington County to – first and foremost – create awareness that wellness is important,” Campanella says. “We create videos and internal communications documents that help support a culture of wellness. And, within the county courthouse itself – which is the main hub of where many of their employees are located – we have an employee walk-in clinic to help individuals that have low-level acute conditions. The goal of the clinic is to help employees ward off something that can potentially lead to something more serious. In some cases, we have a chronic disease management program to help employees better manage a disease like diabetes, as well. It has been a great relationship that has helped change the culture for Burlington County as a corporate entity. We hope to use this relationship as a catalyst that will see more entities get on board with wellness programs.”

Health insurance company AmeriHealth New Jersey offers a similar program that it calls Commit2Wellness, to which all of its commercial members have access.

“Commit2Wellness is aimed at helping people make smart lifestyle choices,” says Brian Marshall, manager of AmeriHealth New Jersey’s Commit2Wellness program. “Participants can earn incentives through us by visiting their primary care physician or completing weight loss or smoking cessation programs, which can then be redeemed for gift cards to a wide variety of retailers. We also provide wellness support to employer groups that consist of consultative services. We have onsite screening for blood pressure and body mass composition. We perform online and phone health coaching. We have a stable of nurses who create seminars and in-house educational series for stress management, proper eating and more. We also create webinars for remote employees that might not have access to our onsite services.”

Additionally, AmeriHealth helps employer groups monitor insurance claims to review the potential impact wellness strategies can have on the health and well-being of employees.

“In concert with our employer groups, we use center metrics to monitor claims,” Marshall says. “We can tell an employer, for instance, ‘Here’s how many emergency room admissions were prevented this year,’ or ‘Because of one of our programs, patient stays related to asthma have dropped.’ If a company wants to get an idea of how engaged their employees are, we can help them with that as well. We can conduct a survey where we ask employees whether they are utilizing a program or not, or what is working and what isn’t, for example. We then filter that data and feed it back to employer.”

Even though laws and regulations have helped garner attention towards health and wellness, Marshall says a lot of people are still struggling to understand them, particularly the ACA.

“People are still trying to get a handle on the ACA, because it can be confusing,” he says. “At AmeriHealth, we have nurses who go out into the field who are knowledgeable and well-versed on the ACA. A lot of individuals, for example, don’t understand that preventive services are covered without cost sharing anymore. So, someone can go to the doctor once a year and have a checkup they might need to keep them well.

“Educating businesses and individuals on health and wellness and what is available to them is something we have been doing and will continue to do,” Marshall continues. “There will always be challenges, but we strive to do our best in getting as many people involved in taking control of their health. Employers should also reach out to providers to see what kinds of programs are available as well as what incentives will help get employees engaged.”

At the end of the day, “the return on investment for a company that offers incentives can be significant, particularly if the account is self-insured,” Horizon BCBSNJ’s Lara concludes. “When people keep up with their health, they’re more likely to avoid involuntary hospital admissions and readmissions, as well as avoid or manage chronic conditions – all of which reduces healthcare costs for everyone and helps to keep premiums affordable. Businesses also benefit from having more productive and engaged employees, with less absenteeism and improved morale.”

 

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