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Business Group in the NewsWal-Mart Endorses Employer Mandate
After years of strenuous opposition, Wal-Mart, the nation's largest private employer, announced yesterday that it supports a controversial proposal requiring businesses to contribute to the cost of employee health insurance. The retailing giant's endorsement comes as the push and pull on health reform intensifies, and it could have broad economic and political consequences. Many business groups, displeased with the shape of the legislation that has emerged so far, have begun to mobilize against President Obama's top domestic priority. Opinion in the corporate world over an employer mandate is split. "This would be bad for businesses, employees and consumers everywhere, even Wal-Mart shoppers," said E. Neil Trautwein, a vice president at the National Retail Federation. The federation is pressing for an individual mandate and significant insurance market reforms. But some large employers support an employer mandate as a way to "level the playing field," said Helen Darling, president of the National Business Group on Health, which represents primarily Fortune 500 companies. "A lot of big companies in the retail business already provide it, and they feel that creates a competitive disadvantage for them," she said.
New CDC Site Helps Employers Address Obesity
The Centers for Disease Control and Prevention unveiled a new Web site on Thursday named LEANWorks! Announced at a National Business Group on Health meeting in Washington, D.C., the site will help businesses -- particularly small and mid-sized ones -- address the obesity problem among employees. The site "was developed in direct response to organizations asking CDC for help in addressing the obesity epidemic. Specifically they wanted to know what interventions were effective in helping employees maintain a healthy weight," said William Dietz, M.D., Ph.D., director of CDC's Division of Nutrition, Physical Activity and Obesity. "CDC has identified science-based interventions that work to prevent and control obesity. CDC LEANWorks! provides the tools that employers need to take action." The site can help employers calculate the cost of obesity for their organizations and develop approaches to control these costs through fitness classes, lunchtime health education sessions, weight management programs, and other initiatives. CDC says obesity is a risk factor for high blood pressure, type 2 diabetes, stroke, and heart disease; in addition, obese people spend 77 percent more money for essential medications than non-obese people. "Obesity affects more than just health care costs. It also has a significant impact on worker productivity because the more chronic diseases employees have, the more likely they are to be absent from work, or less productive if they come to work sick," said Janet Collins, Ph.D., director of CDC's National Center for Chronic Disease Prevention and Health Promotion.
Companies pushing wellness must step lightly with workers
Businesses that promote wellness often have bigger worries than candy bars in office vending machines. They must confront employee concerns about privacy and discrimination and be ready for potential backlash from employees who don't like bosses pushing them to ramp up workouts or quit smoking. LuAnn Heinen, vice president at National Business Group on Health, adds that even if companies adhere to legal rules, they still have to take care to not overstep the personal boundaries of employees. These programs "can't be pushed on people."
Companies re-evaluate wellness programs
Companies, desperate to slice fat from their budgets during this recession, increasingly are targeting workplace wellness programs. A big problem: It can take years to analyze the impact of these programs, and even then, the return on investment isn't always clear. Faced with the uncertainty of what shape the health care overhaul will take and with health care expenses rising more than 6% a year, companies aren't willing to completely abandon wellness. Big firms are almost all self-insured for health insurance plans and, therefore, pay for employees' health care costs from their own coffers. Slightly more than 60% of companies with 10,000 or more employees said they had a wellness program in 2008, up from 47% in 2005, according to the MetLife survey. In 2008, the median health care cost per employee was $7,173, according to a survey by human resources consultants Watson Wyatt and employer coalition National Business Group on Health. IBM, which spent $1.3 billion on health care for its employees, dependents and retirees in 2008, continues to invest in wellness, though it has cut expenses in other ways, including layoffs. PepsiCo has invested heavily in well-being. Its Purchase, N.Y., headquarters offers pilates, yoga and spinning classes as well as a free laundry service for those who don't want the hassle of washing their sweaty gym clothes. Keeping healthy employees such as Hurley fit -- and productive -- is vitally important to a company's success, says Dee Edington, director of Michigan's Health Management Research Center. The cost of an ailing worker goes beyond just medical expenses, he says. There's also the monetary cost of paying for disability leave, as well as the strain on productivity if an ill person isn't effective at work. While some employees are enthusiastic about wellness programs, many are sitting on the sidelines. "A big issue is getting noticed and getting employees to participate," says LuAnn Heinen, National Business Group on Health vice president. Workers -- stressed by the economic downturn -- are often more focused on work and finances than eating right and exercising. Nearly half of employees surveyed by the National Business Group on Health in July said work demands prevent them from having a healthier life. That poll was taken before the full brunt of the economic downturn was felt.
Not exactly health IT
Time will tell whether companies will decide to integrate electronic cigarettes as a tool in the smoking cessation programs that they offer to their workers. So far, the electronic cigarettes haven't been marketed as a quitting aide. Smoking carries a large cost for employers in terms of medical claims, absenteeism and lost productivity. "Tobacco use continues to be the No. 1 cause of preventable illness and premature death in the workforce. It costs U.S. businesses $167.5 billion per year in health care costs and lost productivity," notes Helen Darling, president of the National Business Group on Health.
Parity is Coming
The Paul Wellstone-Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 prohibits employers' health plans from imposing any caps or limitations on mental-health treatment or substance-use disorder benefits that aren't applied to medical and surgical benefits. In 2008, the Congressional Budget Office estimated the act will "increase premiums for group health insurance by an average of about 0.4 percent." According to the National Business Group on Health, treatment for mental illness and substance abuse in 2001 totaled $104 billion, which is less than 8 percent of the $1.4 trillion spent on overall healthcare in the United States.
The Other 'Big Three' in the Health Care Debate
The third G stands for groups. Because premiums vary by the size of the company and average age of employees for which insurance is purchased, workers in smaller firms and firms with many older employees would be subjected to higher taxes than those in large companies with younger workforces. While adjustments can be made for these factors, it would be very difficult, Reischauer says. Big companies agree, and their lobbies, such as the American Benefits Council and the National Business Group on Health, are objecting to potential changes in the exclusion.
Taxes fair target for U.S. healthcare revamp: experts
...Economists from across the political spectrum back putting some type of cap on tax-free benefits, whether based on income or other factors that account for geographic variation. ...But touching the tax benefit enjoyed by tens of millions of Americans to help pay for universal health coverage is proving to be a tough sell, because of Obama's earlier opposition and also because unions and employers oppose any changes. ...Employers say cost savings can be wrung out of the delivery of care to help pay for expanded coverage, if only doctors and hospitals would follow best treatment practices. "We've always had the view that we should maintain the current tax system," said Steve Wojcik, vice president at the National Business Group on Health, which represents Fortune 500 companies. Still, he acknowledged evidence the current tax treatment may encourage unneeded healthcare consumption. "What we realize is that there are a lots of gains to be had especially in terms of controlling costs that would benefit the employer-sponsored coverage world," Wojcik said.
Conference Explores Total Rewards
Helen Darling Honored Helen Darling, president of the Washington-based National Business Group on Health, received the WorldatWork Keystone Award during the conference for her efforts on behalf of businesses to identify practical solutions to the nation's healthcare crisis. Darling, a former practice leader at Watson Wyatt, serves on many boards and committees including the Committee on Performance Measurement of the National Committee for Quality Assurance, the Medical Advisory Panel, and a number of other advisory and editorial boards. "This is a woman," said WorldatWork's Ruddy, "who is making a significant impact on doing the right think on healthcare in the United States."
HHS Guidance on Health Data Security Needs More Work on Specifics, Groups Say
A Department of Health and Human Services guidance on the technologies and methodologies to secure health information and to prevent harm provides a solid framework that providers and other businesses can use to better protect individuals' health information, but the specifics need more work, according to comments submitted to HHS by various groups. The two methods described in the HHS guidance for securing patients' information are destruction and encryption. Some commenters urged greater flexibility in determining appropriate methods to secure health information, while others said precise definitions of an information breach or of unauthorized access would be useful. In addition, a hospital group cited the effect that encryption would have on use of some medical devices. HHS issued the guidance April 17 with a May 21 deadline for public comments (17 HCPR 624, 4/27/09). It was published in the April 27 Federal Register (74 Fed. Reg. 19006). The guidance stated that private health information could be protected by making it "unusable, unreadable, or indecipherable to unauthorized individuals." It also provides steps that entities can take to secure personal health information, and it establishes the trigger for when entities must provide notice that patients' data have been compromised. The American Recovery and Reinvestment Act (Pub. L. No. 111-5) required publication of the guidance, HHS noted in April. At that time, Obama administration officials said HHS is required to issue an interim final rule on notifying people when health care information is breached by mid-August, or 180 days after the law was enacted. In the guidance, HHS said it consulted with information security experts at the National Institute of Standards and Technology, and identified encryption and destruction as the two methods for rendering protected health information (PHI) unusable, unreadable, or indecipherable to unauthorized individuals. The guidance applies to paper and electronic records. The National Business Group on Health, a nonprofit group concerned with large employers' health care and related benefits issues, told HHS in a comment letter that the guidance should be more general in its description of acceptable methodologies for securing electronic media. "A high volume of clerical and clinical processing of personal health information occurs in real time behind encrypted firewalls. Personal health information is also secured and transmitted through password protected compressed files," the group wrote. "It is an unrealistic expectation that the guidance can 'be an exhaustive list of the technologies and methodologies that can be used to render PHI unusable, unreadable, or indecipherable to unauthorized individuals.' This is especially true in light of the ever changing and evolving computer industry."
Workers skimp on care to save money: Study
Healthy NY looks at adult child's income
The economic downturn is taking a toll on employees' physical and mental health, according to a survey by the National Business Group on Health. The survey of 1,500 workers found 27 percent of respondents reported forgoing health care treatment to save money on co-payments or coinsurance costs. One in five respondents skipped taking their prescription drug medication dosage as prescribed by their doctor. Many workers, particularly older workers, reported that their mental health has been negatively affected by the economy. The survey also found 52 percent of the workers surveyed reported that living a healthy lifestyle is more of a priority than it was a year ago. One in three said they are exercising more and 46 percent said they are eating healthier.
Insured workers skip medical care
One in four employees is choosing to ignore medical care to save on costs, while many other workers are either splitting their pills or skipping their medications to make them last longer, according to a new survey Wednesday. According to the National Business Group on Health (NBGH), 27% of insured workers are skipping health care treatments to avoid co-payments, 20% of employees are not taking their prescriptions as advised by their doctors, and 17% of employees are cutting their pills in half to make them last longer. The NBGH said these types of risky behaviors are a result of the recession, and illustrate the "toll [it is taking] on employees' physical, mental and financial health." The survey is disturbing to some. "We think the last two trends are particularly dangerous, assuming that a correct diagnosis was made to prescribe the medicine and they are intentionally not being taken," said Helen Darling, president of NBGH, which is a non-profit group representing mostly large employers, including 60 of the Fortune 100 companies. The emotional toll. Not surprisingly, the survey also showed that the recession had become a burden on workers' mental and financial health: 40% of employees said their stress and anxiety was worse since the start of the economic slump, and 50% said the economy has worsened their financial situation. Also, 67% of those polled said saving more is a top priority this year, up sharply from 29% in 2008. Regarding the cost of health care, 58% of those surveyed said they "continue to be surprised" at their out-of-pocket costs. Still, 68% of employees say having access to health benefits is a key reason for staying with their employer. Another significant finding was that improving their health has jumped in priority for American workers. The survey showed 52% of respondents said living a healthier lifestyle is more of a priority this year, compared with 44% who felt the same way a year ago. In that regard, more than half of workers polled believed that smokers should pay higher health care premiums and 47% said obese employees should also pay higher premiums. A majority of those polled said financial incentives from their employers has motivated them to try to lead a healthier lifestyle. "We aren't surprised by these findings. They show that people are really worried," said Darling. Helping people cope. However, Darling said her group is also focused on recommending steps employers can take to help their workers manage their health care expenses. 'Employers have to be aware that they can do several things," she said. Among the group's recommendations, she said employers can offer financial incentives to motivate healthy behavior. They can also provide more transparency to workers about costs and quality of services from health care providers, and spread awareness about financial counseling services available through employee assistance programs. The NBGH also suggested that employers remind their workers of cost savings through use of generic medication, mail-order and nurse help-line services. The NBGH survey was conducted in March and polled 1,500 workers between the ages of 22 and 69 who either have employer-sponsored insurance or union-sponsored health plan.
Hard Cash for Healthy Living
A pilot program that pays employees to fill out health-risk assessments, undergo screenings and participate in wellness initiatives is showing high levels of engagement by the workers. Experts say such cash incentives work better than premium discounts -- especially for younger workers. Will other businesses begin adopting such cash-award programs? Helen Darling, president of the Washington-based National Business Group on Health, thinks so. "We are seeing more and more of this," she says. "The reality is that cash incentives work, so if an employer wants strong participation, it will get the best engagement if it pays employees. Higher amounts yield greater participation. "My own view is that we should go with what works," Darling says, "even if we would all prefer to think that people should want to choose healthier lifestyles because they are in their own best interests ... . But given how much unhealthy employees or dependents cost an employer, such an initiative is well worth trying."
Economy continues to take toll on health
The economic downturn is taking a toll on employees' physical and mental health, a new survey commissioned by the National Business Group on Health (NBGH) finds. More than one-fourth of respondents (27 percent) report putting off treatment to save money on copayments or coinsurance costs, the survey found. One in five respondents (20 percent) skipped taking their prescription drugs Many workers, particularly older workers (44 percent of those age 45 to 64), report that their mental health has been negatively affected by the economy. Employees are more sensitive to the cost of health care, with 72 percent saying they have become more aware of the total cost of health care services in the past year, and 56 percent say they are more aware of what they pay for health insurance. Nearly all workers said they have reviewed their health plan options during their last annual enrollment period, and about one in four changed their plans. A majority of respondents (52 percent) reported that living a healthy lifestyle is more of a priority than it was a year ago. One in three (34 percent) reported exercising more. Nearly half (46 percent) say they are eating healthier, and 44 percent report eating out less at fast-food restaurants. "These data confirm that the widespread economic anxiety is cascading onto individual workers' health and well-being," NBGH President Helen Darling said. "At the same time, the data also show that workers are more aligned with businesses about cost concerns and that individuals are taking demonstrable steps to improve their own personal health." The survey, conducted in March, included 1,500 workers at companies with 2,000 or more employees. Respondents were between the ages of 22 and 69, and had benefits through an employer-sponsored or union-sponsored health plan.
Getting Healthy, With a Little Help From the Boss
Once upon a time, corporations offered generous health benefits as a way to woo employees into their ranks. Now, most companies have turned from amorous suitors into stern parents - shifting more costs, and more responsibilities, to their employees. About 80 percent of big employers offer health risk surveys, which are aimed at identifying health problems or potential health problems. And 60 percent of employers give financial incentives to employees who fill them out, according to a joint survey by the benefits consulting firm Watson Wyatt and the National Business Group on Health, an association of more than 300 large employers.
More Companies Are Paying Workers to Stay Healthy
If you're like most people, you probably have a mile-long to-do list that includes items like "Get blood pressure and cholesterol checked" and "Start walking 20 minutes per day." Who knows when you'll get around to all that? But if your employer offered to pay you cold, hard cash for taking better care of yourself, you'd probably start right now. At least, that's one finding of a new study by human resources consultants Watson Wyatt and a nonprofit outfit called the National Business Group on Health. Bent on slashing costs left and right these days, a growing number of big companies are nonetheless investing serious money in bribing, er, encouraging employees to get healthier. Nearly 6 in 10 (58%) now offer "wellness" programs, up from fewer than half (43%) in 2007; and the number of companies paying people to ditch bad habits (especially eating junk food and not exercising enough) has gone from 53% in 2008 to 61% this year. That trend seems likely to continue. Another survey, by employee-benefits experts Towers Perrin, says that, among employers who don't yet have programs in place, 33% plan to start one, and 23% say they will introduce or increase financial rewards for their employees who get off the couch and snack on peaches instead of pizza. Smart. Notes the Watson Wyatt-NBGH study: 'Companies that offer financial incentives report significantly higher participation in wellness programs.' It's the old adage in action: What gets rewarded gets done.
Health groups pledge to lower care costs
Congress Plans Incentives for Healthy Habits
In its effort to overhaul health care, Congress is planning to give employers sweeping new authority to reward employees for healthy behavior, including better diet, more exercise, weight loss and smoking cessation. A web of federal rules limits what employers and insurers can do now. Congress is seriously considering proposals to provide tax credits or other subsidies to employers who offer wellness programs that meet federal criteria. In addition, lawmakers said they would make it easier for employers to use financial rewards or penalties to promote healthy behavior among employees. Helen Darling, president of the National Business Group on Health, which represents 300 large employers, said, "We would like Congress to change the law so it would not be taxable income if an employer provides a benefit to help employees stay healthy."
HR policy high on Washington agenda
Of course, lobbying Congress on what employers expect of health care reform is bound to take center stage at any forum on employer-sponsored health benefits - especially when it's held in D.C. Also in March, the National Business Group on Health threw its Business Health Agenda conference in the nation's capital. Richard Stephens, senior vice president of human resources and administration at The Boeing Company, presented one of the keynote addresses at the three-day event. The Business Health Agenda forum also included a session that rolled out the findings from the 14th annual study on health care trends conducted by the NBGH and Watson Wyatt. Theodore Nussbaum, director of group and health care consulting at Watson Wyatt, and Helen Darling, president of NBGH, presented the research. Overall, smart employers refuse to let a bad economy stifle their efforts to stabilize their health care costs, according to the research. Best-performing employers saw a median health care cost trend of only 0.5% for 2008. Darling told attendees, many of them HR/benefits professionals, that U.S. employers can expect their health care cost trend to remain steady at 6% for 2009, although that's twice the rate of inflation. Companies that struggle with reducing their health care costs - the poor performers - can expect to see their median cost trend hit 10.5% for 2009, up slightly from 10% in 2008. That the best performers were able to cut their health care cost trend by half a percentage point, from 1.0% in 2007 to 0.5% in 2008, "tells us that the best performers have differentiated themselves to even a greater degree from all others in terms of their ability to manage two years of annual trends," said Nussbaum. Watson Wyatt and NBGH studied 489 companies providing benefits to more than 8 million individuals. The survey was conducted from November 2008 to January 2009, and the survey participants spend more than $56 billion in health care expenses each year. Some companies have aimed to hit a zero cost trend by the end of 2009, Nussbaum said.
'Meaningful use' hearing provides broad HIT dialogue
Employer Groups Express 'Grave Reservations' About Public Plan
Responding to a question by House Ways and Means Committee Chairman Charles B. Rangel last week, a lineup of powerful business groups have weighed with a letter to the New York Democrat expressing "grave reservations" about creating a new government-run health insurance plan as part of health overhaul legislation. The groups signing the letter included the Business Roundtable, the American Benefits Council, the National Association of Manufacturers, the U.S. Chamber of Commerce, the National Business Group on Health, the National Retail Federation and the ERISA Industry Committee.
Employers Need Better Data, Strategies To Reduce Disparities, Employer Group Says
The National Business Group on Health April 20 released an issue brief for employers that details how to address health disparities in the workplace, including information on collecting relevant data and implementing strategies. The brief, Eliminating Racial and Ethnic Health Disparities: A Business Case Update for Employers, also explains why it believes disparities exist among racial and ethnic populations and how employers can benefit from addressing them. "Some employers go to great lengths to attract a diverse workforce. But they may not realize that these populations have diverse health needs and may experience different treatments when they seek health care," Helen Darling, president of NBGH, said in a statement. "Despite employers' best intentions, the fact is that disparities in health and health care exist, even among employees with equal benefits." According to the brief, employers who address health disparities accrue direct benefit such as reduced medical costs, as well as indirect benefits such as increased productivity. However, employers are not necessarily aware of the benefits associated with reducing disparities, according to the brief. In a 2008 NBGH member survey, a majority of employers were "unaware of disparities as a business issue," and few had a strategy or program for reducing them. In addition, the survey showed that the primary barrier to reducing disparities is a lack of data demonstrating the problem. The brief outlines how employers can better use data, including how to collect or extrapolate relevant data and create a strategy for reducing disparities. "Recognition of health disparities should be woven into everyday work. Changing the culture to address disparities should be an integral part of mission and vision of values-driven organizations," according to the brief. Suggestions for working with employees, health plans, and other health vendors to address disparities also are included in the brief.
More Large Employers Concerned About Future of Health Benefits
The prediction that healthcare cost increases are expected to stay at the same level this year is not allaying employer fears that they won't offer the same health benefits in 10 years. Healthcare costs are predicted to rise 6% for the third straight year in 2009, which pales in comparison to the 14.7% increase in 2002. However, the 489 large U.S. employers surveyed about health benefits are still concerned whether they can continue to offer employee health benefits in a decade, according to the 14th annual National Business Group on Health/Watson Wyatt Employer Survey on Purchasing Value in Health Care. Helen Darling, president of the National Business Group on Health in Washington, DC, says many of these programs are extra services that health plans did not offer more than five years ago. "What that is saying is even in a time of severe financial stress, including a recession, employers are spending extra money in order to do these things to try to improve the health of their employees and dependents," says Darling. Nussbaum doesn't expect "radical changes," but thinks employers will adopt data initiatives, provide quality and price information, measure program ROI, remove programs that aren't producing positive ROI, and create new incentive-laden consumer-directed health plans. Employers are also linking employee health to the bottom line. The survey found agreement on the top challenge that employers face in order to maintain affordable benefit coverage. About two-thirds of large employers surveyed pointed to employees' poor health habits as the No. 1 concern, with the underuse of preventive services a distant second. "[Employers] recognize that employees' poor health habits are so important," says Darling. In the past, Darling says, employers focused on hospital and provider costs and didn't think about employee health and prevention. "They have really begun to connect the dots between costs and cost drivers, not just costs for providers . . . That's a totally different framing of it," says Darling. Darling says health insurers should learn from the results that there is a lot of work needed to fix healthcare, such as reducing waste and unneeded services. "I think the most important thing, and I think the president is saying it very well, is 'we will not be able to have a strong economy and strong country if we don't have control of our healthcare costs,'" says Darling. Though healthcare costs have increased at the same level over the past three years, Nussbaum says Watson Wyatt expects a spike soon because healthcare expenses work in cycles. "I don't know if we will get to a 15% trend again, but this is a cycle like most other economic systems," he says.
Democrats Consider Bypassing G.O.P. on Health Care Plan
With solid majorities in both houses of Congress, Democrats are tempted to use their political muscle to speed passage of health care legislation with minimal concessions to the Republican minority. That approach may be the only way they can fulfill President Obama's campaign promises, but it carries high risks as well. In the budget blueprint for the coming year, Democrats may resort to an obscure procedure known as reconciliation to clear the way for Senate passage of a comprehensive health bill with a 51-vote majority, rather than the 60 votes that would otherwise be needed. Helen Darling, president of the National Business Group on Health, said, "Most of our members are big employers, and they offer health benefits, but they do not like an employer mandate." If the government specifies a minimum package of benefits, Ms. Darling said, it could quickly become more comprehensive, without any significant cost controls. Many lawmakers have promised to give all Americans access to the same health insurance they have as members of Congress. But the package of benefits available to Congress and other federal employees is more generous and more costly than what many private employers offer.
Racial, ethnic care disparities still exist: NBGH
Well-being indices next on stock ticker?
The wellness industry is moving toward creating well-being indices similar to a consumer-price index or Dow Jones indices. Some wellness experts believe that U.S. employers eventually will have access to daily and monthly well-being indices that capture and forecast, through statistically valid numbers, the physical, psychological and social health of the American workforce. This could create, for example, a possible scenario in which 21st-century executives will tell bankers that their company deserves a higher line of credit than its competitors, given that the organization has a higher well-being index score, demonstrating that it's more productive and likely has lower heath care costs. The industry is still in the early stages when it comes to a well-being index that captures a single number that represents multiple measures everyone can understand and relate to, says LuAnn Heinen, health vice president at the National Business Group and director of its Institute on the Costs and Health Effects of Obesity. Yet rolling up, on a daily basis, national health and wellness data into one valid indicator is a great concept, because everyone who works in benefits and wellness wants to reach the C-suite, and anything that helps put employee health on the radar is a good thing, Heinen asserts.
Coalition Outlines Reform Agenda Based on Improving Health Care Quality
The Department of Health and Human Services should provide $100 million a year for research to discover the most effective methods for measuring, reporting, and paying for quality improvements in health care, according to a March 24 report from a coalition of employer groups, health plans, public agencies, and consumer and health care organizations. The 165-member coalition, Stand for Quality in Health Care, identified six objectives for health care quality improvements in the report, Building a Foundation for High Quality, Affordable Health Care: Linking Performance Measurement to Health Reform. Business groups, such as the American Benefits Council, the National Business Group on Health, and the U.S. Chamber of Commerce, are members of the coalition that produced the report.
More Support for Health-Care Fix
Recent movement on Capitol Hill and by major health-care players suggests that consensus is growing for action this year, but deep rifts remain over how to pay for expanded coverage and whether a new government-sponsored program should be offered to people who have trouble buying private insurance. A coalition of hospitals, insurers, employers, physicians, drug makers and consumers released a report yesterday endorsing a set of policy changes that could cut in half the number of uninsured Americans. White House Chief of Staff Rahm Emanuel authorized House leaders to move ahead with the strategy, which several Democratic sources have described as a "fallback" in case Congress does not reach a bipartisan compromise over the summer. Helen Darling, president of the National Business Group on Health, said her members did not object to the strategy. "What we want is for reform to happen this year," she said, referring to growing concern in the business community that soaring health costs are hurting U.S. global competitiveness.
Employers getting more strict on health-care eligibility
Facing a difficult economy and running short of ways to reduce health-care costs, employers are becoming more aggressive about checking the eligibility of their workers' dependents. A Watson Wyatt survey of 489 employers this month for the National Business Group on Health found that audit reviews are the fastest growing change that companies are making to their health-care programs, well ahead of health risk appraisals or improving case management.
Large Employers Generally Favor Status Quo, Oppose Major Reforms
Large employers, especially those that are successfully controlling their employee health care costs, oppose many of the reform proposals that are on the table in the current health care reform debate, according to survey results released March 12 by Watson Wyatt and the National Business Group on Health.
Wal-Mart lends muscle to health reform
Wal-Mart is ramping up its Washington activity to push for comprehensive health care reform, and the world's largest retailer says it is ready to use its economic muscle to get out in front and influence the discussion. "We're willing to take a stand independently and not just do it through our associations," said Linda Dillman, the retail giant's executive vice president of benefits, who was in town last week with a posse of Wal-Mart employees bending ears on Capitol Hill. Long a target of complaints from labor, environmental and health care activists, Wal-Mart has been trying to rehabilitate its reputation in recent years by going green in its stores and becoming more employee-friendly. For instance, the company has begun offering employees a broader range of low-cost insurance options and, as part of its health care reform campaign, is pushing for greater use of electronic medical records - and helping doctors pay for the upgrade. The company began its congressional outreach last summer with regular Washington visits, and its officials and employees have dropped in on about 75 lawmakers' offices since then. Chief Executive Mike Duke has talked with both House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid, according to Dillman. And last week, Dillman gave a keynote speech to the National Business Group on Health, which represents large employers in the health care debate.
Worker Wellness Programs Could Lower BMIs, Bottom Lines
In today's volatile economy, corporations must train a watchful eye on costs to keep their doors open and their employees on the payroll. Obesity-related medical spending often constitutes a major business expense, at a cost of about $45 billion annually for private employers. However, a new analysis suggests that investing in employer-sponsored health programs could improve companies' bottom lines by reducing medical claim costs. "It's a win-win opportunity - employers and employees can benefit from a healthier workforce," said LuAnn Heinen, vice president of the National Business Group on Health and the article's lead author. Heinen and coauthor Helen Darling analyzed four employer-sponsored wellness programs targeting a combined 75,000 employees. The findings appear in the March issue of The Milbank Quarterly. One program, a hospital system that offered free annual health checks, Weight Watchers at Work and an on-site fitness facility, reported direct cost savings - a 40 percent drop in medical costs over a three-year period for the 324 participating employees, a savings of more than $1 million, Heinen said. "The most advanced and successful approaches go beyond assuming that obesity starts and ends with personal responsibility," Heinen said. In another program sponsored by a utility company with 6,000 employees, 352 employees lost an average of seven pounds during a 12-week weight management program at work. A food manufacturer with 27,000 employees ran a program that featured a weight-loss competition. In 2005, 23 percent of employees who participated had a body mass index (BMI) greater than or equal to 30 (considered obese), but by 2008, only 6 percent of participating employees had a BMI in that range. What's the bottom line? Workplace programs had positive results when they took a multipronged approach - including offering healthy foods in the cafeteria and vending machines, providing physical activity opportunities and fostering a workplace culture that supports health, Heinen said. Jennifer Huberty, Ph.D., assistant professor of physical activity in health promotion at the University of Nebraska at Omaha agreed with the authors' recommendations that environmental changes are vital to the success of workplace wellness programs. However, she discouraged the authors' suggested use of incentives, such as offering cash or insurance premium discounts. "It can manipulate someone to do it for a little while, but will they continue?" Huberty said. "Employers have to ask themselves, 'Am I teaching a behavior that is going to be used for a long time?'" For cost-conscious companies, implementing obesity prevention at work need not be prohibitively expensive, Heinen said. She recommended creating a wellness committee, led by employees who have had success in health and fitness. From there, employers can take simple steps, such as requiring vendors to provide healthy snack options and providing pedometers to employees to encourage physical fitness, she said.
Baucus seeks employer input for health system
National Business Group on Health Honors Outstanding Leaders for Excellence and Innovation in Value Purchasing
WASHINGTON, DC - The National Business Group on Health (NBGH), a non-profit association of more than 300 mostly large employers, today announced the winners of its 2009 Award for Excellence and Innovation in Value Purchasing recognizing individuals for outstanding contributions to the field of health and productivity. The awards, the highest honors given each year, were presented to Dr. Pamela Hymel of Cisco Systems and Dr. Catherine Baase of The Dow Chemical Company, at the National Business Group on Health's Business Health Agenda conference in Washington, DC. "We are very pleased to honor Drs. Hymel and Baase for the outstanding contributions that both of these physician executives have made to the field of health and productivity," said Martín Sepúlveda, MD, FACP, Vice President, Integrated Health Services at IBM, member of the Business Group's Board of Directors and Chair of its Award Committee. "Both recipients are clearly leaders, innovators and visionaries in health and productivity, and our award committee is proud to recognize both individuals." Dr. Hymel, senior director of integrated health and corporate medical director at Cisco Systems, was honored for the leadership role she has played in designing and implementing two major health and productivity initiatives at Cisco -- HealthConnections and LifeConnections Health Center. HealthConnections is a health and productivity program that invigorates and inspires Cisco employees and their families worldwide to enhance their health and well-being through a network of healthcare providers, disability management, workplace resources, food services, fitness centers and other resources. LifeConnections is an innovative onsite medical facility on Cisco's San Jose campus that provides a wide range of services including primary medical care, routine physicals, laboratory services, physical therapy and health coaching. Dr. Baase, global director of health services at The Dow Chemical Company, was honored for the many contributions she has made over the years at Dow and specifically for her contributions to the development and implementation of Dow's Health Strategy. Health is a strategic priority for Dow, which focuses on the four pillars of the strategy: prevention, quality and effectiveness, health system management and advocacy. At Dow, health spending is regarded as an investment rather than a cost. Through Dr. Baase's dedication to the health of Dow People, there is a stronger commitment to building solutions which create a healthier workplace culture. "As health care costs continue to spiral, employers increasingly are placing a greater emphasis on programs to create healthier and more productive workforces," said Helen Darling, President of the National Business Group on Health. "The research, innovation and leadership that these two outstanding visionaries share will go a long way toward advancing this extremely important field of health and productivity throughout corporate America. There has never been a more important time to honor excellence in the management in human capital since it will be intelligence, innovation and resiliency that will bring us out of these challenging times. We congratulate them on their achievements and are proud to honor both individuals."
New Employer's Guide to EAPs Out Today
"An Employer's Guide to Employee Assistance Programs" is a new document being released today by the National Business Group on Health, an association of more than 300 large employers. The organization's president, Helen Darling, will announce it at the National Press Club today along with Kathryn Power, director of SAHMSA's Center for Mental Health Services, and Paul Heck, manager of global employee assistance & worklife services for DuPont Company. NBGH says the guide was developed after a study of best practices and evidence-based approaches to the design and delivery of effective and efficient employee assistance programs. Funded by the Substance Abuse and Mental Health Services Administration and conducted by NBGH's Employee Assistance Workgroup, a 27-member committee of EAP, behavioral, and mental health services experts, the study took almost two years. "For decades, EAPs have been providing value to employers, employees, and families with various services. In fact, one can see their value by the increase of utilization of services during this recession," Darling said. "Despite this recognition of the value of EAPs, there is a continued lack of definition, coordination, and the rigorous cost-impact assessment necessary for employers and their employees to understand and derive full benefit from EAPs." NBGH created the EAP Workgroup to develop recommendations to improve the coordination and integration of employee assistance programs. The group believes aligning an EAP with an organization's values and vision generates a positive return on investment, improves business operations and employees' experience, and bolsters community perceptions of the company. "Mental health and substance-use conditions continue to be among the leading causes of illness and lost productivity for most large employers," said Power. "EAPs represent a first-line response to providing prevention, triage, and short-term problem-resolution services within an organization. As such, they enable employers to leverage the value of their investment in their workforce, address the costs of doing business, and mitigate business risks." For a copy of the guide and more information about EAPs, visit www.businessgrouphealth.org.
Obama Rounds Out His Health Care Team
President Obama has chosen two officials experienced in health policy to lead his efforts to overhaul the nation's health care system: Kansas Gov. Kathleen Sebelius to be secretary of health and human services, and former Clinton administration health staffer Nancy-Ann DeParle to head a new White House Office for Health Reform. Unlike the president's first choice to head up the effort -- former Senate Majority Leader Tom Daschle, who dropped out in the wake of tax problems -- Sebelius and DeParle aren't that well-known outside health policy circles. But within the community of those who work on health care, both are highly respected. "They both understand the intricate issues around health care policy, they understand the issues around politics, and they understand what the people of America need in a health care plan that is American," said Anna Burger, secretary-treasurer of the Service Employees International Union. That sentiment was echoed by Helen Darling, president of the National Business Group on Health: "Both appointments are people who have proven themselves; they have track records." Sebelius, 60, is no novice when it comes to health care. Before being elected governor, she spent eight years as Kansas' insurance commissioner.
Obama picks Sebelius to head HHS
President Barack Obama on Monday nominated Kansas Gov. Kathleen Sebelius to be secretary of the U.S. Department of Health and Human Services, and he announced the release of $155 million in stimulus grants to support community health centers. Sebelius' selection received good reviews from organizations that will be involved in the health care reform debate. Helen Darling, president of the National Business Group on Health, said Sebelius blends a highly regarded expertise in insurance regulation with a well-grounded pragmatism that will serve our nation well.
Employers Expect Health Care Cost Increases To Hold Steady At 6% This Year, According To Survey
U.S. employers expect increases in health care costs to remain at 6%, twice the rate of inflation, and more will offer consumer-directed health plans in 2010 in an effort to control costs, according to a Watson Wyatt and National Business Group on Health survey released Thursday, Reuters reports. Ted Nussbaum, a group and health care practice expert at Watson Wyatt, said, "Cost increases have stabilized, but the financial crisis is causing many companies to re-evaluate their health plan strategies."
Healthcare cost increases remain steady
Healthcare winners and losers
Some lawmakers wanted to make the COBRA subsidies available to people who lost their jobs before September. But such a move would have faced resistance from employers who have long been wary of the administrative burdens of keeping former employees on their health plans. Some companies already encourage employees and their families not to use the health plans they offer. Business groups successfully beat back a proposal by House Democrats to allow unemployed workers over 55 to pay to keep their employer-based health insurance for up to 10 years until they qualify for Medicare. "COBRA should not be regarded as a source of long-term coverage," Helen Darling, president of the National Business Group on Health, wrote lawmakers last month, warning it would push up healthcare costs for existing employees.
Healthcare Stimulus Provisions
Comparative Effectiveness Research The stimulus legislation will also establish a Federal Coordinating Council for Comparative Effectiveness Research -- a 15-member board composed entirely of federal employees appointed by the president. Spending authority of the proposed $1.1 billion-funded council would be held by the Health and Human Services Secretary to investigate the effectiveness of different drugs and medical devices. Helen Darling, president of the National Business Group on Health, based in Washington, says this represents a positive benefit to employers. "This is very important to employers because it would help them determine what is effective medical care and what isn't," she says. "It would help us determine if we're paying for things that are not effective or that are ineffective." "Without independent, reliable information comparing clinical effectiveness of alternative treatment options, patients may not get the right care they need at the right time," says Darling, whose organization represents about 300 large companies and shares best practices related to healthcare. The determinations of the board will directly impact which medical treatments the federal government will or will not pay for. House Appropriations Chairman Rep. David Obey (D., Wis.) indicated that drugs and treatments "that are found to be less effective and in some cases, more expensive, will no longer be prescribed." That bothers some observers, who believe the council may at some point prevent patients from receiving the medical procedures they need because of cost. Critics of the council say this type of research should be conducted within the private sector to ensure the personal freedom of patients to choose the healthcare options that -- in the opinion of their medical providers -- best meets their needs. "The health-related provisions take a sharp turn toward greater government control over our health sector, without any hearings or serious debate in Congress and without telling the American people what the changes would mean for their personal healthcare," write William Winkenwerder, Jr. and Grace-Marie Turner in an article on National Review Online. Winkenwerder is a former assistant secretary of defense for health affairs in the U.S. Department of Defense. Turner is president of the Galen Institute, an Alexandria, Va.-based think tank specializing in health reform. "This is the biggest land grab in the health sector ever attempted by the federal government, and it would be a major step toward thrusting full responsibility for healthcare financing onto the American taxpayer -- today and for decades to come," they write. Darling says that, in addition to the funding for comparative research, "there are also funds in there for prevention and wellness, which I think will indirectly benefit employers." John Heins, senior vice president and chief human resources officer for Spherion Corp., a staffing and solutions company based in Fort Lauderdale, Fla., also says the research is a welcome addition. "We have experienced the positive aspects of providing preventative care which results directly in reduced cost related to critical disease state cases," he says. COBRA The biggest benefit in the recovery package is COBRA assistance subsidies to unemployed workers, says Darling. Anyone who lost their job involuntarily between Sept. 1, 2008 and Dec. 31, 2009 will be eligible for a premium subsidy of 65 percent for up to nine months. "The moment of eligibility starts as soon as the president signs the law, whether you initially turned it down or not," says Darling.
President should light the smoke-free path
Employers see advantages of onsite health clinics
Last March, 29 percent of large companies in one survey said they already have a clinic or planned to have one by 2009. That was up from 27 percent in 2006, according to the Watson Wyatt/National Business Group on Health research.
Audit of dependent health coverage is common in private sector
Helen Darling, president of the National Business Group on Health, a nonprofit organization that advises companies on health care issues, said employee audits for health coverage have been what is known as a "best practice" in the private sector for years. "What happened is the private sector moved on it very quickly and it's very common now," Darling said. "About seven years ago employers began discovering, as they were looking at all the ways they might control their costs, one of the ways was to make certain you're not paying for someone who's not an eligible employee or dependent." The state launched its audit at the end of January when a benefits management consultant it hired began sending out letters to 25,000 state employees asking them to provide income tax returns and other documentation to verify the status of the dependents receiving coverage. Another 200,000 letters are to be sent out in the coming months so all state and local government workers, as well as school and college employees, will have been surveyed. The Division of Pensions and Benefits has cited estimates that there may be as many as 10,000 to 15,000 ineligible dependents and terminating their health coverage could save the state as much as $185 million over five years. The state believes some common examples of ineligible dependents are spouses who have divorced or children who have married or are no longer enrolled as full-time college students. Ronald Adler of Laurdan Associates, a human resources consultant in Potomac, Md., said he was surprised by the size of the state audit. "That's a pretty significant audit," he said. "You normally wouldn't start with doing everyone at that size. I would think they would start with a randomly selected audit that would give them a statistically significant outcome so that they could say we're certain within plus or minus five percentage points that we've identified the problem." Some human resources experts said merely announcing an audit is often enough to rid the health coverage rolls of ineligible dependents. "If an employer notifies an employee that an audit is going to take place, some employees just react by updating their dependents," Stearns said. Fear of job loss can be a powerful incentive to be honest. "For the most part, for these people, this is their jobs," said Darling. "The one thing you have in a work situation is if you get caught, you'll be fired if you lie, if you commit fraud. You could actually go to jail, but you'll certainly be fired."
More Smokers Quit if Paid, Study Shows
According to the federal Centers for Disease Control and Prevention, which helped fund the study, smoking costs companies about $3,400 per smoking employee annually, or about $7.18 per pack of cigarettes, in health-care bills, reduced productivity and absenteeism. The study "shows that incentives work," said Smokers who are paid to quit succeed far more often than those who get no cash reward, according to a new study that provides some of the strongest evidence yet that financial incentives can help change such behavior. The study, one of the largest of its kind, comes at a time when more employers, schools and other institutions are paying people to do everything from lose weight to improve their grades. The latest findings were published in this week's New England Journal of Medicine. Steven Schroeder, director of the Smoking Cessation Leadership Center at the University of California, San Francisco, who wasn't involved with the research. Helen Darling, president of the National Business Group on Health, a professional organization, said the findings give employers solid evidence that such incentives can help them save money on health-care costs for employees. "You'd prefer not to pay them, but it's worth it," she said.
Appeals Court Rules That Consumer Group
Helen Darling, president of the National Business Group on Health, a national nonprofit organization representing large employers in Washington, told BNA Feb. 2 that her organization is disappointed with the appeals court decision, although the decision was made on a pretty narrow ground. For most jurisdictions, there is not enough data for accurate information and employers, health plans, or anyone looking at the larger database needs more information, she said.
Senate Passes Health Insurance Bill for Children
The Senate overwhelmingly approved legislation yesterday to provide health insurance to 11 million low-income children, a bill that would for the first time spend federal money to cover children and pregnant women who are legal immigrants. Both sides had hoped, and even predicted, that early bipartisan action on children's coverage would demonstrate that Washington's elected officials can cooperate on critical issues such as health care. "This is on something for which there is so much agreement and something that almost no one argues about," said Helen Darling, president of the National Business Group on Health, which represents 300 large employers. "For the tough things like real national health-care reform, it unfortunately portends a really rocky road."
Retaining Healthcare Coverage
Although Congress' proposed economic stimulus package is designed to help spur the ailing economy, critics say one item in the package may end up hurting employers. Specifically, the proposal to subsidize COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage for laid-off employees may impose more burdens on companies. Helen Darling, president of the National Business Group on Health in Washington, says her organization is supportive of COBRA subsidies so long as the legislation gives employees the option of immediately enrolling in a cheaper plan offered by their employer rather than having to wait for the next open enrollment period to do so. "We could reduce the costs to employees and employers if we gave them this option," she says. "Laid-off workers might prefer a less-expensive plan than the one they had when they were employed." According to Darling, the actual cost of COBRA coverage can be as high as 133 percent to 150 percent of the average employer-plan costs, with the extra costs borne by employers and active-employee enrollees.
COBRA Proposal Could Counteract Loss of Coverage
This provision has already elicited a strong reaction from employers. Helen Darling, president of the National Business Group on Health (NBGH), sent a letter to Rep. Charles Rangel (D-NY), chairman of the House Ways and Means Committee, complaining about the potential cost of the COBRA expansion. While NBGH supports temporary subsidies for COBRA premiums, she wrote, her group opposes the extension of COBRA until laid-off employees find a new job with insurance or become Medicare-eligible. She offered two reasons: the cost of retaining former employees in group plans increases as they grow older, and the administrative cost of doing so would mount over time, "at the expense of current employees and their employers."
Large Employers Outline Stimulus Priorities, Urge Action on Health IT, COBRA Subsidies
The National Business Group on Health Jan. 12 outlined health care-related priorities for the economic stimulus package that include temporary subsidies to help the unemployed pay for health coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). NBGH, which represents 300 large employers, also called for investments in health information technology (HIT) and funding for comparative effectiveness research. Helen Darling, president of NBGH, said in a letter to Senate and House leaders that "investments that increase productivity, improve quality, and eliminate waste in health care will aid in the economic recovery and set the stage for responsible long-term growth." COBRA Subsidies. COBRA allows a worker who loses health coverage to temporarily continue employer-sponsored benefits provided that the worker assumes responsibility for the full premium cost. Darling said at a briefing for reporters that stimulus negotiators are considering proposals that would pay for somewhere between 50 percent to 65 percent of COBRA premiums--allowing those who lose their jobs to maintain coverage because the costs otherwise might be unaffordable. "If it's not a pretty high subsidy, people are not going to take it," she said. NBGH also recommended in its letter that Congress consider letting former workers choose a less-expensive benefits package for their COBRA coverage--which would result in lower premiums--rather than requiring them to continue the same coverage they previously had. In addition, NBGH cautioned that COBRA should not be considered a long-term source of coverage, nor should a subsidy provision increase employers' administrative costs. Health IT. Darling also told reporters that the $20 billion to $50 billion under consideration for investment in HIT funding would be an appropriate down-payment on improving the nation's electronic infrastructure. Any provisions included in the stimulus should require HIT systems to meet interoperability standards and focus on small practices that are "the least likely to be able to afford the upfront capital costs for HIT or have the resources for training and time off to transform their practices," according to the letter. In addition, the letter called for the federal government to set a timetable for interoperability standards "if the private sector does not establish them by consensus in a timely way." Darling said it is possible, and necessary, for private stakeholders to move faster on developing such standards--and that they will if forced to work on a timetable. "We can do things when somebody says we have to," she said. The letter also called for the Health Insurance Portability and Accountability Act (HIPAA) to serve as the privacy and security standard for HIT. Comparative Effectiveness Funding. NBGH also recommended a boost in federal funding for comparative effectiveness research done through the Agency for Healthcare Research and Quality. Though no proposal for including such research in the stimulus package has been released officially, Darling said she anticipates its inclusion under the broad category of medical research funding. In NBGH's letter Darling also said that Congress should avoid "simply pouring more federal dollars into an overcapitalized--and often wasteful--health care industry without any assurance the funds will improve the efficacy of health care." For example, Darling cautioned against providing money for hospitals' capital projects that are not truly needed just because the plan is ready to go. In addition, Darling said the priorities outlined by NBGH should not be lost in the shuffle of projects that may be perceived as more exciting, such as massive infrastructure projects. "This is a war. We are in war for our economy," she said.
On- and near-site clinic slowdown could hurt access: AAFP president
Health technology may get massive investment, though concerns persist
The Obama transition team and Congressional Democrats plan to invest tens of billions on health information technology in the economic stimulus plan now being fashioned on Capitol Hill, even as a growing number of specialists raise concerns about the ability of existing electronic records systems to share information and help doctors treat patients. Helen Darling, president of the National Business Group on Health -- a voice for large corporations on healthcare issues -- told reporters in a lunchtime briefing today that at this point, those involved in crafting the legislation plan to include $25 billion to $50 billion for health information technology. In a report last week, the National Research Council identified grave shortcomings in existing health information technology software. The council said medical software is unnecessarily complicated to use -- far more difficult than conventional office software -- and it focuses on accumulating small bits of patient data rather than interpreting that information to help doctors take care of patients in a more sophisticated and effective way. Implementing the technology before it is substantially improved, the report said, could actually hinder progress toward a top quality wired system. Other health technology experts, including a leading technology adviser to the American Academy of Family Physicians, have also warned the Obama transition team that different brands of electronic medical records do not mesh well, despite government standards that are supposed to guarantee easy exchange of information. Two doctors in the same town often cannot exchange full patient records easily, even if their offices are wired. Darling said she strongly believes Congress must get tougher on the industry, which she said could move far more quickly if forced to do so. "We are in a war for the recovery of the United States economy," she said. "We should have the same attitude towards all these things we would have in war, which is, we don't have time..... Getting some of these problems resolved is more important than anyone's narrow interest." She also said that those working on the health stimulus legislation hope to include $1 billion for comparative effectiveness research, which seeks to advise doctors on the best course of treatment for sick patients based on all available scientific research. They also plan, she said, to subsidize at least half of COBRA insurance premiums for the unemployed, who must now pay the entire cost of their health care -- more than $12,000 a year for the average family -- if they wish to keep the insurance they had at their former job.
Big Employers Back Health Cost Measures in Stimulus Package
The National Business Group of Health (NGBH), which represents many if not most of the nation's biggest companies, urged President-elect Obama and congressional leaders Monday to include investments in comparativeness effectiveness research and health information technology in the economic stimulus package now being drafted on Capitol Hill. The organization, which represents 300 large employers including 63 of the Fortune 100 companies, also urged policy makers to include subsidies to help newly jobless workers pay premiums for health care coverage available under COBRA, a law that guarantees many workers who have lost their jobs continued access to their health coverage at group rates provided they pay the full cost themselves. While group rates are often lower than rates on the market for non-group insurance, they are nevertheless unaffordable for many people who have lost their jobs. COBRA subsidies would reduce premium costs to workers. Congress should begin addressing health care quickly in the stimulus package rather than delay, NBGH President Helen Darling said in a letter Monday to congressional leaders. "We must tackle these extraordinarily complex issues now because the nation will not be able to pull out of this deep recession while health care costs continue to work against businesses' ability to grow jobs and compete globally," she said. Big employers are a powerful force in health care policy, and helped derail President Clinton's health overhaul plan in 1994. NBGH, whose members cover some 55 million workers, describes itself as the only national organization representing large employers that focuses exclusively on health care issues. Darling said at a mid-day press briefing that the inclusion of various health care provisions in the stimulus would not take the steam out of efforts later for a larger overhaul. "There'll be plenty of pressure for health care reform," she said. She described herself as "very optimistic" about the chances for a broader overhaul later, calling Obama's health appointments thus far first rate. "I've never seen such a good collective package" of such appointments, she said. In a letter to congressional leaders, Darling specifically endorsed an increase in the stimulus in federal funding of comparativeness effectiveness research overseen by the Agency for Health Care Research and Quality. The research helps "determine the best course of treatment. It improves quality and reduces health care costs as less effective, unnecessary and duplicative health care services are eliminated," she said. Darling said at the briefing that the absence of a broad set of "interoperability" standards to ensure that health IT systems are compatible should not be a reason to keep health IT funds out of the stimulus. A major hospital group also weighed in Monday in support of including health IT money in the stimulus. (See related story, CQ HealthBeat, Jan. 11, 2009)\ "Health IT is an area where there are a lot of different ways to spend money and still be effective," she said. Funds could be spent on technology where standards do exist and the industry could be prodded to move quickly to adopt more standards, Darling said. "We can do things when somebody says we have to," she said, adding that "we are in a war. We are in a war for our recovery." Darling said that COBRA subsidies would have to cover most of the costs of health coverage because the unemployed wouldn't be able to afford it otherwise. She said the subsides would be a very expensive part of the stimulus package but that workers need to be able to maintain access to health care services. She noted that under the COBRA law now, employees have to stick with their current health plan until the company's next open enrollment period. Congress should consider changing the law to let workers pick a cheaper health plan offered by their employer, she said.
Employer Groups Push for Health Care Reform, Reject Mandatory Employer-Provided Insurance
Employer groups are pushing for health care reform to be part of the massive stimulus package being crafted by the incoming Barack Obama administration and Congress. The National Business Group on Health endorsed the incoming Obama administration's plans to spend $50 billion over five years to expand health information technology, including digitizing all health records by 2014. That date was also set by the George W. Bush administration. The group also supported spending part of the $775 billion proposed stimulus bill to help laid-off workers maintain their company health insurance. Helen Darling, president of the National Business Group on Health, whose members include 63 of the Fortune 100 companies, said the legislation in the stimulus bill should provide funding for doctors in small practices to set up health IT that works across various computer systems. Darling acknowledged that federal aid to help the jobless maintain their company health plan, known as COBRA, would add substantially to the stimulus price tag. With all the emphasis on "shovel-ready" infrastructure and other capital projects, Darling urged Congress not to lose sight of the benefits of spending on medical research that could result in better treatment and lower costs. "It could get lost in the shuffle," she said. Health IT and research spending "increases the productivity of the economy."
NBGH backs temporary COBRA subsidies
Improving health at the office
As a remedy to rising health care costs and lost worker productivity, a growing number of employers are building on-site medical clinics. In fact, a study by Watson Wyatt Worldwide and the National Business Group on Health found that 29 percent of companies in the United States plan to have a health center on-site by 2009.
50 Ways to Improve Your Life
More employers are paying workers to take a physical, get cancer screenings, eat well, exercise, and take better care of themselves. Irene Gernon of Harrison, N.Y., pocketed $200 from her employer, PepsiCo, in 2008 by completing a personal health assessment and entering a smoking cessation program. She also avoided a $600 surcharge on her health insurance by completing the antismoking program. Gernon figures PepsiCo has paid her $500 in recent years to eat healthfully and adopt other good habits. "I've saved a lot of money. I think it's great," says Gernon, a PepsiCo executive assistant. Gernon, a 30-year, three-pack-a-day smoker, has been smoke free for nearly a year. "I've never felt better," she says. Paying workers to adopt more healthful lifestyles helps the company bottom line and workers' pocketbooks, according to PepsiCo, which also pays employee spouses up to $400 per family per year for participating in a variety of wellness programs. "Good health is its own reward, but incentives help," says Greg Heaslip, PepsiCo's benefits vice president. Even in the recession, employers say offering financial incentives makes sense: It can lower the rate of health insurance premium hikes. While most large employers saw premiums rise 6 percent or more in 2008, premiums at PepsiCo remained flat. Benefits consultant Mercer reports that more than one third of large employers are planning to offer such financial perks in 2009. The National Business Group on Health says half of its members, some of the nation's largest companies, will offer payment for healthful behaviors. The rewards come by way of cash, gift cards, lower health insurance premiums or copays, or prefunding of health accounts workers can use to pay deductibles and other health costs, which is how PepsiCo structures its rewards. Which behavior gets rewarded varies by firm, so check with yours, but options can include annual checkups, filling out health questionnaires, joining wellness or disease management programs, or even participating in team-based health competitions.
At National Conference, MetLife Unveils Research; Uncovers Four Employer Types for the New Economy
Yesterday, at the National Business Group on Health's 22nd National Conference on Health, Productivity and Human Capital in San Diego, California, MetLife vice president Ronald Leopold, M.D., unveiled proprietary research that identifies how employers fall within four key profile types when it comes to workplace benefits investments and strategies. The implications are that understanding one's profile can help employers maximize the return on their benefits investment, which has become increasingly important in these challenging economic times. The research looks at benefits optimization, especially in the context of a new framework that challenges traditional notions of medical, retirement, work/life balance and benefits administration.
Stop the bleeding
Many large employers are counting on disease management programs to help them control health care costs. Despite the investment, premiums continue to rise Return on investment Helen Darling is president of the District-based National Business Group on Health, which has 300 members, including 64 of the Fortune 100. Virtually all of these employers offer disease management for at least three conditions, and many cover five. Depression and asthma are the most common conditions excluded, she said, because there's not as much evidence that the intervention is cost-effective. Her members find the money they spend on disease management does provide a good return on investment - sometimes $3 in savings for $1 spent. But because emphysema, type II diabetes and heart disease often become more severe after age 55 - and because not everyone makes the changes to improve their health - the numbers of workers who avoid hospitalization is small compared to the size of the workforce. Darling estimated the savings might represent 0.1 or 0.2 percent of the total. Missed targets But it's not that easy. Medicare's fee-for-service division ran a three-year large-scale random trial of disease management with eight vendors - including XL Health. Not only did the program not reach its target of 5 percent net savings, but in preliminary data, Medicare spent 5 to 11 percent more on the 68,000 patients. Some of those patients lived in Montgomery and Prince George's counties. Darling, of the National Business Group on Health, believes efficient disease management does save money, but said, "The unfortunate thing is it is not likely to be well-run [in Medicare], but the theory is good."
Change in federal law could mean small companies will take a big hit on insurance rates
When it goes into effect January 2010, the Mental Health Parity Act will exempt businesses with fewer than 50 employees, but those just above that level may be facing a Hobson's Choice -- either significantly upgrade their mental health and substance abuse coverage, or drop it altogether. "For people who need mental health treatment, it [the new law] is definitely a win because it will be easier to get appropriate care," said Steven Wojcik, vice president for public policy for the National Business Group on Health in Washington, D.C. "But for those smaller employers, it's definitely going to make health-care costs more expensive, so those employers operating at the margins may have a hard time continuing to offer those benefits." Here's why: While it's not unusual for a small- to medium-size employer to offer unlimited outpatient visits for a physical ailment, doing the same for mental health and addiction treatment can add significantly to a company's health premium. The same may hold true for inpatient hospitalizations. For a large employer, many of whom self-insure, the risks and costs are spread out enough to be manageable. For a small-to-medium size business, both risk and cost can look daunting. "Probably what's going to happen is that the substance abuse treatment benefit will become more generous," said Mr. Wojcik. "I can't imagine you would have limits on outpatient services for conditions like stroke, diabetes or asthma." Under the new law, he said, if you don't limit rehabilitation services for a stroke, you can't limit them for mental health or substance abuse either. "The timing is certainly not good, and it's ironic that this was attached to the bailout bill. The last thing you want to do is to raise labor costs at a time of rising unemployment."
Democrats may tax health benefits
Helen Darling, president of the National Business Group on Health, a nonprofit that represents the perspective of large employers on healthcare issues, said her members would oppose any dramatic changes in the tax treatment of employer-sponsored insurance. "If you were starting from scratch 40 years ago, a cap wouldn't have been a bad idea, but we have a system already in place," she said. "A very significant number of people in the country will have their benefits taxed at the very time they can't afford another financial hit." She also noted that a cap would hit Boston-area residents particularly hard since the cost of healthcare is much higher in Massachusetts than it is in most of the rest of the country.
U.S. 'Not Getting What We Pay For'
Moving from pricey, high-tech solutions such as MRIs to older, low-tech approaches such as physical therapy requires solid data and a culture change, said Helen Darling, president of the National Business Group on Health, which represents large employers. Americans are attracted to innovations, regardless of cost or whether they have been proven to achieve results. A whole-body scan that is covered by insurance may seem like a bargain, Darling said. "But one way or another we're all paying" for it in higher premiums, increased government expenditures and even false-positive results that lead to more costly, invasive procedures. The members of Darling's group are in the vanguard of a movement toward comparative effectiveness research, which evaluates various drugs, devices and treatments and publicizes which work best and at what cost. Ideally, doctors and patients armed with that data could make more rational decisions -- such as whether to choose a more expensive, but therapeutically equivalent, medication.
Getting the Wellness Message Right
Whether you're launching a wellness initiative or kick-starting an existing program, you've got to get the message right. Here's what experts say about effectively communicating your efforts: "The 'what's in it for me?' message has to be clear," said LuAnn Heinen, a vice president and director of the National Business Group of Health's Institute on the Costs and Health Effects of Obesity in Minneapolis. Increasingly, she said, that involves some kind of incentive, monetary or otherwise.
Trying to Hit a Moving Target
The same strategies that helped supersize the American workforce are being used to slim it down. Employers and the health-care management companies they hire are using data on consumer behavior to cost effectively identify employees with health risks and craft a message that can get them to change their unhealthy ways. "It's not that [incentives] don't work, it's just that behavior change is really hard," said LuAnn Heinen, vice president at the National Business Group on Health in Washington. "It's really important to us and our work to understand what will be effective, because a lot of employers are putting a lot of investment and attention into this issue." Health experts believe that companies may rely too heavily on financial incentives to get people to enroll in programs, while doing little to keep them involved long enough to change their behavior. That, after all, is the ultimate measure of a program's success.
New Cessation Site Coincides with 33rd Great American Smokeout
The non-profit National Business Group on Health (NBGH) launched a new Web site yesterday titled The Business of Quitting, promising it will be the definitive site for U.S. employers interested in helping their workers quit smoking. Yesterday was the 33rd Great American Smokeout, a day when the American Cancer Society (ACS) encourages people to commit to making a long-term plan to quit for good. Most smokers can't quit the first time they try, NBGH officials and leaders who support the new site agreed. "Helping employees quit smoking is a win/win proposition for employers and employees, as well as their families," said Helen Darling, president of NBGH. She said the new site will help all Americans, because even non-smokers can be exposed to tobacco smoke. Smokers' children are healthier when the parents quit, she added. American companies spend about $167 billion per year on health costs and lost productivity related to smoking, according to NBGH.
Depression Influenced by Industry
Working in the arts, retail or utilities industries can be depressing for workers, although the current economic turmoil will have an impact on everyone. Employers would be wise to put some resources toward combating the problem, as the costs of doing nothing are very high. Just how costly depression is to an organization was the focus of an earlier study by Ron Finch, a vice president at the Washington-based National Business Group on Health. That study, Employers' Guide to Behavioral Health Services, 2005, found a depressed person loses 2.2 hours of productivity per day and costs U.S. employers $12 billion a year, also in lost productivity. Given the current economic crisis, says Finch, who focuses on mental health and workplace depression, "I do think we'll be seeing increased cases of stress. Primary emotions linked with stress are anger, anxiety and depression," he says, "so I do expect a spike in cases coming as a result of the current economy." Although Finch couldn't concur with the actual findings of the Gordian study, "only because I'm not working with and observing employees," he did say the gender differences are reflective of the cultural and behavioral differences between men and women. "You see similar differences playing out in the returning military," says Finch. "We see different armed services reporting different levels of problems by gender and specialty. Culture plays a part in that. For instance, it's kind of tough for a male Marine to say he's crying a lot, feeling depressed and needs help." But the more studies "that we continue to generate, the more we're able to bring these issues to light," he says. "It's long been proven that depression is one of the leading causes of disability and one of the hardest to manage." Employers could be doing a better job of managing the illness, Finch says. Companies should be paying more attention to their short-term disability cases and working with disability managers and employee-assistance programs "to ensure the patient is following a good treatment plan." "Some who are disabled by depression," he says, "are only using an anti-depressant, yet research shows a combination of that and psychiatry or psychotherapy will have much more positive outcomes. "Employers can be communicating [these types of concerns] better with these other agencies as well as creating better lines of communication for employees regarding their availability and services," Finch says.
Workers Get Health Care at the Office
As Costs Rise, Some Employers Focus on Preventive Services; Relying on the On-Site Clinic Companies say the clinics generally aren't designed to replace family doctors. However, most on-site centers leave it to patients to notify their primary-care physicians about test results and treatments they might have had at the workplace. About 29% of big employers had or were planning to install on-site health clinics in 2008, according to a survey by consulting firm Watson Wyatt and the non-profit National Business Group on Health. The clinics are generally operated by outside providers, including Take Care Health Systems, a Walgreen Co. subsidiary that runs 366 on-site clinics for various employers, including 40 facilities offering a wide range of primary-care services. CVS Caremark Corp. and CareHere LLC also manage clinics for major employers, including some smaller facilities mainly meant to handle routine coughs and sniffles.
Baucus Unveils Health Reform Blueprint, Says Legislative Passage Possible Next Year
"At a time of widespread economic anxiety, Chairman Baucus is to be commended for rightly recognizing that health care reform goes hand-in-hand with addressing our nation's broader economic problems," the National Business Group on Health, which represents 300 large employers, said in a Nov. 12 statement. "As America's businesses work hard to stay competitive in a global marketplace, the rising cost of providing health care benefits to workers, their families, and retirees continues to be a major challenge for businesses," the group said.
Carrot and stick approach: Behavior and health
"So employers said 'rather than focus on the cost, let's focus on health,'" said LuAnn Heinen, Vice President of National Business Group on Health, an organization that helps companies find health care solutions. "We shifted it to the demand side." In the National Business Group survey, 83 percent of employers said they offer health assessments that help people identify their risks. But fewer than 60 percent had programs to promote lifestyle change, and only 29 percent offered on-site health centers. "It doesn't make sense to offer health risk assessments unless you have something to offer once health risks are identified," Heinen said. While incentives get people to pay attention, it is not enough to create behavior change, Heinen said. That requires a supportive work environment with access to good food and opportunities for physical activity. Thirty-one percent of companies in the National Business Group survey rewarded employees for good health management.
Employers Offer Workers Fewer Health Care Plans
Because the health plans currently on offer were devised early this year, long before the full magnitude of the financial market meltdown and global recession were evident, experts predict that benefit offerings a year from now during sign-up season could demand that employees dig even deeper into their own pockets. "Many more big companies will be making dramatic changes in their health plans next year, as the effects of the economic crisis become clear," said Helen Darling, the president of the National Business Group, a national association of large employers.
DOL, Industry Groups Ask Full Ninth Circuit To Review San Francisco Preemption Ruling
Preemption 'Powerful Incentive' for Employers. The same day the Labor Department filed its amicus brief, a similar brief was filed jointly by the ERISA Industry Committee (ERIC) and the National Business Group on Health (NBGH). In their brief in support of GGRA's petition for rehearing, ERIC and NBGH argued that the full court should take up the case because the three-judge panel's decision disregarded the strong congressional intent in ERISA's preemption provision which was aimed at creating uniformity for employee benefit plans. ERIC and NBGH argued that since the enactment of ERISA with its "expansive preemption provision," the federal law "has provided a powerful incentive to employers to provide employee benefit plans, including health care plans, by allowing employers to sponsor voluntary plans, giving those employers considerable flexibility in deciding what benefits to offer and how to fund their plans, and by exempting employers from the patchwork quilt of state and local regulation that they otherwise would face." The industry groups further argued that the "balkanization" that would be encouraged by the three-judge panel's opinion "would be detrimental to the maintenance of uniform benefit plans by multi-jurisdiction employers." According to the groups, one of the fundamental features of ERISA is that it gives employers the flexibility to choose and design the benefit plans they establish. "If health care coverage is legally mandated, some employers might lack the resources to provide the mandated coverage and might be required to terminate employees, reduce employee compensation or other benefits, or cease operations," the groups said in their brief. ERISA preemption is essential to multi-jurisdictional employers because they can offer a single, coordinated package of employee health care benefits to all eligible employees regardless of where they live or work, the groups argued. If the three-judge panel's opinion stands, it will create a "patchwork regime that requires multi-jurisdictional employers to adapt their policies to the disparate mandates of every locality and state that regulates health care coverage," the groups added. Moreover, ERIC and NBGH argued that the three-judge panel's decision will create recordkeeping problems for employers operating in multiple jurisdictions. "Absent preemption of such local mandates, employers would face a maze of requirements that would divert time and resources from providing care and toward compliance with the huge administrative burden that these various ordinances would create. Few, if any, employers would find that maintaining a health plan was worth the effort even if it were possible," the groups said.
San Francisco employer mandate challenged
Two national business groups are asking the 9th U.S. Circuit Court of Appeals to reconsider its recent decision upholding a San Francisco ordinance mandating employer contributions to health coverage. The measure requires that employers with 20 or more workers spend a certain amount on health coverage or put the money into a pool to fund a universal access program for the city's uninsured and underinsured. A panel of the 9th Circuit in September ruled that the mandate did not violate the federal Employee Retirement Income Security Act. But the National Business Group on Health and the ERISA Industry Committee disagreed in a friend-of-the-court brief the organizations filed jointly on Nov. 3. The business groups say ERISA was intended to contain health care costs and encourage employer-sponsored health coverage by streamlining national benefits administration, rather than leaving it up to individual states or municipalities. The organizations fear the panel's decision, if upheld, would have the opposite effect and are supporting a petition by the Golden Gate Restaurant Assn. -- which challenged the city ordinance in court -- for a review by the full 9th Circuit.
Health insurance firms offering online therapy for insomnia
Cognitive behavior therapy -- offered online by insurers -- is more effective than pills, an expert says. Health insurers are sometimes better known for causing sleepless nights than for creating restful ones, but in the last few months, helping consumers get a good night's sleep has become a priority for most of the top-tier U.S. health insurance companies, including WellPoint, Aetna, Cigna, Kaiser Permanente and several Blue Cross plans. Their new programs don't involve sleeping pills. Instead, insurers are advocating the use of cognitive behavior therapy. Traditionally, the therapy has been done largely through face-to-face sessions, but many of the programs are now available online. Why would health insurers, often tight-fisted for even life-saving treatments, be so quick to cover the cost of a few extra Zs? "To reduce the tens of millions they're spending on sleeping pills each year, as well as improve medical conditions that may be caused by a lack of sleep," says Helen Darling, head of the National Business Group on Health in Washington, D.C., which advises large employers on health cost issues.
Employer Groups Warn Against San Francisco Coverage Plan
Two employer groups announced Monday that they have filed a "friend-of-the-court" brief siding with San Francisco dining establishments challenging a city law requiring that employers offer health coverage or pay into a health coverage fund. The National Business Group on Health and the ERISA Industry Committee said the law violates the federal Employee Retirement Security Act, which pre-empts state laws governing private employer health plans. It is "not a question of if, but when and where" a ruling by a three-judge panel upholding the San Francisco Ordinance will be overturned, said Mark Ugoretz, president of the ERISA Industry Committee. "We are hopeful that the entire 9th Circuit Court of Appeals will decide upon an immediate review."
Businesses Wary of Details in Obama Health Plan
Left undefined has been what size firms would be exempted, what constitutes a "meaningful contribution," and how much noncompliant businesses would be required to pay. Senator John McCain, the Republican nominee, badgered Mr. Obama in two of their debates to define the penalty, but Mr. Obama did not rise to the bait. "We made a decision even before the plan was rolled out not to decide," said David M. Cutler, a Harvard economist who speaks for the campaign on health care. "It's not that there's a decision out there that we're not telling. It's literally that we've decided not to decide." That may be smart politics. But it makes business groups nervous that Mr. Obama might impose an unmanageable burden. They also worry that any time his health plan faces a shortfall, businesses will be asked to up their ante, as has happened in Massachusetts. "Play-or-pay can become a blank check to an already overcapitalized health care system," said Helen B. Darling, president of the National Business Group on Health, which represents 300 companies. Business groups also have concerns that Mr. McCain's plan to change the tax treatment of health benefits would erode employer-sponsored insurance.
Time spent on benefits choices could save money
Watson Wyatt Worldwide, a leading global consulting firm, found a few trends in its open enrollment survey this year: -Some employers are requiring that employees complete health risk assessments. In exchange for their participation, they receive an incentive award. -More employers are also replacing co-payments for prescription drugs with co-insurance arrangements in an effort to control costs. With a co-payment, you pay a specified amount depending on the type of medication you take or whether there is a generic form available. Co-insurance is when you share a percentage of the cost with the insurance company. A typical split is 80/20. So, for example, your insurance picks up 80 percent of the cost of your medication and you pick up 20 percent. -Nearly 30 percent of employers surveyed by Watson Wyatt and the National Business Group on Health plan to operate on-site clinics next year. -More employers are covering preventive medical care and even preventive drugs at 100 percent with no deductible.
While some workers make better health decisions, others don't
New research from the National Business Group on Health shows many workers are indeed making better health decisions. The employer group found that 55% of workers have regular health-related screenings or exams, another 54% go for physical exams, and finally 53% admitted to regularly trying to improve their health through exercise and nutrition. Overall 88% of employees surveyed say they have taken steps to improve their health in the last year or have been doing so for more than a year. "U.S. employers should be encouraged to see that a larger portion of workers want to improve their health and are getting involved in various health promotion programs," Helen Darling, president of the NBGH, says. Hear what else Darling has to say on this issue online. All the news isn't good however. The number of consumers that went without a prescription, tapped into retirement savings to pay for health care or skipped a doctor visit for themselves or a child rose in the last year, according to research conducted this past summer by the Rockefeller Foundation and Time magazine. The research shows that 25% of people surveyed say they decided not to see a doctor because of cost in 2008. That's up from 18% in 2007. Another 10% say they didn't take their kid to the doctor for the same reason. NBGH's own research shows that nearly half, 47%, of employees say work demands prevent them from leading a healthier life. One out of four workers say they are more stressed today than they were two years ago. The top stress factors cited were work, finance and work/life balance (54%, 54% and 43%, respectively).
Mothers Launch National Petition for Preemies
The Petition for Preemies also is supported by the American Academy of Pediatrics, the Association of Women's Health, Obstetric and Neonatal Nurses, the National Business Group on Health, and more than two dozen other maternal and infant health agencies and concerned business and quality improvement organizations. It can be found at http://www.marchofdimes.com/petition. "Modest investments in infant health will pay off many times over in future health and productivity," said Helen Darling, president of the National Business Group on Health. "Employers can play a pivotal role in helping their employees and dependents have the information, resources, benefits and support to have healthy, thriving families. We applaud the March of Dimes for promoting and protecting the health of all children."
In need of desperate remedies
But companies are starting to rebel. Tax break or no tax break, increases in health costs, which have long outpaced inflation, have meant that employers are spending ever greater amounts on providing cover. Those costs have nearly doubled this decade alone, and a new report by Towers Perrin, a benefits consultancy, forecasts they will surge by another 6% in 2009. This, firms argue, burdens them with unfair costs. "The price tag for this care makes many American goods and services relatively more expensive," complains the National Business Group on Health (NBGH), which represents many of the country's biggest employers.
Take time to decide on health care plan
Employers are also looking for opportunities to keep costs down by encouraging their employees to live healthier lifestyles. A study by Watson Wyatt and the National Business Group on Health shows that nearly half of employers offer financial incentives for enrolling in smoking cessation courses and weight management seminars. Some offer discounts on gym memberships and offer other incentives to help those with CDHP plans ensure that their waistlines thin out rather than their pocketbooks.
The Obama Health Care Plan: More Power to Washington
Taxpayer Reinsurance for Employers Under my plan, employers will be reimbursed for a portion of the catastrophic costs they incur above a threshold if they promise to use those savings to reduce the costs of workers' premiums.[30] The Obama plan would have the taxpayers reimburse employers for the high-end health costs in their health plan. This proposal broadly resembles the 2004 proposal by Senator Kerry.[31] The Lewin Group, basing its calculations on the government's assuming 75 percent of the cost in excess of $140,000 for each plan member, estimates that the Obama reinsurance proposal would cost $419.2 billion over the first 10 years.[32] Beyond saddling taxpayers with employers' high health care costs, the reinsurance proposal would weaken incentives to control or manage health care costs.[33] Helen Darling, president of the National Business Group on Health, has noted that once a patient reaches the threshold at which the taxpayer funding kicks in, "there's no reason for anyone to pay attention to costs."[34] In other words, the premium rebate would drive up health care costs. Merrill Matthews, executive director of the Council for Affordable Health Insurance, a health insurance trade association, argues: [Such a proposal] would undermine the innovative health insurance products currently being designed both by new health plans, third-party administrators and traditional insurers. The government likes uniformity, not diversity and competition, because it makes regulation simpler.[35] Government reinsurance would not only stifle existing efforts by insurers, employers, and individuals to seek out value, but also likely replace those efforts with more regulation.
Survey: Workers Want Employers' Help to Get, Stay Fit
American workers are trying to improve their health through a better lifestyle and education, and they want their employers' help in accomplishing that goal, according to a survey released Wednesday. The National Business Group on Health, a nonprofit association of 300 large U.S. companies, interviewed more than 1,500 U.S. workers. Eighty-eight percent of employees have taken steps to improve their health within the past year or have been regularly doing so for more than a year. At the same time, 47 percent said work demands are preventing them from living a healthier life. Helen Darling, president of the National Business Group on Health, said that when trying to guide employees toward healthier lifestyles, it is important to emphasize that they are doing something that will make them feel better and lower their health care costs, not just benefit their employer. "To be honest, employees are not going to be out there getting on treadmills [at] 6 a.m. for their employers' sake, but they will when they make a connection between health and finances," Darling said. A quarter of the workers said they are more stressed out today than they were two years ago. Darling, who emphasized exercise as the best medicine for stress, said that stress levels probably would have increased even in the past few days as a result of the financial market collapse. The survey found that half of workers consider the health care benefit communications they receive from either their employer or their health plan very valuable or extremely valuable. Different generations of workers value different methods of communication, however, with younger, "Facebook generation" workers wanting more frequent communication, Darling said.
NBGH: Economy Affects Wellness Efforts
Stress may be clashing with employer moves to get workers to take better care of themselves. Researchers at the National Business Group on Health, Washington, have based that observation on results from a July survey of 1,502 U.S. employees ages 22 to 69 who work for employers with 2,000 or more employees.
New law requires parity for mental health coverage
Health insurance plans can no longer treat mental illnesses differently than physical problems when it comes to co-payments and coverage limits. "This legislation strikes the right balance," said Helen Darling, president of the National Business Group on Health. "We are especially gratified that this final product preserves large employers' flexibility in plan design and medical management, and helps assure that employees and their families have access to effective, evidence-based care."
Financial Rescue Legislation Broadens Mental Health Coverage
The financial-services rescue package approved by the U.S. House of Representatives Friday would give millions of Americans access to more affordable mental health services. Included in the bailout package, which was approved by the Senate Wednesday, are provisions that would require most employers that offer mental health benefits to provide the same level of coverage for these services as they do for medical and surgical care. The bill doesn't define what disorders must be covered. But major problems such as depression, anxiety disorders, schizophrenia and drinking and drug problems are likely to be covered, according to Steve Wojcik, vice president of public policy at the National Business Group on Health, non-profit association of employers, including General Motors Corp. (GM) and Wal-Mart Stores Inc. (WMT).
Business Cool Toward McCain's Health Coverage Plan
American business, typically a reliable Republican cheerleader, is decidedly lukewarm about Senator John McCain's proposal to overhaul the health care system by revamping the tax treatment of health benefits, officials with leading trade groups say. The officials, with organizations like the U.S. Chamber of Commerce, the Business Roundtable and the National Federation of Independent Business, predicted in recent interviews that the McCain plan, which eliminates the exclusion of health benefits from income taxes, would accelerate the erosion of employer-sponsored health insurance and do little to reduce the number of uninsured from 45 million. Helen B. Darling, president of the National Business Group on Health, a coalition of 300 companies, agreed that many workers would face a net loss. "The last thing you want to do to the average working person, especially when you're bailing out big financial companies, is take something they hold near and dear partially away," Ms. Darling said. Economists forecast that the problem would worsen over time because Mr. McCain, according to advisers, would index his tax credits to overall inflation. Health insurance premiums have grown four times faster than inflation since 1999.
Mental-Health Bill Signed
While noting the bill "strikes the right balance" between the needs of employees and employers, Helen Darling, president of the National Business Group on Health, a Washington-based group that represents more than 300 large employers, did says that "nonetheless [the bill] remains a benefit mandate on large employers. At a time when large employers are working hard to maintain benefits, mandates have the potential over time to erode large employers' ability to provide coverage to their workers and dependents." She said that the "policymakers concluding that this legislation indicates an appetite for a 'one-size-fits-all' approach to health reform would be gravely mistaken. Our nation cannot mandate its way to meaningful and successful healthcare reform." However, she did say that the employers are pleased the law preserves the ability of employers to be flexible in their plan design and that the legislation "will help millions of Americans to help manage and address mental health issues."
Some employers using screeners to reduce imaging costs
Causes for cost increases Direct-to-consumer advertising and increasing patient demand have contributed to the growth in imaging. In addition, "the improved availability and convenience of in-office diagnostic imaging services are also considered to be contributing factors in the overall rise in utilization of these services," the AHIP report states. Likewise, an issue brief from the National Business Group on Health attributes some of the growth in imaging to the oversupply of equipment and self-referrals by doctors. "There is no question that radiology advances are aiding in the diagnosis and treatment of illness, and some studies point to less invasive testing and lower total costs as a result," the issue brief states. "But imaging use varies widely across geographic areas, giving rise to speculation that these increases may be related to other factors, such as imaging equipment availability, and do not necessarily correlate with better quality or superior outcomes." The group cites back pain as one example of a condition where advanced imaging doesn't necessarily improve the treatment plans or health outcomes for patients. In addition, NBGH has expressed concern that doctors are ordering advanced imaging to protect themselves against malpractice claims, even when the scan is not medically necessary. Dr. Leonard Berlin, chairman of radiology at Rush North Shore Medical Center in Skokie, Ill., concedes that defensive medicine is happening in response to the increase in medical malpractice lawsuits in recent years. "I think there is some overutilization," he says. "That doesn't happen as often as people would like to think." Solutions The primary tool for reducing unnecessary or duplicate scans is prior authorization, where a health plan requires a doctor to obtain approval from the plan before the procedure is covered. But it's tricky to determine what tests are truly needed. "We really don't know what is necessary until after the fact. How do we define unnecessary?" Berlin asks. To reducing spending on imaging, NBGH recommends that employers: -Educate employees and their family members about diagnostic imaging and radiation exposure, presenting a balanced view of benefits, risks and options. -Educate women of childbearing age to inform health care providers about possible pregnancy prior to undergoing imaging. -Encourage employees to bring imaging studies to scheduled exams and appointments in order to avoid duplicate studies. -Provide a secure, portable personal health record that includes a cumulative record of medical radiation exposure. -Educate employees about why they should keep such a record for each child, as well as for themselves. -Encourage employees to talk with their physicians about imaging and avoid heavily marketed imaging centers that make claims about how useful imaging is in detecting disease without discussing the relative risks. -Don't cover full-body CT scans for patients who aren't showing specific symptoms. -Contract only with imaging providers that meet evidence-based guidelines issued by the American College of Radiology. "Making certain that evidence-based guidelines are followed should improve quality, encourage appropriate usage and increase the likelihood of affordability," the NBGH issue brief states.
More patients heading to the emergency room
"ER use is a serious problem both from a quality and a safety perspective," says Helen Darling, president of the National Business Group on Health. In almost all cases, treatment in an ER costs much more than treatment at a physician's office. "The ER is the most expensive setting for people to get care," confirms Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute. That's why, for years, employers have been educating their employees about why they shouldn't go to the ER for non-urgent conditions, like a cold or flu. But even so, workers often don't understand when they should and should not use an ER, and they don't always realize how long they'll have to wait at an ER, Darling observes. Sometimes patients feel the need to go to the ER for a prescription or treatment at night or during a weekend, when their primary care doctor's office is closed. "That's often the case," Fronstin notes. Consequently, some experts have called for expanding physician office hours to cut down on the non-urgent ER visits. Part of the problem is the shortage of primary care doctors in many parts of the country, which means patients might have to wait for too long to get an appointment with their doctor. "We have a primary care crisis in this country," Darling says. "We need more primary care physicians and advance practice nurses in this country." To further encourage employees to use lower-cost settings when appropriate, Darling recommends offering a lower copay for visiting a retail health clinic instead of an ER. In addition, she suggests, it helps to have good communication with employees about where they can find a retail health clinic or an urgent care center near their home. Medical care tends to costs less in those settings, and it's best to have the location information before an illness or injury occurs.
Watson Wyatt Identifies Trends for Benefits Open Enrollment Season
-- Greater access to onsite clinics, retail clinics and health coaches. More employers will open onsite clinics for employees and their families next year, as well as give them greater access to retail medical clinics and personal health coaches. Nearly 30 percent of employers surveyed by Watson Wyatt and the National Business Group on Health (NBGH) plan to operate onsite clinics next year while six out of 10 employers plan to give workers access to personal health coaches. More employers are also including retail medical clinics as part of their health coverage to help ease access to primary care services and avoid emergency room visits for after-hours urgent care needs. -- Health savings accounts linked to high-deductible health plans. One- third of large employers intend to offer workers health savings accounts linked to high-deductible health plans (HDHPs) next year, according to the Watson Wyatt/NBGH survey. Also, roughly one out of 10 employers intends to offer a consumer-directed health plan as its only health plan next year, while others are attempting to steer workers into these plans through lower premiums.
GlaxoSmithKline Named a 2008 100 Best Company by Working Mother Magazine
Earlier this year, the National Business Group on Health (NBGH), a national non-profit organization of large employers, named GSK a leader in providing a healthy workplace and promoting a healthy lifestyle for employees and their families. GSK was among 52 employers to receive the Best Employers for Healthy Lifestyles award at the Leadership Summit sponsored by the National Business Group on Health's Institute on the Costs and Health Effects of Obesity. "We are so honored to be recognized by such organizations as Working Mother and NBGH," said Ann Kuhnen. "GlaxoSmithKline is fully committed to providing solutions for working parents to integrate professional and personal demands. By encouraging-and supporting-our employees to engage fully both at work and at home, we can help them achieve and maintain healthy high performance levels."
Company wellness plans target medical costs
Health insurance premiums have increased more than 100 percent during the last decade, about 8 percent annually, according to the Urban Institute think tank. Estimates show that companies will spend $7,720 per employee on health care in 2008, $500 more than last year, according to the nonprofit National Business Group on Health. About half of large employers use incentives to encourage workers to participate in health improvement programs, according to a survey by the National Business Group on Health and a consulting firm.
Wellness Incentives Are Paying Off
Is your company looking for a way to both decrease its healthcare costs and help employees attain better health? Try wellness programs and make sure to offer incentives. A recent study from the National Business Group on Health and Watson Wyatt reported that almost half (46%) of the employers they interviewed offer financial incentives to encourage healthy behaviors.
Leading Healthier Lives
Employers should focus more attention on the health of younger workers, as 30-somethings are often more likely to be consumed by raising families than spending time exercising and watching their diets. HR should also consider demographics when communicating wellness initiatives, experts say. A recent report adds a slightly different twist to conventional wisdom, finding that workers in their 30s are far more neglectful of their health than those in their 60s. The research by ComPsych Corp., entitled Generational Differences in Employee Wellness, shows more than half (52 percent) of the older group studied had healthy diets, compared to only 18 percent of the younger age group. Employees in their 50s and 60s also fared better in level of exercise, outlook on life, social support and stress levels. Although the stats are surprising to some, Helen Darling, president of the Washington-based National Business Group on Health, says they shouldn't be. Research on levels of happiness, marital problems and life satisfaction for those older than 20 "has shown that the toughest times are when a couple has children, or there is a single parent," she says. "When we add long commutes, high gas prices, etc., things are even worse. People are most satisfied as they get older." One key problem not mentioned in the ComPsych study, says Darling, is the obesity epidemic, something she thinks companies could be doing a much better job fighting. "They should be beefing up their EAPs and communicating their availability," she says. "They can also send out tips on how to cope with food availability during especially difficult times, such as holidays."
Local Workers Bringing Home Fatter Paychecks
Despite a dismal U.S. economy, employers in the region offered raises averaging 4.7 percent this year, according to a survey by the Human Resource Association of the National Capital Area. Last year's Compensation Survey Report, which had 236 of the same companies participating as this year's, said local companies gave out raises of 3.5 percent in the year ended in March 2007. The surge in salaries has spilled over to nonprofit associations, which increasingly must scramble for good workers. "We have to be competitive with corporate America, including the consulting firms, because we share the same talent pool," said David A. Fogle, vice president of finance and administration for the National Business Group on Health. The District-based organization, which advises Fortune 500 companies, not only offered raises comparable to those of private-sector counterparts but two years ago opted to pay 90 percent of employees' health benefits rather than the standard 70 percent, Fogle said.
Companies offering on-site health care
A survey released this year by Watson Wyatt Worldwide Inc., a human resources consulting firm, and the National Business Group on Health found that 29 percent of large employers had an on-site health center or planned to open one by 2009, up from 27 percent in 2006. The study faulted the companies for failing to analyze how the health centers were affecting spending. In the survey, companies with on-site centers said they were interested primarily in improving productivity and saving money. Center operators say they can reduce absenteeism, both from sickness and from long trips to the doctor's office in the middle of a workday. They can save money by preventing serious illnesses and reducing emergency room visits.
Workplace wellness surge
According to a survey this year by the nonprofit National Business Group on Health (NBGH) and consulting firm Watson Wyatt, 83 percent of large companies now issue annual health surveys to their employees, up 65 percent from 2006. Seventy-four percent offer weight management programs; 60 percent provide health coaching; and 29 percent offer onsite health centers. Wellness hits the big time The notion of workplace wellness is hardly new. As far back as the 1920s, Japanese workers began their day with calisthenics. And in the United States, there have always been a few fit cheerleader types coaxing co-workers to head to the conference room for a Weight Watchers class or a lunchtime aerobics class. For more than 26 years, Coors Brewing Co. in Golden has had a wellness program, which includes access to an onsite wellness center, smoking cessation programs and a pedometer program. The difference now is that wellness is everywhere, and even the biggest corporations are investing in it. "There have always been lone advocates tugging at the sleeve of management people in a remote location to try to get a program together," says NBGH Vice President LuAnn Heinen. "But today, you see huge national companies saying this is important and putting their logos and branding behind it." For instance, Kellogg Co. has its "Feeling Gr-r-r-eat" employee wellness program, Union Pacific Railroad has its "Fast Tracks" program, and General Mills has its "Totally You" program. In May, Quest Diagnostics (43,500 employees nationwide with roughly 725 in Denver), was awarded the NBGH Best Employers for Healthy Lifestyles Gold Award for its "HealthyQuest" corporate wellness program, which relies heavily on diagnostic tests and health-risk assessments to make customized wellness plans for employees. The company's director of employee wellness took the program to heart and was last year's winner of the reality TV program, "The Biggest Loser," dropping 164 pounds (49.1 percent of his body weight) in 34 weeks. Return on investment Experts say a good wellness plan can ultimately result in as much as a $3 to $1 return on investment, the bulk of it coming from savings in medical costs. According to the NBGH/Watson Wyatt survey, 31 percent of employers offer rewards for healthy behavior, while 6 percent penalize those who live unhealthy lives. However, more and more companies say they intend to begin penalizing poor health behavior in the coming years. Companies are expected to spend an estimated $7,720 per employee on health care this year, up from $7,211 last year, according to NBGH. With health-care costs expected to continue to rise and cash-strapped employees less able to shoulder more premium increases, employers face a dilemma. "Companies are worried about whether they can shift any more cost to employees," Heinen says. "A lot of them cant. Their employees are going to end up opting out of coverage, and that is not good." Enter wellness programs, which have the potential to temper those annual increases by simply reducing claims. According to a study of 2,400 adults, published in the journal Preventive Medicine in 2003, people who increased their physical activity from none to three days per week or more paid $2,200 less on average per year for health care than those who remained sedentary. According to NBGH research, obesity-related health issues alone cost American companies roughly $13 billion per year.
Wellness Programs Get a Makeover
Comprehensive health promotion programs mostly start with health risk assessments, sometimes coupled with biometric screenings, which measure cholesterol, blood pressure and glucose levels. They also can include virtually anything designed to promote better health and well-being, services that were once associated with employee assistance programs combined with traditional wellness, disease management and sometimes even safety and occupational medicine. "Some of it goes back to the old California mind-body connection that we all rolled our eyes at," says Helen Darling, president of the National Business Group on Health. "There is a focus on mental health to make workers happy and engaged and interested. We want them to come to work ready and eager to work. If you want to keep knowledge workers productive, you've got to keep them healthy and not depressed. We know a lot more than we did back then. There's more science, more studies."
Aid From Unlikely Sources
Patients often are automatically contacted by a case manager because a hospital visit will bring the situation to the insurance company's attention. Alternatively, the patient or a family member could check the insurer's Web site or contact the employee's human-resources department or the insurance company. "It is cost effective for employers to do because even in a recession we're in a war for talent so we want our talent to come back to work," says Helen Darling, president of the National Business Group on Health.
Two isn't always better than one
Recent research indicates that employee assistance programs frequently aren't much different from counseling services available through employers' mental health benefits. Many EAP practitioners vehemently argue that the programs are distinct from mental health services in that they are work-based, operating on behalf of an employer for the purpose of identifying troubled employees and providing interventions or referrals to treatment as needed. However, in the National Business Group on Health's Guide to Behavioral Health, researchers conclude that services provided by EAPs "have become duplicative with services offered by the employer's mental health benefit plan." In other words, the boundaries between EAP intervention and outpatient mental health benefits are entirely blurred. If this observation is accurate, employers with both types of benefits may be paying two premiums for what amounts to an identical service.
From reality-show star to wellness director
Viewers may sometimes forget that the contestants on the television show "The Biggest Loser" are also just regular employees. From that vantage point, contestants' triumphs and setbacks on the show may offer insights for employers trying to create a healthy workforce. Last year, Bill Germanakos, a medical sales representative for Quest Diagnostics, won top prize on "The Biggest Loser." He lost 164 pounds - 49.1% of his body weight - in 34 weeks, dramatically improving his health. In April, Quest Diagnostics appointed Germanakos, who had previously led a sales team selling new technologies, as its director of employee wellness initiatives. "Now that I have been re-educated and have more knowledge about health and wellness, it seems like a natural fit for me to join the company's health and wellness management team," explains Germanakos. On a quest for health Germanakos clearly has the New Jersey-based company following in his healthy footsteps, as Quest Diagnostics was named a Gold Award winner among the 2008 Best Employers for Healthy Lifestyles. The award, presented by the National Business Group on Health, annually honors more than 50 U.S. employers for their commitment to help employees choose a healthier way of life. This is the second consecutive year that NBGH has named Quest Diagnostics, which employs about 43,500 workers, as a Gold Award recipient. The hard work has more than paid off - personally and professionally - not only for Germanakos, but his Quest colleagues as well. "We are very pleased to honor these forward-thinking companies for their leadership in the development of a wide range of innovative programs and opportunities they are offering their workers to create a healthy work environment," says LuAnn Heinen, vice president and director of the NBGH Institute on the Costs and Health Effects of Obesity.
Employers Reach Out to Children With Wellness Programs
The challenge is that companies don't want to be viewed as encroaching on parents' domain, says LuAnn Heinen, a vice president at the National Business Group on Health. "Companies have to be cautious," she says. "They don't want to offend parents, but they want to include kids."
How Do Employers Cut Rx Costs? Let Us Count the Ways
Employers have implemented a number of methods to slow down prescription drug costs, but waiving copayments for chronic conditions has yet to enjoy widespread use. Last year the cost of prescription drugs was the single largest part of health cost increases to employers, according to a recently released survey by Mercer, a national consultancy. As a result, promoting the use of generics and the management of specialty drugs are top priorities to employers - and therefore to health plans and pharmacy benefit managers. "Employers expect health plans to have strategies that help them control the rise in costs," says Steven E. Wojcik, vice president for policy at the National Business Group on Health. "They look for aggressive, creative strategies."
Health experts advise against skipping vacations
Americans on average already receive less time off than others around the world. The French, for example, receive on the average 37 days per year, compared to the United States' 14 days off annually, according to the survey. And the French use it, too. Only about 20 percent surveyed by Expedia.com in France reported not using all of their vacation. "It's a real problem," said Helen Darling, president of the Washington, D.C.-based National Business Group on Health, a nonprofit that focuses on employers' perspectives on health care issues. "Americans will eventually get back to realizing that for their physical and mental health, they need to take vacations." According to the survey, Americans will not use about three days of their vacation on average this year, the same number reported by those surveyed in 2007. Catherine Tunis, a Takoma Park resident who works for the federal government, said it took her 13 years to take a dream vacation to Yosemite National Park. While she said she uses most of her vacation time fairly easily -- she receives four hours per week of annual leave -- most of that has been spent on visiting elderly family members or on family emergencies. "I felt like I was a person, rather than an employee," Tunis said of her long-awaited vacation. "Clearly, I didn't put myself first for a long time. ... And I even felt guilty for taking this." Tunis said that by the time people are settled enough in their jobs to be able to afford trips, other responsibilities take over, such as aging parents, children or home improvements. But Darling said any break from work was beneficial, whether that was taking a few days off or staying close to home to compensate for the expense of a more elaborate vacation. "Now, people are so worried about the price of gas, food and energy that they're worrying in a different way. ... The view is, if you want to be successful, you have to work hard," she said. "But we're saying they should work hard in a smart way. ... It's very dysfunctional for people to work too long hours."
Dieting at work may be advantage
Business groups agree that workplace diets pose ethical problems. "We would never ever say we're putting our employees on a diet," said LuAnn Heinen, vice president of the nonprofit National Business Group on Health. "But companies have really connected the dots: We're paying for healthcare costs, our employees are paying for healthcare costs, and we're serving them Krispy Kremes every morning." Instead of diets, she said, businesses are now taking steps to write caloric limits or nutritional guidelines into their contracts with food service providers.
While the U.S. Spends Heavily on Health Care, a Study Faults the Quality
Business leaders also see a pressing need for health care changes, said Helen Darling, the president of the National Business Group on Health, which represents big employers that provide medical benefits to their workers. The report "documents that it's been as bad as we have been thinking it is," she said. But Ms. Darling and others were also heartened because some areas in the report said that the United States had shown marked improvement, including the measurements hospitals use to track how well they treated conditions like heart failure and pneumonia. "It proves once again if you have quantitative information and metrics and make people pay attention, they change," Ms. Darling said. But the report also emphasizes the inefficiencies of the American health care system. The administrative costs of the medical insurance system consume much more of the current health care dollar, about 7.5 percent, than in other countries. Bringing those administrative costs down to the level of 5 percent or so as in Germany and Switzerland, where private insurers play a significant role, would save an estimated $50 billion a year in the United States, Ms. Davis said. "It kind of dwarfs everything else you can do," she said. Much of the high costs are attributed to the lack of computerized systems that may link pharmacies and doctors' offices for filling prescriptions, for example, or that may enable insurers to more efficiently pay doctors' bills. "An awful lot of the waste in this system is the antiquity of the information technology," Ms. Darling said.
Financial Health Incentives on the Rise, but Design Is Key
Employers increasingly are using financial incentives to steer employees toward healthy lifestyles and reduce health care costs, but the effectiveness of those incentives depends on how they are used. About half of the 453 employers surveyed by Watson Wyatt and the National Business Group on Health say they use financial incentives to encourage healthy behaviors, such as quitting smoking or losing weight. Seventy-nine percent of employers surveyed say they will offer such incentives next year.
Employer-Based Health Coverage and Wellness Programs Critical to Keeping Workers Healthy, Panel Says
Research has shown that education programs and activities, such as tracking logs, pedometers and internal competition, can increase worker participation in wellness programs by at least 21 percent, according to a report also released Monday by BCBSA and Harvard Medical School's Department of Health Care Policy. But encouraging employees to begin and maintain healthy habits is still a challenge for many employers, according to a separate report also released Monday by the National Business Group on Health, a non-profit organization of mostly 300 large employers. "We can change plan design, we can increase co-pays, we can put in deductibles, but if the population underlying is still sick . . . you're not gonna do anything other than move the pieces around of an exploding cost scenario," said Helen Darling, president of NBGH. Darling described employers' approaches to health care over the past five years as "revolutionary." "They're beginning to understand what they have to change," she said. For example, 83 percent of employers offered health risk appraisals in 2008, an 18 percentage-point change since 2006, the report said. In addition, a recent NGBH survey showed that 80 percent of employees said employers should actively provide health information. Meanwhile, sixty-six percent of workers support discounts for employees who show healthy lifestyles. But more than half said they have not seen information to help them compare and assess different health plans or providers and that the medical information available is too difficult to understand.
Wellness Programs Require More Than Education
Company programs that encourage weight loss, a healthy diet and exercise are more likely to be embraced by workers if employers motivate them to sign up and give them tools to record their progress, according to a study released in Washington on Monday, July 14, by a major health insurer. "More employers are designing and executing programs," said Helen Darling, president of the National Business Group on Health. "It is deeply embedded in the culture of these companies. C-Suite leadership is the key. It really is a sea change."
Genetic-Testing Guidance
In recent years, about 1,000 genetic tests have become available. Many are covered by health insurance plans, as are additional screenings or interventions that may be advisable based on the results. A new federal law and many state laws prohibit employers and health insurers from discriminating on the basis of genetic tests. Consumers should recognize, however, that some genetic tests involve more out-of-pocket costs -- and also raise thorny questions about their benefits and desirability. Insurers typically cover a genetic test that's definitive and could make a difference in someone's treatment, says Helen Darling, president of the nonprofit National Business Group on Health. In such cases, "it is advantageous for the [insurance] plan for these risks to be identified," she says. Consumers can look at their insurance carriers' Web sites for more details about coverage for genetic testing and associated counseling. Ms. Darling recommends also getting information from sources such as the National Institutes of Health or an association affiliated with a condition, such as the American Heart Association or the American Cancer Society. Useful Web sites to visit include MedlinePlus.gov1, Mayoclinic.com2 and nsgc.org3.
Health-Incentive Use Increasing
The number of employers offering workers financial incentives to better manage their health is expected to jump sharply next year, according to a survey by Watson Wyatt Worldwide and the National Business Group on Health. The two Washington-based organizations polled 453 large employers and found that half currently use incentives to encourage their workers to participate in health-improvement activities, such as smoking cessation or weight-management programs. It also found that, by 2009, that percentage is expected to increase to three-quarters (74 percent), based on those citing plans to add incentives to their existing health-benefit programs.
Problems found with consumer-directed health plans
The number of large companies offering a consumer-directed health plan has nearly doubled over the last two years, according to research published earlier this year by Watson Wyatt and the National Business Group on Health. About one-half of large U.S. employers offer the plans, up from 33 percent in 2006. Fifteen percent of employees at organizations that offer consumer-directed health plans are currently enrolled in such plans, up from 8 percent in 2006.
Get Your Shots: Adults Needs Vaccines, Too
Public-Health Experts Push For National Inoculation Plan; A Rise in Whooping Cough One problem is a lack of any national system to promote and monitor adult vaccination. While the federal Vaccines for Children Program provides vaccines at no cost to children who can't afford them, and carefully monitors supply and demand, "the infrastructure to ensure the adult-vaccination pipeline is woefully inadequate," says L.J. Tan, director, Infectious Disease, Immunology, and Molecular Medicine at the AMA. He says there is currently little coordination between federal public health agencies, private medical providers, and the private companies that make adult vaccines. Most adults over 65 have many vaccines paid for by Medicare, Medicaid or private insurers. But for adults under 65, insurance often doesn't cover all types of recommended vaccines. Several bills have been introduced in Congress that would create a national vaccine program to provide free immunizations for uninsured and under-insured adults and streamline the way vaccines are covered by Medicare to cut paperwork. The National Business Group on Health, an employer coalition, is recommending that its members cover all CDC recommended vaccines at 100% and educate employees about the benefits of vaccination.
Talking Health: A Webcast on Covering the Underinsured
A series of health-related webcasts, Talking Health, debuted last week with an episode on the growing problem of the underinsured -- people who have insurance but are still at risk for substantial out-of-pocket expenses. Talking Health is presented by the Association of Health Care Journalists (AHCJ), The Commonwealth Fund, and the City University of New York Graduate School of Journalism. An archived version of the webcast on the underinsured is now available on the Commonwealth Fund Web site. The program featured panelists Sara R. Collins, Ph.D., an assistant vice president at The Commonwealth Fund; Helen Darling, president of the National Business Group on Health; and Mila Kofman, Maine's superintendent of insurance. In a special feature of the webcast, two journalists, Julie Appleby of USA Today and Reed Abelson of The New York Times, offered suggestions and ideas for reporters based on the information discussed by the panelists. AHCJ board president Trudy Lieberman moderated both sessions.
Can your company force you to be healthy?
Almost a third of companies offering health insurance benefits to their employees also provide a wellness program of some sort. Fitness, smoking cessation and weight-loss programs are provided most frequently, according to 2006 employer health benefits survey by the Kaiser Family Foundation. The telephone survey contacted 2,122 randomly selected public and private employers. While most companies say they have a genuine concern for their employees' well being, the rising cost of health care is obviously part of the equation. Obesity-related health issues, for example, cost American companies approximately $13 billion dollars per year, according to the Washington D.C.-based National Business Group on Health, a non-profit organization representing large employers on health policy issues.
Waistlines Expand Into a Workplace Issue
But here is where the situation becomes confusing. Corporate leaders often speak out on issues that cost them tens of billions of dollars annually. Numerous executives have called for a plan for providing health insurance to the uninsured, for example. So why aren't they making more noise about obesity? "People in charge of benefits plans completely, 100 percent get it," said LuAnn Heinen, director of the Institute on the Costs and Health Effects of Obesity, an offshoot of the National Business Group on Health. It is also clear, she said, that top executives are very interested in health benefit costs. But, she added, "their perception of obesity as a driver of costs -- they may not understand that as well." Or maybe they are generally aware of obesity's cost -- almost 14 percent of United States chief executives counted it as a top health care benefits concern in the Conference Board-RTI report -- but, as Ms. Heinen said, "It's a sensitive issue to address head-on." (It's quite a contrast to Japan, where employers are actually measuring workers' waists and doling out dieting guidance.)
Obesity surgery for diabetes is a tough sell
Obesity surgeries have risen dramatically in recent years, from 23,100 procedures in 1997 to an estimated 205,000 in 2007, according to the American Society for Metabolic & Bariatric Surgery. Employers and insurers see a big price tag, as well as the risk of severe complications, including bleeding, pneumonia, heart issues and even death. These can tack on even more costs from emergency room visits and additional hospital stays. The surgeons' group says only 1 percent of those eligible for weight-loss surgery seek it out. "Even the numbers that are going up so dramatically are the tip of the iceberg," said LuAnn Heinen, a vice president at the National Business Group on Health, which represents large U.S. employers. Officials of insurers Cigna Corp, Aetna Inc and the Blue Cross Blue Shield Association said it was too early to make any coverage changes based on available data. It would take five to 10 years for an employer to recoup surgery costs by not having to pay for other treatments and medications, such as insulin injections, according to a study by the Research Triangle Institute, which consults for business and governments. "It's clear to me that a lot of employers would not see an ROI (return on investment) in this," Heinen said.
Single Payor Bill Hits Bottom Again In Md.
Steve Wojcik, vice president of public policy for the National Business Group on Health, is skeptical about how a single payor system would be paid for and claims that current funding would not be enough. "I'm assuming the [legislators] would end up trying to tax employers like the did with the Wal-Mart Bill two years ago," he said.
Employers wary of new role embodied in platforms
Employers understand that politicians have to offer proposals to reform the health care system, considering that escalating medical costs are straining the nation's and consumers' budgets. Yet overall, employers are not rushing to revamp their health benefits in response to ideas floating around in the public policy sphere regarding universal coverage, private/public health insurance or a single-payer health system. According to the National Business Group on Health and Watson Wyatt, 35% of employers say that health care reform proposals have no influence on their benefit plan designs, while 62% report that they are monitoring reform proposals but will continue to make changes to their benefits programs. The HR consulting firm and NBGH surveyed 453 companies that employ 8.4 million workers and spend $60 billion on health care. "Rather then focusing on how the proposals will affect their benefit designs, employers are asking broader questions about how the proposals will redefine their role, and whether the [Employee Retirement Income Security Act] will change," says Steven Wojcik, vice president of public policy at NBGH.
Digitizing Healthcare
The total cost savings from using information technology in healthcare may be disputed, but there's little doubt some savings would ensue. HR professionals should try to boost the use of electronic health records and e-prescribing in their local and regional medical networks, experts say. Helen Darling, president of the National Business Group on Health, a Washington-based group that represents the large employers' perspective on national health-policy issues, says that if you read both reports carefully, you will see that the two are not really at odds. "Our view is that at no point, in all the material we put out about the RAND report, did anyone say just moving everything to digital files was going to save any money," says Darling. "What we have always said, and the CBO talked about it in its report, is that if you took all paper files and digitized them, nothing would be different. But the transformative nature of improving the processes would make things better, and that's where cost savings would occur." The point, Darling says, and what CBO correctly reports, is that you can't count savings until you transform the business processes. "This has turned more into a battle of headlines," she says. "But both sides on the issue have merit." The CBO report questioned the estimated $77 billion annual savings projected by the RAND Corp. analysis. However, the CBO report also said there are potential savings in specific situations, including improved technology combined with "broader reforms," which is what Darling refers to as improved business processes.
Employers Forced to Pick and Choose When it Comes to Benefits
To cover skyrocketing health care costs, employers have had to get creative. Sometimes that means cutting spending on other benefits. "Even though current statistics show the overall healthcare increase is 7% each year, many large employers have been working to keep the trend at 1% or 0% by putting in active care programs," said Helen Darling, president of the National Business Group on Health. "So for example you have someone with diabetes work with a nutritionist or specialist to keep them from going to the hospital to keep them from getting sicker."
Insurer's venture to focus on wellness
The JourneyWell program by HealthPartners will sell the benefits of healthier lifestyles. Health coaching programs have taken off in recent years as employers strain to pay rising health care costs. According to the Mayo Clinic, the average employee costs upwards of $8,000 per year for health care. Employees in turn are paying higher out-of-pocket costs for medical care, providing added incentive for them to sign on to programs that help keep them well. "If we can be healthier and need less care, it's a clear win for employers and employees," said LuAnn Heinen, vice president for the National Business Group on Health.
Swapping the carrot for a stick
Paying for employees' health insurance is one of the biggest expenses many companies face. So, when employers hear of a way to cut insurance premium costs, they're eager to listen. One of the biggest challenges in controlling costs can be the poor health habits of their employees. About 31% of employers nationally offer rewards for workers who improve their health, while 6% penalize employees for poorly managing their health conditions, according to the 2008 National Business Group on Health/Watson Wyatt Employer Survey on Purchasing Value in Health Care. Many of the companies surveyed reported that they may well consider implementing a punishment program in the next two years. But as companies move from using the carrot approach to brandishing the stick, they run the risk of breaching company culture, alienating their work force or even running afoul of antidiscrimination laws. Companies typically consider punitive approaches after they've already taken other steps to handle costs, including shifting more of the premium cost to the employee. "No employer wants to remove employee choice, but they do want to remove obstacles to healthy living," said LuAnn Heinen, vice president of the employer coalition National Business Group on Health. And with companies spending $7,211 per employee in 2007 on health care costs and no significant letup in the forecast, more businesses are exploring the difficult decision to institute penalties. "After trying the carrot for a long time, they're starting to think about the stick," Heinen said.
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