Senate HELP Committee Hearing Highlights Employer Uncertainty in Face of EEOC Lawsuits Against Wellness Programs

On Thursday, Jan. 29, the Senate Health, Education, Labor and Pension (HELP) Committee held a full committee hearing entitled “Employer Wellness Programs: Better Health Outcomes and Lower Costs.” The hearing was triggered by the recent EEOC lawsuits against three companies related to their wellness programs and the use of incentives.

Population Health Alliance (PHA) members know that worksite wellness programs are one segment of a broad continuum of population health approaches that includes disease management, case management and other population health services being implemented by employers seeking to improve the health of their employees. This, in turn, can increase productivity and lower costs.

The PHA has been tracking and working on this issue for over a year and a half. In May 2013, the PHA organized a meeting of its Washington, D.C.-based Government Affairs Committee members, with Chris Kucszynski of the EEOC, to discuss disability issues and wellness programs. This effort ramped up even more in May 2014 with the public announcement that the EEOC would soon release guidance on this issue (which never happened). Since then, and in light of the EEOC’s lawsuits, the PHA established an internal subgroup of our Government Affairs Committee to begin working on this issue, and formed a larger coalition of organizations and individuals to collaborate.

In the past few months, the PHA has developed a white paper for our members, held a webinar in collaboration with the National Business Coalition on Health (NBCH), reached out and provided support to the Senate HELP Committee, met with key staff on The Hill and organized a meeting with HELP Committee staff for our members and collaborators.

Jan. 29 hearing takeaways

Overall, the Senate HELP Committee was positive about the use of wellness programs in the workplace. This section of the Affordable Care Act (ACA) passed with bipartisan support and there was little disagreement from committee members regarding the merits of programs like this.

In his opening statement, Committee Chair Sen. Lamar Alexander, commented on the EEOC lawsuits relative to wellness programs, saying, “We want to make sure we don’t have a countervailing move going on in the government to discourage that. Even the White House has expressed concerns regarding the EEOC actions.”

The EEOC has had the opportunity to weigh in on this issue for quite some time and in May, announced that it would provide rules. The EEOC has not issued rules and instead, has chosen to litigate the issue. This approach has created considerable uncertainty for employers whose wellness programs adhere to the requirements of the Patient Protection and Affordable Care Act (PPACA), HIPAA and the Genetic Information Discrimination Act (GINA), yet find themselves in the cross hairs of the EEOC. As Dr. Catherine Baase, medical director of The Dow Chemical Company stated, “Employers should not have to face this uncertainty.”

Ranking Committee Democrat, Sen. Patty Murray highlighted the positives of wellness programs, “The ACA has put the power back into the hands of patients and encourages new, innovative delivery systems.”

Dr. Gary Loveman, president and CEO of Caesars Entertainment Corporation, also testified that “Wellness programs are ideally suited to address the epidemic of chronic diseases in this country.”

Additional testimony focused on these themes

1) Engagement is critical.

“In the absence of incentives for biometrics, we would not have such significant results.” – Dr. Loveman

“Successfully engaging employers is critical to achieving health for our society. We cannot achieve the results we want without it.” – Dr. Baase

“Engagement is key in wellness programs. Financial incentives are just one part; we need an integrated aligned system.” – Dr. David Grossman, medical director for Population and Purchaser Strategy, Group Health Research Institute

James Abernathy, a Blue Cross and Blue Shield of Tennessee employee, testified that the financial incentives of his company’s wellness program motivated him to lose weight and make significant improvements to his health.  He said that the program incentives are tied to participation and that he receives discounts and rebates.

2) Wellness programs are generating results

The King County program saw smoking levels drop by six percentage points as a result of their program, according to Dr. Grossman.

The Dow Chemical Company spent $4.8 million less in 2014 than it would have without the program, based on the industry average trend, noted Dr. Baase.

3) There is additional work to do

Jennifer Mathis of the Bazelon Center for Mental Health Law, expressed concerns from the disability community that these programs force individuals to self identify as being disabled. She questioned the voluntary nature of the wellness programs named in the EEOC lawsuits because of the high amounts of the incentives.

Dr. Grossman suggested that we use what we already know and then fill in the gaps, noting that the programs that have succeeded are those that implemented incentives based on best practices.

Eric Dreiband, partner with Jones Day law firm, felt there were two possible solutions, “Either the EEOC articulates a public solution that ACA meets requirements [of the ADA] or Congress enacts legislation.”

Sen. Murray echoed that urgency, “I think it’s really important that the EEOC get the rules out and makes sure all people are protected. I am assured they will be out very shortly.”

The PHA and our members will continue to follow and work on this issue in an effort to provide more certainty to employers, employees and vendors.

PHA Forum 2017 – Stakeholders United for Population Health

The Population Health Alliance (PHA) was proud to host our PHA Forum 2017 in Philadelphia, PA on March 27 co-located with the Population Health Colloquium and co-hosted by Jefferson College of Population Health.  We spent the morning hearing from industry experts and executive leaders among our membership discussing past, present and future innovations in the population health industry. Featured presentations included:


Stakeholders united for Population Health™, Rose Maljanian. Chairman & CEO HealthCAWS, Chairman of the Board, Population Health Alliance


Implications for Health Care under the New Administration, Clay Alspach, Principal, Leavitt Partners,


A Thought Leadership Perspective on Population Health, Congresswoman Allyson Y. Schwartz President & CEO Better Medicare Alliance


Panel: Advancing Population Health for Seniors 

Moderated by David Chess, MD, Chief Medical Officer and Co-Founder, TripleCare Senior Health

Chris Long, Executive Vice President and Chief Operating Officer, AxisPoint

Sean McManamy, SVP, HealthFitness

Initiative Sponsored by AARP


Panel: Population Health Implications for Value-based Care

Moderated by John Sory, Chief Executive, UHealth Regional Alliance, University of Miami

Andrew Baskin, MD, Aetna Quality & Clinical Policy

Barbara A. DeBuono, MD, MPH, VP, Clinical Strategy and Value Based Care, 3M Health Information Systems


Panel: PHA Looking Glass: A Window into PHA Initiatives

Moderated by Brenda Schmidt, Founder and CEO, Solera Health

Mary Jane Osmick, MD, Vice President and Medical Director, American Specialty Health, Quality and Research Chair

Victoria Shapiro, JD, Vice President Health Policy, External Affairs, UnitedHealth Group, Government Affairs Chair


The event concluded with the PHA Membership Annual Meeting and VIP Luncheon.





Thank you to our sponsors:


Good Measures

Noridian Healthcare Solutions

PHA Forum 2016

Thank you to our Chairman Sponsor, Aetna and sponsors Health Fitness and Noridian Health Solutions.


The Population Health Alliance (PHA) was proud to host our members at our invitation only PHA Forum 2016 in Washington, DC on November 10 held at the Kaiser Center for Total Health.  We spent the day hearing from industry experts and executive leaders among our membership discussing past, present and future innovations in the population health industry. It was a productive day of networking and rich discussion of specific industry segmented population health strategies that impact multiple stakeholders organizations, consumers and providers.



Welcome remarks provided by Rose Maljanian, PHA Board Chair, and Sandeep Wadhwa, MD, At-Large PHA Executive Committee Member


Erwin Tan, MD, AARP Thought Leadership – Director, Health followed with his presentation, “Life Purpose as a Lever to Impact Health and Healthcare Costs Across the Age Continuum.”


JP Sharp, JD, MPH, MACRA Lead, CMS Innovation Center, presenting, “QPP-MACRA Implications for Population Health Across All Stakeholders”


Board Alumni Panel, “Today’s Pop Health: What Has Staying Power, What Needs to Evolve”

Richard Vance (Panel Chair), Peter Dibiaso, David Nace, Jaan Siderov


Board of Directors Panel, “Population Health: Markets and Winning Strategies”

Sean McManamy (Panel Chair), Jim Pshock, Brenda Schmidt, Anthony Akosa, MD


Select invited members with the PHA Board and Alumni

Hon Pak, 3M, Peter Dibiaso, Quintiles, Chris Seleckey, Population Health Strategies, Mary Jane Osmick, American Specialty Health, Jim Pshock, Bravo Wellness, Sandeep Wadhwa, Noridian Healthcare Solutions, Rose Maljanian, HealthCAWS, Susan Riley, TripleCare, Sean McManamy, HealthFitness, Anthony Akosa, Franciscan Health, David Nace, MarkLogic, Sunny Ramchandi, Aetna, Al Lewis, Quizzify, Allison King, Population Health Alliance, Andrea Powers, Silverlink, Chris Long, AxisPoint Health, Brenda Schmidt, Solera Health, Gordon Moore, 3M, Richard Vance, Chrysalis Ventures, Ashley Reynolds, Sensei, Jaan Sidorov, MedSolis

Save the Date for PHA Forum 2017 March 27th in Philadelphia, PA in conjunction with the Population Health Colloquium!

The Popularization of Population Health: Enduring Traits & Current Challenges

Rose Maljanian is founder and CEO of HealthCAWS, a privately held corporation focused on improving health and making healthcare more affordable by aligning accountability models and supports for success. Throughout her career, Maljanian has served on the frontlines of health innovation as SVP for Product Innovation at Magellan Health Services, a senior member of the Innovation Center leadership team at Humana, and as the founding director of Hartford Hospital’s Institute for Outcomes Research and Evaluation. She is a founding and current Board member of the Population Health Alliance.
Note that this post was originally published by Oliver Wyman Health on May 17, 2016.

Population Health is the latest topic talked about in every innovation and investor setting, yet it has been in the making for decades. Frameworks have been made publically available for years by thought leadership groups such as the Population Health Alliance (PHA). The primary reason population health has moved up higher on the national radar is that the umbrella term “population health” includes “value-based care.” Other groups such as the American Medical Group Association (AMGA) and the Patient-Centered Primary Care Collaborative (PCPCC) have additionally contributed to the advancement of the underpinnings for the delivery of value-based care.

The enduring traits of population health management include: accountability for a defined population, intervening in partnership with the consumer and producing results in the form of measured outcomes tied to performance agreements. While great strides had been made by multiple stakeholders to advance population health in a fee-for-service environment, the current trend of aligning financial incentives for care delivery, versus consumer engagement and care coordination initiatives alone, substantially improves the likelihood that all stakeholders will work together toward value-based goals.

Common challenges in population health management have been highlighted over the years but authors in a recent article published in the International Journal of Integrated Care summed up the major challenges we are facing today quite succinctly: governance models, engagement of the population served, payment models, and evaluation of what by its nature is a complex multifaceted set of interventions.

Here are three ways to move the industry forward:

1) Lead with your strengths: Understand roles and focus on accountability and outcomes

a) Population health management entities: These organizations take responsibility for a defined population for a defined set of outcomes (quality and cost). Examples all share common themes of defined population, accountability, intervention, and outcomes:

  • Providers and hospital systems in various risk sharing models for quality and cost outcomes for defined populations owning, licensing, or partnering for necessary data and technology solutions
  • Payer initiatives (health plan and employer)that for a defined population take full risk and/or support providers to take risk, provide front end and back end data solutions, and coordinate care and other services and interventions (licensed or wholly owned) leading to outcomes for which they are accountable
  • Health services companies that for a defined population in total or for a phase of the care continuum (e.g. inpatient, outpatient, post acute) provide front end and back end data solutions and coordinate services and interventions (licensed or wholly owned) leading to outcomes for which they are accountable
  • Community or public health entities that are responsible for a defined population for which they monitor, intervene with, and produce outcomes for which they are accountable

b) Population health support solution companies: It really is OK for one organization not to do it all. Partners are needed to enable the implementation of population health with support tools and services. A company can provide a vital component of support to population health management entities. The four market segments above all need supports that integrate well with their core competencies. These tools and functions are vital to identifying and stratifying the population, setting triggers for outreach or quality improvement, engaging consumers, intervening and measuring and tracking outcomes to ensure the success of both consumers in achieving their goals and healthcare organizations in meeting their value-based contract requirements. Solutions that fall into this category may be:

  • Analytics companies, front end or back end, that provide predictive modeling, risk stratification, outcomes evaluation, and reporting
  • Electronic Health Record (EHR) or Health Information Exchange (HIE) solutions for data acquisition and management and transmission platforms and services
  • Consumer portals, health risk assessments, health and wellness trackers, biometric monitoring, telehealth, and CRMs
  • Care management software alone or with staffing but no risk bearing
  • Administrative services companies

2) Checklist for success: Build from past evidence and learnings

  • Look at evidence based research and case studies for components of the population health strategy that make up the total program
  • Use data assets and modeling to identify and intervene with high risk groups and work with providers and consumers to get quality gaps and high but avoidable utilization under control quickly
  • Don’t forget that health is dynamic and a static snapshot is out of date immediately, even more so if based on a report from a 1-3 month data lag
  • Don’t forget about the full continuum of care; moderate risk individuals can move to high risk and low to moderate if they are ignored
  • Leverage care extenders and technology to keep support strategies for all groups affordable
  • Take a community approach; the environment of live, work, and play represents the bulk of impactable hours

3) Consumer is king: Keep the focus on patient-centered solutions  

The future of population health tied to consumer experience: Consumers are expected to continue taking a more proactive, holistic approach to health; care is also increasingly occurring remotely, at home or in nontraditional settings; and advancements in technology are growing exponentially not only for what in other fields is 101 items like data capture, analysis, and sharing but with more focus on improved diagnostics, monitoring, and treatments that put consumers increasingly in the driver’s seat. Consider these keys to population health consumerism:

  • Population health ultimately involves the roll-up of individual consumer’s goals and their personal best outcomes. Shoe horning individual consumers into predefined goals will likely yield unrealistic care plans, avoidance behaviors, and unintended consequences
  • Understand the average consumer is overwhelmed by delivery systems, insurance procedures; thus most need guidance and support at each touchpoint
  • Provide convenience and efficient self-service and self-management options where possible like other industries but pair them with the necessary clinical expertise and support

The Great Debate

In November at the PHA Annual Forum, Al Lewis, CEO of Quizzify, and Ron Goetzel, Senior Scientist, Johns Hopkins Bloomberg School of Public Health engaged in “The Great Debate” on whether employee wellness programs demonstrate a return on investment. Download the recording here.

Don’t miss the chance to learn real strategies and tools to improve population health

The 16th Annual Population Health Forum is just one week away and here at the Population Health Alliance we are thrilled about the speaker line-up and incredible learning opportunities we have in store. Our goal is for every participant to come away with actionable strategies and tools to improve population health.

We can’t wait for our attendees to hear from our keynote speakers, including noted journalist Eleanor Clift, about what the elections mean for health care, along with Oliver Wyman partner Sam Glick who will share his thoughts on how to safely navigate the consumer health care revolution.

Providers should be sure to take advantage of CEU available for nurses and physicians and can attend several education sessions focused on everything from scaling programs to population health strategies for aging populations. Henry Chueh, MD, MS, Chief of Biomedical Informatics and Director of the Lab of Computer Science, Massachusetts General Hospital’s Lab of Computer Science is just one of the excellent educational presenters sharing insights. There is so much to learn and understand in population health related to the dizzying maze of  new models of payment.

Those who attend the Executive Leadership session on November 2nd will be treated to a debate to remember as expert Al Lewis squares off against expert Ron Goetzel.  Al Lewis has already said wellness industry defenders have “got some ‘splaining to do.” It will surely be a fun and educational session!

Our Convening Leaders workshops offer participants the chance to delve deeper into specific topics like how to deliver the right message to patients at the right time. Our sponsors including Health Dialog, Healthy Roads, Interactive Health, Healthwise, Silverlink, and Intel-GE Care Innovations have vast expertise to share.

Employers have a keen interest in population health and there will be plenty for them to learn about including wellness programs and how to structure health challenges to get the most engagement from employees. A special Innovators Learning Lab will also focus on how we help individuals and employers take data and create an actionable plan for behavior change and improved whole health. Those interested in incentives can learn from Welltok’s Michael Dermer and other industry experts about the latest science and strategies.

As a reminder, thanks to our sponsor Healthy Roads, all attendees will receive a complimentary copy of the updated Population Health Alliance Outcomes Guideline Report, the “official playbook” of population health program measurement.

We hope to see everyone in Washington next week!

It is a Matter of Time Before Every Health Plan Has a Rewards Program

Rewards for healthy behaviors have been growing at leaps and bounds as a way to reduce healthcare costs for several years. In 2009, employers offered employees $260 in rewards for making healthy choices. Now, companies are projecting to spend $693 per employee on wellness incentives. ObamaCare added fuel to the fire. It increased the allowable amount of rewards from 20 percent to 30 percent (and in the case of smoking cessation) 50 percent of annual premium. Forbes named “health rewards” as two of the top 5 health IT trends in 2014.“Incentive Driven Healthcare” is here to stay.

Why don’t health plans want consumers to know this? It seems like a win-win. Well in some ways they do. Health plans win by reducing costly behavior through prevention and lifestyle changes. Consumers benefit not only by getting healthier and making better health decisions, but by receiving rewards. This is all true. But in some ways they don’t. Once consumers realize that purchasing health insurance, while incredibly personal, is nothing more than purchasing another consumer product, the marketers of the world will be faced with a health rewards competition.

ObamaCare created “exchanges” or “marketplaces” through which health insurers compete for the business of individuals and businesses. These marketplaces were established with a series of pre-packaged health plan options, which limit the variations in using traditional levers such as coverage and networks. Health plans that were used to competing on these levers are left with a single lever – price. Selecting from gold, silver and bronze hardly creates differentiation among UnitedHealthcare, Cigna, Aetna, Humana, Wellpoint, the Blues and many other plans in the United States.

Think of your credit card, hotel, airline or favorite retailer. It is a sure fire way to create loyalty, brand affinity and engagement. Let’s be honest, you are more inclined to use specific services or retailers if they provide a robust rewards program. When marketers of consumer products ask themselves “what tools do I need to attract, retain, and generate loyal customers?” the answer inevitably comes to reward programs.

As further evidence, consumers across multiple demographics were interviewed on what they wanted from their health plan. The only item that appeared in every demographic was “rewards for healthy behavior.” Would you have a more positive opinion of your health plan if they sponsored a program that rewards consumers for healthy behaviors? According to a Welltok survey, 75  percent of respondents agree. Furthermore, 81 percent said that access to such a program positively influences their decision to renew with their current plan. Not to mention, the fact that incentives are a proven means to motivate health choices and change behaviors. More than 96 percent of consumers would engage in healthier behaviors if rewarded.

Health plans are entering a new competitive landscape. Rewards will not only be an essential component, but will also drive a healthier population – creating a win-win situation for all.


Michael Dermer is the Chief Incentive Officer of Welltok. Prior to his current role, Michael was the founder and CEO of IncentOne, the first company that in 2003 identified incentives in healthcare as a critical solution to driving consumer and provider engagement.  Michael is considered one of the nation’s experts on rewards and incentives in healthcare –learned in running over 4,000 programs and 40 million transactions over ten years. His personal mission is a national reward program in which all Americans can “be healthy and be rewarded.” Since 2003, he has been guiding health plans, employers, health systems, governments and providers in how to use incentives to deliver cost reductions and health improvement.

Twitter: @rewardforhealth

Linked In:

What Employers Want from ACOs for Better Population Health

When employers think about population health, they are thinking about the health of their workforce and their retirees. Employers want their workforce and their retirees to become and remain healthy. For large, self-funded employers this is about the bottom line and reducing health care costs, but more important than that, it’s about employee/retiree health outcomes, satisfaction and employee productivity.

Accountable Care Organizations (ACOs) are one of the promising new models of health care delivery that seeks to deliver better quality care at lower costs. ACOs can be designed to improve the quality of care, increase patient satisfaction, and lower the cost of care by aligning incentives and connecting the care provided by hospitals, medical groups, and health plans to work together to decrease fragmented care. So what are large employers looking for from ACOs?

First and foremost, employers want an ACO to consider the care of “the whole person.” They recognize that not all ACOs are alike and that they have different capabilities.  They expect ACOs to meet all the care needs of their employees, including behavioral health. To do this, the ACO needs a wide variety of service providers that deliver a holistic menu of care. For example, if the patient has a psycho-social issue, the ACO should have a social worker who can address that issue. If the patient needs to lose weight to help with her diabetes, she should have access to a dietician to work on changing her eating habits.

Second, employers want their ACOs to offer integrated care. Fragmented care is not only challenging for patients to navigate– it is not clinically optimal.  Primary care providers, behavioral health providers, pharmacy staff and specialists should work together, share information with each other, and have shared incentives for the same goal: the patient’s best interest.

Employers also want their ACOs to be able to identify the highest-risk patients and target them for special intervention. The greatest savings come from identifying the sickest patients and keeping them out of the hospital. The ACO needs to be able to identify these individuals and intervene before episodes escalate out of control. Some early employers in this space have seen great success with this targeted intervention, which is now a vital component of both employer-driven and health plan-driven ACO products.

ACOs also need to be able to support“smart” benefit design features designed by employers to engage employees in a partnership for value based healthcare.  This means ACOs should have programs and policies in place that align with the employer’s goals of promoting patients’ access high quality care, and  efficient use of care.  Appropriate utilization of high priced procedures, integration of step therapies, and shared decision-making have been shown to reduce cost and improve outcomes.

Finally, employers want their ACOs to embody quality improvement and payment reform. For decades, employers have been concerned about the variance inquality of care of our health care system. They know they spend too much for care that is too often unneeded, unsafe, and of poor quality. ACOs should be committed to quality improvement, and capture data so they can track their quality outcomes including patient reported outcomes. They should work with their partners implement new forms of payment that rewards for good quality, and that does not pay for waste and efficiency.

Vela headshot

Lauren Vela, MBA

Senior Director of Member Value, Pacific Business Group on Health

As Senior Director of Member Value, Lauren works directly with the large purchaser members of PBGH to facilitate collaboration and to support their purchaser-driven initiatives impacting healthcare delivery in the US. To that end, Lauren manages the processes of translating PBGH’s ground-breaking work in transparency and accountability into workable solutions for PBGH member organizations.

Prior to this role, Lauren was the Executive Director of the Silicon Valley Employers Forum (SVEF), a coalition of high tech employers that benchmark benefit designs and collaborate for improvement. During her SVEF tenure, Lauren systematized the group’s benchmarking practices and served as a facilitator and strategist for their joint projects with regard to both US-based and international employee benefit programs.

Prior to the SVEF role, Lauren enjoyed a twelve-year tenure with PBGH serving in three distinct areas; multi-stakeholder health information exchange, provider group organization improvement, and employer value-based purchasing. To this day, SVEF and PBGH maintain a strategic alliance and Ms. Vela works closely with purchaser members of both groups.


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