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.

What is True Population Health Management?

“Population health” is now a popular buzzword and all the rage, whether you are talking to disease management vendors, providers, employers, IT companies or even health policy wonks. But in my experience, far too many of us use that term too liberally, without really understanding what true population health management entails. And then sometimes we throw up our hands too quickly when our so-called population health programs don’t succeed. So what is true population health management?

Any population health program should start with identifying the population and conducting some form of an assessment; then amalgamate those assessments to determine the overall health of the population and stratify the population into risk buckets. This is followed by the all important and difficult engagement, and then person-centered, evidence-based interventions. These interventions must be tailored to meet the needs of each person. Too often, we focus just on disease specific interventions in this stage, when we should also be examining the workplace, home, community and other environments and full range of community resources. For example, how is a diabetic supposed to come in for regular treatment when he or she can’t drive and there is no public transportation in place? The final important step is impact evaluation—we need to understand how our interventions are working across the risk continuum. This can help us refine and readjust our approach if needed.

I’m truly looking forward to our 16th Annual Population Health Forum, where we will learn from the experts about the best ways to approach each of these crucial steps.  I’m pleased we’re really giving person-centered intervention the recognition it is due by making this year’s Forum theme “Welcome to Health.  Population of One.” Too often we get frustrated trying to decide how to improve the health of a large population — the task just seems too massive. It is critical we remind ourselves population health management creates improvements by focusing on the needs of one person.

In the coming weeks I look forward to having a robust conversation with all of you about the strategies and programs you have used to successfully change population health. What examples have you experienced first-hand where the change in population health started with just one person?

What is the PHA Forum 2014? The Juried Award Tracks

By Fred Goldstein, PHA Executive Director 

Bringing you insights, ideas and successes from the large-scale community based population health initiatives to best practices in population health including the new age of analytics, apps and engagement, the PHA Forum 2014 has it all.  It’s the go to place to understand population health and what works. It’s not about the fluff or the hoopla, but the substance behind population health. This year we received roughly 70 submissions reviewed by the PHA program committee for our 16 jury awarded presentations. The four tracks will focus on:

Analytics to Action:  For Providers and ACOs

You can’t do population health management without data.  But what can and should you do with the data, how do you make it actionable?  Digital surveys and dashboards, big data machine learning to better target the individual and data for outcomes based payment models are all covered in this track.  Get actionable intelligence for your provider group, ACO, or population health management program.

Excelling in Engagement

Remember the “Not documented. Not done” hospital mantra, how about “Not Engaged, Not Improved!” Engagement is the buzzword of population health; but how can you improve engagement?  From provider/patient engagement to engagement by risk level and the power of incentives, explore how to engage your population.

Powerful Population Health Management Strategies

Culture of Health, reporting and collaboration; sure that makes sense, but what are some of the best strategies to actually do these things? This session will present what works and why, giving you the ideas and tools to improve these critical areas. We can all point to examples of what didn’t work, oh yeah the boss stepped out for a smoke after handing out the wellness awards; learn from those who have documented what does.

Tech Touch: Strategies for Apps in Health

Activity Trackers, mHealth, the web and gamification; a few of the new tools and approaches to supposedy create better population health management programs. Talk about buzz and hype, there are new entries every day! Ever ask if anyone has any outcomes data? Look behind the cloud, no pun intended, and remember it’s only going to improve your population health program if if it works These presentations do and that’s the difference!

You get it now, go Register.

What is the PHA Forum 2014? The Keynotes

By Fred Goldstein, PHA Executive Director

Bringing you insights, ideas and successes from the large-scale community based population health initiatives to best practices in population health including the new age of analytics, apps and engagement, the PHA Forum 2014 has it all.  It’s the go to place to understand population health and what works. It’s not about the fluff or the hoopla, but the substance behind population health. What are some of the big issues we face, whose doing some really interesting stuff, what does the business community think and can we look beyond our own borders?

These are just a few of the issues the Visionaries Series Keynote Speakers discuss.  Hear from:

Esther Dyson

Wow, astronaut trainee, early stage Angel Investor, writer, and more; and now she wants to create communities of health?  I’ve got to hear that.  Esther will focus on her new initiative The Way to Wellville.  Hear about the idea, the process, what she hopes to learn and share and early results from this privately launched initiative.

 

 

David Nash, MD, MPH

Who better to discuss where we are and where we are going than the Founding Dean of the first school of population health at a medical school in the entire country. From his perch at Jefferson, his board position with Humana, as the Editor of the Journal Population Health Management, (the official journal of the Population Health Alliance and his programs shaping future generations of population health leaders, David has his pulse on the industry, the science behind it and its future.

 

Kaveh Safavi, MD, JD

It’s a big world out there, and they do population health too.  Kaveh Safavi, the Managing Director Global Health for Accenture, sees and works on many of these initiatives. He’ll bring his expertise and experience to Forum 2014 and help us learn from initiatives outside our borders.

 

 

Brian Klepper, PhD

Brian’s known for saying it like it is.  I’ve seen many individuals from the health care industry sit in stunned silence as he presents his ideas on why it costs so much and how to fix it; you know sometimes we can’t point to the other guy. Population Health is one of the key components to a solution, but only if we also consider costs and utilization and some of the drivers of inappropriate behavior from the provider side.  I can tell you this one will be interesting!

Only at the PHA Forum 2014 will you hear from this diverse group of great Keynote speakers.

Register now

Placing Workplace Wellness in Proper Context: Value Beyond Money

By Nicolaas P. Pronk, PhD, MA

Most companies in the United States now offer some kind of wellness programming to their employees. In 2012, about half of US employers with at least 50 employees and more than 90% with more than 50,000 employees offered a workplace wellness program (1).

Employer surveys (eg, the 2011 Automatic Data Processing Survey) suggest that the most often-cited reasons for offering these programs include improved employee health, health care cost control, increased productivity, and absenteeism reduction. Each of these reasons is quantifiable, and their value can be monetized, allowing for a calculation of savings and an estimation of a return on investment (ROI).

Yet it isn’t necessarily always about saving money. Dr Risa Lavizzo-Mourey, president and chief executive officer of the Robert Wood Johnson Foundation, notes in a recent online post that companies committed to nurturing a culture of well-being consider broader motivations, including low turnover rates, attraction of top candidates, job satisfaction, and recruitment and retention of workers (2). Each factor was reported as being a more important driver of workplace wellness programs than ROI.

There is understandable interest in learning if, and how, workplace wellness programs produce results and generate savings. Publications on the effect of workplace wellness on financial outcomes continue to accumulate (1–5), but instead of producing consistency and clarity, they have introduced doubt and controversy. Systematic reviews and meta-analytic findings indicate that workplace wellness can generate savings (3). However, recent ROI studies indicate that such savings come only from disease management (DM) programs not lifestyle management (LM) programs (1). To gain clarity, 2 issues must be addressed. First, there is a need to standardize the definition of workplace wellness programs so that casual use of what constitutes such programs can be avoided. Second, research approaches should more explicitly recognize that workplace wellness programs generate a range of outcomes, many of them non–health related, that provide substantial value to employers even though they are often not represented in ROI analyses.

This essay addresses these 2 issues in the context of a set of best practice program-design principles that allow for properly designed workplace wellness programs to be differentiated from other activities that, although well-intended, may not rise to the level of a bona fide program.

Read the article.

Countdown to PHA Forum 2014: The Employer Perspective

On a special broadcast Tuesday, October 7th, 2014 at 12 Noon Eastern and 9 AM Pacific we continue the 2nd installment in the series Countdown to the Population Health Alliance PHA Forum 2014.

Listen here: http://www.blogtalkradio.com/healthtechmedia/2014/10/07/countdown-to-pha-forum-the-employer-perspective

The PHA Forum is an annual ‘go to’ industry standard for the entire ecosystem of population health management stakeholders including innovators in accountable care, care management and the general pursuit of the triple aim – better care, improved outcomes and lower per capita cost. This dynamic community gathers in Scottsdale, Arizona from December 10th – 12th.

On this broadcast we hear from Brian Klepper, health care analyst and the CEO of The National Business Coalition on Health (NBCH) who will supply an overview of the large employer persepctive and by proxy the essence of the purchaser communities message to the domestic provider community writ large.

More about NBCH:

The National Business Coalition on Health (NBCH) is a national, non-profit 501(c)6, membership organization of purchaser-led health care coalitions. NBCH and its members are dedicated to value-based purchasing of health care services through the collective action of public and private purchasers. NBCH seeks to accelerate the nation’s progress towards safe, efficient, high-quality health care and the improved health status of the American population.

NBCH has a membership of 53 coalitions across the United States representing over 4,000 employers and approximately 35 million employees and their dependents.

A detailed agenda for the PHA Forum 2014 is available here. For more information, or to register click here.

Suppport Population Health Research: Sponsor a PHA Forum 2014 Scientific Track

 

PHA Forum 2014
October 3, 2014
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PHA Forum 2014 Educational Track Sponsor

NEW Sponsorship Opportunity – $25,000    

Collaborate + Communicate = Engage. Support the research that underpins your industry by sponsoring an educational track at the PHA Forum 2014

Educational Tracks

  • Analytics to Action for Providers and ACOs
  • Excelling in Engagement
  • Powerful PHM Strategies
  • Tech Touch: Strategies for Apps in Health
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Sponsorship Perks   

Be a Presidential Sponsor  
7 registrations. Multiple branding opportunities.
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Booth in The Solutions Zone
When we say integrated learning experience, we mean it.
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Your booth at The Solutions Zone 

The Solutions Zone is designed in four neighborhubs that complete attendees’ integrated learning experience with the hands-on demonstrations of the theories and initiatives presented in the scientific tracks.  

  • Innovations in Interventions
  • Worksite Solutions
  • Data Stream
  • Tools for Consumer Engagement
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PHA Forum Scientific Program is Different  

  • Peer Reviewed Program
  • No Pay for Play
  • Panel of Judges select presentations for the PHA Outstanding Leadership in Population Health Management Award
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Who attends the PHA Forum?

  • Health plans and payer organizations
  • Employer organizations
  • Physician group practices
  • Hospital and health systems
  • Federal, state and local governments
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Better Value for Exhibitors

PHA Forum offers a free, complete booth package, including electricity, chairs, skirted table and trash receptacle in a ballroom setting – no need to buy carpet. Each paid 10′ x 10′ booth includes three registrations.

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Want more information?

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Cindy DeClark
Director, Meetings, Special Events & Corporate Relations
(202) 737-5681
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Walking Learning Labs

These are designed to provide an in-depth look at some of the key components of population health management, with an overview of PHA’s research followed by a guided tour of solution providers, in the Solutions Zone.  For more information go to Walking Learning Labs.

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PHA Forum 2014

Schedule of Events

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Educational Sessions

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Follow us @PHAVoice

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Keynote Speakers

Esther Dyson

Brian Klepper

 

Kaveh Safavi

David B. Nash

Workplace Healthcare & Benefits Institute

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10 Reasons to Attend

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Population Health Alliance. P.O. Box 73127. Washington, DC 20056

(202) 737-5980. info@populationhealthalliance.org. www.populationhealthalliance.org

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