Guest Post: Creating Value through Effective Member Engagement in 2014

kellmore_largeBy Kathleen Ellmore, Vice President, Consumer Engagement, Silverlink Communications

With the advent of the ACA, consumerism has become both mandatory and immediate. Creating value, especially in the eyes of the consumer, will be a tremendous opportunity for health plans and others in 2014.

Engagement through communications will be key, especially since healthcare insurance is an abstract product. Consumers can now vote with their feet in the same way they operate with the rest of retail world. Effective communications give health plans the ability to create proactive, cohesive, engaging experiences that will validate the consumers’ plan choice, as well as build trust between the plan and its membership.

Data management and analytics will increase in importance. While health plans already have a variety of data, they now need to capture the new class of engagement data to understand what is motivating members to change behavior. Tools and technology to capture, analyze and share the combined data and insights across the organization will be critical. Once plans unlock the secrets of behavior change on both an individual and aggregate level, they will have the keys to solve the complex equation of improving health and lowering costs.

Becoming member-centric is a company-wide sea change. Understanding and respecting consumer preferences will be a “must-have” for competing in the new world of healthcare consumerism. In addition to gathering language, channel and frequency of communication preferences, communications need to be coordinated across all channels and departments to speak with the member in one voice.

Increasingly, consumer health engagement will be mobile, fast and personal. Multichannel efforts will continue as proven vehicles for smart, results-oriented communications and member engagement. According to a recent infographic from mobile services company GreatCall, 52 percent of smart phone users already gather health-related information on their phones. Additionally, 83 percent of participants in a recent health consumer engagement program completed by Silverlink indicated that SMS text messages helped them think about or make lifestyle changes such as eating better or getting more exercise. Finally, consumer research is going to be an avenue of change. Gathering consumer attitudinal and behavioral data will provide additional opportunities for health plans to know their members and understand what consumers perceive as relevant value.

Undoubtedly, the industry is on the verge of an historic change and evolution. Many plans are redefining their member relationships to drive lower costs and create value through becoming more member-centric. As we move through 2014, effective consumer engagement will lead to improved health, the best value of all.

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Kathleen Ellmore is Vice President, Consumer Engagement, at Silverlink Communications, the proven leader in engagement management solutions for healthcare organizations. Our solutions enable health plans and other key stakeholders to engage and support their members in smarter and more effective ways. We deliver better control, coordination and effectiveness in member communications to promote healthy and loyal behaviors.To learn more about what makes Silverlink the leader in consumer health engagement, please visit http://www.silverlink.com, email info@silverlink.com, or call 1.781.425.5700.

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Guest Blog Post Disclaimer CCA invites guest bloggers to post on Voice of Population Health Blog as a benefit for our members and the industry and to allow for exchange of ideas and information regarding population health. The views, opinions and positions expressed within these guest posts are those of the author alone and/or of the company the author represents and do not represent those of the Care Continuum Alliance (CCA), its members, or the industry as a whole. CCA is not responsible for the accuracy, completeness and validity of any statements made within this guest post article. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author(s) and any liability with regards to infringement of intellectual property rights remains with them.

 

Guest Post: Preventive Care & the Affordable Care Act: Why Engagement Is Essential for Success

By Jordan Dolin, Co-founder of Emmi Solutions 

Jordan DolinAll new models of care, including ACOs, medical homes and shared savings, are looking to answer the same question: What’s the most cost-effective and efficient way to manage the health of large populations? This is a major challenge, and I’ve found patient engagement is an ideal way to address the issue. However, patient engagement needs to happen both within and beyond the four walls of the hospital, especially when it comes to preventive care.

Patients not following recommended screenings and preventive services are a large contributing factor to the spiraling cost of healthcare. For example, despite colorectal cancer being the second-leading cause of cancer-related deaths in the United States and one of the most preventable, only 53 percent of people 50 years and older follow recommendations for screenings.

On the surface, the new preventive services provision under the Affordable Care Act (ACA) should help address this issue, as the screenings are one of many preventive services recommended by the United States Preventive Services Task Force that insurers must now cover without cost-sharing.

Yet, even with an estimated 71 million Americans now eligible for copay-free colonoscopies, what remains to be seen is the level at which these patients will take advantage of the benefit.

That’s why forward-thinking health plans, hospitals and physicians are turning to outcomes-driven patient engagement solutions that close gaps in care and inspire patients to take action.

The following engagement strategies are powerful ways healthcare professionals can increase utilization of preventive services as well as member satisfaction and loyalty:

  • Multi-modal communication: If the goal is to put patients at the center of care, then patient messaging efforts need to be designed with their convenience in mind. Patients need tools that allow them to be engaged on their terms, when and where they choose and on the devices they already own.
  • Customized contact: Tools such as the Patient Activation Measure (PAM) that gauge individual members’ ability and interest in managing their own health and healthcare can be used to meet patients where they are, tailor engagement strategies and increase activation levels.
  • Web-based interactive programs: Web-based programs cannot only increase the bandwidth of providers, free more time for the delivery of care and motivate patients to schedule colorectal cancer screenings and other types of preventive care, but they can also help patients to follow through. A study presented last year at Digestive Disease Week found that patients who viewed a 30-minute online instructional video were 40 percent more likely to keep their colonoscopy appointments.
  • Financial incentives: Financial incentives and wellness programs can be great motivators—if members know about them. Effective programs engage patients not only about the health benefits of preventive care, but also the more tangible ones, such as insurance premium reductions for adherence to scheduled screenings.

Empowering patients isn’t just good for their health—it’s good for disease management and the business of managed care.

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Jordan Dolin is co-founder of Emmi Solutions (www.emmisolutions.com), a healthcare communications company that builds technology-focused patient empowerment solutions for health organizations that measurably impact outcomes.

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Guest Blog Post Disclaimer

CCA invites guest bloggers to post on Voice on Population Health Blog as a benefit for our members and the industry and to allow for exchange of ideas and information regarding population health.

The views, opinions and positions expressed within these guest posts are those of the author alone and/or of the company the author represents and do not represent those of the Care Continuum Alliance (CCA), its members, or the industry as a whole. CCA is not responsible for the accuracy, completeness and validity of any statements made within this guest post article. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author(s) and any liability with regards to infringement of intellectual property rights remains with them.

Rand Report on Workplace Wellness: What Employers Must Know (Part II)

Q&A about the Rand Report on Workplace Wellness (Part II)

What Employers Must Know

Read Q&A about the Rand Report on Workplace Wellness (Part I)

Questions and Answers: A Conversation with Soeren Mattke and Hangsheng Liu

How were the final sample sizes (N) determined?

Due to the potential for future publication of the study analysis, we cannot provide additional information that was not included in the final report. However, we can point you to Table B1 (p. 122) in the appendix and to the footnotes throughout the report for sample size data.

In Table B3 (p. 126), we see a column labeled, “Variables Not Balanced After Matching,” but no detailed percentages or averages are stated. Can we see the statistics on the matching variables before and after the match?

None were imbalanced between groups.

Other risk factors (e.g., glucose, blood pressure, alcohol consumption, overall health status, fruit/vegetable consumption) were provided in the data but not included in the report. Why?

There were several reasons. First, due to the length of the report we were unable to include all risk factors. We prioritized the list and analyzed the most common risk factors. Data availability was also a factor.

In the obesity analysis, Figure 4.17 (p. 50) indicates a 14% difference between the participant and nonparticipant rates. How does this relate to a 1-pound reduction?

Using the same regression analysis and underlying sample, we simulated a final analytic sample supposing all participants participated in the program all five years. This simulated hypothetical cohort of participants and nonparticipants was then projected over time. The dichotomy between the actual regression and the simulation makes it difficult to explain how the numbers were derived but provides an elegant way of translating parameter estimates in a nontechnical way. Since the model runs on BMI units, we then assumed the characteristics of a standard man and woman (based on CDC data) and translated the change in BMI to change in pounds. This finding of a 1 pound per year reduction is significant since it represents the average weight loss of participants compared to nonparticipants on a population level (i.e., 1 lb. times the number of participants). Furthermore, participants continued to lose an average of one pound/year in the first and second years after the year of participation.

Regarding the cost analysis (pp. 53-57). a. Is this cohort over the whole time horizon? b. Were outliers excluded? 3. Did you use company cost or company + employee cost?

a. Not all employees were involved for all years.

b. We used 99% threshold for outliers. 3. Analysis was based on allowable claims data, or company cost + employee cost.

Can you explain further the conclusion that incentives were associated with significant improvements in smoking, BMI and exercise, yet the effect size was small (p. 87)? How were these conclusions determined?

The challenge with this estimation was that the employers included in the analysis had little variation with incentives offered, both across employers and within each employer over time. Therefore, we had a large sample size with little variation to run the regression. Figure 5.19 (p. 87) indicates that higher incentives impact reduction in BMI with significant effect. When translated to pounds, we still detect a significant effect. However, given the small effect size and little variation, it is difficult to make a strong statement on the effect of incentives on health outcomes. Furthermore, employers in the sample used incentives for participation only, not outcomes.

Did you adjust for the differences in benefit plans between employers?

No, we did not have access to benefit information, but we did match by employer, candidate year, employee comorbidities, prior utilization and cost. While this limitation could confound the results, the problem should be minimal. One might speculate that analysis of the benefit design might show that the impact was underestimated. This would make and interesting empirical study for future research.

Was there any adjustment for cost differences for the same service in different facilities and regions of the country? For example, an individual living in a high cost region of the country pays $4,000/year with a 6%/year increase, while another living in a low cost region pays half the amount. Even in a difference-in-difference model, the analysis would indicate a cost increase when the % change favors the participant.

Yes, but the analysis matched on baseline cost also. However, this introduces another issue, which is matching on services or on baseline costs, not both. Ideally, the groups would be matched by geographical area, and in one regression analysis geographical region was considered.

How was participation defined? Without a minimal threshold of participation, there may be little to distinguish a participant from a nonparticipant, and thus little expectation of savings.

We used the definition from each respective data contributor, including their definition of minimal threshold, for the comparison group. We did consider the effect that the definition might have on the analysis and assumed program responsibility to engage the participant. With that technique, we arrived at a real-world estimate of the program’s impact. We would like to do further research to include a dose-response curve and examine efficacy of continuous participation.

Was there any attempt to measure presenteeism, absenteeism, or productivity impact other than asking employers what they liked about the program? Do you plan to do so in future research?

We did not have data on presenteeism or absenteeism. However, we would like to have this data for additional analysis. See Section 7.4.2 (p. 109) regarding future research.

Read Q&A about the Rand Report on Workplace Wellness (Part I)

Rand Report on Workplace Wellness: What Employers Must Know (Part I)

Q&A about the Rand Report on Workplace Wellness (Part I)

What Employers Must Know

The RAND Corp Workplace Wellness Programs Study, presented to Congress, brought about much needed discussion and questions about the state of workplace wellness programs, their outcomes, and their long term role in the transformation of our health care system and the attainment of a better health status for all in our Nation. Questions abound on the report, its methodology and its findings. CCA received and studied many of those questions and, on Wednesday June 19, convened a group of researchers and experts to go over the methodology, data and conclusions of the RAND Workplace Wellness Programs Study with the authors.

Soeren Mattke and Hangsheng Liu, senior scientists at RAND, answered the questions received and the follow up clarifications posed by those on the call. The following is a summary of that long and in depth conversation.

Read Q&A about the Rand Report on Workplace Wellness (Part II)

The RAND Corp Workplace Wellness Programs Study, presented to Congress, brought about much needed discussion and questions about the state of workplace wellness programs, their outcomes, and their long term role on the transformation of health care and the attainment of a better health status for all in our Nation.

Did anything surprise you?

I was surprised that the cost curve did not reach statistical significance, due to random noise in the model. Another surprise…high-powered incentives tied to health outcomes are much less common than the literature would have us think. Nine percent of employers use health contingent incentives and use them in modest amounts. Public debate is ahead of the actual state of the field.

Did the study look at all at components – online, in-person counseling, content, classes, support, communications, etc.?

No. The limited time and funding prohibited that level of granularity. Our wish list for future research includes amount of exposure, level of interventions, and level of exposure.

Among the nonparticipants who also receive the benefits of health promotion, a. Is there a motivation selection bias or in fact could the nonparticipants be receiving benefits? b. Could savings, therefore, be underestimated?

a. Yes, there is still the possibility of some bias because it was not a randomized, controlled trial. The difference-in-difference method is powerful in observing those, but we can’t rule out unobservable differences between participants and nonparticipants. It is possible that some nonparticipants were exposed to health promotion activities (e.g., better food offerings, exercise messaging) at the worksite but didn’t participate in personalized counseling program and would not be picked up by the analysis.

b. These estimates, given the research design used, reflect the marginal impact of a lifestyle management component. Changes in environment would impact both participants and nonparticipants, and we would have no way of comparing to other employers to get to that effect.

How does the report affect the current position of wellness in the market? For example, do you feel it does anything to temper the “rosy” expectations that came from earlier meta-analyses?  Will the current data in the report help us to better manage more realistic expectations around workplace wellness?

Some past numbers were too rosy. Look at what wellness programs are doing. It is not unrealistic that cost neutrality is a positive result because these programs are intervening in a workforce population that is not sick. These programs are a preventive effort to avoid future healthcare costs, so if we can get to cost neutrality and better health this is a good result for the industry and the programs.

Given the fact that some of these presentations are somewhat old now, a. What’s your thought about some of the newer strategies/approaches to wellness program engagement, including outcomes-based interventions? b. Were there sufficient data to look specifically at the outcomes-based programs for their impact on healthcare costs?

a. These types of programs remain rare, so there is not enough good data for meaningful statistical assessment.

b. No, there was not enough data and no employers tied to outcomes. A fine line exists between shifting risk and cost to more vulnerable employees and dependents and making employees feel compelled to take advantage of the programs offered. More research and more data are needed to find the right balance between appropriate risk sharing and inappropriate cost shifting.

a. What value do you think there’d be in formulating a clearly established list of wellness-sensitive conditions, so that outcomes can be more specifically studied? b. What about process measures – the outcomes of wellness on use of preventive care services, disease-specific preventive care, and medication adherence?

a. Hard question. In essence, we know many conditions are sensitive to health behaviors. The former surgeon general attributes 75% of healthcare costs to behavior. Many cancers, and potentially asthma and COPD, can be tied to obesity. We must find a way to quantify the strength of relationship in order to call it “wellness sensitive.” To begin to unpack the “black box,” we should define conditions and look more closely at what can be done for a quicker response versus what can be expected to happen later in the process.

b. The more clinical outcomes are better tied to disease management, the better, because that is the intervention strongly tied to medication adherence. There would be value in looking at the use of preventive services, either through employer screenings or healthcare providers, but really only those recommended by USPSTF.

I saw a tweet that approximately says, “…see? Wellness doesn’t work.” I would assume, seeing your presentations, that you would not make such a strong statement. Comment?

Workplace wellness involves complex interventions, and success will always depend on the particular intervention within the particular context and the particular measures of outcomes used. From what we see here, there is clear evidence for a qualitative and meaningful effect on health risks, but no strong evidence for savings of healthcare costs. Here we see a roughly cost neutral intervention that achieves a gain in health risk reduction.

a. What costs were or were not included in the cost analysis?  b. Were there any assessments of costs directly related to the interventions versus costs unrelated to interventions?

a. We included medical and prescription drug costs. We did not have data on work loss, workers comp, disability, etc.

b. We did not analyze whether changes in healthcare utilization were for wellness sensitive conditions. Rather, this was a high level look at overall costs without attempting to attribute at a more granular level. We did, however, take out years in which an employee was pregnant or participating in a case management program for high cost, high-risk conditions.

Can you comment on suggestions for future research?

Future research should seek to get more granular with related versus unrelated costs. Another area to consider is different type of outcomes, like productivity and other work-related impacts. A larger sample size may show significant effect on cost, so more employers in the database and a longer time series may indicate at what difference the curves converge and reach statistical significance. Also, we need to begin to unpack the black box. We can’t assume that all programs are effective or all programs are ineffective, and we need to understand the distinctions, i.e. how do employer (e.g., culture, support) and employee (e.g., health literacy, age, gender, ethnicity) characteristics drive changes so that targeting interventions becomes more effective.

Read Q&A about the Rand Report on Workplace Wellness (Part II)

U.S. Preventive Medicine: CCA Members Employee Wellness Showcase

The Prevention Plan from U.S. Preventive Medicine

U.S. Preventive Medicine, Inc. Prevention Plan LogoU.S. Preventive Medicine, Inc. (USPM) has created an innovative information technology solution for a personalized prevention program. USPM’s The Prevention Plan is based on the clinical practice of preventive medicine with engagement in primary, secondary and tertiary prevention.  Users complete a health risk appraisal, receive virtual coaching, live coaching and social challenges to reduce their risks, participating at self-determined levels of engagement.           NEWM_2013_Supporter_Logo_f

The two-year study, “The Association of Technology in a Workplace Wellness Program with Health Risk Factor Reduction,” recently published in the Journal of Occupational and Environmental Medicine (March 2013), concludes that active Prevention Plan participants show significant improvements in health risk reduction. The study proves the relationship between level of engagement in workplace wellness programs and health risk reduction. Engaging technology and interactive Web-based tools can empower individuals to be more proactive about their health and reduce their health risks.

From 15 employer groups, 7,804 employees completed health risk appraisal and laboratory testing at baseline and again after two years of participating in their personalized version of the USPM Prevention Plan. Of those participants who started in a high-risk category at baseline, 46% moved down to medium risk and 19% moved down to low risk after 2 years on The Prevention Plan. In the group that only engaged through the Web-based Prevention Plan technology, 22% of those individuals significantly reduced their health risks.

Dr. Ronald Loeppke, M.D., M.P.H., USPM president and vice chairman and lead author of the study, noted that The Prevention Plan tool used to initiate awareness of health, raise consciousness and determine health risk status is the health risk appraisal. The Prevention Plan’s interactive technology also displays an individual’s Prevention Score and reveals risk reduction visibly to the participant, as actions are taken and lifestyle changes are made.

“The study yields more evidence for the business case for employers that prevention is an investment to be leveraged rather than a cost to be justified,” added Dr. Loeppke.

The study was authored by: Ron Loeppke, MD, MPH; Dee Edington, PhD; Joel Bender, MD, PhD; and Ashley Reynolds, MSN, RN. Review the full published research study: “The Association of Technology in a Workplace Wellness Program with Health Risk Factor Reduction”

Engage with U.S. Preventive Medicine in Social Media

Facebook http://www.Facebook.com/ThePreventionPlan

YouTube YouTube.com/ThePreventionChannel

Twitter: @USPM

Incentives For Nondiscriminatory Wellness Programs In Group Health Plans: Highlights From The Final Rule

General Information About The Final Rule …

On May 29, 2013, HHS, the Department of Treasury and the Department of Labor issued a Final Rule on Incentives For Nondiscriminatory Wellness Programs In Group Health Plans. The final rule clarifies the scope of HIPAA and Affordable Care Act rules governing wellness programs and incentives. It outlines criteria that a wellness program must satisfy for an affirmative defense in response to a claim that the health plan or issuer discriminated under HIPAA provisions.

Read the Wellness Incentives Final Rule Expanded Summary

HIPAA Nondiscrimination Requirements For Wellness Programs By Program Type …

Wellness programs can be either Participatory or Health-Contingent.

Participatory programs either (1) do not offer rewards or (2) offer rewards that are not based on health factors. These programs must be made available to all similarly situated individuals, regardless of health status. No other restrictions or requirements are imposed.

Health-Contingent programs require an individual to satisfy a standard related to a health factor in order to obtain a reward. Health Contingent Programs can be Outcomes-Based or Activity-Only.

Activity-Only programs require an individual to perform or complete an activity, but not achieve a specific health outcome in order to obtain a reward. *A reasonable alternative standard for obtaining the incentive must be provided to any individual who has a medical condition or restriction that makes it unreasonably difficult or inadvisable to attempt the activity.

Outcomes-Based programs require an individual to attain or maintain a specific health outcome in order to obtain a reward. *A reasonable alternative standard or waiver must be provided to all individuals who do not meet the initial standard.

5 HIPAA Nondiscrimination Criteria For Health-Contingent Programs …

Health-Contingent wellness programs must: (1) Provide individuals with the opportunity to qualify for the reward at least once per year; (2) Keep the total reward offered to an individual or any class of dependents within 30% of the premium or 50% for tobacco-related programs; (3) Be reasonably designed to promote health or prevent disease without being overly burdensome or a subterfuge for discrimination based on a health factor; (4) Make The Full Reward Available To All Similarly Situated Individuals; (5) Provide notice of a reasonable alternative standard.

Additional Rules and Considerations For “Reasonable Alternative Standards” …

Health-Contingent programs must offer a “reasonable alternative standard”. The same full reward must be available to those who satisfy the reasonable alternative as provided to those who satisfy the otherwise initial standard. In lieu of providing a reasonable alternative, a plan or issuer may always waive the applicable standard and simply provide the reward. Plans and issuers do not have to establish a particular reasonable alternative standard in advance of an individual’s specific request for one. An individual can involve a personal physician at any time and must be given the opportunity to comply with a physician’s recommendations as a 2nd reasonable alternative standard.

Verification Rules In Health-Contingent Programs …

“Verification” is when a plan or issuer requires an individual obtain verification from a personal physician that a health factor prevents the individual from meeting the otherwise applicable standard for receiving a reward/ incentive.

Outcomes-Based programs: plans and issuers cannot condition their obligation to provide a reasonable alternative standard on verification by an individual’s personal physician.

Activity-Only programs: plans and issuers may require verification as a condition of providing a reasonable alternative standard when it is reasonable to determine that medical judgment is required to evaluate the validity of the request for an alternative.

Room For Innovations …

The final regulations provide the flexibility to encourage innovation. Nothing prevents a plan or issuer from establishing more favorable eligibility rules, premium rates, or rewards for individuals with adverse health factors compared to individuals without adverse health factors.

Future Considerations …

HHS, Treasury and DOL anticipate issuing future sub-regulatory guidance to provide additional clarity and potentially proposing modifications to this final rule as necessary. Also, compliance with the HIPAA nondiscrimination and wellness provisions is not determinative of compliance with any other applicable Federal or State law, which may impose additional accessibility standards for wellness programs.

Wellness Incentives Final Rule Expanded Summary

For Questions, Please Contact:

Victoria L. Shapiro

Director of Government Affairs

vshapiro@carecontinuumalliance.org 

office: 202.737.1107

cell: 202.870.2166

What Does the RAND Report on Workplace Wellness Programs Really Say?

Speculation was running rampant on the web and the blogosphere about the bad news that the Rand Report was going to be for the industry.

Only problem was: Those who were talking hadn´t read it. And those who had read it were not talking.

But here it is. Please, read the COMPLETE Final Report, from RAND Corp, on Workplace Wellness Programs Study.

And what did we find after a good read? Apparently, the old adage is true: Reading is fundamental.

May we quote?

“In an analysis of the CCA database, when comparing wellness program participants to statistically matched nonparticipants, we find statistically significant and clinically meaningful improvements in exercise frequency, smoking behavior, and weight control, but not cholesterol control. Those improvements are sustainable over an observation period of four years, and our simulation analyses point to cumulative effects with ongoing program participation.” Page XVII, for the inquisitive minds. This point is of critical importance as it speaks to the importance of workplace wellness programs to help contain the epidemic of lifestyle-related diseases in the U.S. (RAND report, p. xxvi)

Then, there is this other morsel of wisdom:

“The published literature, the results presented here, and our case studies corroborate the finding of positive effects of worksite wellness programs on health-related behavior and health risks among program participants.” Page XVIII

Please, CCA will issue a more complete analysis and responses to any of your questions and inquiries, now that we actually know what we are discussing… You know, we are sticklers for full picture, well-informed statements.

But we want to give our readers a nice preview of some of the most relevant points of the report. And, unlike others, we are actually giving you chapter and verse…and a link to the actual report, so you can make sure we are quoting correctly.

  • Programs with a weight management component can be credited with a positive impact on weight over time. Results show a differential change of about 1 pound per year sustained for the current year of participation and two years thereafter, in a population of 104,920 employees. (RAND report, p. 48) Compared to this: the average adult gains between 5 and 15 lbs. per year after age 40.
  • Cholesterol improved for participants and nonparticipants alike. (RAND report, p. 52) Increased use in statins among the full population can partly explain the lack of program effect.
  • Even with a small sample size (N=746), smoking cessation programs were found to have a significant sustainable effect for 1-2 years after the year of participation. “One year of program participation decreases the smoking rate of participating smokers by nearly 30% in the first year compared to nonparticipating smokers.” (RAND report, pp. 45-46)
    • Program participation is associated with a trend toward lower health care costs, while those changes are not statistically significant. Over a five year span, the cumulative simulated effect of wellness program participation on total health care costs per health plan member per month shows a curve that flattens for participants and continues on an upward trajectory for nonparticipants. This lower cost trend is driven by reduction in hospital inpatient cost of approximately $40 per member per month. (RAND report, pp. 56-57)
  • Corresponding to these cost reduction trends are declines in inpatient admissions and emergency department visits, compared with an increase or slight decrease for the nonparticipant comparison group. (RAND report, p. 57)
  • While the report’s estimates of wellness program effects on health care cost are lower than results reported in the literature, the RAND research sought to isolate the effect of lifestyle management interventions as opposed to the effect of an employer’s overall approach to health and wellness. (RAND report, p. xxvi) Even with a program that is cost neutral, positive impact on health risk, i.e. healthier employees, is a good result without added cost.

Read the Final Report, from RAND Corp, on Workplace Wellness Programs Study

View the presentation of Wellness Program Study Final Briefing

News from CCA Quality and Research

CCA Forum Program Committee

With more than 90 proposal submissions received last month, the Program Committee has a multitude of high quality presentations from which to choose for CCA Forum 2013 in Scottsdale, AZ, on October 23-25, 2013. Through a process of online review and scoring along with an in-person meeting and conference call, the Committee is making final selections for the educational program. Themes for 2013 will include collaborative strategies for practice transformation, Big Data, and employer strategies for employee health, to name a few. And the traditional session format of the past will be transformed into more engaged presentations, working sessions, and workshops.

Walking Learning Labs and a pre-conference workshop on program evaluation are new offerings for 2013, providing additional opportunities for attendees to gain hands-on learning. The walking learning labs will guide attendees through a mini-tour of The Solutions Zone exhibit hall and demonstrate how, for example, a health care provider might use population health management strategies to better care for his patients. The half-day program evaluation workshop, on Wednesday afternoon (Oct. 23), will interest employers (HR and benefit managers) who want to better understand their wellness programs and what they should measure, resulting in “take back to the office” information. Forum attendees will need to register separately for these opportunities.

For the third year, the International Symposium on Wellness & Chronic Care will demonstrate the application and success of a variety of population health management strategies around the globe. This half-day conference will take place on Friday afternoon (Oct. 25) and will bring new perspectives from countries/regions that have not been represented at past conferences.

Our sincere appreciation goes to the Program Committee, reviewers, and their associated organizations for the commitment of time and resources: Greg Berg (McKesson Health Solutions), Suzanne Duda (Healthways), Neil Gordon (INTERVENT International), Cynthia Hallam (Blue Cross Blue Shield Louisiana), Nancy Hedstrom Wigley (Cigna), Natalie Heidrich (Ethicon), Iver Juster (ActiveHealth Management), Craig Keyes (Alere), Rose Maljanian (HealthCAWS), Michael Taylor (Accenture), and Mike Van Den Eynde (Deloitte).

Stay tuned as we begin to release more details on the CCA Forum program within the next month. Those who submitted proposals can expect to receive notification of the Committee’s decision by the end of May.

Population Health Management in Health Insurance Exchanges

A 2013 research initiative, the Population Health Management in Health Insurance Exchanges has kicked off with two work groups: HIX Assessment and Exchanges 101. We are conducting an environmental scan of the state exchanges to better understand the variety in structure, design decisions, measurement, etc. We are also using past CCA research to build the value proposition for population health management and communicate that value to the exchanges. If you have resources or expertise to share in these areas, please contact Karen Moseley, KMoseley@CareContinuumAlliance.org.

CCA Quality & Research Update – Focus on Partnerships

Quality & Research March Update

Population Health Management in Health Insurance Exchanges

The Affordable Care Act requires health insurance exchanges (HIX) to be established and working by 2014 in every state. Currently, 17 states are pursuing a state-run marketplace, while the remaining 33 states will allow a federally facilitated marketplace or partner for a state-federal marketplace. These exchanges will function as a transparent and competitive marketplace where buyers of health insurance, mainly individuals and small businesses, can buy affordable and qualified health benefit plans.

This move toward increased health care access for broader populations provides an opportunity to apply population health management (PHM) beyond Medicare and Medicaid populations to the commercial market. As employers shift the ways in which they provide health benefits, this work will be applicable to any population health model trying to gain access to broader populations through broader access models such as state and private exchanges.

CCA and its members have already laid the groundwork for population health management as the cornerstone for this broader access model. PHM strategies and tactics will be important to the success of the health insurance exchanges. As the voice of population health, CCA will develop tools and guidance to address three main objectives: 1) help PHM vendors to understand the health insurance exchanges and the opportunities that may exist in these new markets; 2) demonstrate the value of PHM to the health insurance exchanges; and 3) inform policy makers about the value of PHM for the HIX and differentiate the payment models used.

The Quality & Research Committee has formed two work groups for this effort. If you are interested in participating, please contact Karen Moseley, kmoseley@carecontinuumalliance.org.

  1. HIX Assessment. This work group will perform the environmental scan of HIX, including participating states, design decisions, product offerings, populations served, measurement, health information technology, and other exchanges such as private exchanges and state-federal marketplaces.
  2. Exchanges 101. This work group will develop guidance around the value proposition of HIX as a new business opportunity for PHM organizations as well as the value proposition of PHM for the success of HIX.

HERO-CCA Employer Dashboard

CCA’s collaborative effort with HERO is progressing and will be in the final stages of review within the next few months. The project leadership group plans to meet for a full-day working session in April to finalize the document for review by experts in the industry and stakeholder groups within HERO and CCA. If you have expertise in measures for employee health management programs—specifically the domains of health impact, satisfaction, participation, financial outcomes, productivity, organizational support, and value of investment—please contact Karen Moseley, kmoseley@carecontinuumalliance.org, if you would like to serve as a reviewer of the work prior to release. The final review will include public comment, so stay tuned.

Workplace Wellness

The CCA data aggregation buzz has been quiet for several months, but it is becoming louder as we await the release of RAND’s Report to Congress on the effectiveness of wellness programs in the workplace, including factors such as the incentives offered, the impact participation has on employee behavior, and programs’ ultimate impact on employees’ health. We expect to have the full report in April, and RAND has offered to brief the CCA data advisory board as well as the data contributors on the report findings post release.

On a similar note, CCA Quality & Research is collaborating with CCA Advocacy to develop a detailed, comprehensive, and evidence-based response to a recent article in Health Affairs titled, Wellness Incentives In The Workplace: Cost Savings Through Cost Shifting To Unhealthy. The authors draw several conclusions that merit a response, and CCA members are called to submit case studies to increase the evidence. Read the Call to Actionand act now!

 

CALL FOR ACTION: Showcase The Value of Workplace Wellness Incentives

CCA has reviewed the March 2013 Health Affairs article discussing the use of incentives in wellness programs. The authors’ conclusions are not reflective of the evidence and experience of CCA members in implementing health contingent wellness programs. In addition, the title of the article seems to be unduly inflammatory, and not fully supported by the analysis.

We are concerned that the timing of this publication could adversely affect the nature of the forthcoming regulations on non-discriminatory wellness programs.  Therefore, the Care Continuum Alliance is:

  1. Alerting our members and the industry to the potential impact of this negative-toned article in the current regulatory and policy environment;
  2. Conducting a comprehensive literature review including CCA’s recent research on Participant Engagement and the Use of Incentives;
  3. Issuing a Call for Case Studies from the CCA membership to address the points made in the Health Affairs article;
  4. Calling our members to a concerted action in response to the assertions made in this article:
    1. Respond to CCA’s Call for Case Studies.
    2. Read Care Continuum Alliance Evidence Statements: The Use of Incentives in Employer-Sponsored Wellness Programs.
    3. Attend CCA Capitol Caucus, on April 11, where discussions on incentives and other regulatory issues will be center stage. Learn more and register today.
    4. Highlight your organization’s research and outcomes on incentives for wellness programs through media and public outreach.

Article’s Key Points

The article Wellness Incentives In The Workplace: Cost Savings Through Cost Shifting To Unhealthy, published in the peer-reviewed journal Health Affairs, offers a conceptual framework for assessing whether health-contingent wellness programs are effective in achieving cost-savings through health improvement. The authors determine that the relationship between high-risk health conditions/ behaviors and increased healthcare costs is not definitive; conclude that the current evidence on the effectiveness of incentives in behavior change science is ambiguous; and posit that demonstrated cost-savings from wellness programs may result from cost-shifting and placing an undue burden on those of lower socioeconomic status.

Our Response

CCA is developing a more detailed, comprehensive, and evidence-based response, which will incorporate our members’ research.

Please submit your case studies, experience and evidence illustrating the following points:

  • CCA members engage in rigorous program evaluations and scientific assessments with ample data to ensure wellness programs are appropriately designed and tailored to improved health outcomes.
  • Significant evidence suggests a clear relationship between high-risk health conditions/ behaviors and increased healthcare costs.
  • Years of epidemiological data clearly show that a healthy lifestyle reduces the likelihood of disease.
  • CCA acknowledges that current evidence yields mixed outcomes on the effectiveness of incentives in behavior change science. Though, as program innovation continues, a growing body of research positively indicates that incentives can, in some cases, facilitate behavior change to increase patient engagement in wellness programs.
  • Appropriate incentive and wellness program design can produce cost savings for employers without any cost shifting to less healthy employees.
  • The value of wellness programs extends beyond direct healthcare cost-savings. As one component of an organizational culture of health, wellness programs can produce additional positive outcomes such as workforce productivity, aside from short-term Return On Investment.

The final rules on Incentives for Nondiscriminatory Wellness Programs in Group Health Plans from the Department of Health and Human Services (HHS), the Department of the Treasury, and the Department of Labor are under development and expected in the coming months. In addition, there is concern about the possibility of lawsuits. Read CCA Letter to HHS Secretary Sebelius on Incentives for Wellness Programs.

CCA’s Actions

Your Actions

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