Heads up HR managers! Check out PHA Forum 2014 Workplace Healthcare & Benefits Institute

PHA Forum Logo Final-01The Workplace Healthcare and Benefits Institute is a cornerstone of the educational program at the Population Health Alliance’s (PHA) annual conference, the PHA Forum 2014, to be held December 10-12, in Scottsdale, Arizona, with the theme, Collaborate + Communicate = Engage. Registration is open online.

The Workplace Healthcare and Benefits Institute, on Wednesday, December 10, from 10 am to 5 pm, will provide HR and benefits managers and employers across the spectrum a solid basis to assess their wellness programs, as well as, for newcomers a review of core metrics, engagement strategies, and comparison of emerging and existing trends in wellness, incentives and more.

“HR managers, employee benefits specialists, as well as organizations and vendors new to the population health management space will benefit from the in-depth analysis and interactive exercises on engagement strategies, incentives, measuring program impact, and value metrics,” said Karen Moseley, PHA Director of Research.

The registration for the annual conference is now open and members of the media can request press credentials. Employers enjoy a great rate of $195 for the entire conference.

Check the Agenda for the Workplace Healthcare and Benefits Institute.

Register for the PHA Forum 2014 and save with great early bird rates!

Engagement, what was that again…and how do I know it when I see it?

By Fred Goldstein, PHA Executive Director 

Engagement has been on the spotlight for a while. In this new economy and ecology of companies invested in getting their clients to interact directly and constantly with the organizations and among themselves using various platforms, measuring engagement has become the angular rock of business. It has also become ever more elusive. Vanity measures – followers, likes – are no longer enough, and neither investors not customers are fooled by them.

If you are in the health care world, as I am, you know that engagement is paramount. You also know you would like to be able to define it, measure it, understand it, and figure out how it translates into better outcomes for your patients and employees.

It seems as if every organization reports on engagement in a different way, and the time for standardized metrics and homogenous methods has come. In order to define engagement, members of the Population Health Alliance have created a Workgroup on Engagement as part of the work of PHA’s Quality and Research Committee.

They are very happy to hear and receive continuous feedback from the organizations involved in worksite wellness, population health management, and others who are make strides to get engagement right. Get involved by contacting Karen Moseley, PHA Research Director, kmoseley@populationhealthalliance.org or just email me.

For PHA, 2014 is truly the year of engagement.

–       The theme of the annual conference, PHA Forum 2014, is Collaborate + Communicate = Engage.

–       Excelling in Engagement, an educational track at PHA Forum 2014, gathers presentations that discuss in depth engagement as an overall theme, including provider, engagement, health plan member engagement, incentive program design, and engaging the moderate risk population.

–       Engagement again! So, how do we do it?is the title of one of PHA Forum 2014 Walking Learning Labs of the Exhibit Hall, in which organizations will provide hands on demonstrations of how engagement works in real life.

Learn more about the PHA Workgroup on Engagement’s Charge.

The Wait Is Over: PHA and HERO Release Core Metrics for Employee Health Management

For the past two years, PHA has partnered with Health Enhancement Research Organization (HERO) to identify and recommend measures and standards for the assessment of employee health management programs for the employer community.

The employer dashboard covers 7 domains: organizational support, health impact, participation, satisfaction, financial outcomes, productivity and performance, and value on investment. The recommendations have been reviewed by several subject matter experts and are currently under review by stakeholder organizations and public comment.

Read the Program Measurement Evaluation Guide: Core Metrics for Employee Health Management (Executive Summary)

Read the Program Measurement and Evaluation Guide: Core Metrics for Employee Health (Handout)

PHA Forum Logo Final-01Why PHM in the workplace is the new black?

A discussion and in-depth presentation of the core metrics for employee health management and the work of PHA and HERO will be a centerpiece of the Workplace Healthcare and Benefits Institute at the PHA Forum 2014.

Population Health Management (PHM) is changing workplace wellness for the better. The Workplace Healthcare and Benefits Institute, a preconference event of the PHA Forum 2014, will provide HR and benefits managers and employers across the spectrum a solid basis to assess their wellness programs, as well as, for newcomers a review of core metrics, engagement strategies, and comparison of emerging and existing trends in wellness, incentives and more.

Check PHA Forum 2014 Schedule of Events

Register for PHA Forum 2014


NEW at CCA Forum 2013: Walking Learning Labs

Care Continuum Alliance Forum 2013This year the CCA Forum has made it easier than ever to make meaningful, face-to-face connections between attendees and exhibitors through our new Walking Learning Labs.

These unique, hands-on demonstrations are intended to help you determine the value of specific solutions for your organization. The Walking Learning Labs are guided and facilitated by CCA researchers and provide attendees with an opportunity to explore particular areas of interest throughout the exhibit hall. Register today!


All Eyes on Alere, CCA Forum 2013 Presidential Sponsor

The CCA Forum’s Presidential Sponsor is Worth WatchingCare Continuum Alliance Forum 2013

As Presidential Sponsor of the CCA Forum 2013, Alere brings acute expertise and advanced solutions to this year’s conference. With a vision of connected health, Alere is an established leader in the healthcare industry for innovation. Don’t miss this rare opportunity to meet several of Alere’s top innovators. Register today!


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)

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


office: 202.737.1107

cell: 202.870.2166

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