Health Care Reform Spurs Employer Interest in Wellness Programs

In the year since health care reform became law, employers have maintained health care benefits, implemented cost-sharing methods and assessed the long-term impact of reform on their organizations, according to findings from a newly released survey.

Health Care Reform: Employer Actions One Year Later, issued by the International Foundation of Employee Benefit Plans, is the second in a series of surveys on the impact of the Patient Protection and Affordable Care Act on single employer plans. The foundation is a non-profit organization that conducts studies on employee benefits, compensation, and financial literacy education and information.

“For the most part, employers have moved beyond the wait-and-see phase they were in just a year ago and are beginning to take action,” said Sally Natchek, senior director, research at the foundation. “Although many employers are concerned about rising costs, very few have drastically altered or ended their health care benefits. Most employers remain committed to offering quality health care benefits to their employees.”

Of particular interest, the data show nearly one in five employers adopted or expanded their use of wellness initiatives in the last 12 months (18%), and more than one-quarter (27%) reported they plan to do so in the next 12 months. Additionally, 38% are expanding the use of financial incentives to encourage healthy behaviors, and 27% are adopting or expanding their disease management offerings.

Other Findings

A majority of employers (60%) have conducted an analysis to determine how health care reform will impact their 2011 plan costs. Among respondents analyzing cost impacts, the largest proportion (36%) estimates health care reform legislation will increase their organization’s health care costs by 1%-2% in 2011. Although extending coverage to adult children to age 26 is seen as the top driver of cost increases, administrative costs and cost-shifting due to reduced Medicare and Medicaid payments to providers have emerged over the past year as major concerns.

To help ease increased costs brought on by health care reform, 40% of employers are increasing employees’ share of premium costs, 29% are raising in-network deductibles and 28% are increasing employees’ proportion of dependent coverage cost. Many employers also plan to increase out-of-pocket limits and co-payments or coinsurance for primary care (27% and 24% respectively).

Only 2.6% of respondents plan to cut health benefits for new hires, 1.6% plan to drop dependent coverage, 0.9% will close health benefits to new hires and 0.8% will discontinue health benefits for active workers or retirees. Less than one percent of employers (0.7%) plan to stop providing employees with health care coverage in 2014, when “play or pay” provisions become effective.

Additionally, although required only to extend health care benefits to dependents until age 26, 60% of  employers are going a step further and changing the eligibility requirements for dependents in other benefit plans (e.g., dental, vision, etc.) to conform to the requirements of their medical plans.

High-Deductible Plans
Employers continue to perceive value in the role of high-deductible health plans (HDHPs) for cost management. Approximately one-third of responding organizations are increasing their emphasis on or assessing the feasibility of such plans with a health savings account (HSA).

Grandfathered Status
Even though employers report several benefits of maintaining their grandfathered status—namely that their plans are exempt from the appeals process and the requirement to provide coverage for preventive care with no cost sharing or annual limits—just 30% expect to maintain grandfathered status beyond the next three years.

“Maintaining grandfathered status will be very challenging for employers,” Natchek said. “Plans can lose the status in numerous ways including reducing benefits, raising coinsurance or significantly raising co-payments or deductibles. To remain grandfathered, an employer will be able to make only limited changes in their health care plan. This does not appear feasible for most organizations.”

About The Survey
Responses were received from 1,350 individuals including benefits and human resources professionals, general and financial managers, and other professionals. Those asked to participate in the survey are members of the International Foundation of Employee Benefit Plans and the International Society of Certified Employee Benefit Specialist.

Another Step in the Process Toward Creation of a National Registry for Certified Medical Examiners

The Federal Motor Carrier Administration published a notice in the Federal Register today seeking comments on the proposed core curriculum for training medical examiners who perform Department of Transportation (DOT) physicals. 

Comments are due June 16, 2011. Refer to http://www.gpo.gov/fdsys/pkg/FR-2011-05-17/pdf/2011-11934.pdf

The development of minimum training requirements is part of efforts to implement a proposed rule establishing the National Registry of Certified Medical Examiners. The National Registry is required by section 4116 of the Safe, Accountable, Flexible,Efficient Transportation Equity Act: A Legacy for Users (SAFETEA–LU). 

As proposed, medical examiners will be required to successfully complete certain training and testing prior to being listed on the National Registry.

The intent of the Registry is to provide a list of medical examiners who are authorized to determine drivers' physical qualifications to operate commercial motor vehicles. A national database of certified medical examiners would help ensure that examiners understand the physical and mental demands of driving a commercial vehicle, transportation officials said.

Rationale for Coordinating Protective Interventions With Health Promotion

Rather than having regulated workplace hazard-reduction initiatives in one bucket and wellness programs that address workforce lifestyle risks in another, it makes sense to co-mingle them in one pool, says Dr. L. Casey Chosewood, senior medical officer for WorkLife at the National Institute for Occupational Safety and Health (NIOSH).

In addition to the altruistic aspects of taking steps to ensure a safe workplace and a healthy workforce, the financial motivation is clear: employers are responsible for a significant percentage of the nation’s health care expenditures and are looking for ways to control their costs through an integrated approach that encourages employee buy-in.   

In a bellwether report commissioned by NIOSH in 2004, researchers at the Harvard School of Public Health articulated one of the challenges associated with integrating regulated  protection with voluntary wellness programs: 

“The belief that worker health begins with individual behavior change sets in motion a different set of intervention strategies from the legal formulation in the Occupational Safety and Health Act, which starts from the assumption that management bears primary responsibility for worker health and safety on the job. Overcoming the segmentation of these fields ultimately will require an inclusive, comprehensive model of work and health, providing for resolution – or at least understanding – of our differences, assumptions, vocabulary, research methods and intervention approaches.”

While seven years old, the report is still relevant today, and it outlines a number of arguments in favor of integration:

• Workers’ risk of disease is increased by exposure to both occupational hazards and risk-related behaviors.
• Workers at highest risk for exposures to hazardous working conditions also are those most likely to engage in risk-related health behaviors and live in higher-risk communities.
• Integrating occupational safety and health with health promotion may increase program participation and effectiveness for high-risk workers.
• Integrated safety/health and health promotion programs may support broader work organization issues and improve the work environment.

Examples of integrated worker protection-and-health promotion programs include:

• Respiratory protection programs that comprehensively address tobacco use.
• Ergonomic consultations that discuss arthritis management strategies.
• Stress management programs that first seek to diminish workplace stressors, then work to build worker resiliency.
• Integrated training and prevention programs (falls, motor vehicle safety, first aid, hearing conservation, stretching, flexibility, safe-lifting programs).
• Comprehensive screenings for work-related and non-work risks.
• Occupational health combined with a primary care home model.
• Full integration of clinics, behavioral health/employee assistance, traditional safety, health promotion, coaching, nutrition, disability and workers’ compensation programs.

Dr. Chosewood said NIOSH researchers prefer to use the term “workability” as opposed to “productivity,” particularly when referring to employees’ expressed desire for greater control over their work schedules and environment. Studies show that employees who are given some latitude in their work life experience less anxiety and stress, which in turn reduces complaints that result in costly work absence.

Reference: Steps to a Healthier U.S. Workforce: Integrating Occupational Health and Safety and Worksite Health Promotion-State of the Science;  

G Sorensen, E Barbeau, Harvard School of Public Health, 2004.

Market Factors Drive Workers' Compensation Reimbursement

Changes in a state workers’ compensation fee schedule for a specific service do not necessarily stabilize the percentage of change in provider reimbursement, according to a new study from the National Council on Compensation Insurance (NCCI).

The Impact on Physician Reimbursement of Changes to Workers’ Compensation Medical Fee Schedules compares distributions of group health payments to workers’ compensation reimbursement in 2002 and 2006. The six CPT codes featured in the study illustrate the effect of certain special circumstances and outside influences on workers’ compensation medical reimbursement.

Among the findings:

• The change in average workers’ compensation reimbursement resulting from a change in a state physician fee schedule for a given service depends heavily on the relationship between the fee schedule and actual market prices.
• Workers’ compensation fee schedules are more effective at controlling the cost of high-volume, low-priced procedures than low-volume, high-priced procedures.
• The impact of increasing a workers’ compensation fee schedule maximum reimbursement is not simply the reverse of decreasing the scheduled amount.
• The lag time for providers to respond may depend on the relationship between the current fee and prices paid by group health and the timing of provider network contract renewal.
• Who performs the procedure and who bills for it—whether a single physician, multiple providers, or a hospital or other facility—can influence the reimbursement pattern and whether a fee schedule applies.
• Some medical treatments are performed several times, and some are reimbursed on a time basis rather than on a per-service basis.

For those of you who wish to delve deeper, group health is compared to workers’ compensation experience in the following state studies:

• Alabama—Emergency Department visits (CPT Code 99283)
• Florida—Carpal tunnel surgery (CPT Code 64721)
• Georgia—Burn treatment (CPT Code 16020)
• Kentucky—Established office visit (CPT Code 99213)
• Maryland—Therapeutic exercise (CPT Code 97110)
• Oregon—Shoulder X-ray (CPT Code 73030)

The NCCI notes that with the advent of more complex billing methods, such as Medicare’s Ambulatory Payment Classifications and Diagnosis-Related Groups, the task of building and maintaining workers’ compensation medical fee schedules is becoming more challenging. “These billing schemes and other reforms, such as treatment protocols, are meant to address utilization of services as well as prices. To meet the challenges these pose to monitoring, estimating and ultimately controlling workers’ compensation medical costs, it is important to make optimal use of information that reflects the entire medical marketplace," NCCI researchers conclude.

Many American Workers Are Discontented

The Gallup-Healthways Well-Being Index® is the first-ever daily assessment of U.S. residents' health and well-being. By interviewing at least 1,000 U.S. adults every day, the Well-Being Index provides real-time measurement and insights needed to improve health, increase productivity and lower health care costs, according to the sponsors.

Now the collective 2010 data is in, and it doesn’t bode well for the workforce. 

Newly released city, state and congressional district rankings show the

the Work Environment Index, as a subset of the Well-Being Index, fell to a low of 48.2 out of a possible 100 last year. This continues an annual downward trend that indicates increasing discontent with the U.S. work environment, declining job satisfaction and a lack of trust in employee/supervisor relations, researchers said.

The Work Environment Index measures Americans' perceptions in four categories:

• Job satisfaction 
• Ability to use one's strengths at work
• Supervisor's treatment (a boss or a partner?) 
• Supervisor creates an open and trusting work environment

Among the findings, unionized federal, state and local government workers, as well as unionized private-sector workers, have a lower Work Environment Index score than their counterparts who are not in a union. Workers who are unionized are more likely to consider their supervisor to be a boss rather than a partner, and less likely to say their supervisor creates a trusting and open work environment.

In addition, Gallup-Healthways reports that American workers who are emotionally disconnected from their work and workplace (known as "actively disengaged" workers) rate their lives more poorly than do those who are unemployed: 42% of actively disengaged workers are thriving in their lives, compared to 48% of the unemployed. At the other end of the spectrum are "engaged" employees who are involved in and enthusiastic about their work, 71% of whom are thriving.

Incidentally, other widely publicized studies have shown that one of the leading causes of absence and disability following a work-related injury is the lack of a supportive supervisor.

Behavioral Interventions Recommended to Promote Health

Tomorrow is the final day to submit comments to the U.S. Preventive Services Task Force on recommended behavioral counseling interventions to promote healthy eating and physical activity for cardiovascular disease prevention in adults.

Studies show that medium- and high-intensity counseling interventions improve self-reported dietary intake of salt, energy, fats, and fruits and vegetables, as well as self-reported physical activity. In studies, on average, medium-intensity physical activity counseling interventions produced a 38-minute increase in physical activity per week. Diet and combined lifestyle counseling interventions decreased total fat and saturated fat intake and increased fruit and vegetable consumption. The strongest evidence was for high-intensity counseling interventions to improve physiologic outcomes.

The task force is a national, independent panel of medical experts that makes evidence-based recommendations to physicians about the clinical preventive services they should offer their patients. To review the draft recommendations click here.

States Debtate Workers’ Comp Benefits for Undocumented Workers

A number of states - including Georgia, Montana, New Hampshire and South Carolina - are considering bills that would deny workers’ compensation benefits to illegal immigrants who are injured on the job.

The U.S. Supreme Court recently declined to hear a case that concerned an illegal immigrant in Louisiana who sought workers’ compensation benefits after a workplace accident, leaving it up to states to decide about coverage in their jurisdiction.

The issue is significant: the Pew Hispanic Center estimates there are about 8 million unauthorized immigrants in the nation's workforce. 

Although federal law prohibits knowingly hiring illegal immigrants, once hired, most states provide workers’ compensation benefits regardless of immigration status. Courts have generally held that such workers are entitled to benefits, according to the Insurance Information Institute.  

Meanwhile, the institute reports that most insurers favor sustaining coverage, stating that denial runs counter to public policy and that workers’ compensation laws serve a humanitarian purpose. They assert that unscrupulous employers could recruit illegal aliens, knowing they could avoid the cost of workers’ compensation coverage. In addition, denial of coverage could expose employers to civil suits by eliminating workers’ compensation exclusive remedy protections.

Opponents say undocumented workers should not be eligible for benefits, primarily because they are in the country illegally.

In Montana, legislators on Jan. 19 approved H.B. 71 by a 69-31 vote. The bill, sponsored by Rep. Gordon Vance, R-Bozeman, would prohibit illegal immigrant workers from collecting benefits when they are injured. Vance says the bill would help reduce costs. If passed, Montana would become the first state in the nation to completely ban illegal aliens from receiving workers’ compensation benefits.