Feds Release Health Reform Law Wellness Program Rules

Today, November 20, 2012, the US Department of Health & Human Services (HHS) released guidance, the first of its kind, on provisions of the federal health reform law relating to employer-sponsored workplace wellness programs.

The federal health reform law, also known as the Affordable Care Act, creates new incentive structures and builds on current workplace wellness policies and programs in an effort to promote healthier workplaces and encourage further development of employer-sponsored wellness initiatives.

The proposed rule addresses standards for both participatory wellness programs – programs generally available without regard to one’s health status – and health-contingent wellness programs, which typically require participants to meet certain health outcomes goals in order to receive a reward.

Under the rule, employers may increase the maximum reward amount under health-contingent wellness programs from 20 percent to 30 percent of the cost of health coverage.  The maximum reward may be further increased to 50 percent for programs intended to prevent or reduce tobacco use.

The proposed rule would also require health-contingent wellness programs to follow a set of standards to avoid penalties. These include:

-Programs must be reasonably designed to promote health or prevent disease, meaning that 1) there must be available reasonable means of qualifying for a reward for any employee who does not meet a standard based on the measurement, test, or screening, and 2) there must be a reasonable chance of improving health or preventing disease and not be overly burdensome for individuals.

-Programs must be reasonably designed to be available to all similarly situated employees, meaning that there must be available alternative means of qualifying for the reward if an employee’s medical conditions make it unreasonably difficult to attain the health outcome.

-Individuals who might not qualify to attain rewards through traditional courses of action must be given notice of the opportunity to qualify for the same reward through other means.  The proposed rule offer new sample language that employers can use in communicating the availability of these rewards.

These rules are part of a broader set of health reform guidance released by the federal government today.  Rules on health insurance market dynamics, including a prohibition on pre-existing condition exclusions and actuarial value of health plans, as well as rules pertaining to coverage for essential health benefits were also released.

Health Care & the Election

With the presidential election fast approaching, a number of health policy media and research outlets have published a variety of resources on not only the role of health policy in this election, but also where the candidates stand on the issue.

The two presidential camps recently outlined their visions for federal health reform in the New England Journal of Medicine.  President Obama’s piece can be found at http://www.nejm.org/doi/full/10.1056/NEJMp1211514?query=TOC&.  Governor Romney’s at http://www.nejm.org/doi/full/10.1056/NEJMp1211516?query=TOC.

Two health services researchers and commentators, Austin Frakt of Boston University and Aaron Carroll of Indiana University, compare and contrast the candidates’ competing visions in a JAMA

And just this week, the New England Journal of Medicine published two relevant Perspective pieces, each featuring experts’ competing arguments on the merits of one candidate’s reform plan over the other’s.  Gail Willensky’s article, describing the shortcomings of Obamacare.  A piece describing Governor Romney’s reform plan, penned by faculty from Brown University and Harvard University.

Lastly, the October Visualizing Health Policy piece, a joint effort between JAMA and the Kaiser Family Foundation, offers a snapshot of how health care-related issues are shaping the election.

NEBGH Report Shines Light on Local and Regional Hospital Readmissions Reduction Efforts

NEBGH’s Solutions and Innovations Center (SIC) recently released a report that examines the ways in which hospitals and health plans in the region can collaborate to reduce preventable hospital readmissions.  A result of a unique collaboration between area hospitals, health plans, and employers, and sponsored by Boehringer Ingelheim and Merck, the report sheds light on breakdowns that occur in the health care system that often result in high readmissions rates in New York, New Jersey, and Connecticut.  Tackled in the report are a series of issues that underlie the readmissions issue, including that: by working together, hospitals and health plans could more effectively address readmissions, yet historically this type of collaboration is limited; stakeholders are taking a variety of approaches to reducing readmissions, which leads to complications in standardizing processes and metrics; and the current fee-for-service reimbursement system discourages the adoption of strategies that can reduce preventable readmissions.  The report reflects the findings of a multi-stakeholder panel of area hospitals, health plans, and employers convened by NEBGH.

NEBGH will be hosting a webinar on the hospital readmissions crisis and the findings of the report on September 19th at 12:00pm.  Visit www.nebgh.org/events for more details.

The complete report can be found here.