With the support of the Robert Wood Johnson Foundation, 35 of us visited the Lincoln Cottage, a hilltop retreat overlooking D.C. where Lincoln found solace, but also connected more closely with people, during the Civil War. Our group was there to inaugurate a national dialogue on health equity. Later dubbed the “Lincoln Cottage Assembly,” we were welcomed by health futurist Jonathan Peck at the staircase Lincoln climbed every day to write about the most vexing issue of his time.
Paul Terry, CEO, Heath Enhancement Research Organization
There are two transformations occurring in workplace based health promotion in America. The first is the movement from wellness to “well-being” and, related to this, a shift from a focus on a return on investment (ROI) to the use of value on investment (VOI) measures. These VOI measures are well documented and publicly available, but are we thinking broadly enough?
Limiting access to any pleasures: tobacco, foods that are bad for you, the after-party of a Prince concert—you name it, you’re going to be unpopular with many people. To quash what some see as their right and none of your business is to invite endless arguments that as often as not have little to do with the facts of the matter. As someone who has weighed in on my share of health policy debates, I’ve long observed that the “greatest good for the greatest number” bromide calms my nerves, but it seldom holds sway with those who don’t see what good the policy is doing them.
Though hospitals were the slow adopters of EHRs, most are now fully engaged in trying to satisfy the federal requirement for “meaningful use” of an EHR thanks to CMS financial incentives. Still, as much as acceptance of the complex requirements needed to earn incentives is now a given with three fourths of health systems achieving stage 1 requirements, my discussions with providers from around the country leaves me observing that the intense focus on the details behind satisfying requirements has obscured the greater health policy picture.
One of the more audacious promises of the accountable care organization (ACO) movement is the idea that providers of medical services can play a larger role in improving a population’s health. It stems from a notion that health care financing reforms will move the focus of providers from “the tyranny of the office visit” to activities where success will be judged according to improvement in clinical metrics whether a patient visits the office or not. It’s the right vision from a health promotion advocate’s vantage point because it may serve as a preamble to an era where medical and public health practices and public policies truly intersect.
Recently a Minnesota school was evacuated after 10 students got sick during choir practice. A carbon monoxide leak was the presumed cause, given the similarity of student’s symptoms and the rapid spread of complaints. Thirty students in all were taken to the hospital and the school was closed for the day. Tests proved negative, recovery was quick, and the Minnesota Department of Health (MDH) now reports that the likely cause was psychogenic illness.
The state spokesman said that when people in a group become ill at the same time with subjective complaints, “It is no less real.”
January 1, 2014 marks the most monumental day in the history of American health policy. The individual insurance mandate, the sunsetting of underwriting as we know it, and the planned obsolescence of the term “pre-existing conditions” in insurance all presage a fundamentally different era for access to health care.
The recent Health and Productivity Conference sponsored by the National Business Group on Health (NBGH) signaled the arrival of what social scientists have long held as vital to the success of wellness: a balance between personal and organizational engagement in health.
Though the Department of Health and Human Services and Department of Labor issued final regulations concerning “Incentives for Nondiscriminatory Wellness Programs in Group Health Plans,”1 employers and health plans must still navigate unresolved inconsistencies between the Affordable Care Act (ACA) and the Americans with Disabilities Act (ADA).
The latest ACA rules indicate that if a plan uses a “health-contingent” incentive scheme, that is employees are to meet certain standards related to a health factor (e.g., losing weight or controlling blood pressure) in order to receive a reward in the form of reduced premiums or deductibles, the plan must satisfy several requirements including offering a “reasonable alternative standard” for those who believe that the standard is not accommodating their unique circumstances.
The EEOC has remained silent on whether they deem wellness programs to be voluntary, a key concern of an agency committed to ensuring that all employees enjoy equal benefits and privileges of employment such as is guaranteed under the American with Disabilities Act (ADA).
The Department of Labor has issued new guidelines concerning the wellness provisions of the Affordable Care Act (ACA) that relate to the use of financial incentives, and the Office of Health Plan Standards and Compliance Assistance is seeking public comment. This document proposes “amendments to regulations, consistent with the Affordable Care Act, regarding nondiscriminatory wellness programs in group health coverage." These regulations increase rewards for wellness participation or outcomes from 20 to 30% or up to 50% related to reducing tobacco use.