Health plan costs - disease management |
[Guidance Overview] Effect of New Michigan Health Insurance Claims Assessment Act on Group Health Plans
"Employer plan sponsors with Michigan employees should discuss payment of the HICA tax with their medical, dental, vision, prescription drug and wellness TPAs. Plan sponsors may want to review their service agreements with their TPAs to determine whether the plan sponsor has any obligation to reimburse the TPAs for the tax." (McDermott Will & Emery)
[Opinion] Living Well with Chronic Illness: A Call for Public Health Action
"Chronic disease has now emerged as a major public health problem and it threatens not only population health, but our social and economic welfare." (Institute of Medicine)
[Opinion] Cleveland Clinic: 'Why We Won't Hire Smokers'
"Job candidates are told that the offer is subject to a nicotine-free urine test. If a candidate tests positive for nicotine, the offer is rescinded, and he or she is offered a free tobacco-cessation program and may reapply in 90 days. . . . At Cleveland Clinic, we have a unique perspective on the burden of chronic disease. We not only treat disease, but we also play a vital role in educating patients and employees about lifestyle choices. It is only right to practice what we preach." (USATODAY.com)
[Opinion] It Takes a CEO to Save the U.S. Health Care System
"Forget Washington and the political debate over Obamacare. The real battle for the future of health care is being fought in the world of business, where tens of thousands of companies have seen their financial well-being undermined by skyrocketing employee health costs." (Bloomberg L.P.)
Financial Incentives Raise Value-Based Insurance Design Program Stakes
"[The] programs are taking a bite out of the cost for four health conditions -- cardiovascular disease, cancer, diabetes and obesity -- that account for about three-quarters of the United States' health care costs." (LifeHealthPro)
[Guidance Overview] Health Reform: Fine-Tuning the Medical Loss Ratio Rules
"On December 2, 2011, the [HHS] released both a final rule and an interim final rule updating the medical loss ratio rule that it issued almost exactly a year ago. [DOL] simultaneously issued a technical release giving direction to employer-sponsored health plans governed by [ERISA] as to how to handle rebates provided by insurers who fail to meet the targets established under the MLR rule." (Health Affairs)
Four Ways to Create an HIV/AIDS Inclusive Workplace
"Bring in a local expert for a brown-bag lunch; hold a 'Red-ribbon Day' to promote awareness; conduct a one-day fundraiser to benefit a local HIV/AIDS clinic; promote regular testing." (Employee Benefit News)
Eating Disorders a New Front in Health Insurance Fight
"in the last few years, some insurance companies have re-emphasized that they do not cover residential treatment for eating disorders or other mental or emotional conditions. The insurers consider residential treatments not only costly -- sometimes reaching more than $1,000 a day -- but unproven and more akin to education than to medicine." (The New York Times; free registration required)
Medical Benefits to Manage Chronic Disease or Aid Recovery
"The article presents data on benefits for organ and tissue transplantation, physical therapy, durable medical equipment, prosthetics, diabetes care management, and kidney dialysis." (U.S. Bureau of Labor Statistics)
Economics Favor Retaining Health Coverage in Large Employer Plans, According to Benfield Report
"The Benfield report concluded, 'In addition to concerns over competing for valuable (and increasingly scarce) human capital talent, the math behind the decision is likely behind our finding that only 7% of jumbo employers are considering dropping active employee health care coverage in 2015 and beyond. An additional 7% of jumbo employers are considering dropping health care coverage, but will provide employee vouchers or supplemental compensation.'" (Wolters Kluwer Law & Business)
Pathways to Managing Cancer in the Workplace (PDF)
"This guide provides employers with practical ways to support employees who have cancer as well as those who are taking care of family members with the disease. The guide will assist employers as they implement a full spectrum of benefits and programs . . . ." (National Business Group on Health)
10 Tips for a Successful Chronic Care Management Program
"The key to success with any chronic care management program lies in effective coordination, coupled with powerful data analytics that allow employers to induce their employees to take an active role in their own health care." (Employee Benefit News; free registration required)
Health Care Payment Reform: Analysis of Models and Performance Measurement Implications
"Recently, purchasers and insurers have been experimenting with payment approaches that include incentives to improve quality and reduce the use of unnecessary and costly services." (RAND)
National Business Group on Health Targets Cancer in the Workplace
Excerpt: "The National Business Group on Health has launched an ambitious, three-year initiative aimed at helping employers design benefit plans that reflect the latest scientific information and expert recommendations on cancer treatment and prevention." (Employee Benefit News; one-time free registration required)
Study Proves That Online Chronic Condition Program Offers Patients a Return on Investment and Enhances Ability to Self Manage Health Conditions
Excerpt: "The study, which took place over the course of five years, analyzed data of members who participated in HealthMedia? CARE? for Your Health, an online digital health coaching program designed to teach participants the skills they need to help manage any chronic condition." (Blue Cross and Blue Shield Association)
'Crowdsourcing' Offers New Way for Doctors to Seek Treatment Advice
Excerpt: "Crowdsourcing refers to the process of developing a group consensus by pooling ideas from a broad community, often over the Internet. Physicians can crowdsource by posting a medical question online and seeking input from thousands of medical professionals." (California HealthCare Foundation)
Engaging Large Employers Regarding Evidence-Based Behavioral Health Treatment
Excerpt: "[The project has several objectives; one objective is to] Develop an understanding of how knowledgeable large employers in the U.S. are in regards to behavioral health, collaborative care and the research supporting its effectiveness." (National Business Group on Health)
[Guidance Overview] HHS Releases Further Guidance on ERRP and Allows Plan Sponsors to Submit Early Retiree Lists (PDF)
4 pages. Excerpt: "[The] guidance provides more information on who is an early retiree for purposes of the program . . . ." (Buck Consultants)
[Guidance Overview] New Informal Guidance Issued on Various Health Reform Mandates
Excerpt: "On its web site, the DOL posted new frequently asked questions . . ., providing guidance on various new mandates. The DOL simultaneously issued DOL Technical Release 2010-02 addressing certain issues affecting the new internal appeals and external review requirements. Separately, the IRS issued Notice 2010-63 announcing that the IRS is seeking comments on the application of nondiscrimination rules to insured arrangements." (Proskauer Rose LLP)
For Chronic Care, Try Turning to Your Employer
Excerpt: "Your employer may seem like an unlikely choice. Chronic conditions account for 25 percent of all medical costs, studies show, and an employee with a longstanding illness can mean higher health care expenses and lower productivity to company bean counters." (The New York Times; free registration required)
Medical Home Approach to Care Can Improve the Sickest Employees' Health and Reduce Costs
Excerpt: "Last fall, Boeing announced the completion of a two-year pilot program in Seattle-area clinics for patients with chronic illnesses who get their health insurance through the company. The program . . . was based on the concept of the medical home, which puts patients at the center of a team of nurses and doctors who are paid extra to actively manage a person's health and health care." (Workforce Management; free registration required)
Innovations in Preventing and Managing Chronic Conditions
Excerpt: "Instead of waiting for workers to get sick, leading companies are shifting their focus from sickness to health, fostering work and community environments that help people lower risk factors -- smoking, diet, lack of exercise -- that lead to disease . . . . High-risk employees contribute disproportionately not only to health care cost, but also to absenteeism, disability and other costs." (Center for Studying Health System Change)
Lines Blurring between Wellness and Disease Management Services
Excerpt: "With wide acceptance of a link between lifestyle and the onset of chronic illness, disease management firms are incorporating wellness and health promotion into their traditional service model. Unlike a more fragmented approach in which wellness and disease management services are provided by separate companies, usually to different groups of plan members, an integrated approach puts all plan members together so they can access both services regardless of health status." (Workforce Management; free registration required)
Cancer Prevention and Care Management: Employer Opportunities
Excerpt: "Cancer in both employed and retired populations is a major expense for employers in terms of medical and pharmacy costs, disability costs, lost productivity and diminished quality of life. This Perspective examines the shortfalls in cancer care and explains how employers can adopt best practice designs and medical management programs that support cancer detection and treatment, including working with vendors to ensure best practice management and utilizing centers of excellence whenever possible." (Mercer LLC)
[Opinion] Ten Small-Scale Health Insurance Reforms for Pre-Existing Conditions
Excerpt: "In a reformed health care system, the chronically ill - along with their doctors, employers and insurers - should find lower-cost, higher-quality, more-accessible care in their economic self-interest. [Instead of suppressing the price system, [here] are 10 ways of dealing with this problem that make greater use of it.]" (National Center for Policy Analysis)
Value-Based Health Insurance Design Will Balance Costs for Drugs and Other Medical Services
Excerpt: "A value-based health insurance design program that promotes proven effective drugs for chronic medical conditions will, at the very least, keep costs balanced through reduced use of medical services, according to the results of a study published in the February 2010 Health Affairs. The study, Evidence that Value-Based Insurance can be Effective . . . ." (Wolters Kluwer)
[Opinion] American Benefits Council/HR Policy Association Comments on Interim Final Rules on Genetic Information in Health Insurance Coverage and Group Health Plans (PDF)
12 pages. Excerpt: "We are particularly concerned about the significant restrictions the Rules impose on employers' ability to effectively use HRAs and disease and case management programs to improve employee health." (American Benefits Council)
Estimates of Commercially-Insured Population at High Risk for Cardiovascular Events: Impact of Aggressive Cholesterol Reduction (PDF)
9 pages. (American Health & Drug Benefits via Milliman)
Childhood Obesity Weighs on Benefit Budgets
Excerpt: "Childhood obesity weighs heavily on the financial scales when it leads to increased health care utilization and higher costs for employers. Further, poor child health will decrease employee productivity as working parents often must leave early or be absent to care for their child." (BenefitNews.com)
[Guidance Overview] GINA Interim Final Regulations: Wellness and Disease Management Programs Impacted
Excerpt: "Title I of GINA, as interpreted by the interim final regulations, prohibits plans from ? Increasing group premiums or contributions based on genetic information; Requesting or requiring an individual or family member to undergo a genetic test (other than for certain limited exceptions, including a plan's right to condition payment for a medical service on medical appropriateness which may in turn depend on the genetic information of the individual); and Requesting, requiring or purchasing genetic information prior to or in connection with enrollment, or at any time for underwriting purposes. It is also important to note that unlike the other provisions of the HIPAA portability and nondiscrimination rules, GINA does apply to group health plans with fewer than two participants who are current employees. In other words, GINA does apply to a separate retiree medical plan." (Kilpatrick Stockton LLP)
The 'Next Big Thing' in Health Insurance Plan Design Offers Rich Benefits to Chronically Ill Members
Excerpt: "A startup health insurer aiming to incentivize behavior change for both healthy and chronically ill members will begin marketing its products to small employers in Fresno, Calif., this fall. Unlike traditional health plans, SeeChange Health's value-based benefit model seeks out both the chronically ill and the 'overlooked healthy (i.e., those at risk for developing a chronic condition) and offers them richer benefits in exchange for compliance in managing the condition." (AISHealth.com)
When HR Asks About Your Health
Employers want you to answer some personal questions. Should you? (CNNMoney.com)
Cisco Systems Links High Touch With Hi Tech to Engage Employees in Their Own Health
Excerpt: "Imagine attracting nearly 5,000 employees to a health screening in a heated competition to get their biometric numbers, hosting a secure messaging program where employees can conveniently communicate with their doctors via e-mail, or unveiling an on-site health center on YouTube. These are just a few of the many ways Cisco Systems, a leading provider of Internet technology solutions, is engaging its employees in managing and safeguarding their health for the long term." (Towers Perrin)
Budgetary Effects of Prevention Programs Need Clinical Data Over a Long Time Period
Excerpt: "Although preventive health measures will not necessarily save money on health care spending, over the long term, they at least will offset a large part of the costs of the prevention programs, according to a study published in the September 1 online journal Health Affairs. Health care reform proponents often claim that expanding coverage and preventive health measures will lower health care costs. The study researchers, from the University of Chicago's Medical School and the National Opinion Research Center, detail how an 'epidemiological' assessment over a period of 25 years, not the commonly used ten-year period, can more accurately project the actual costs of health care reform measures, because 'the positive effects of improved treatment often take decades to show clinically significant effects.'" (Wolters Kluwer)
Employers Balance Disease Management and Wellness Efforts to Cut Costs
Excerpt: "If employers focus only on employees with chronic conditions, 'they will get some savings a bit faster, but what they will not be addressing is that people who have those conditions in two to five years are people who have lifestyle problems today,' said Bruce Kelley, national leader of data services at Watson Wyatt Worldwide in Minneapolis.'We have seen some tendency to put more emphasis on the short-term (savings), but I can't think of a client who has abandoned the longer-term strategy' of fostering employee wellness, he said. Watson Wyatt data show that just 5% of the workforce -- those with complex chronic conditions and catastrophic cases -- spend about 50% of the health care dollars . . . ." (Business Insurance)
Chronic Conditions Crank Up Health Costs
Excerpt: "Nearly half of Americans have a chronic condition, and 75% of the $2.6 trillion spent annually on health care goes to treat patients with long-term health problems, says Kenneth Thorpe, a professor at Atlanta's Emory University and head of the Partnership to Fight Chronic Disease. . . . 'All of these diseases are accumulations of what's happened before in a person's life,' says Barbara Starfield, professor of public policy at Johns Hopkins University in Baltimore. 'We have to think about keeping people as healthy as possible so they don't get these diseases.'" (USA Today)
Using Clinical Information to Project Federal Health Care Spending
Excerpt: "Complications from chronic illnesses often do not emerge for many years. Current federal cost projection methods are constrained by ten-year cost estimates, which capture increases in near-term intervention costs but not changes in long-term costs. Current methods also cannot easily capture the cost implications of changes in disease progression. Type 2 diabetes is a prime example of a chronic illness with long-term health and cost consequences. We present results from an epidemiologically based model that projects federal costs for diabetes under alternative policies, and we discuss the potential changes in the federal budget process needed to capture the full impact of these interventions." (Health Affairs)
Study Raises Questions About Cost Savings from Preventive Care
Excerpt: "Preventive services for the chronically ill may reduce health-care costs, but they are unlikely to generate the kind of fantastic savings that President Obama and other Democrats have said could help pay for an overhaul of the nation's health system, according to a study being published Tuesday. . . . 'There's no free lunch here. Prevention will not pay for everything. But it's not as expensive as it looks at first blush,' said Michael J. O'Grady, a senior fellow at the National Opinion Research Center at the University of Chicago, and one of four authors whose work is being published on the Web site of Health Affairs, a leading journal of health policy research." (The Washington Post; free registration required)
Healthcare Costs for Overweight and Obese Patients Grow
Excerpt: "Healthcare payers spent a lot more per person to treat those who were obese and overweight in 2006 than they paid in 2001. That's the message from a new federal report that ranked spending on adult patients categorized by body mass index. The increased spending per person is attributed to greater expense of managing chronic conditions, such as diabetes or high blood pressure." (HealthLeaders Media)
Prevention Efforts Provide No Panacea on Health Costs
Excerpt: "There is one idea for fixing the health-care system that lawmakers in both parties agree on: a bigger government role in disease prevention. Yet many previous government prevention efforts aimed at costly chronic diseases have had little success in reducing illness or costs. 'It is not going to cut costs,' said Louise Russell, a research professor in the Institute for Health at Rutgers University who has studied the issue. 'We already do a lot more prevention than other countries. We are not healthier.'" (The Wall Street Journal)
Diabetes Disease Management Pilot Program Yields Big Cost Savings
Excerpt: "A diabetes disease management program conducted by the American Pharmacists Association Foundation is being made available to employers nationwide as a result of a series of successful tests. The program, the Diabetes Ten City Challenge, has yielded substantial savings for employers even after they've waived co-payments for participants and paid for individual counseling. Patients also saved money and improved in several key clinical areas associated with the condition, officials said." (Workforce Management; free registration required)
Integrated Health Care Can Improve Chronic Illness Treatment
Excerpt: "Improving care for people with chronic illnesses will require addressing barriers such as fragmented care, poor transitions between care settings, and payment that does not recognize the value of better integration of services, according to a recent report from AARP. Other obstacles to improving care for those with chronic illnesses are 'poor information systems' that make it difficult for medical providers to track patients over time, to integrate care among different providers and different care settings, and to track medication adherence and prevent drug interactions." (Wolters Kluwer)
More Large Employers Offer Chronic Disease Management Programs to Reduce Health Care Costs
Excerpt: "Eighty percent of large U.S. companies this year are offering chronic disease management programs for workers in an effort to reduce health care costs, up from 51% last year, according to a new survey by Hewitt Associates . . . . Hewitt surveyed 343 large companies and found that more employers are targeting costly chronic diseases -- such as diabetes, heart disease, asthma and depression -- rather than workers' eating or exercise habits. Hewitt estimates that a company with 9,500 workers and 500 retirees younger than age 65 spends between $18 million to $22 million on health care just for those with diabetes." (Kaiser Family Foundation)
Health Plans Use Variety of Strategies to Identify and Ensure Compliance Among Diabetics
Excerpt: "On Jan. 15, United announced the launch of its Diabetes Health Plan with built-in preventive care incentives. As a value-based design, the plan eliminates copayments for many of the out-of-pocket expenses that discourage many diabetics from effectively managing their condition." (AISHealth.com)
In 'Sobering' Finding, Care Coordination Doesn't Save Money
Excerpt: "When it comes to finding ways to cut costs from the health-care system, an idea that's becoming popular among health-quality gurus, medical organizations and insurers is 'coordination of care.' . . . A study out in JAMA has some disheartening results. Among 15 randomized trials of care-coordination programs involving Medicare patients, only two showed significant differences in hospitalizations between those whose care was coordinated and a control group. And one of those two saw more hospitalizations among the coordinated group. Meantime, not one program ended up saving money. Ouch." (The Wall Street Journal)
Public Employers Focusing More on Disease Management, According to Survey
Excerpt: "A recent health care survey found the majority of public sector employers are working to control costs by implementing disease management and wellness programs, instead of introducing consumer-driven health plans (CDHPs). A news release from the the International Foundation of Employee Benefit Plans (IFEBP) said more than half of public employers who responded to the survey indicate they have implemented a disease management (69%) or a wellness program (65%)." (PLANSPONSOR.com; free registration required)
Do Prevention or Treatment Services Save Money? The Wrong Debate
Excerpt: "Health improvements and cost savings are achievable by providing targeted, evidence-based, and cost-effective health promotion and disease prevention programs that reduce modifiable risk factors, often the cause of costly chronic diseases. Adopting commonsense health practices does not require expensive technology, medication, specialty training, or elaborate treatment facilities. Instituting environmental, policy, and normative interventions, in addition to individual behavior change programs, can shift our thinking about how we pay for health. Employers' efforts in providing health promotion programs to their workers offer a microcosm of how prevention can lead to populationwide risk reduction and cost savings." (Health Affairs)
[Opinion] Preventing Chronic Illness: Prologue (PDF)
1 page. Excerpt: "A core truth about chronic conditions is that most are preventable. As Susan Brink's Report from the Field recounts, the multiyear trial known as the Diabetes Prevention Program (DPP) demonstrated that lifestyle modifications alone could produce sharp reductions in the development of diabetes in high-risk people with prediabetic conditions. Moreover, a few key strategies -- such as improved diet, exercise, and weight loss, along with smoking cessation -- can simultaneously reduce the risk of several conditions such as cardiovascular disease and cancers. So it's no surprise that policymakers say that prevention should assume a far more prominent role in U.S. health care." (Health Affairs)
The Crisis in Chronic Disease: Jan/Feb 2009 Issue of Health Affairs
Most articles require a subscription to Health Affairs Online. (Health Affairs)
Study Shows Health Plans Ease Access to Essential Treatments
Excerpt: "More health plans are reducing barriers to essential treatments in response to employers' requests, according to the 2008 findings of the National Business Coalition on Health's eValue8 tool, which coalition members use to assess the quality of health plans as part of the request-for-proposal process." (Workforce Management; free registration required)
2008 Consumer Awareness on Diabetes Survey Results (PDF)
44 pages. Excerpt: "To help establish baseline knowledge and to provide a statistically significant view into consumers' attitudes and behaviors regarding diabetes care and the use of healthcare quality information, the Dallas-Fort Worth Business Group on Health (DFWBGH) conducted a quantitative survey with the employees of DFWBGH member organizations in support of the Partnership for Peak Healthcare Performance (PPHP). The survey provided an understanding of an insured employee population that the PPHP could directly impact through worksite interventions at Corporate Member locations." (Dallas-Fort Worth Business Group on Health)
New Program for Chronic Disease Prevention
Excerpt: "For employers interested in keeping their employees healthy and productive, Health Care Service Corp., Inc. (HCSC) is launching a novel early disease intervention program that puts chronic disease prevention well upstream in the employee health management cycle." (AISHealth.com)
In Chronic Condition: Experiences Of Patients With Complex Health Care Needs, In Eight Countries, 2008
Excerpt: "This 2008 survey of chronically ill adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States finds major differences among countries in access, safety, and care efficiency. U.S. patients were at particularly high risk of forgoing care because of costs and of experiencing inefficient, poorly organized care, or errors. The Dutch, who have a strong primary care infrastructure, report notably positive access and coordination experiences. Still, deficits in care management during hospital discharge or when seeing multiple doctors occurred in all countries. Findings highlight the need for system innovations to improve outcomes for patients with complex chronic conditions." (Health Affairs)
Lowering Employee Health Care Costs can Lower Business Costs
Excerpt: "The Midwest Business Group on Health (MGBH) says value-based benefit design leads to healthier, more productive employees and lower long-term costs to employers. Value-Based Benefit Design entails reducing the cost of effective health care providers, services, procedures, treatments or drugs to encourage employees to do such things as take their prescribed regular medications or visit better performing, more efficient doctors and hospitals. The payoff comes in the form of healthier employees, with fewer tests, fewer complications from surgery and fewer hospital readmissions, the coalition said in a press release." (PLANSPONSOR.com; free registration required)
Chronic Disease Management: Evidence of Predictable Savings (PDF)
46 pages. Excerpt: "As major health reform once again gains national attention, the drive to obtain better results in caring for those with chronic illness while slowing spending growth has grown stronger. This study shows that carefully targeted and well-designed care management programs can improve health outcomes for people with chronic illness and save money on a predictable basis. Our report identifies the key elements of care management interventions that maximize the opportunity for success." (Health Management Associates)
Obesity Blamed for Doubling Rate of Diabetes Cases
Excerpt: "The information should be a big help as the government and health insurance companies decide where to focus prevention campaigns . . . . Diabetes was the nation's seventh-leading cause of death in 2006, according to the CDC. More than 23 million Americans have diabetes, and the number is rapidly growing." (AP via NPR)
Employers Wade Into Monitoring Care As Diabetes Cases Grow
Excerpt: "Patients can take steps to control [diabetes] and lower the risk of complications, but many don't. That has attracted attention from employers seeking ways to cut costs and helped an industry spring up that targets prevention and management of the disease. The stakes are huge. One out of every five health care dollars spent last year went to caring for someone with diabetes. The total economic cost -- including medical care, lost productivity, absenteeism and disability -- totaled $174 billion, according to the American Diabetes Association." (Sacramento Business Journal via bizjournals.com; free registration required)
Alabama Board Approves Plan To Charge State Employees for Obesity, Health Problems
Excerpt: "The Alabama State Employees' Insurance Board last week approved a plan that will require state employees who are obese or have health problems to make progress to address those issues or pay a monthly charge for health insurance, the AP/Philadelphia Inquirer reports." (KaiserNetwork.org)
Making the Business Case: How Engaging Employees in Preventive Care Can Reduce Healthcare Costs (PDF)
19 pages. Excerpt: "This white paper focuses on four leading types of cancer – breast cancer, colorectal cancer, cervical cancer and cancers associated with tobacco use. The paper illustrates how: Cancer costs burden businesses. Offering prevention and early detection health insurance benefits reduce both the direct and indirect costs of cancer for employers. Companies can start offering preventive and cancer-screening services." (C-Change)
Disease Management Programmes for Major Depression: Making the Financial Case (PDF)
44 pages. The report is geared to depression management in the United Kingdom. (Milliman)
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