Worksite Wellness Gets a Boost From Health Reform
Workplace initiatives that use financial rewards to motivate people to take charge of their health are getting a helping hand.
The Affordable Care Act includes several provisions to support employer-sponsored wellness programs.
"Worksite wellness plans make an awful lot of sense, but only if people participate in those programs because you can't require folks to do that," said Dr. Larry J. Luter, chief medical officer of Meritain Health, which manages self-funded employer health benefit plans. "You can charge them more if they don't, but you can't mandate it, and what I want folks to do is participate in it because it's going to help you understand what your personal health risks are."
Beginning this year, businesses with 100 or fewer employees -- companies that have traditionally not had the workforce or resources to offer weight management, fitness and smoking cessation classes -- may be eligible for federal grants to establish a worksite wellness program.
The legislation provides $200 million over five years for grants to employers who did not have a wellness program in place as of March 23, 2010, when the law was enacted, and whose employees work 25 or more hours a week.
The law also includes provisions to support existing wellness programs.
Beginning in 2014, people already enrolled in an employer-based health plan may be offered larger rewards for participating in the company's wellness program.
HIPAA, the Health Insurance Portability and Accountability Act, prohibits health plans from discriminating against individuals based on health factors. That means employers cannot charge different premiums or impose different deductibles and co-pays based on whether a person has high blood pressure, for example.
But HIPAA makes an exception for wellness programs, as long as those programs meet certain requirements.
An employer, for instance, can offer a reward to individuals for meeting certain results on biometric screenings as long as the program meets certain requirements:
- Eligible individuals must be able to qualify for the reward at least once a year.
- The program must be available to all similarly situated individuals.
- It must be reasonably designed to promote health and prevent disease.
- The program must allow a reasonable alternative to obtain the reward for anyone who cannot satisfy the standard because of a medical condition.
- All terms of the program must be disclosed in all materials.
There's a strict limit on the amount that an employer can offer as an incentive for participating in a wellness program.
"Right now, what the law says is the premium differential between somebody who participates voluntarily and somebody who chooses not to participate can't be more than 20 percent," explained Andrea L. Balogh, Meritain Health's executive vice president and general counsel. "What the law changes is it boosts that differential to up to 30 percent, potentially up to 50 percent, and that's at the discretion of the secretary of Health and Human Services."
The hope is that the larger difference in premiums will persuade more people to participate.
Physicians should look at worksite wellness, including biometric screening programs, as a way to enhance patient education and follow-up, Luter explained.
"What I want physicians to do is embrace the [test] results that patients can then bring in to them," he said, adding that it's OK if they might not be exactly what you would have ordered. "Use those results because, when you start to talk about somebody's risk factors, you're going to get their attention," he said. "Show what they can do to address their personal risk because their personal risk is going to be different from their co-workers'."
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