Final Wellness Regulations: What You Need to Know LIVE Webcast

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Recently, the Department of Health and Human Services (DHHS) issued final wellness regulations governing health- out-come-based wellness programs increasing rewards to up to 50 percent for healthy activity such as smoking cessation. The new regulations were published on June 3, 2013 and become effective on January 1, 2014 (or upon renewal after January 1, 2014). As compliance date draws near, companies should have a complete and thorough understanding of the final rules to avoid potentially steep penalties.

The Knowledge Group has assembled a panel of key thought leaders and practitioners to provide the audience with an in-depth analysis of the Final Wellness Regulations. In a two-hour live webcast, speakers will discuss:

- Recent Developments and Key Changes on Final Wellness Regulations
- Enforcement of and Compliance with the Final Rules
- Impact of the Final Rules
- Penalties and Exemptions
- Best Practices in Compliance
- Up to the Minute Regulatory Changes

To view the webcasts go to this link: http://youtu.be/Kn7zwS-jdbU

To learn more about the webcast visit our website: http://theknowledgegroup.org/

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  • Example: A physician may think that a LDL cholesterol level of 135 for a 25 year old is okay. That same level for a 55 year old that has high blood pressure, family history of heart disease, may not be okay.
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  • Final Wellness Regulations: What You Need to Know LIVE Webcast

    1. 1. Speaker Firms and Organization: Partner Firms: Presented By: Alyson Mathews Partner Lamb & Barnosky, LLP Kendra Roberson Of Counsel Covington & Burling LLP Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Jim Pshock Founder and Chief Executive Officer Bravo Wellness Thank you for logging into today’s event. Please note we are in standby mode. All Microphones will be muted until the event starts. We will be back with speaker instructions @ 11:55am. Any Questions? Please email: Info@knowledgecongress.org Group Registration Policy Please note ALL participants must be registered or they will not be able to access the event. If you have more than one person from your company attending, you must fill out the group registration form. We reserve the right to disconnect any unauthorized users from this event and to deny violators admission to future events. To obtain a group registration please send a note to info@knowledgecongress.org or call 646.202.9344. 1 January 30, 2014
    2. 2.  If you experience any technical difficulties during today’s WebEx session, please contact our Technical Support @ 866-779-3239.  You may ask a question at anytime throughout the presentation today via the chat window on the lower right hand side of your screen. Questions will be aggregated and addressed during the Q&A segment.  Please note, this call is being recorded for playback purposes.  If anyone was unable to log in to the online webcast and needs to download a copy of the PowerPoint presentation for today’s event, please send an email to: info@knowledgecongress.org. If you’re already logged in to the online webcast, we will post a link to download the files shortly.  If you are listening on a laptop, you may need to use headphones as some laptops speakers are not sufficiently amplified enough to hear the presentations. If you do not have headphones and cannot hear the webcast send an email to info@knowledgecongress.org and we will send you the dial in phone number. 2 January 30, 2014
    3. 3.  About an hour or so after the event, you'll be sent a survey via email asking you for your feedback on your experience with this event today - it's designed to take less than two minutes to complete, and it helps us to understand how to wisely invest your time in future events. Your feedback is greatly appreciated. If you are applying for continuing education credit, completions of the surveys are mandatory as per your state boards and bars. 6 secret words (3 for each credit hour) will be given throughout the presentation. We will ask you to fill these words into the survey as proof of your attendance. Please stay tuned for the secret word.  Speakers, I will be giving out the secret words at randomly selected times. I may have to break into your presentation briefly to read the secret word. Pardon the interruption. 3 January 30, 2014
    4. 4. Welcome to the Knowledge Group Unlimited Subscription Programs. We have Two Options Available for You: FREE UNLIMITED: This program is free of charge with no further costs or obligations. It includes:  Unlimited access to over 15,000 pages of course material from all Knowledge Group Webcasts.  Subscribers to this program can download any slides, white papers, or supplemental material covered during all live webcasts.  A special discount code which will give you 50% off the purchase of all Live webcasts and downloaded recordings. PAID UNLIMITED: Our most comprehensive and cost-effective plan, for a one-time fee:  Access to all LIVE Webcasts (Normally $199 to $349 for each event without a subscription). Including: Bring-a-Friend – Invite a client or associate outside your firm to attend for FREE. Sign up for as many webcasts as you wish.  Access to all of Recorded/Archived Events & Course Material includes 1,500+ hours of audio material (Normally $299 for each event without a subscription).  Free CLE/CPE/CE Processing (Normally $49 Per Course without a subscription).  Access to over 15,000 pages of course material from Knowledge Group Webcasts.  Ability to invite a guest of your choice to attend any live webcast Free of charge (Exclusive benefit only available for PAID UNLIMITED subscribers).  6 Month Subscription is $299 with No Additional Fees Other options are available.  Special Offer: Sign up today and add 2 of your colleagues to your plan for free Check the “Triple Play” box on the sign-up sheet contained in the link below. https://gkc.memberclicks.net/index.php?option=com_mc&view=mc&mcid=form_157964 4 January 30, 2014
    5. 5. Knowledge Group UNLIMITED PAID Subscription Programs Pricing: Individual Subscription Fees: (3 Options) Semi-Annual: $299 one-time fee for a 6 month subscription with unlimited access to all webcasts, recordings, and materials. Annual: $499 one-time fee for a 12 month unlimited subscription with unlimited access to all webcasts, recordings, and materials. Month-to-Month: Pay $49 monthly. Cancel anytime (No Commitment). Group plans are available. See the registration form for details. Best ways to sign up: •Fill out the sign up form attached to the post conference survey email. •Sign up online by clicking the link contained in the post conference survey email. 3. Click the link below or the one we just posted in the chat window to the right. https://gkc.memberclicks.net/index.php?option=com_mc&view=mc&mcid=form_157964 Discounts: Enroll today and you will be eligible for the “Triple Play” program and 3% off if you pay by credit card. Also we will waive the $49 CLE/CPE processing fee for today’s conference. See the form attached to the post conference survey email for details. Questions: Send an email to: info@knowledgecongress.org with “Unlimited” in the subject. 5 January 30, 2014
    6. 6. Partner Firms: Lamb & Barnosky, LLP is one of Long Island's largest and most respected law firms, representing a wide variety of corporate, municipal and individual clients. As a full-service law firm, Lamb & Barnosky, LLP is comprised of numerous practice areas, including Banking; Real Estate; Taxation; Corporate Mergers and Acquisitions; Education; Labor and Employment; Municipal; Health Care; Intellectual Property, Land Use, Planning, Environmental and Zoning; and Trusts and Estates. The firm has an AV rating from Martindale-Hubbell, the nationally renowned legal directory, recognizing the firm's commitment to providing the highest standard of legal ability, professional conduct and ethics. Additionally, the firm has been named to the Bar Register of Preeminent Lawyers. The firm proudly honors its commitment to pro bono and bar association work by having several partners who have served/currently serve on New York State and local bar association boards. Covington & Burling LLP, a full-service firm with over 850 lawyers in Beijing, Brussels, London, New York, San Diego, San Francisco, Seoul, Shanghai, Silicon Valley, and Washington, is one of the leading international life sciences law firms in the world. Covington represents most of the major biotechnology and pharmaceutical companies in the United States and Europe and numerous other life sciences companies worldwide. Covington also advises and represents hospitals, health plans, and other health care providers on issues involving payment and reimbursement under a range of federal and state health care programs and on issues of health information privacy. With its multi-disciplinary and multi-jurisdictional practice that integrates regulatory, corporate, transactional, intellectual property, litigation, competition, and trade law expertise, Covington meets the specialized needs of life sciences and health care companies. 6 January 30, 2014
    7. 7. Partner Firms: Greenberg Traurig, LLP is an international, multi-practice law firm with approximately 1750 attorneys serving clients from 36 offices in the United States, Latin America, Europe, the Middle East and Asia. Greenberg Traurig is among the Top 10 law firms on The National Law Journal's 2013 NLJ 350, an annual ranking of the largest firms in the U.S. GT provides integrated legal services for clients worldwide. The firm offers a multidisciplinary team, including senior lawyers who have been the chief legal officers at major multinational companies and have spent years solving real-world problems in the business, political and legal environments of major commercial centers. GT’s experience in more than 100 practice areas and their network of contacts throughout the world positions them to help clients achieve their objectives both domestically and in the global marketplace. Founded in 2008, Bravo Wellness is the thought leader in health-contingent wellness incentive programs. Bravo's market leadership provides unique insights into industry best practices, identifies ways to mitigate the cost of healthcare, and minimize potential legal risks or compliance concerns. Bravo helps employers engage their employees, foster personal accountability, and bring about real behavior change towards better health and wellness. Bravo Wellness and its subsidiary, IncentiSoft Solutions, are headquartered in Cleveland, OH. For more information, visit www.bravowell.com. 7 January 30, 2014
    8. 8. Brief Speaker Bios: Alyson Mathews Alyson Mathews represents employers in labor and employment law matters. She has assisted clients with grievance arbitrations, improper practice charges before PERB, disciplinary charges and contract negotiations. Ms. Mathews has comprehensive knowledge of the Affordable Care Act, including employer implementation strategies and best personnel practices. She has been featured in the Long Island Business News' Who's Who in Women in Professional Services. Kendra Roberson Kendra Roberson, of counsel at Covington & Burling LLP, advises clients on a broad spectrum of employee benefits matters, including tax-qualified retirement plans, employee stock ownership plans, executive compensation arrangements, stock option and other equitybased compensation plans, cafeteria plans, VEBAs, self-insured medical plans, and other health and welfare plans. Her experience includes plan design and drafting, regulatory compliance, ERISA litigation, and handling employee benefits matters and plans in corporate transactions. In addition, Ms. Roberson has extensive experience advising employers and state governments on compliance with the Patient Protection and Affordable Care Act ("PPACA") 8 January 30, 2014
    9. 9. Brief Speaker Bios: Joseph F. Coniglio Joseph F. Coniglio has wide-ranging experience in the areas of health care law and complex business litigation. He represents hospitals, physicians, and other related health care entities in litigation and transactional matters. He also provides service on a national basis to privately held and publicly traded companies related to corporate entity issues and health care regulatory matters. Joe advises health care clients on operational matters, liability exposure of corporate entities, federal and state health care regulatory compliance involving complex fraud issues and health care reimbursement disputes, as well as professional liability and risk management. He also represents health care providers before their respective state boards in grievance and disciplinary proceedings. Joe received his J.D., cum laude, from Texas Tech University School of Law. Magan Pritam Ray Magan Pritam Ray has wide-ranging experience in all facets of employee benefits, compensation and ERISA matters, including the design, implementation and operation of retirement plans, health and welfare benefit plans, cafeteria plans, fringe benefit plans, and non-qualified deferred compensation programs. Magan is a specialist in counseling clients on the business impact, strategic response, plan design and compliance with health care reform. Magan regularly advises clients, from startups to Fortune 100 companies, on issues in mergers, acquisitions, spin-offs and joint ventures. Magan also has experience in representing companies undergoing employee benefits, employment and tax audits before the IRS, DOL and EDD. She received her J.D., with distinction, from Stanford Law School. 9 January 30, 2014
    10. 10. Brief Speaker Bios: Jim Pshock Jim Pshock is a leader known for cutting-edge innovation in the healthcare sector. His career spans over 20 years in the health insurance industry including executive positions in technology, operations, sales, marketing and corporate strategy with carriers and third-party administrators. Jim has developed a comprehensive and unique expertise in the regulations related to governing wellness programs and the practical application of incentives to improve employee health. Jim frequently presents to regional and national audiences, including human resource professionals, occupational health professionals and insurance industry associations. He also serves on a national committee of HERO, an advocacy group exploring the innovation and evaluation of worksite wellness. Jim was recognized for his talents receiving the Northeast Ohio Ernst & Young Entrepreneur of the Year® Award in 2011. ► For more information about the speakers, you can visit: http://www.knowledgecongress.org/speakers_2014_Final_Wellness.html 10 January 30, 2014
    11. 11. Recently, the Department of Health and Human Services (DHHS) issued final wellness regulations governing health- out-come-based wellness programs increasing rewards to up to 50 percent for healthy activity such as smoking cessation. The new regulations were published on June 3, 2013 and become effective on January 1, 2014 (or upon renewal after January 1, 2014). As compliance date draws near, companies should have a complete and thorough understanding of the final rules to avoid potentially steep penalties. The Knowledge Group has assembled a panel of key thought leaders and practitioners to provide the audience with an in-depth analysis of the Final Wellness Regulations. In a two-hour live webcast, speakers will discuss: - Recent Developments and Key Changes on Final Wellness Regulations - Enforcement of and Compliance with the Final Rules - Impact of the Final Rules - Penalties and Exemptions - Best Practices in Compliance - Up to the Minute Regulatory Changes 11 January 30, 2014
    12. 12. Featured Speakers: SEGMENT 1: SEGMENT 2: Alyson Mathews Partner Lamb & Barnosky, LLP Kendra Roberson Of Counsel Covington & Burling LLP SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP SEGMENT 4: Jim Pshock Founder and Chief Executive Officer Bravo Wellness 12 January 30, 2014
    13. 13. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Introduction Alyson Mathews represents employers in labor and employment law matters. She has assisted clients with grievance arbitrations, improper practice charges before PERB, disciplinary charges and contract negotiations. Ms. Mathews has comprehensive knowledge of the Affordable Care Act, including employer implementation strategies and best personnel practices. She has been featured in the Long Island Business News' Who's Who in Women in Professional Services. Ms. Mathews is actively involved in the NYSBA and serves on the Electronic Communications Committee and on the Executive Committee of the Labor and Employment Law Section. She is a co-editor of NYSBA's second edition ofImpasse Resolution under the Taylor Law. Ms. Mathew is also a member of the American Bar Association and the Suffolk County Bar Association. Ms. Mathews received her law degree from Brooklyn Law School and her undergraduate degree, cum laude, from Boston College. 13 January 30, 2014
    14. 14. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Overview of Wellness Programs • • Program Goals: – Promote health and prevent disease – Keep healthy individuals healthy – Encourage unhealthy individuals to change their behavior to reduce or eliminate risk factors Incentives (“Carrot & Stick Approach”) – Carrot  Reward • Reduction in premium costs • Waiver of copays or deductibles – Stick  Penalty • Surcharge 14 January 30, 2014
    15. 15. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP HIPAA Non-Discrimination Rules • • The Health Insurance Portability and Accountability Act (HIPAA) prohibits a group health plan from discriminating against similarly situated participants based upon health status. A wellness program is not a group health plan if, in general, the program is offered to all employees regardless of whether they are enrolled in the employer’s health plan and the program does not provide any medical care. – Example: A wellness program that provides employees with a discounted gym membership is not a group health plan. 15 January 30, 2014
    16. 16. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP HIPAA Non-Discrimination Rules • • • Providing medical care may include: – Health assessments – Screenings – Immunizations In addition, a wellness program becomes a group health plan if it provides rewards or penalties with regard to premiums. The final wellness program regulations, as amended by the Affordable Care Act, set forth the requirements for wellness programs to comply with the HIPAA non-discrimination rules. – Regulations apply to any group health plan (grandfathered or nongrandfathered) and group health insurance issuers offering coverage for plan years beginning on or after January 1, 2014 16 January 30, 2014
    17. 17. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Two Types of Wellness Programs • Participatory – Eligibility for reward is unrelated to a health factor; or – No reward offered – Must be available to all “similarly situated individuals,” regardless of health status • Health-Contingent – Must satisfy a standard related to a health factor in order to obtain a reward; or – Must do more than a similarly situated individual based on a health factor to obtain the same reward 17 January 30, 2014
    18. 18. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Examples of Participatory Wellness Programs that Are Unrelated to a Health Factor • • • • • • Reimburse employees for all or part of cost for gym membership Reward for participation in diagnostic testing program (without regard to outcome) Encourage preventive care by waiving copay or deductible Reimbursement for participating in smoking cessation program (without regard to whether employee quits) Reward for attending a monthly, no-cost health education seminar Reward for completing health risk assessment regarding current health status 18 January 30, 2014
    19. 19. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Two Types of Health-Contingent Wellness Programs • • Activity-Only – Requires individual to perform or complete an activity that is related to a health factor in order to obtain a reward, but does not require a specific outcome • Examples: Diet or exercise program Outcome-Based – Requires individual to attain or maintain a specific health outcome in order to obtain a reward or avoid a penalty • Examples: Attain/maintain healthy BMI or cholesterol level 19 January 30, 2014
    20. 20. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Requirements for Health Contingent Programs Generally, the same requirements apply to activity-only and outcome-based wellness programs. •Frequency: Must be able to qualify for full reward at least once per year •Size of Reward: up to 30% of total cost of employee coverage, or up to 50% if additional percentage is in connection with a program designed to prevent or reduce tobacco use – If spouses and dependents can participate in the wellness program, then the size of the reward is based on the total cost of the coverage in which they are enrolled. 20 January 30, 2014
    21. 21. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Requirements for Health Contingent Programs • Reasonable Design: – Must have reasonable chance of improving the health of, or preventing disease in, participating individuals – Must not be overly burdensome – Must not be a subterfuge for discriminating based upon a health factor – Must not be highly suspect in the method chosen to promote health or prevent disease 21 January 30, 2014
    22. 22. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Requirements for Health Contingent Programs • Uniform Availability and Reasonable Alternative Standards: must be available to all similarly situated individuals – Achieved by providing reasonable alternative standard (or waiver of otherwise applicable standard) – Differences between activity-only and outcome-based wellness programs 22 January 30, 2014
    23. 23. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Requirements for Health Contingent Programs • Notice of Availability of Reasonable Alternative Standard: – All plan materials describing the terms of the wellness program must disclose the availability of a reasonable alternative standard (or the possibility of a waiver) – Must include contact information for obtaining a reasonable alternative standard – Must include a statement that the recommendations of an individual’s personal physician will be accommodated – For outcome-based programs, must also include the availability of a reasonable alternative standard in any disclosure that an individual did not satisfy the initial outcome-based standard 23 January 30, 2014
    24. 24. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Uniform Availability & Reasonable Alternative Standard Activity-Only Wellness Programs • • Plan must provide a reasonable alternative standard for obtaining the reward (or waiver of otherwise applicable standard) for any individual for whom, for that period, it is: – Unreasonably difficult due to a medical condition to satisfy the otherwise applicable standard; or – Medically inadvisable to attempt to satisfy the otherwise applicable standard No obligation to determine a reasonable alternative standard in advance, but one must be furnished upon request or the condition for obtaining the reward must be waived. 24 January 30, 2014
    25. 25. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Uniform Availability & Reasonable Alternative Standard Activity-Only Wellness Programs • All facts and circumstances are taken into account to determine whether the plan offered a reasonable alternative standard including, but not limited to: – If the reasonable alternative standard is an educational program, the program is made available by the plan (or assistance is given for finding one) and is free of charge. – If the reasonable alternative standard is a diet program, the plan must pay for the membership or participation fee, but not the cost of food. – Whether required time commitment is reasonable – If individual’s personal physician states that a plan standard is not medically appropriate, plan must provide a reasonable alternative standard that accommodates the physician’s recommendations. 25 January 30, 2014
    26. 26. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Uniform Availability & Reasonable Alternative Standard Activity-Only Wellness Programs • A reasonable alternative standard may be participatory, activity-only or outcome-based – If participatory, the individual is eligible for the reward so long as he/she participates. No additional reasonable alternative standard must be provided if the individual elects not to participate. – If activity-only, a second reasonable alternative standard must be provided if the first reasonable alternative standard was unreasonably difficult to complete due to a medical condition or medically inadvisable to attempt to complete. – If outcome-based, must satisfy rules for outcome-based programs 26 January 30, 2014
    27. 27. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Uniform Availability & Reasonable Alternative Standard Outcome-Based Wellness Programs • • Plan must provide reasonable alternative standard (or waiver of otherwise applicable standard) for any individual who does not meet the initial standard based on the measurement, test or screening – Does not matter whether initial standard was unreasonably difficult – Does not matter whether initial standard was medically inadvisable to attempt to achieve – Cannot require physician verification that a health factor makes it unreasonably difficult to satisfy or medically inadvisable for the individual to attempt to satisfy the otherwise applicable standard as a condition of providing a reasonable alternative standard Whether plan furnished a reasonable alternative standard depends on the facts and circumstances (same rules as for activity-only) 27 January 30, 2014
    28. 28. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Uniform Availability & Reasonable Alternative Standard Outcome-Based Wellness Programs • A reasonable alternative standard may be participatory, activity-only or outcome-based – If participatory, the individual is eligible for the reward so long as he/she participates. No additional reasonable alternative standard must be provided if the individual elects not to participate. – If activity-only, then a second reasonable alternative standard must be provided if the first reasonable alternative standard was unreasonably difficult to complete due to a medical condition or medically inadvisable to attempt to complete. – If outcome-based, must satisfy rules for outcome-based programs, subject to additional special rules. 28 January 30, 2014
    29. 29. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Uniform Availability & Reasonable Alternative Standard Outcome-Based Wellness Programs • Special Rules – Reasonable alternative standard cannot be a requirement to meet a different level of the same standard without additional time to comply that takes into account the individual’s circumstances. • Example: If the initial standard is achieving a BMI of less than 30, the reasonable alternative standard cannot be to achieve a BMI of less than 31 as of the same deadline. A permissible reasonable alternative standard could be to reduce the individual’s BMI by a small percentage over a realistic period of time, such as one year. – Individual must be given the opportunity to comply with the recommendations of his/her personal physician as a second reasonable alternative standard, but only if the physician joins in the request. The individual may request to involve his/her personal physician’s recommendations at any time, and the personal physician can adjust his/her recommendations at any time, “consistent with medical appropriateness.” 29 January 30, 2014
    30. 30. SEGMENT 1: Alyson Mathews Partner Lamb & Barnosky, LLP Trust, Personal Attention and Results ® Alyson Mathews, Esq. 534 Broadhollow Road - Suite 210 P.O. Box 9034 Melville, New York 11747 631-414-5825 am@lambbarsnoky.com lambbarnosky.com 30 January 30, 2014
    31. 31. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP Introduction Kendra Roberson, of counsel at Covington & Burling LLP, advises clients on a broad spectrum of employee benefits matters, including tax-qualified retirement plans, employee stock ownership plans, executive compensation arrangements, stock option and other equity-based compensation plans, cafeteria plans, VEBAs, self-insured medical plans, and other health and welfare plans. Her experience includes plan design and drafting, regulatory compliance, ERISA litigation, and handling employee benefits matters and plans in corporate transactions. In addition, Ms. Roberson has extensive experience advising employers and state governments on compliance with the Patient Protection and Affordable Care Act ("PPACA") 31 January 30, 2014
    32. 32. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP Disclaimer This presentation provides general information, not legal advice as to any specific matter. It should not be used as a substitute for appropriate legal advice. 32 January 30, 2014
    33. 33. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP Americans with Disabilities Act (ADA): Application to Benefits • Prohibits providing benefits on a less favorable basis because of a disability – however, disability-based distinctions permissible if not a “subterfuge” to evade ADA – subterfuge if not justified by risks or costs 33 January 30, 2014
    34. 34. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP ADA: Application to Employers • • Requires reasonable accommodation to enable disabled to participate in wellness program Limits employer’s ability to make disability-related inquiries or require medical exams – E.g., cholesterol screenings, health risk assessments – EEOC has said permissible if “voluntary” 34 January 30, 2014
    35. 35. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP ADA: Voluntary Inquiries/Exams • Meaning of voluntary unclear based on EEOC guidance: – clearly “involuntary” to condition health coverage on completion of HRA – “Could be involuntary” to provide financial incentive – threshold amount unknown. 35 January 30, 2014
    36. 36. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP ADA: Voluntary Inquiries/Exams • Seff v. Broward County, 691 F.3d 1221 (11th Cir. 2012) – a wellness program that is part of a bona fide group health plan might not violate ADA even if “involuntary” – must not be a subterfuge for evading ADA – must have an underwriting purpose 36 January 30, 2014
    37. 37. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP ADA: Key Questions • • • Is there a disability-related inquiry or medical examination? Is there a financial incentive? Is reasonable accommodation provided? 37 January 30, 2014
    38. 38. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP ADA: Examples • • Reward for completing medical questionnaire about family medical history: – genetic information = disability-related inquiry (ADA applies) – Generally not permitted unless voluntary – Incentive might make involuntary Reward for walking 3 miles per week (activity-only program) – Must provide reasonable accommodation – May require documentation that accommodation necessary 38 January 30, 2014
    39. 39. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP GINA and Health Risk Assessments • Genetic information – genetic test (individual and family members) – family medical history (manifestation of disease/disorder) – genetic services/information (individual, family, fetus, embryo) 39 January 30, 2014
    40. 40. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP GINA and Health Risk Assessments • Title I: Prohibits plans from requesting, requiring, or purchasing GI – prior to or in connection with enrollment • date coverage is effective – for purposes of underwriting • includes financial incentive for providing GI, including family history • cannot use voluntarily provided GI to guide employee to a wellness program 40 January 30, 2014
    41. 41. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP GINA and Health Risk Assessments • Title II: prohibits employer from requesting, requiring, or purchasing genetic information about job applicant or employee – exception for voluntary wellness programs – information can be used to guide employees and provide financial incentives to participate in wellness programs 41 January 30, 2014
    42. 42. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP GINA and Health Risk Assessments • Employer has three options – Do not offer financial incentive to complete HRA – Offer incentive but do not include questions concerning family medical history (and state that should not volunteer family medical history) – Offer incentive only for completing questions that do not relate to family medical history (and identify questions) 42 January 30, 2014
    43. 43. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP GINA: Key Questions • • • Is the request made by employer or health plan? – If health plan, is request made prior to enrollment? Is there a financial incentive? Is genetic information sought? 43 January 30, 2014
    44. 44. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP GINA: Examples • • Reward for completing medical questionnaire about family medical history: – family medical history = genetic information (GINA applies) – No incentive is permitted by employer/plan – If no incentive, employer could use to guide to wellness program; plan could not give before enrollment or use to guide to wellness programs Reward for walking 3 miles per week (activity-only program) – GINA does not apply 44 January 30, 2014
    45. 45. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP ADA and GINA Enforcement • • ADA and Title II GINA: EEOC or employee lawsuit seeking compensatory and punitive damages Title I GINA: Excise taxes under IRC, agency enforcement actions, and private lawsuits under ERISA 45 January 30, 2014
    46. 46. SEGMENT 2: Kendra Roberson Of Counsel Covington & Burling LLP Questions? Kendra Roberson (202) 662-5044 kroberson@cov.com 46 January 30, 2014
    47. 47. PRIVATE LABEL PROGRAM & INTERNAL TRAINING The Knowledge Group provides complete private label webcasts and in-house training solutions. Developing and executing webcasts can be a huge logistical nightmare. There are a lot of moving parts and devolving a program that is executed smoothly and cost effectively can prove to be a significant challenge for companies who do not produce events on a regular basis. Live events require a high level of proficiency in order to execute proficiently. Our producers will plan and develop your webcast for you and our webcast technicians will execute your live event with expert precision. We have produced over 1000 live webcasts. Put our vast expertise to work for you. Let us develop a professional webcast for your firm that will impress all your clients and internal stakeholders. Private Label Programs Include: Complete Project Management Topic Development Recruitment of Speakers (Or you can use your own) Marketing Material Design PR Campaign Marketing Campaign Event Webpage Design Slides: Design and Content Development Speaker coordination: Arranging & Executing Calls, Coordinating Slides & Content Attendee Registration Complete LIVE Event Management for Speaker and Attendees including: o Technical Support o Event Moderator o Running the Live event (All Aspects) o Multiple Technical Back-ups & Redundancies to Ensure a Perfect Live Event o Webcast Recording (MP3 Audio & MP4 Video) o Post Webcast Performance Survey CLE and CPE Processing Private Label Programs Start at just $999 47 February 11, 2014
    48. 48. RESEARCH & BUSINESS PROCESS OUTSOURCING The Knowledge Group specializes in highly focused and intelligent market and topic research. Outsource your research projects and business processes to our team of experts. Normally we can run programs for less than 50% of what it would cost you to do it in-house. Here are some ideal uses for our services: Market Research and Production o List Research (Prospects, Clients, Market Evaluation, Sales Lists, Surveys) o Design of Electronic Marketing Collateral o Executing Online Marketing Campaigns (Direct Email, PR Campaigns) o Website Design o Social Media Analysis & Research o Research Companies & Produce Reports o Research for Cases o Specialized Research Projects eSales (Electronic Inside Sales – Email and Online) o Sales Leads Development o eSales Campaigns  Inside Sales people will prospect for leased, contact them and coordinate with your sales team to follow up.  Our Inside eSales reps specialize in developing leads for big-ticket enterprise level products and services. o Electronic Database Building – Comprehensive service which includes deveolment od sales leads, contacting clients, scoring leads, adding notes and transferring the entire data set to you for your internal sales reps. eCustomer Service (Electronic Inside Sales – Email and Online) o Real-Time Customer Service for Your clients  Online Chat  Email o Follow-Up Customer Service  Responds to emails  Conducts Research  Replies Back to Your Customer Please note these are just a few ways our experts can help with your Business Process Outsourcing needs. If you have a project not specifically listed above please contact us to see if we can help. 48 February 11, 2014
    49. 49. SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Introduction Joseph F. Coniglio has wide-ranging experience in the areas of health care law and complex business litigation. He represents hospitals, physicians, and other related health care entities in litigation and transactional matters. He also provides service on a national basis to privately held and publicly traded companies related to corporate entity issues and health care regulatory matters. Joe advises health care clients on operational matters, liability exposure of corporate entities, federal and state health care regulatory compliance involving complex fraud issues and health care reimbursement disputes, as well as professional liability and risk management. He also represents health care providers before their respective state boards in grievance and disciplinary proceedings. Joe received his J.D., cum laude, from Texas Tech University School of Law. 49 January 30, 2014
    50. 50. SEGMENT 3: Magan Pritam Ray Shareholder Greenberg Traurig, LLP Introduction Magan Pritam Ray has wide-ranging experience in all facets of employee benefits, compensation and ERISA matters, including the design, implementation and operation of retirement plans, health and welfare benefit plans, cafeteria plans, fringe benefit plans, and non-qualified deferred compensation programs. Magan is a specialist in counseling clients on the business impact, strategic response, plan design and compliance with health care reform. Magan regularly advises clients, from startups to Fortune 100 companies, on issues in mergers, acquisitions, spin-offs and joint ventures. Magan also has experience in representing companies undergoing employee benefits, employment and tax audits before the IRS, DOL and EDD. She received her J.D., with distinction, from Stanford Law School. 50 January 30, 2014
    51. 51. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP ACA Directives Regarding Wellness Programs > Includes provisions intended to encourage workplace health promotion as a means to reduce the burden of chronic illness, improve health, and slow the growth of health care costs. > A “wellness program” is defined as a program offered by an employer designed to promote health or prevent disease. > Interventions directed at healthy behaviors can change the trajectory of long-term health. 51 January 30, 2014
    52. 52. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Wellness Program Recap > Participatory Wellness Programs > Health-Contingent Wellness Programs – Activity-Only Program – Outcome-Based Program **Health-contingent wellness programs must meet certain requirements to avoid being deemed discriminatory. 52 January 30, 2014
    53. 53. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Potential Impact of Wellness Programs > 1 in 10 Americans has diabetes today. > CDC projects diabetes rate to be 1 in 3 Americans by 2050. > Lifestyle interventions (reduce body weight, dietary changes, physical activity) reduce development by 60%. > Programs are viable strategy to contain health care costs. 53 January 30, 2014
    54. 54. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Increase of Wellness Promotion Initiatives > Approximately half of U.S. employers with 50 or more employees offer wellness promotion initiatives. > Wellness benefits can be offered by employers directly to all employees or though group health plans to members. > 69% of Employers with wellness programs use “rewards” or financial incentives to encourage utilization. > Most common monetary incentive is Health Risk Assessment (HRA) completion or lifestyle management programs. 54 January 30, 2014
    55. 55. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP The Future of Wellness Programs > Long Term Health Impact of Wellness Programs – Longer follow up required given latency between health risks and development of chronic disease. > Impact on Broader Range of Measures > Absenteeism, Productivity, and Retention are Critical to Employers. 55 January 30, 2014
    56. 56. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP The Future of Wellness Programs > Program Design and Delivery – Accreditation of certain programs and operation by third parties. – Address concerns regarding discriminatory programs by permitting a “safe harbor” for those employers who establish conduct for reasonable design of a wellness program. – Questions remain regarding level of participation and cooperation of physicians in crafting wellness program alternative standards. 56 January 30, 2014
    57. 57. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Case Studies > Group health plans are prohibited from discriminating against participants with respect to eligibility, benefits, or premiums based on a health factor. > As an exception to this rule, a properly designed wellness program may provide rewards. > Not all wellness programs are via a group health plan. > Participatory Programs do not require an individual to satisfy a standard related to a health factor but must be available to all similarly situated individuals. > Health-Contingent Programs (Activity-Only or Outcome-Based) require an individual to satisfy a standard and must comply with 5 requirements. 57 January 30, 2014
    58. 58. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP 5 Requirements for Health-Contingent Programs > Must have a chance to qualify for the reward at least once per year (frequency). > Total reward may not exceed 30% of cost of coverage with an additional 20%, for total of 50%, for programs aimed at reducing tobacco use. > Must be “reasonably designed” to promote health or prevent disease. > Reward must be available to all similarly situated individuals; must offer a “reasonable alternative standard” (RAS) or waiver. > Notice of availability of RAS. 58 January 30, 2014
    59. 59. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP 59 January 30, 2014
    60. 60. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Case Study One – Outside Health Plans > Employer subsidizes gym membership ($50/month). – > Employer offers to pay for weight loss program for all employees (regardless of whether they are in health plan). – > Not part of health plan but ensure proper tax treatment. Not part of health plan but ensure proper tax treatment. Employer gives $100 gift certificate to each employee (and spouse) who completes an HRA, which does not ask for family history or other genetic information. – May/may not be through health plan but ensures tax treatment of gift cards is addressed. – HRA complies with GINA. 60 January 30, 2014
    61. 61. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Case Study Two – Health Risk Assessment > Employer provides $50 a month premium discount for completion of an HRA and biometric screening, which does not ask for family history or other genetic information and does not base the reward on the information (e.g., whether the employee is a smoker or not or what level blood pressure is). – HRA complies with GINA. – This is a Participatory Program and not a Health-Contingent Program because the reward is not based on the outcome of the answers to the HRA or results of biometric screening, so no need to analyze frequency, size of reward, design, RAS, or notice requirements. 61 January 30, 2014
    62. 62. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Case Study Three – Smoking Cessation > Employer continues with earlier wellness programs and adds a reimbursement for the cost of participating in a smoking cessation program without regard to whether the individual quits smoking. – This is a Participatory Program because the reward is participation in the smoking cessation program and not the outcome (i.e. quitting smoking). – As a Participatory Program no need to analyze frequency, size of reward, design, RAS or notice requirements. 62 January 30, 2014
    63. 63. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Case Study Four – Exercise Program > Employer adds a “healthy heart” program which provides $100 premium reduction for participating in a walking program (e.g., 150 minutes per week). Employee only coverage is $400. > “Healthy heart” is an Activity-Only Health-Contingent Program. – Should be able to meet frequency, reasonable design and notice requirements. – Reward of $100 (25%) is within maximum range. – RAS must be provided if medically inadvisable to attempt , or due to medical condition it is unreasonably difficult, to meet standard.  May seek verification from physician but must take into account recommendations in establishing a RAS.  RAS may include, e.g., other exercise (activity rules apply), diet or education program (must pay for course but not food). 63 January 30, 2014
    64. 64. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Case Study Five – Tobacco Surcharge > Employer requires a certification (as part of HRA) regarding tobacco use and provides premium reductions of $50/month for completion of HRA and $100/month for certification of no tobacco use. > Full $100 reward available to tobacco users who certify they will complete a tobacco cessation program without regard to whether they quit. > This is an Outcome-Based Health-Contingent Program because standard is to be a non-tobacco user. > Potential frequency issues related to mid-year hires and length of cessation programs. > Reward of $150 is 37.5% of total cost of employee coverage ($400/$150 = 37.5%) which is within 50% maximum. 64 January 30, 2014
    65. 65. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Case Study Five – Tobacco Surcharge cont’d. > To meet reasonable design test, smokers must be given a RAS whether or not individual has medical condition or it is medically inadvisable to meet the standard. – Employer voluntarily established the completion of the tobacco cessation program (without regard to outcome) as a RAS up front. – The tobacco cessation program is Participatory Program so no further alternatives are required. – Employer must find and pay for cessation program. > Notice of availability of RAS must be provided in plan materials that describe program and in disclosure that individual did not meet standard to be tobacco free. 65 January 30, 2014
    66. 66. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Case Study Six– Biometric Levels > Employer continues HRA/biometric screening and smoking cessation and adds a $50 per month premium reduction if BMI is at/under 28. > This an Outcome-Based Health-Contingent Program. > Total available reward $200 ($50 for HRA/biometric screening, $100 for tobacco-free certification/tobacco cessation program, $50 for meeting BMI standard) is within maximum allowable reward. – $400/$200 = 50% for all rewards. – $50 for HRA and $50 for BMI tested separately are within maximum for non-tobacco related programs ($400/$100 = 25%). 66 January 30, 2014
    67. 67. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Case Study Six– Biometric Levels cont’d. > To meet reasonable design test, if BMI exceeds 28, a RAS must be given whether or not individual has a medical condition or it is medically inadvisable to meet standard. – – RAS may be a walking program (which must comply with the Activity-Only rules). – > RAS may be to reduce BMI by 1 point but since RAS is Outcome-Based, individual must be given opportunity to comply with doctor recommendations as a RAS, if doctor joins the request. RAS may be a diet or exercise course (employer must pay for course). Notice of availability of RAS must be in plan materials that describe the program and with results for those who do not meet the BMI standard. 67 January 30, 2014
    68. 68. SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP Things to Consider > Is the wellness program part of the group health plan? > If not, has the tax treatment and other legal requirements (e.g. ADA) been addressed? > If yes, have all the compliance issues, e.g. ERISA (reporting, disclosure, fiduciary duties etc.), COBRA, HIPAA, GINA, ACA, been addressed? > Design of plan is company decision but implementation and ongoing administration are fiduciary duties; have governance issues been addressed? > How are vendors selected and do the contracts contain appropriate provisions (clear allocation of duties, standards for delivery of services, risk allocation, indemnity, reasonable fees, termination, HIPAA privacy/security etc.)? 68 January 30, 2014
    69. 69. SEGMENT 4: Jim Pshock Founder and Chief Executive Officer Bravo Wellness Introduction Jim Pshock is a leader known for cutting-edge innovation in the healthcare sector. His career spans over 20 years in the health insurance industry including executive positions in technology, operations, sales, marketing and corporate strategy with carriers and third-party administrators. Jim has developed a comprehensive and unique expertise in the regulations related to governing wellness programs and the practical application of incentives to improve employee health. Jim frequently presents to regional and national audiences, including human resource professionals, occupational health professionals and insurance industry associations. He also serves on a national committee of HERO, an advocacy group exploring the innovation and evaluation of worksite wellness. Jim was recognized for his talents receiving the Northeast Ohio Ernst & Young Entrepreneur of the Year® Award in 2011. 69 January 30, 2014
    70. 70. Beyond the laws of what’s legal and what’s not – we can’t dismiss why implementing wellness is important. • Chronic diseases related to lifestyle account for 75% of national medical costs.1 • Over the last five years:2 - Employers saw a 34% increase in healthcare spending. - Employees saw a 40% increase in contributions to healthcare. Prior to 2007, only participation could be rewarded. • 1 2 www.cdc.gov/chronicdisease/overview/index.htm Towers Watson/National Business Group on Health (2012) 70
    71. 71. Risks Drive Conditions Even moderate health improvement could result in significant cost reduction. AON Hewitt 2012 Health Care Survey http://www.aon.com/attachments/human-capital-consulting/2012_Health_Care_Survey_final.pdf
    72. 72. “Outcomes-Based” Programs Are Growing Employers planning to reward or penalize based on biometric outcomes other than smoker, tobacco-use status (Towers Watson/National Business Group on Health Annual Survey 2013) 50% 45% 40% 35% 30% 25% 47% 47% 20% 15% 10% 5% 12% 12% 10% 10% 16% 16% 0% 2011 2012 2013 2014
    73. 73. Bravo Wellness Fact Sheet •Technology platform and administrative service company dedicated to the administration of participation, improvement, and outcomes-based wellness incentives •Over 300 unique plan designs managed and tracked for efficacy •Over one million participant screening result records tracked •Winner of numerous business awards with numerous clients winning wellness program success-based awards and recognition •125 full time employees based in Cleveland, OH serving technology and administrative support needs of employers, insurance companies and wellness companies •Experts in designing “cost-neutral” programs that create win/win opportunities •Screening, coaching, HRA and intervention program agnostic; serves as platform to connect the right people with the right resources at the right time •Average participation in annual blood draw and biometric screening: 97%
    74. 74. “Reasonable alternatives” must be provided for all health-contingent wellness programs. • Activity-only programs can be limited to “medically inadvisable” situations. • Outcomes-based programs must always have an alternative; may be automatically offered or “upon request.” - A medically sound progress goal IS considered a reasonable alternative (e.g. have a BMI less than 27.5 or reduce your BMI by 1 point). - Must provide adequate notice of the progress goal (Bravo suggests 60 day minimum). - Must provide an alternative to the alternative if a medical issue makes the goal unreasonably difficult or medically inadvisable. Personal physicians can always provide an alternative goal that is more medically appropriate. Health coaches and physicians of the wellness plan may suggest a goal but cannot override personal physician recommendations. Bravo Best Practice 74
    75. 75. How It Can Work In Two Cycles Cycle One Reward Categories National Institutes of Health (NIH) Goals Employer’s Goals Body Mass Index ≤ 24.9 kg/m2 Participation Blood Pressure ≤ 120/80 mmHg Participation LDL Cholesterol ≤ 100 mg/dL Participation Tobacco / Nicotine Negative Negative Alternative Goals^ Financial Impact N/A + $50/mo. Complete Cessation Program + $50/mo. Participant receives results, client receives aggregate report, health improvement resources are utilized all year. Cycle Two Reward Categories National Institutes of Health (NIH) Goals Employer’s Goals Alternative Goals^ Financial Impact Body Mass Index ≤ 24.9 kg/m2 ≤ 27.5 kg/m2- OR - Waist <33 Female/ <35 Male 10% Weight Loss - OR -Move to Improved Category $30/mo. $10/mo. EXAMPLE HEALTH IMPROVEMENT RESOURCES HEALTH IMPROVEMENT PROVIDER OR EMPLOYER CONTRACTED •Health Assessment •Health Monitor •Healthy Aging Guide •Healthy Recipe Collection •Symptom Checker •Women’s Health Guide •And so much more! HEALTH PLAN COVERS •Preventative Services at 100% •Chantax and Nicotine Replacement Therapy •Nutritional Counseling OTHER PROGRAMS Blood Pressure ≤ 120/80 mmHg ≤ 130/86 mmHg Move to Improved Category LDL Cholesterol ≤ 100 mg/dL ≤ 130 mg/dL Move to Improved Category $10/mo. Tobacco / Nicotine Negative Negative Complete Cessation Program $50/mo. •Offers Financial Planning and Stress Mgmt. •Offers Tobacco Cessation Program •Weight Watchers at Work •Fitness Center Reimbursement •Health Coaching Participant receives results, client receives aggregate report, health improvement tools are utilized. Strategic planning for Cycle 3 and following. 75
    76. 76. Design Goals For Your Culture & Budget If Bravo does not have prior results, participants will be provided with the information needed to request an alternative goal in the results letter. What defines improvement? As an example: If your 2013 screening result for glucose is 126 (Elevated III), you would need to either improve your glucose into the Elevated II range of 111-125 – OR – achieve the employer’s goal at your 2014 screening. Sample Improvement Categories BLOOD PRESSURE (mmHg) Systolic Diastolic Desirable Below 120 Below 80 Elevated I 120 - 135 80 - 85 Elevated II 136 - 139 86 - 89 Elevated III 140 - 159 90 - 99 Elevated IV 160 or Higher BODY MASS INDEX (kg/m2) 10% weight loss or reduce your BMI by 2 points since prior year screening Improvement category levels are not intended to identify risk or medical appropriateness. Always consult with your medical doctor before starting any new exercise or nutrition program. LDL CHOLESTEROL (mg/dL) Reduce your LDL cholesterol by 100 or Higher 10% from prior year screening GLUCOSE (mg/dL) Desirable Below 100 Elevated I 100 - 110 Elevated II 111 - 125 Elevated III 126 or Higher
    77. 77. Administering Alternatives & Appeals Bravo has classified appeals and alternatives as follows: • • • • Alternative Requests: Completing an improvement goal or program regardless of a medical issue Type One: Disputing the accuracy of results Type Two: Exceptions due to medical issues preventing achievement of goal or alternative goal Type Three: Progress made off-cycle for nonretroactive rewards Medical Issues Bravo works with individuals and their healthcare providers to set personalized alternative goals and complete healthy lifestyle programs when appropriate. 77
    78. 78. “What if a participant has a genetic issue?” “Is BMI really fair?” “Do screenings need to be done on the clock?” “How can I avoid having dozens of different premium contributions to manage?” “Will people change behavior for $10/month or $50/month?” ANSWERS HDL or “Do penalties work “Does this ITH “Can I use EPARED W total cholesterol better thanBE PR rewards?” violate the ADA?” instead of LDL?” “What about privacy concerns?” “What about new employees and COBRA participants?” “Have any unions agreed to a model like this?” “Does this impact my employee’s W2?” “How can we involve spouses?” “Can we test for nicotine?” 78
    79. 79. Bravo’s Data On Spouse Engagement
    80. 80. THREE-YEAR STRATEGIC ROLL OUT YEAR ONE HRA participation and baseline biometric screening, impacting full premium ($200+/month) YEAR TWO YEAR THREE HRA participation and modified biometric goals with outcomesbased incentives (added $50/month) HRA participation and tighter biometric goals with progress goals introduced After only one year of applying the outcomes-based model, Southwest General saw a dramatic slowing in the increase in claims. Claims increased by 16% in the initial (participation-based) year, yet by only 1% from year 2 to 3. 80
    81. 81. After experiencing a 20% premium increase in their healthcare costs, management introduced a wellness program to accomplish two goals – improve the health of its employees and reduce the cost trend. Year 2 to Year 3 Change After implementing an outcomes-based program, they saw the following results: • 99+% participation each year • In year three: 7.6% participants stopped smoking and of those who failed BMI year two, 16.4% had a BMI reduction of 2 or more points in year three • Net savings of $124 per employee, per year enabling them to continue to invest in wellness programs 81
    82. 82. • • • • Workers’ compensation expenses have been reduced by two-thirds. Elimination of activity impact on healthcare costs while maintaining high participation in health activities and programs. Decrease of almost 50% of participants with more than 1 risk factor. High program impact - Obese participants lowered from 37.2% to 31.2%. High LDL cholesterol has had a relative decrease of more than 50%. High blood pressure has gone down 80% amongst Graco participants. 2013 Honorable Mention
    83. 83. Graco’s Medical And Pharmacy Cost Trends $600.00 $550.00 $500.00 $450.00 $400.00 $350.00 $300.00 $250.00 $200.00 $150.00 $564.00 $529.00 $426.00 $328.00 $320.00 $311.00 $215.00 $189.00 2008 $193.00 2009 Employee 2010 Spouse 2011 Child 2012
    84. 84. Graco’s Financial Impact Workers’ compensation expense reduction Measure 2008 2009 2010 2011 2012 Safety Incident Rate 5.71 3.77 4.24 3.63 3.60 $452,000 $273,000 $345,000 $145,000 $124,000 $179,000 $107,000 $307,000 $328,000 Workers’ Compensation Expense WC Expense Reduction (from 2008 baseline) Total $921,000 Total financial impact on medical/pharmacy trend and workers’ compensation expense Measure 2009 2010 2011 2012 Total Med-Pharm Claims -$265,015 $1,243,604 $1,623,789 $1,569,109 $4,171.487 Workers’ Compensation $179,000 $107,000 $307,000 $328,000 $921,000 Total Financial Impact -$86,015 $1,350,604 $1,930,789 $1,897,109 $5,092,487 Med-Pharm claims show cost avoidance assuming employees health care costs would have trended at the same rate as spouses without a wellness program.
    85. 85. Q&A: SEGMENT 1: SEGMENT 2: Alyson Mathews Partner Lamb & Barnosky, LLP Kendra Roberson Of Counsel Covington & Burling LLP SEGMENT 3: SEGMENT 3: Joseph F. Coniglio Shareholder Greenberg Traurig, LLP Magan Pritam Ray Shareholder Greenberg Traurig, LLP SEGMENT 4: Jim Pshock Founder and Chief Executive Officer Bravo Wellness ► You may ask a question at anytime throughout the presentation today. Simply click on the question mark icon located on the floating tool bar on the bottom right side of your screen. Type your question in the box that appears and click send. ► Questions will be answered in the order they are received. 85 January 30, 2014
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