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Thursday, July 12, 2012 Supreme Court Ruling:Implications for the Field of Health Promotion Presented by: Tracey Moorhead Paul E. Terry, Ph.D. President & Chief Executive Officer Chief Executive Officer Care Continuum Alliance StayWell Health Management www.carecontinuum.org www.staywell.com
The voice of wellness, prevention and chronic care managementSupreme Court Ruling: Implications for the Field of Health Promotion Tracey Moorhead, President & Chief Executive Officer Care Continuum Alliance www.carecontinuum.org
SCOTUS: Implications for Employers • PPACA Implementation ramp up • Employer-related regulations expected in coming months: • Employer play or pay • Full-time employee methodology • Exchange Operations • Auto-enrollment • Increase in Wellness Incentives 4
PPACA: Prevention and WellnessEmployers• Codifies premium discounts, cost-sharing waivers and other employee rewards up to 30 percent of the cost of coverage • HHS can increase reward percentage to 50 percent.• Authorizes $200 million in grants over five years for small business workplace wellness programs.• Establishes a 10-state pilot by July 2014 to apply similar rewards for participating in wellness programs in the individual market.• Requires report on the effectiveness and impact of wellness programs due three years after enactment – Care Continuum Alliance supporting RAND in report development. 5
SCOTUS: How will Health Plans Respond?• Plans will likely offer strategies focused on: Cost management, limiting care to a narrow network of providers or price controls Care management, requiring or incenting covered members to utilize health coaching or care/disease management Enhanced customer service 6
"Supreme Court Ruling:Implications for the Field of Health Promotion" Paul E. Terry, Ph.D., Chief Executive Officer StayWell Health Management www.staywell.com 1 . 1
Our mission & vision Our missionKoop Award To help people achieve optimal health through solutions Winners that set the standard for quality, effectiveness and value. 2011 2001 Cummins Northeast 2010 Utilities Volvo 2000 2009 Caterpillar Our commitment to our clients Alliance Data CIGNA 2008 DaimlerChrysler We partner to ensure high levels of satisfaction and deliver successful 1998 Wachovia Applied Materials results defined by our clients and the industry. 2007 Pepsi Chevron Bottling Group 1997 2006 Motorola Roche, Inc. 1995 2003 CIGNA Our commitment to the industry Fairview Health 1994 2002 Quaker We will lead research to define best practices, innovate in search of HMSA excellence, publish outcomes to inform the industry and drive standardization. 2009 Emerging Healthcare Trends Our impact Leadership Award StayWell enjoys unparalleled long-term relationships with our clients, who have received industry recognition for their programs. . 2
Chief Roberts: “Put simply, Congress may tax and spend.”Something for every Individual Social ResponsibilityIdeology Responsibility for for Health: A Culture Health: Employee of Health EngagementNot a mandate, • No more “free • No lifetime limits onbut a tax. riders.” coverage. • HIPAA Incentives for • No pre-existing achieving a standard. conditions denials. • Less employer • No premiums based based coverage? on risk. (Higher (CBO: 20 million fewer premiums for young, covered by 2019.) healthy.) . 3
Paul Terry and John Horton 1973, 2010 Richard Nixon: Health Maintenance Organization Act, 1973 Barack Obama: Affordable Care Act, 2010. 4
By LISA ABENDBeating Butter: Denmark Imposes the Worlds First Fat Tax The tax, the first of its kind in the world, imposes a 16 krone (roughly $3) hike per kilo of saturated fat on any food that contains more than 2.3%. "At the political level there was a high degree of consensus for this law," says Tor Christensen, chief consultant for Denmarks Ministry of Taxation. Its just going to push more people to buy cheaper industrially produced products, rather than good food. Its insanely stupid. Christian Puglisi, chef of Copenhagens highly-regarded Relae . 5
Health Policy Progress Technical, historical, incremental 1973-2012. 6
Effects of Risk Factors on Monthly Resource Use (Seniors 65 and Older)Variable At Risk Not at Sign Risk LevelSmokers $255 $258 NSExcess Alcohol $188 $291 NSObesity $326 $264 .05Physical Inactivity $358 $238 .0001Unhappiness $424 $253 .0001 Terry, Am J Health Promot, May 1998 .
Adherence to Quality Indicators 55% 56% 55% 18.3%Recommended Recommended Recommended Counseling/Education Care Chronic Care Preventive Care . Source: N Engl J Med 2003; 349:1866-1868 November 6, 2003 8
Effective Programs Drive Positive Outcomes Grossmeier, J., Terry, P.E., Anderson, D., Wright, S., “The Financial Impact of Population Health Management Programs, Reevaluating the Literature.” Population Health Management. Vol. 15, No. 3, 2012. June 2012: P. 129-134. Terry, P.E., Seaverson, E., Staufacker, M.J., Tanaka, A., “The Effectiveness of a Telephone-Based Tobacco Cessation Program Offered as Part of a Worksite Health Promotion Program.” Population Health Management. Dec. 2010, Volume 14, Issue 7, 2011. Terry, P.E., Seaverson, E., Grossmeier, J., Anderson, D. "Effectiveness of a Worksite Telephone- Based Weight Management Program." American Journal of Health Promotion. January/February 2011, Vol. 25, No. 3. Pp. 186-189. Grossmeier, J., Terry, P.E., Cipriotti, A., Burtaine, J., “Best Practices in Evaluating Worksite Health Promotion Programs” American Journal of Health Promotion: Vol. 24, No.3, TAHP1-9.2010 Terry, P.E., Xi, M., "An Examination of Presenteeism Measures: The Association of Three Scoring Methods with Health, Work Life and Consumer Activation" Population Health Management. Dec. 2010, Volume 13, Issue 6. Terry, P.E., Seaverson E.L., Staufacker M., Gingerich, S.; A Comparison of the Effectiveness of a Telephone Coaching Program and a Mail-Based Program, Health Education and Behavior. October 27, 2010.1177 Terry, P.E., Fowles, J., Harvey, L., "Employee engagement factors that affect enrollment compared with retention in two coaching programs-The ACTIVATE Study" Population Health Management. DOI: 10. 1089, Vol. 13, No. 3, 2010. P.115-122. See additional StayWell research, publications and reports at www.staywell.com. . 9
Terry, P.E., Anderson, D. R. (2011). Finding common ground in the use of Incentives for financial incentives for employee health management: A call for aParticipation or progress-based approach. American Journal of Health Outcomes Promotion, Sept. 2011, Vol. 26, No. 1, ev-evii.