Credits - Pallav Bansal, Abhilash Mondrathi, Pranav Nahal- IIM Kozhikode, PGP21 Batch

6. Thank You

7. Annexure
HOSPITALS, PHYSICIANS & CLINICS, PRESCRIPTION
DRUG SPENDING BY ALL SOURCES OF FUNDS, 1960 - 2016
SOURCE: HTTPS://WWW.HEALTHSYSTEMTRACKER.ORG/INTERACTIVE SOURCE: HTTPS://WWW.HEALTHSYSTEMTRACKER.ORG/INTERACTIVE
HOSPITALS, PHYSICIANS & CLINICS, PRESCRIPTION
DRUG SPENDING BY ALL SOURCES OF FUNDS, 1960 - 2016

8. Data Privacy and Healthcare security
HIPAA Health Insurance Portability and Accountability Act: The law has emerged into greater prominence in recent years with
the proliferation of health data breaches caused by cyberattacks and ransomware attacks on health insurers and providers.
The act, which was signed into law by President Bill Clinton on Aug. 21, 1996, contains five sections, or titles.
Title I: HIPAA Health Insurance Reform
Title I protects health insurance coverage for individuals who lose or change jobs. It also prohibits group health plans from
denying coverage to individuals with specific diseases and pre-existing conditions, and from setting lifetime coverage limits.
Title II: HIPAA Administrative Simplification
Title II directs the U.S. Department of Health and Human Services (HHS) to establish national standards for processing electronic
healthcare transactions. It also requires healthcare organizations to implement secure electronic access to health data and to
remain in compliance with privacy regulations set by HHS.
Title III: HIPAA Tax-Related Health Provisions
Title III includes tax-related provisions and guidelines for medical care.
Title IV: Application and Enforcement of Group Health Plan Requirements
Title IV further defines health insurance reform, including provisions for individuals with pre-existing conditions and those
seeking continued coverage.
Title V: Revenue Offsets
Title V includes provisions on company-owned life insurance and the treatment of those who lose their U.S. citizenship for
income tax purposes.

9. Data Privacy and Healthcare security
HIPAA Health Insurance Portability and Accountability Act: Implications
• The wellness program will never disclose any of your personal information either publicly or to the employer.
• Medical information that personally identifies you that is provided in connection with the wellness program will not be
provided to your supervisors or managers and may never be used to make decisions regarding your employment.
• Health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to
carry out specific activities related to the wellness program
• Participants will not be asked or required to waive the confidentiality health information as a condition of participating in the
wellness program or receiving an incentive.
• Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by
the same confidentiality requirements.
• In addition, all medical information obtained through the wellness program will be maintained separately from your
personnel records, information stored electronically will be encrypted, and no information you provide as part of the
wellness program will be used in making any employment decision.
Source : Wells Fargo Wellness program
Americans with Disabilities Act (ADA)
Under the ADA regulations, employers are allowed to ask disability-related questions and conduct medical exams for
voluntary wellness programs that promote health or wellness
Employers may only receive information from wellness programs in aggregate, any individually identifiable information
received is considered PHI
Privacy notices describing the handling of medical information, and procedures for safeguarding information privacy must be
distributed to all wellness program participants
Source :https://www.cigna.com/health-care-reform/wellness-and-incentives

10. Insurance terminology
1.Deductible: amount paid on a yearly basis to
insurer /payer
2.Co-payment: Percentage of cost to be paid after
the deductible
3.Out of Pocket maximum: maximum amount of
expenses that participant has to pay in a year
4. HSA : Health Savings Account
5.HRA : Health reimbursement account
6.FSA : Flexible Savings Account
Plan
Sponsor
Payroll
deduction
(participant)
Deductible I
Co-payment I
Out of pocket
maximum
Employer Sponsored
Insurance Breakup
Links 1 2
Employer
Sponsored
Insurance
Self Funded
Self insured
Reimbursement Plan
Partially Insured
Integrated HRA
Fully Insured
Admin by
Insurer
• Increase the
deductible
• Use HRA
accounts to
reimburse
• Use HRA
accounts to
reimburse
health care costs

11. Data Sources for Slide 4( Financials):
Study by SpringBuk (Wellness Provider)
In a Study , more than 60 percent of employers said workplace wellness programs reduced their organizations’ healthcare costs.
A study revealed that Johnson & Johnson’s wellness programs produced a ROI of $3.92 for every dollar spent on their wellness
budget
A study revealed that Pepsi had an average reduction of $30 in health care costs per member per month (PMPM) for members
engaged in either the lifestyle or disease management program.
In a study the Rand Company found that Employees that participated in a disease management program resulted in savings of $136
PMPM. These savings were largely in part by the 30% reduction in inpatient visits.
Additional Return on Wellness: Efficiency and Productivity
Companies care about every number on their financial spreadsheets, but what about the factors that influence those
numbers overall? An investment in wellness initiatives is an investment in the employee, which affects every aspect of a
successful organization.
• A study revealed that Employees who scored low on “life satisfaction” stayed home from work 1.25 more days per
month than those with higher scores, adding up to about 15 additional days off per year.
• A meta-analysis conducted by The American Journal of Health Promotion found that having a lifestyle management
program in place resulted in a 25% reduction in absenteeism and sick leave.
Annexure

12. Annexure
Data Sources for Slide 1:
Data Referred For Slide 1 (Excluding Introduction Slide):
Source : https://www.thebalance.com/healthcare-costs-3306068
Source : kaiser/HRET Survey of Employer -Sponsored health Benefit, 2007-2017
Source : https://www.kff.org/other/state-indicator/total-population/

13. Annexure
(1) : Optum white paper, 6th Annual Wellness in the Workplace
Study – Optum
(2) :PWC: The Wearable Life 2.0 – PwC
(3) :Reb Brick Health , RedBrick Health ROI study
(4) :Sprinbuk Health , How to Measure ROI on Corporate
Wellness Programs – Springbuk
(5) Proyoga, http://www.proyogausa.com
(6) UHC ,Tobacco cessation corporate wellness
(7) :Delloite , The convergence of health care trends
(8) :Optum white paper, 7th Annual Wellness in the Workplace
Study - Optum
(9) : https://www.thebalance.com/healthcare-costs-3306068
(10) : Anni Ylagan and Andre Bierzynski, “Using Sensor Technology
to Lower Elder Care Costs,” The Wall Street Journal, July 2014
(11) : Joanne Spetz, Stephen T. Parente, Robert J. Town, and Dawn
Bazarko, “Scope-Of-Practice Laws For Nurse Practitioners
Limit Cost Savings That Can Be Achieved In Retail Clinics”
(12) : Joseph Kvedar, Molly Joel Coye, and Wendy Everett,”
Connected Health: A Review of Technologies and Strategies to
Improve Patient Care with Telemedicine and Telehealth”
(13) : Alex H. Krist, Steven H. Woolf, and Stephen F. Rothemich,
Interactive Preventive Health Record to Enhance Delivery of
Recommended Care: A Randomized Trial, Annals of family
medicine, July/August 2012.
(14) : https://nccih.nih.gov/health/integrative-health
(15) : https://nccih.nih.gov/research/statistics/2007/most-
common-cam-therapies-among-adults
(16) : Deloitte Center for Health Solutions, 2015 Survey of US
Health Care Consumers.
Data Sources for Slide 3: