Though healthcare continues to capture the nation's collective attention, insurers and employers have begun to look beyond the underlying political debate in an effort to introduce innovative wellness programs to the consumer. Because the Affordable Care Act (ACA) was designed to bring medical services to the everyman, insurers and employers have implemented various health and wellness programs to both foster healthy living and reduce financial burdens, all while providing easy access to preventive and risk management care.
According to a study conducted by MetLife, 72 percent of companies with at least 500 employees now offer wellness programs. From weight loss initiatives and lifestyle coaching, to on-site flu shots and biometric screenings, wellness programs include an array of health incentives that promote overall well being and employee engagement. In many cases, such programs also offer financial incentives, potentially reducing premiums, co-pays, and deductibles as a result. In 2014, nearly 75 percent of employers expect to offer workers a financial bonus for participating, up 57 percent from five years ago, according to research conducted by Fidelity Investments and the National Business Group on Health.
Yet, while the financial benefits are often an ideal incentive, wellness programs also aim to motivate participants by linking monetary aspects with health outcomes to drive awareness and willingness to partake in said initiatives. Many employees remain sedentary throughout the workday, so programs often encourage movement, while others promote smoking cessation to both improve health and productivity. Though these types of programs are primarily tied to financial incentives, as well, the ultimate goal revolves around encouraging and facilitating long-term improvements and positive change.
Last June, the Departments of the Treasury, Labor, and Health and Human Services jointly issued final rules regarding health and wellness programs to align with the inception of the ACA. Such amendments and regulations outlined two acceptable types of wellness programs:
1. Participatory wellness programs don't offer rewards based upon health outcomes, nor do they require any qualifying conditions for obtaining health-based rewards. Instead, such programs reward consumers based on participation. For instance, programs will reimburse employees for all or part of their fitness center membership, while others offer diagnostic testing that rewards those who partake. None of these incentives are dependent upon long-term goals.
2. Health-contingent wellness programs require each participating individual to satisfy standards related to given health factors in order to obtain their reward. Such programs are broken down even further into two sub-categories:
- Active-only wellness programs require individuals to perform or complete an activity related to given health factors in order to obtain their reward, yet they don't require participants to achieve or maintain specific health outcomes.
- Outcome-based wellness programs require individuals to attain specific health outcomes, as with smoking cessation incentives and biometric screening results, to obtain the reward. Such programs often test participants for pre-existing medical conditions or risk factors to identify the necessary steps to receive this reward.
Similarly, insurers and employers have established programs that align with these requirements, offering two particularly popular paths for consumers:
1. Reward/penalty programs tie healthcare costs, such as premiums, co-pays, and deductibles, to the consumer's health improvement activities and achievements. While such programs do encourage participants to lead healthier lives, those who cannot meet such goals suffer adverse consequences, as they are typically charged higher premiums, thereby creating a financial barrier to getting necessary care.
2. Value-based insurance design encourages consumers to use high-value drugs and healthcare services by reducing or eliminating cost-sharing for such treatments. By alleviating the financial burden for drugs and services that are clinically proven to be effective, consumers can afford the care and treatment necessary for improved health outcomes. Preventive care doesn't require consumers to meet goals.
Both insurer and employer wellness programs foster improved lifestyles, as these elements emphasize how long-term health goals benefit both the individual and the business. Reducing costs not only encourages workers to participate, but it also allows easier access to the life-saving drugs and treatments these employees may otherwise neglect.
The State of Nebraska Brings Wellness to Government Workers
In 2009, the State of Nebraska became one of the first state governments to launch an integrated health plan linked to wellness program participation. Because healthcare costs began escalating out of control, the state implemented a value-based benefit package that offers individually tailored wellness programs to help ease premium costs and encourage employees and their spouses to stay healthy via preventive coverage. With the state's wellness motto in mind--wellness is a journey we take together--Nebraska created wellnessoptions, a program built on three guiding principles: provide premium incentives for employees who meet wellness program criteria; increase preventive adherence with an effective communication strategy; and reduce healthcare costs by building a culture that promotes and encourages healthy lifestyles.
State government officials recognized that, if nothing changed, workers' health was doomed to decline. Many didn't have the coverage necessary to support preventive screenings and medications, allowing chronic and life-threatening conditions to persist. With quality of life on the line, Nebraska understood that it needed to cater to its workforce's overall well being if it were to alleviate state costs, reduce out-of-pocket employee costs, and promote healthy lifestyles. Thus, beyond premium reductions, the state's wellness program eliminates age restrictions for preventive screenings, covers routine and follow-up mammograms and colonoscopies 100 percent, offers reduced co-pay for hypertension and diabetic prescriptions, and provides tobacco cessation medications at no cost. Employees need only choose and enroll in their plan of choice, complete a biometric screening, and fulfill the online health assessment requirement each year. In return, participants also have access to personal health coaches and weight management programs year-round, facilitating healthy living on a constant basis.
To this day, Nebraska's case highlights the growing importance of wellness programs, not only from a monetary standpoint, but from an employee engagement perspective, as well. Employers now understand that their success depends upon their workforce, and if said employees are not functioning at optimal capacity, they will negatively impact the entire organization. Healthcare has become an integral element within the enterprise and wellness programs allow insurers and employers to enhance quality of life by providing easy access and peace of mind to employees across the board, ultimately impacting customer experience and the bottom line for the better.