Jennifer L. Pomeranz, JD, MPH, Temple University
Chronic disease cost ~$347 billion = 30% of total health spending, 2010 Affordable Care Act Revised → Employer “wellness programs” Targeted setting Growing health care costs and lost productivity For every $1 wellness medical costs fall ~ $3.27 productivity increases; absenteeism costs fall ~$2.37. APHA-AHRQ 2010; Census 2011; Baicker et al., Health Affairs 2010
Promote health or prevent disease Participatory No reward or no health-related standard Health Contingent Activity Only or Outcome Based More large businesses, mostly participatory Small businesses employ ~1/2 workforce Trust for America’s Health 2013; 78 FR 33158
Must be available to all similarly situated Health Risk Assessment Rewards = Penalties No requirements related to efficacy State bills and laws 78 FR (2013).
5 Requirements 1. opportunity to qualify for reward once a year; 2. reward percentage allowances; 3. must be reasonably designed to promote health or prevent disease; 4. available to all similarly situated individuals; 5. plan materials must disclose the terms of the program, availability of a reasonable alternative to qualify for the reward or possibility of a waiver 78 FR (2013).
Reasonable chance improve health/prevent disease, not overly burdensome, not discriminatory, not highly suspect method No requirement evidence-based standards Flexibility! Innovation! Aromatherapy? Still not widely used 78 FR (2013); 71 FR (2006)
We must move beyond “wellness” Support evidence based research/programs Efficacy from health and financial standpoint Community Preventive Service Task Force Innovate then require (and grandfather) Build evidence base ACA Precedent USPSTF “A” and “B” services
State bills and laws ERISA litigation warning Best practices and program evaluation
Thank you to the Vitality Institute for funding this work as part of their broader support for a Commission on the prevention of chronic diseases among working age Americans.