Employee Health Promotion in Massachusetts: Federal and State Regulatory Landscape Tom Hubbard Senior Program Director, NEHI April 30, 2010 ● Waltham, MA

- 2 - For Discussion Employee Health Promotion – Why Now? The Regulatory Landscape – Federal and State Key Questions

- 3 - Employee Health Promotion: Why Now? Source: Trust for America’s Health; MassINC and Northeastern University Center for Labor Market Studies, Mass Economy: The Labor Supply and Our Economic Future, December 2006 Projected Changes in MA Working Age Population, 2005 – 2015

- 4 - Where Are the Employees Located? Source: Medical Expenditure Panel Survey, 2008 MA Employers and Employees by Firm Size

- 5 - The Regulatory Landscape – Federal and State Self-InsuredFully-Insured Fundamental Concern: Non-discrimination on the basis of health status and pre-existing conditions

- 6 - The Regulatory Landscape – Federal and State Self-InsuredFully-Insured Incentives allowed for employee participation in wellness/prevention programs AND for health status Value of incentives capped at 20 percent of cost of coverage Other conditions apply – to protect against discrimination on basis of health status Premium discounts for small employers allowed based on employee ‘usage’ of wellness programs Employers (small and mid-sized) may grant employees premium discounts, based on usage of wellness programs

- 7 - The Regulatory Landscape – Federal Self-Insured  5-year grants to small employers  Increase value of employee incentives to 30 percent of overall premiums per employee  10 state pilot projects Federal Health Care Reform Incentives allowed for employee participation in wellness/prevention programs AND for health status Value of incentives capped at 20 percent of cost of coverage Other conditions apply – to protect against discrimination on basis of health status

- 8 - Key Questions How do we expand adoption among both self- insured and fully-insured employers? How should we incorporate the use of incentives? –Among self-insured employers –Among (state regulated) fully-insured employers

Employee Health Promotion: Opportunity and Challenge for Massachusetts April 30, 2010 Waltham, MA

Panelists Phyllis Yale Partner, Bain & Company Director, Employers Action Coalition on Healthcare (EACH) Dena Broderick, RN VP of Clinical Programs & Development, Tufts Health Plan Marie Chalmers Principal, Advisory Enterprise Market Leader, Mercer Health & Benefits Judith Frampton, RN, MBA VP of Medical Management, Harvard Pilgrim Health Care Thomas Hawkins, MD, SM Medical Director for Health Informatics, Blue Cross Blue Shield of Massachusetts Alan G. Macdonald Executive Director, Massachusetts Business Roundtable Eileen P. McAnneny Senior VP of Government Affairs, Associated Industries of Massachusetts Lynn Nicholas, FACHE President and CEO, Massachusetts Hospital Association Kerry Hands Vice President, Small Business Solutions, The Bostonian Group

Employee Health Promotion: Opportunity and Challenge for Massachusetts April 30, 2010 Waltham, MA