1. Jennifer L. Pomeranz, JD, MPH, Temple University

2.  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

3.  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

4.  Must be available to all similarly situated  Health Risk Assessment  Rewards = Penalties  No requirements related to efficacy  State bills and laws 78 FR 33158 (2013).

5. 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 33158 (2013).

6.  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 33158 (2013); 71 FR 75014 (2006)

7.  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

8.  State bills and laws  ERISA litigation warning  Best practices and program evaluation

9. jennifer.pomeranz@temple.edu 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.