Healthcare Industry News
May 19, 2020
Chronic disease is a monumental health issue in the United States. Approximately six in 10 adults in the U.S. have a chronic disease, while four in 10 have two or more.
The most prevalent chronic diseases are diabetes and obesity. An estimated 34.2 million people, or 10.5% of the U.S. population, have diagnosed diabetes, costing the country around $327 billion annually. Worldwide obesity has nearly tripled since 1975, with approximately 93 million Americans affected by it. According to the Centers for Disease Control and Prevention (CDC), the annual nationwide productive costs of obesity-related absenteeism range between $3.38 billion and $6.38 billion ($79 to $132 per individual with obesity).
Enter wellness and preventive health programs from health plans. These are designed to promote healthy living and prevent diseases before they occur, as well as educate members and reduce healthcare costs. These programs typically require health screenings and risk assessments at the outset. They then provide participants with educational materials, exercise and nutrition plans, smoking cessation tools, stress reduction resources, mental health assistance and more.
The Kaiser Family Foundation (KFF) 2019 Employer Health Benefits Survey contains a wealth of information on wellness programs in the employer-sponsored health insurance market. Here is a summary of some of the results:
An important note in the report is that many employers believe improving the health of their workers, and their family members, can improve morale and productivity, as well as reduce healthcare costs.
There are differing reports on the advantages of wellness programs from health insurers; however, benefits to these programs have been proven by a number of respected studies.
The Journal of the American Medical Association (JAMA) found that 8.3% more employees in workplaces with a wellness program reported exercising regularly and 13.6% more were actively managing their weight.
A Health Affairs case study of large companies reported that total medical spending at a company with an employee wellness program experienced slower growth in health costs than companies without one.
The Journal of Occupational and Environmental Medicine reported that employees who participated in a health promotion program and improved their healthcare or lifestyle regained an average of 10.3 hours in productivity annually and saved their companies an average of $353 per person per year in productivity costs.
These studies aren’t the only evidence that wellness programs can work. The Office of Disease Prevention and Health Promotion lists the following five reasons employee wellness is worth the investment:
On the federal level, in October 2019 the Centers for Medicare & Medicaid Services (CMS) invited states to take part in a demonstration project to employ wellness programs in their health insurance markets. The program was created to enable a total of 10 states to implement wellness programs that are health-contingent, which is prohibited under the Affordable Care Act (ACA).
One report found that more than 60 percent of consumers in the U.S. are interested in sharing personal data collected by devices as part of health insurance rewards programs. The following two health plans are among many that have established their own wellness program initiatives:
AllWays Health Partners
As part of Partners HealthCare, the AllWays Path to Lifestyle Change program was developed by Massachusetts General Hospital (MGH) to help members at risk for type 2 diabetes. The goal of the program, which was announced earlier this year, is to encourage eligible members to reduce their weight by seven percent and increase their time spent exercising to a minimum of 150 minutes per week. There are no additional out-of-pocket costs for members who have been identified as being at risk for developing type 2 diabetes.
This health insurer’s health and wellness programs include a focus on women’s healthcare, personal health and wellness coaching, mindfulness and workplace wellness. Called Aetna Health Connections, these 70+ wellness programs are comprised of solutions such as a disease management initiative, the 24-hour Informed Health® Line, the Aetna HealthSM app and an online health assessment for targeted strategies for weight loss, stress reduction and smoking cessation.
Mental health is a prevalent issue in the United States. The National Alliance on Mental Illness (NAMI) reports that one in five U.S. adults experiences mental illness each year. However, the average delay between the onset of mental illness symptoms and treatment is 11 years. An increasing number of health plans are implementing programs to make it easier for members to receive treatment. These are examples from America's Health Insurance Plans (AHIP):
Health insurance providers including Cambia Health Solutions and Centene Corporation are making investments in Quartet, a healthcare technology company that connects with primary care providers to match patients to in-person or virtual mental health resources depending on their needs.
MLS Group of Companies partners with many group health plans who have rolled out wellness programs to its members. Nicole Long, General Manager of MLS, explains, “As one part of the vast healthcare industry, we understand that valuing health and wellness is an important way to connect us with other healthcare entities. Not only do we share these values, but we also share a commitment to improving the quality of healthcare. In our own offices, employees have access to resources offered by our human resources department that assist staff with navigating their healthcare choices and finding support to make sustainable, healthy choices.”
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