Preventive Care

Vegging Out at Work in Company Gardens
Excerpt:"More companies are ripping out manicured lawns to create on-site vegetable gardens as healthy perks or volunteer opportunities for employees."(Star Tribune)

[Guidance Overview] Vigilance and Policies Needed to Meet New Preventative Health Care Cost-Sharing Requirements
Excerpt:"When reviewing the potential impact of these regulations and their internal operating procedures, providers should consider: documenting and implementing internal policies and procedures with respect to the billing treatment of preventive services and office visits; maintaining communication with health plans and insurance providers, as many have begun implementing the new preventive care regulations; educating patients about potential and actual changes in the collection of cost-sharing amounts and about the provider's billing practices with respect to preventive services and office visits."(Pepper Hamilton LLP)

Are Workplace Smoking Bans Hazardous?
Excerpt:"A study finds that reduced smoking in the workplace may lead to higher rates of obesity, leading some experts to wonder whether company smoking bans really do have an overall beneficial effect. They stress that a holistic view on wellness initiatives, including incentives, is necessary."(Human Resource Executive Online)

Caution Advised Before Rushing Into Wellness Incentives
Excerpt:"More employers are hitting workers in the pocketbook by adopting financial penalties to curb risky health behaviors such as smoking or, conversely, using incentives to encourage healthy habits like losing weight. Experts say careful program design is key to avoiding legal and privacy issues."(Workforce.com)

Dallas-Fort Worth Business Group on Health Starts Health Strategy Program to Help Employers Ensure Their Health Benefits Improve the Health of Their Employees
Excerpt:"The Texas Health Strategy Project is part of the American Health Strategy Project, a national initiative sponsored by the Washington-based National Business Coalition on Health, which was designed to improve the health of employees and their families, promote wellness and prevention, and better manage health care costs."(Business Insurance)

HHS Website Is One-Stop Shop for Details about New Preventive Services Mandate
Excerpt:"The U.S. Department of Health and Human Services has established a Web site - www.healthcare.gov - that includes a comprehensive, detailed list of all the mandated preventive services along with other information about the health reform law."(Deloitte via BenefitsLink.com)

Employers See Value in Offering Preventative Care
Excerpt:"A Midwest Business Group on Health . . . news release about its survey said 97% of poll participants agree they can help employees by offering various screenings and vaccines, to those in their health plans. By doing so, the employers admit, they can keep their workers healthy (84%), keep employees productive (59%), and reduce medical disability costs and prevent illness (94%)."(PLANSPONSOR.com)

Healthy Employees Shave $14M from Trihealth Costs
Excerpt:"'It's more than just about the medical claims cost -- we look at absence costs, productivity savings, short-term and long-term cost savings, clinical indicators,'. . . ."(Cincinnati Business Courier)

Vision Benefit Plan Design a Powerful Tool in Employee Health Promotion
Excerpt:"Because optometrists can (and do) look at blood vessels during an eye exam, they can help identify symptoms of ? and manage ? a variety of conditions that might not otherwise be detected at a pre-symptomatic stage."(Employee Benefit News; free registration required)

Low-Cost, High-Impact Employee Benefits
Excerpt:"No matter how loyal, hard-working, or committed your employees may be, it's hard for them not to feel discouraged or unappreciated when their paychecks shrink. But money isn't the only motivator. Consider creative ways to show appreciation and boost team morale without hurting the bottom line."(Morningstar)

[Guidance Overview] Agency Regulations on Preventive Care under the Affordable Care Act
Excerpt:"Plan sponsors that have lost their grandfathered status -- or that are contemplating plan design changes that might have that impact -- should work with their insurers and plan administrators to determine what additional services will have to be covered."(The Segal Group, Inc.)

Obesity Fight Shifts to Prevention
Excerpt:"[T]he medical cost of the epidemic, estimated at more than $147 billion in 2008, continues to climb. People who are overweight are at higher risk of diabetes, stroke, heart disease, sleep apnea and other health conditions."(Sacramento Business Journal)

[Guidance Overview] Regulations Issued Under Health Care Reform on Preventive Services and Internal Claims and Appeals, and External Review Procedures (PDF)
Excerpt:"imposing any cost-sharing requirements (e.g., co-pay, co- insurance, or deductible) on certain in-network preventive health services . . . A list of the preventive services currently falling within one of these categories is available at"(Bryan Cave)

Why Health Reform's New Protections May Not Apply to You
Excerpt:"Most employers will likely inform their workers of such benefit exclusions during the upcoming September-October open enrollment. One of the first things employees need to look for in their benefits packet is whether or not their plan is'grandfathered,'. . . ."(CNNMoney.com)

[Guidance Overview] Guidance on Preventive Services and Claims Processes Impacts Next Plan Year's Design and Grandfathered Plan Decisions
Excerpt:"The most recent guidance covers several requirements of the Act that are effective for plan years beginning on or after September 23, 2010 (January 1, 2011, for calendar year plans): coverage of preventive services, and new internal claims review and external appeals procedures for group health plans."(Holland&Hart LLP)

Employer Wellness Initiatives Grow, but Effectiveness Varies Widely
Excerpt:"While employer wellness programs have spread rapidly in recent years, few employers implement programs likely to make a meaningful difference in employees'health -- customized, integrated, comprehensive, diversified programs strongly linked to a firm's business strategy and strongly championed by senior leadership and managers throughout the company."(National Institute for Health Care Reform)

More Employers Peg Workers'Insurance Premiums to Health Status
Excerpt:"As companies put the final touches on their health care plans for 2011, more of them say they are planning to penalize workers who decline to participate in disease management or lifestyle behavior programs, who smoke, or who do not take part in voluntary health screenings offered by an employer."(MarketWatch, Inc.)

Health Care Reform Law Will Increase Demand for Preventive Services, Say Experts
Excerpt:"Despite the benefits of the preventive care provisions in the health reform bill, they have raised some concerns. For example, insurance plans might shift costs to compensate for the mandated coverage of preventive services, resulting in higher insurance premiums."(American Academy of Family Physicians)

[Guidance Overview] Agencies Outline Preventive Care Coverage Requirements under PPACA (PDF)
6 pages. Excerpt:"The Regulations clarify that a network-based plan is not required to provide coverage for recommended preventive services delivered by an out-of-network provider and may impose cost-sharing requirements for any such out-of-network services that are offered."(Alston&Bird LLP)

[Guidance Overview] Interim Final Rules on Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Patient Protections, and Preventive Care (PDF)
8 pages. Excerpt:"Under the Law, group health plans are subject to new requirements related to coverage offered under such plans, including a prohibition on the application of preexisting conditions for individuals under age 19, no lifetime or annual limits, restrictions on rescissions, mandatory patient protections, and coverage of preventive care services."(Morgan, Lewis&Bockius LLP)

[Guidance Overview] Implementing Preventive Services under Health Reform
Excerpt:"The Affordable Care Act . . . requires insurers to cover specific preventive services without cost sharing, thus making the services more accessible and increasing the likelihood that individuals will take them up."(Health Affairs)

[Guidance Overview] Agencies Issue Regulations on Coverage of Preventive Services
Excerpt:"[I]t looks like more guidance may be coming -- according to the preamble, the agencies are developing additional guidelines on the use of value-based insurance designs involving preventive services and are seeking comments on this topic."(Employee Benefits Institute of America)

[Guidance Overview] Federal Agencies Rules Implementing Preventive Care Requirements Under Health Care Reform (PDF)
Excerpt:"The rules clarify the application of PPACA's first-dollar preventive care coverage requirements, which are effective as of the first day of the first plan year beginning on or after September 23, 2010 (Effective Date)."(Sutherland Asbill&Brennan LLP)

[Guidance Overview] Preventive Services Interim Final Rules Under Health Care Reform
Excerpt:"The rules are designed to make preventive health services accessible and affordable by (1) requiring coverage of recommended preventive health services that have strong scientific evidence of their health benefits and (2) not charging plan participants co-payments, co-insurances or deductibles for these services when they are delivered by an in-network provider."(Proskauer Rose LLP)

[Guidance Overview] Preventive Care Guidance for Non-Grandfathered Health Plans (PDF)
Excerpt:"BUCK COMMENT. It is hoped that more guidance will be forthcoming as to whether non-grandfathered plans will be required to provide reimbursement for these treatments. It would be somewhat burdensome to adjudicate these types of claims, and certain items might not be able to be covered by an employee benefit plan on a tax-favored basis."(Buck Consultants)

Employers Say Health and Productivity Management Programs Work
Excerpt:"According to the analysis, six practices ? nurse case management, transitional return-to-work . . ., health risk coaching, onsite providers, participation incentives, and weight management ? have positive impacts on at least two important health and productivity outcomes and therefore should be considered an essential part of an effective and efficient HPM program, according to the press release."(PLANSPONSOR.com)

[Guidance Overview] Rules Clarify Office Visit Reimbursements for Preventive Care Services
2 pages. Excerpt:"NOTE: If final rules are not issued within three years, the IRS version of these interim regulations expires . . . . The DOL and OCIIO versions have no expiration date."(Wolters Kluwer)

[Guidance Overview] Guidance on Health Care Reform's Preventive Services Mandate
The target page provides links to a brief summary of the rules, full text of the final interim rules on preventive services, and to the HealthCare.gov webpage with preventive services resources. (Mercer LLC)

[Guidance Overview] New'Preventive Services'Coverage Mandate Requirements Clarified
Excerpt:"[N]on-grandfathered health plans must provide coverage for, and may not impose any cost-sharing requirements with respect to, certain preventive care services effective with the first plan year beginning on or after September 23, 2010."(Deloitte via BenefitsLink.com)

No-Cost Preventive Care in New Insurance Plans
Excerpt:"The government estimates that the changes may increase insurance premiums by 1.5 percent on average, though people who have little or no coverage for preventive health services now would likely benefit from the reduction in out-of-pocket costs."(Chicago Sun-Times)

[Guidance Overview] Required First Dollar Coverage for Preventive Services
Excerpt:"Specifically, the rules require coverage for four categories of preventive services: Services rated'A'or'B'by the U.S. Preventive Services Task Force (USPSTF); Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; Preventive care and screenings for children as recommended by the Health Resources and Services Administration; Preventive care and screenings for women as recommended by the Health Resources and Services Administration."(Seyfarth Shaw LLP)

[Guidance Overview] New Guidance Issued Under Health Care Reform Legislation
Featured in this edition: Agencies Issue Guidance on Required Coverage for Preventive Health Care without Cost-Sharing, and, Agencies Issue Rules on Preexisting Condition Exclusions, Lifetime and Annual Limits, Recissions, and Patient Protections. (Miller&Chevalier Chartered)

[Guidance Overview] Employers May Limit No-Cost Preventive Services to In-Network Care Under Interim Health Reform Regulations
Excerpt:"A plan is not required to provide coverage for recommended preventive services delivered by an out-of-network provider if the plan utilizes provider networks."(HR Policy Association)

[Guidance Overview] Under New Health Care Regulations . . . No More Cost Sharing for Evidence-Based Preventive Services
Excerpt:"For plan years beginning on or after September 23, 2010, non-grandfathered group health plans must cover preventive services that have strong scientific evidence of their health benefits."(Jackson Lewis LLP)

Wellness&Health Care Reform: The Battle for Both Cost Containment and a Healthier Workforce
Excerpt:"Employers need to plan ahead to reap the benefits from new wellness incentives. It's not a cure-all, but health care reform attempts to hold down rising costs in coming years through several provisions that make workplace wellness programs more affordable and attractive to both employers and employees."(Ceridian Corporation)

Health Lobbyists Focus on U.S. Preventive Services Task Force
Excerpt:"Under the new law, the task force could become a political lightning rod. If it doesn't recommend a service, insurers might not pay for it, and advocates might argue the decision is a barrier to care. If the panel does back a service, it might increase patients'access, as well as create new business opportunities."(The Washington Post; free registration required)

[Guidance Overview] Agencies Release Interim Final Rule on Preventive Care Services (PDF)
3 pages. Excerpt:"Under the Affordable Care Act, group health plans and health insurance issuers that are not grandfathered health plans or that lose their grandfathered health plan status are required to provide a wide array of preventive care items and services with no cost sharing."(Hewitt Associates)

New Health Care Rules Issued for Preventive Services
Excerpt:"Q: Will the added benefits drive up premiums? A: They could. The administration estimated that the new benefits may push up premiums by 1.5 percent on average."(Los Angeles Times)

Blues Plans'Practice What They Preach'With Onsite Health and Fitness Programs
Excerpt:"An AIS survey of 12 Blues plans'human resources initiatives found that the companies are prioritizing fitness and healthy eating among employees and encouraging habits through financial incentives and other creative measures."(AIS Health.com)

White House to Unveil List of Free Preventative Services
Excerpt:"Cancer screenings, including mammograms and colonoscopies, as well as obesity prevention services, immunizations, blood pressure screenings and tobacco cessation services are among those that will be available to consumers without a copayment or other direct costs for consumers on new health plans after Sept. 23."(The Wall Street Journal)

Boosting Wellness Participation Without Excessive Costs
Excerpt:"Successful employers share a common commitment in their wellness strategy. They provide broad-based and targeted communication to their workforce and develop a healthy workplace culture with strong support from senior leadership."(Towers Watson)

Most Employers Trying Reduce Workplace Stress, According to Survey
Excerpt:"In response to workplace stress, 66% of the employers have put at least four programs aimed at reducing stress in place, with employee assistance programs used most often. The survey noted other strategies, such as work-and-life balance support, on-site fitness centers and stress awareness campaigns."(Business Insurance)

Health Care Reform May Spur More Office Wellness Programs
Excerpt:"In the last few years, corporate wellness programs have been fueled by employers'desire to curb increases in health care costs, cut back on absenteeism and make employees more productive. . . . Now, with health care reform ready to kick in, more employers are poised to dangle financial incentives and use creative measures to get their workers healthier."(KansasCity.com)

[Opinion] The Health-Related Tax Provisions of PPACA and HCERA: Contingent, Complex, Incremental and Lacking Cost Controls
Excerpt:"While Republicans and Democrats alike portray the adoption of PPACA and HCERA as a pivotal moment in American life, we Americans are fated to conduct a prolonged -- indeed, an indefinite -- debate about health care and its costs."(Prof. Edward A. Zelinsky, Benjamin N. Cardozo School of Law)

How Obesity Threatens America's Future 2010
Excerpt:"Adult obesity rates increased in 28 states in the past year, and declined only in the District of Columbia (D.C.), according to . . . a report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF)."(Trust for America's Health)

Employers Deal with Effects on Employees of End-of-Life and Caregiver Issues
Excerpt:"[Pitney] Bowes now includes end-of-life and caregiver benefits in its wellness offering, with the idea that it wants to help employees consider planning for such terrible scenarios, like they would plan for their children's college tuition or for their own retirement."(Human Resource Executive Online)

Pittsburgh, Pennsylvania, Companies Become Proactive to Keep Health Care Costs Down
Excerpt:"Here???s what???s new: An increasing number of employees are choosing the Internet rather than the telephone for reminders about preventive health measures, and employers are making it easier for workers to comply with medical regimens by waiving copays associated with some prescription drugs and devices. The result overall is sweeter incentives for participating in wellness programs."(Pittsburgh Business Times)

Innovations in Preventing and Managing Chronic Conditions
Excerpt:"Instead of waiting for workers to get sick, leading companies are shifting their focus from sickness to health, fostering work and community environments that help people lower risk factors -- smoking, diet, lack of exercise -- that lead to disease . . . . High-risk employees contribute disproportionately not only to health care cost, but also to absenteeism, disability and other costs."(Center for Studying Health System Change)

[Opinion] Employers Grapple with Reform and the Costs of Unhealthy Employees
Excerpt:"'When you are giving people the choice, they tend to put their health care last,'. . . employees often view health care spending as what you do when you're sick, rather than paying for preventative care.'As an employer, you have to look at the population and decide from a'total rewards'compensation and benefits perspective what to offer.'"(Wharton School of the University of Pennsylvania via Knowledge@Emory)

Sixty-Six Large Firms Capture Honors for Their Healthy Workplace Policies
Excerpt:"According to the news release, winners were honored in one of three categories: Platinum, for established workplace well-being programs with measurable success and documented outcomes; Gold, for creating cultural and environmental changes that support employees who are committed to long-term behavior changes; and Silver, for employers who have launched programs or services to promote living a healthier lifestyle."(PLANSPONSOR.com)

Wellness Programs: Worth it or a Waste of Time and Money?
Excerpt:"There is little evidence to back up the conventional wisdom that wellness initiatives reduce healthcare costs or create healthy workforces. And it's questionable whether company incentives are able to prompt participation by employees who aren't already interested in healthy lifestyle choices."(Human Resource Executive Online)

New Health Insurance Products Target Rate Hikes, Incentives to Improve Employee Health
Excerpt:"Making premiums more affordable for employers and arming them with tools to improve the health of their employees are two of the most common features being included in new insurance products, according to several health plans . . . ."(AIS Health.com)

Biometrics Generate and Measure Savings for Employers
Excerpt:"Like a health risk assessment (HRA), biometric screening (of an employee's blood pressure, body mass index, cholesterol levels and/or blood sugar) aims at learning who has or may develop chronic diseases that affect health care costs."(Thompson Publishing Group Inc.)

Employer's Wellness Program Works Doctor Visits Into Company Time
Excerpt:"'The argument for this on-site wellness effort is that we have caught things and prevented illnesses from becoming so serious that [as a result] these employees won't have to take sick time and CNA won't lose productivity,'. . . ."(Chicago Sun-Times)

Companies Offer Cash to Employees to Lose Weight
Excerpt:"Companies are betting that cash incentives will make employees want to lose weight and get healthier in other ways, The Associated Press reports. A third of companies in the U.S. offer such incentives."(Henry J. Kaiser Family Foundation)

Facing Health Reform and Health Benefit Strategies
Excerpt:"With the recent signing of the healthcare-reform law, insurance brokers are scrambling to educate clients about what they need to do, and when they need to do it. At the same time, employers are struggling to figure out how they can provide effective, affordable health benefits to their employees."(Human Resource Executive Online)

Employers Preparing to Expand Wellness Efforts, Survey Finds
Excerpt:"The costs of the health care reform law make it more important than ever that employers keep their workers healthy and motivated to adopt healthy lifestyles, a vast majority of employers said in a recent survey. Not only did 78 percent of employers agree or somewhat agree with that statement, but most also said they are likely or very likely to create or expand corporate wellness programs as a result of an incentive provision in the new law."(Workforce Management; free registration required)

Recent Study Connects Long Work Hours with Heart Problems
Excerpt:"Are long hours leading to employee heart disease and heart attacks? One study says,'Yes.'And even though most organizations won't be able to hire more staff to take some of their workload, there are actions HR leaders can take to alleviate some of the problem."(Human Resource Executive Online)

How Does Insurance Coverage Improve Health Outcomes? (PDF)
Excerpt:"This brief looks at how insurance improves health outcomes by helping people obtain preventive and screening services, prescription drug benefits, mental health and other services, and by improving continuity of care. Vulnerable populations are especially at risk of poor health outcomeswhen they are uninsured. Insurance coverage can also improve social and economic well-being, by averting developmental problems in children, increasing workforce productivity . . . ."(Mathematica Policy Research, Inc.)

Lines Blurring between Wellness and Disease Management Services
Excerpt:"With wide acceptance of a link between lifestyle and the onset of chronic illness, disease management firms are incorporating wellness and health promotion into their traditional service model. Unlike a more fragmented approach in which wellness and disease management services are provided by separate companies, usually to different groups of plan members, an integrated approach puts all plan members together so they can access both services regardless of health status."(Workforce Management; free registration required)