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 Post subject: Wellness programs
PostPosted: Wed 22 Oct , 2014 7:44 pm 

Joined: Fri 10 Aug , 2012 4:42 pm
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We're in the annual open enrollment period for health insurance again, and along with the unwelcome news that our health insurance program is being dropped, forcing us into either an HMO plan or a higher priced PPO plan, the letter says that we will be penalized for every covered member of the family who fails to complete a "health assessment screening," with additional penalties that rise yearly (to about $400 so far, I think) if you fail to meet the goals they identify in the wellness screening.

After my initial "what the hell...?" reaction faded, I went looking for information. Guess I haven't been following the news, because this seems to be a trend. Anyway, it's an interesting read. (and to me, a disturbing one. While I'm all for healthier living, mandating it raises a red flag to me.)

http://www.businessweek.com/articles/20 ... ove-health

Quote:
Will Workplace Wellness Screenings Under Obamacare Improve Health?

CVS Caremark (CVS) was widely criticized in March when word got out that its employees would have to submit to yearly health screenings or pay $50 more a month for insurance. The pharmacy chain isn’t exceptional: The Kaiser Family Foundation reports nearly half of U.S. companies with more than 200 employees have wellness programs that measure workers’ weight, blood pressure, blood sugar, and cholesterol. That number is likely to grow next year, when rules take effect under the Affordable Care Act that give employers more tools to prod workers into healthier behavior. The law will let companies charge employees who don’t meet certain health targets 30 percent more for insurance premiums, up from 20 percent now....


I found this especially bothersome, and plausible.

Quote:
While some studies suggest $3 or more in savings for every dollar spent on wellness programs, the gains may come from shifting costs to less healthy employees rather than changing behavior, a March analysis in Health Affairs concluded.



Edit: After reading the details on ours more carefully, it's worse than I thought. Should you have or develop any chronic condition, you are now required to comply with all the recommendations of their plan's "care manager" or pay hundreds of dollars extra each year. Not your doctor's recommendations, but the insurance company's.

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That no river is a river which does not flow.

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 Post subject: Re: Wellness programs
PostPosted: Sun 09 Nov , 2014 12:41 am 
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aninkling wrote:
Edit: After reading the details on ours more carefully, it's worse than I thought. Should you have or develop any chronic condition, you are now required to comply with all the recommendations of their plan's "care manager" or pay hundreds of dollars extra each year. Not your doctor's recommendations, but the insurance company's.

I wonder what would happen if your doctor's recommendations flatly contradict those of the insurance company. My guess is that if it went to court, the insurance company's case would be extremely weak.

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 Post subject: Re: Wellness programs
PostPosted: Mon 10 Nov , 2014 2:29 pm 

Joined: Fri 10 Aug , 2012 4:42 pm
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Jude, I hope so. But I am honestly wary of any healthcare reform where insurance companies can say "you must do this, or we can charge you." And it will take a brave doctor to flatly contradict an insurance company. More likely, the situation will be that there is more than one option, and the patient's choice will be to either choose the one the insurance company wants, or pay more. And doctors may be under pressure to push patients to comply with insurance company "standards" even when there are pros/cons to a certain drug or procedure.(and there are pros/cons to most things) What we've already seen with defensive medicine in the U.S. One-size-fits-all medicine.

My suspicion is also that this is actually a thinly veiled attempt by these insurance companies to charge more for healthcare to some groups, including those with chronic illnesses and certain "lifestyle factors" like being overweight or smoking, while claiming that premiums did not go up. If I remember right, smokers will be given a couple of chances to quit, then their rates go higher. Given that smokers already have plenty of incentives to quit, and many can't, I suspect most will just be charged more.


The one ray of hope I saw in the newspapers is that some officials have said this is "too onerous" a plan - but whether they just said that, and once the fuss dies down, the plan will go ahead...

My other issue with these mandatory yearly "wellness checkups" is that they're taking valuable time from doctors who could be seeing sick patients. I know some people who did theirs - they get regular checkups, but this was a separate appointment where they were asked lots of questions about whether they are depressed, have throw rugs in the house (seriously!), had their waistlines measured, etc. Their doctor thought it was a waste of time, too. I think they said it took 45 minutes, with most of the time being used for the mandated questions (this was for 2 people doing their wellness checkups at once).

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The building of castles in sand, of queens in snow,
That we cannot make any corner in life or in life's beauty,
That no river is a river which does not flow.

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 Post subject: Re: Wellness programs
PostPosted: Mon 10 Nov , 2014 4:49 pm 
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I assume the insurance company pays the bill for these Wellness Checks?

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 Post subject: Re: Wellness programs
PostPosted: Mon 10 Nov , 2014 5:37 pm 

Joined: Fri 10 Aug , 2012 4:42 pm
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Yes. Although I assume what that means is that the insurance company pays the doctor for them, then the insurance company passes on the cost to everyone who has their insurance. :)

The wellness checks are separate, though, from
1) charging people more if they don't comply with the insurance company's treatment plans for any "chronic condition", and
2) charging people more if they fail to meet the goals identified in the wellness checkup

I know people whose plans have the wellness check requirement alone.

Of course, when both exist together, the wellness checkups look like fishing expeditions for smokers, people who are overweight, etc.

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It is this we learn after so many failures,
The building of castles in sand, of queens in snow,
That we cannot make any corner in life or in life's beauty,
That no river is a river which does not flow.

- Louis MacNeice, Autumn Journal


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 Post subject: Re: Wellness programs
PostPosted: Mon 10 Nov , 2014 7:14 pm 
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Our plan gives us a discount if we (and our spouses) have annual wellness checkups, regardless of their outcomes. Of course, it's semantics whether it's really a discount for those who participate or a penalty for those who don't.

And it's true that in the year where this rule was added, premiums increased by an amount greater than the discount.


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 Post subject: Re: Wellness programs
PostPosted: Thu 13 Nov , 2014 6:13 pm 

Joined: Fri 10 Aug , 2012 4:42 pm
Posts: 1322
I saw something interesting that might also contribute to employers wanting to try these wellness programs.

It's in a long discussion of the new taxes on "Cadillac" healthcare plans and how employers are changing their healthcare plans to avoid them (in itself, worth a read. For me, it helped explain why we now have to pay 30% of any out-of-network healthcare, when it used to be 20%).

http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=99

Quote:
A 40 percent excise tax will be assessed, beginning in 2018, on the cost of coverage for health plans that exceed a certain annual limit ($10,200 for individual coverage and $27,500 for self and spouse or family coverage).


Quote:
Although the excise tax will not take effect for more than four years, many employers are indeed scaling back coverage to avoid the tax. Others are considering passing the cost on to employees in the form of both higher premiums and more cost sharing, requiring higher deductibles and copays to keep the health plan costs as they are.


Quote:
Critics of the Cadillac tax say this reality is especially unfair for people with chronic or costly medical conditions, such as cystic fibrosis or cancer, who have large medical bills and rely on their generous coverage to cover their care. Although employers are looking for ways to reduce costs, they will also be adding costs to plans such as covering, as mandated by the Affordable Care Act, preventive, maternity, and emergency care.


Quote:
To compensate, some employers are responding with innovative cost-reduction strategies. For example, some employers are expanding their disease-management programs to more effectively target and reduce employees' chronic conditions. Others are experimenting with more unusual strategies. For example, according to reports, Wal-Mart is considering paying health-related travel costs to send its employees to hospitals and other providers with better track records for quality care and health outcomes.


I have to wonder how well either will work. Any cost savings will depend on how well the diseases are already being managed, and what percentage of people with a particular chronic condition will respond predictably to the currently prescribed treatments. And what happens if large numbers of employers start trying to send employees to "better performing" hospitals, and now the wait times for all of those employees to get treatment increase.... ?

Plus, someone will have to pay salaries, etc. for health insurance company employees to implement these wellness programs, and/or pay for those travel-related costs. Will cost reductions (if any) be enough to offset that?

_________________
It is this we learn after so many failures,
The building of castles in sand, of queens in snow,
That we cannot make any corner in life or in life's beauty,
That no river is a river which does not flow.

- Louis MacNeice, Autumn Journal


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 Post subject: Re: Wellness programs
PostPosted: Mon 12 Oct , 2015 7:11 pm 

Joined: Fri 10 Aug , 2012 4:42 pm
Posts: 1322
I finally got around to reading the book "Being Mortal" and highly recommend it. It's a long overdue discussion of aging and healthcare and quality of life as we grow older, by the surgeon Atul Gawande. Among other things, he talks about the way older Americans are treated like children unable to make decisions for themselves by the healthcare and elder care system, especially when we reach the stage of needing assistance with daily living.

Between that, and the annual health insurance open enrollment period (I've really come to dread these lately), I found this article interesting:


Quote:
Maryland doesn't trust state employees to manage their health


http://www.baltimoresun.com/news/opinion/oped/bs-ed-wellness-program
Quote:
State employees have all been given a mandate to conform to this new initiative, which purports to cut costs by requiring participants to "better manage" their health, or pay extra for our health benefits. . .

We inquired about the data behind using these coercive Wellness Plans and data related to either disease reduction or dollars saved (by any person or organization). In response to our request, we were sent only a table of the insurance costs for people with selected chronic conditions. Notice that this is a different set of data...

If you are part of the program, you must work with a doctor who is part of the program. Note that this may not be your chosen primary physician. Based on personal experience, the "Disease Management" involves calls and monitoring from an anonymous medical person who may not understand your chronic conditions, but is still ready to "manage" them for you without apparent regard to what you and your doctor have already decided to do over years of managing the condition.


Quote:
If you decide not to accede to the allegedly well-intended program by 2016, with its Orwellian labels such as "Healthy Activities" and "Disease Management Program," the disincentives are severe: You will be penalized with annual surcharges, as summarized below:

•2016: $50 per person, per year, for failure to complete Health Activities;

•2017 forward: $75 per person, per year, for failing to complete Healthy Activities and $250 per person, per year, for failure to participate actively in a "Disease Management Program."


The authors of this op ed piece are 2 professors, one an expert on adult developlment and aging.

One reason the insurance companies probably couldn't give them evidence the program will save money is that there's a good chance it won't (except by charging people for "noncompliance"). Out of curiosity, I've skimmed a few studies on healthcare costs, and so far, it seems like what they find is that most universal screening programs don't save money (as opposed to true prevention activities like getting a polio vaccine). That's not to say that they don't provide benefits for an individual who chooses to be screened, but in terms of costs to society, it can be a lot of testing to catch few cases, which isn't necessarily cost-effective, especially when the test itself is expensive.
Must admit, this leaves me scratching my head as far as why a for-profit system insists on them - except that these companies are managed by bureaucrats rather than physicians and scientists, and I've heard a lot of hype about how screening is supposed to be the panacea for increasing healthcare costs.

And the insurance companies have now released details about the Maryland disease management programs the authors discussed in this article: they are required for anyone with lower back pain, asthma, high cholesterol, diabetes, heart disease in any form, and high blood pressure.

Why this particular list? The insurance companies found these diseases accounted for most of their costs. People with any of these conditions will be contacted by the insurance company's "disease management nurse" and must agree to "engage with that nurse in a treatment plan that will help you manage your illness better." Also, you are no longer allowed to make decisions with your own doctor about the frequency of mammography between the ages of 40-49 (as recommended by some recent physician's expert panels) - it's "have an annual mammogram or pay up." Likewise, pay up if you miss your required physical (annually if ages 18 to 30, or 50-64, and 1-3 years between 30 and 50) or any of their other required tests.

If things continue like this, I suspect we're not just going to be talking about how to balance what's personally important vs what's "good for us" (in terms of optimal safety and "health") as we get old and frail. Not that I'm surprised, given that we handed control of universal healthcare to some for-profit companies, added more bureaucracies, made a few tweaks, and somehow expected an ailing and overpriced system to suddenly start working better and get cheaper.

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It is this we learn after so many failures,
The building of castles in sand, of queens in snow,
That we cannot make any corner in life or in life's beauty,
That no river is a river which does not flow.

- Louis MacNeice, Autumn Journal


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 Post subject: Re: Wellness programs
PostPosted: Tue 13 Oct , 2015 1:53 pm 
The Grey Amaretto as Supermega-awesome Proud Heretic Girl
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That's pretty depressing, inky. :(

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 Post subject: Re: Wellness programs
PostPosted: Tue 13 Oct , 2015 10:50 pm 

Joined: Fri 10 Aug , 2012 4:42 pm
Posts: 1322
I found it depressing and frustrating, myself, and hence the rant - sorry about that.

But what I fear is this model spreading and expanding, and no one protesting. After all, the insurance companies have already been calling the shots on treatment decisions, to some extent, for years. This seems to take away even more autonomy from patients and physicians.

btw, I really do recommend that book. It's not maybe the most cheerful reading, but I really wish I had read it before my mother's last year of life. If nothing else, I would have looked into getting a palliative care specialist. I would have also made some of her physicians (and us) back off and listen to what *she* really wanted instead of what the medical system thought she should have.

_________________
It is this we learn after so many failures,
The building of castles in sand, of queens in snow,
That we cannot make any corner in life or in life's beauty,
That no river is a river which does not flow.

- Louis MacNeice, Autumn Journal


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 Post subject: Re: Wellness programs
PostPosted: Wed 14 Oct , 2015 10:40 pm 
The Grey Amaretto as Supermega-awesome Proud Heretic Girl
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I will add it to my list. Thank you for recommendation.

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