Supreme Court Ruling: Implications for the Field of Health Promotion
Tracey Moorhead President & Chief Executive Officer
Care Continuum Alliance www.carecontinuum.org
Presented by:
Thursday, July 12, 2012
Paul E. Terry, Ph.D. Chief Executive Officer
StayWell Health Management www.staywell.com
The voice of wellness, prevention and chronic care management
Supreme Court Ruling: Implications for the Field of Health Promotion
Tracey Moorhead, President & Chief Executive Officer Care Continuum Alliance www.carecontinuum.org
The Continuum of Care
3
4 4
SCOTUS: Implications for Employers
• PPACA Implementation ramp up • Employer-related regulations expected in
coming months: • Employer play or pay • Full-time employee methodology • Exchange Operations • Auto-enrollment • Increase in Wellness Incentives
PPACA: Prevention and Wellness
Employers • Codifies premium discounts, cost-sharing waivers and other
employee rewards up to 30 percent of the cost of coverage • HHS can increase reward percentage to 50 percent.
• Authorizes $200 million in grants over five years for small business workplace wellness programs.
• Establishes a 10-state pilot by July 2014 to apply similar rewards for participating in wellness programs in the individual market.
• Requires report on the effectiveness and impact of wellness programs due three years after enactment – Care Continuum Alliance supporting RAND in report development.
5
SCOTUS: How will Health Plans Respond?
• Plans will likely offer strategies focused on:
Cost management, limiting care to a narrow network of providers or price controls
Care management, requiring or incenting covered members to utilize health coaching or care/disease management
Enhanced customer service
6
.
1 1
"Supreme Court Ruling:
Implications for the Field of Health Promotion"
Paul E. Terry, Ph.D., Chief Executive Officer
StayWell Health Management
www.staywell.com
.
2009 Emerging
Healthcare Trends
Leadership Award
Our mission & vision
2
Koop Award
Winners
2011
Cummins
2010
Volvo
2009
Alliance Data
2008
Wachovia
2007 Pepsi
Bottling Group
2006 Roche, Inc.
2003 Fairview Health
2002
HMSA
2001
Northeast
Utilities
2000
Caterpillar CIGNA
DaimlerChrysler
1998
Applied Materials Chevron
1997
Motorola
1995
CIGNA
1994
Quaker
Our mission
To help people achieve optimal health through solutions
that set the standard for quality, effectiveness and value.
Our commitment to our clients
We partner to ensure high levels of satisfaction and deliver successful
results defined by our clients and the industry.
Our commitment to the industry
We will lead research to define best practices, innovate in search of
excellence, publish outcomes to inform the industry and drive
standardization.
Our impact
StayWell enjoys unparalleled long-term relationships with our clients, who
have received industry recognition for their programs.
.
Chief Roberts:
“Put simply, Congress may tax and spend.”
Something for every
Ideology
Individual
Responsibility for
Health: Employee
Engagement
Social Responsibility
for Health: A Culture
of Health
Not a mandate,
but a tax.
• No more “free
riders.”
• HIPAA Incentives for
achieving a standard.
• Less employer
based coverage?
(CBO: 20 million fewer
covered by 2019.)
• No lifetime limits on
coverage.
• No pre-existing
conditions denials.
• No premiums based
on risk. (Higher
premiums for young,
healthy.)
3
.
4
Paul Terry and John Horton
1973, 2010
Richard Nixon: Health Maintenance
Organization Act, 1973
Barack Obama: Affordable Care Act, 2010
.
5
Beating Butter: Denmark Imposes the World's First Fat Tax
The tax, the first of its kind in the world, imposes a 16 krone (roughly $3) hike per kilo of saturated fat on
any food that contains more than 2.3%.
"At the political level there was a high degree of consensus for this law," says Tor Christensen, chief
consultant for Denmark's Ministry of Taxation.
It's just going to push more people to buy cheaper industrially produced products, rather than good food.
It's insanely stupid. Christian Puglisi, chef of Copenhagen's highly-regarded Relae
By LISA ABEND
.
6
Health Policy
Progress Technical, historical, incremental
1973-2012
.
Effects of Risk Factors on
Monthly Resource Use
Variable At Risk Not at
Risk
Sign
Level Smokers $255 $258 NS
Excess Alcohol $188 $291 NS
Obesity $326 $264 .05
Physical Inactivity $358 $238 .0001
Unhappiness
$424
$253
.0001
Terry, Am J Health Promot, May 1998
(Seniors 65 and Older)
.
8
Adherence to Quality Indicators
56% 55% 18.3%
Recommended
Care Recommended
Chronic Care
Recommended
Preventive Care
Counseling/Education
Source: N Engl J Med 2003; 349:1866-1868 November 6, 2003
55%
.
Effective Programs Drive Positive Outcomes
Grossmeier, J., Terry, P.E., Anderson, D., Wright, S., “The Financial Impact of Population
Health Management Programs, Reevaluating the Literature.” Population Health Management.
Vol. 15, No. 3, 2012. June 2012: P. 129-134.
Terry, P.E., Seaverson, E., Staufacker, M.J., Tanaka, A., “The Effectiveness of a Telephone-Based
Tobacco Cessation Program Offered as Part of a Worksite Health Promotion Program.”
Population Health Management. Dec. 2010, Volume 14, Issue 7, 2011.
Terry, P.E., Seaverson, E., Grossmeier, J., Anderson, D. "Effectiveness of a Worksite Telephone-
Based Weight Management Program." American Journal of Health Promotion. January/February
2011, Vol. 25, No. 3. Pp. 186-189.
Grossmeier, J., Terry, P.E., Cipriotti, A., Burtaine, J., “Best Practices in Evaluating Worksite Health
Promotion Programs” American Journal of Health Promotion: Vol. 24, No.3, TAHP1-9.2010
Terry, P.E., Xi, M., "An Examination of Presenteeism Measures: The Association of Three Scoring
Methods with Health, Work Life and Consumer Activation" Population Health Management. Dec.
2010, Volume 13, Issue 6.
Terry, P.E., Seaverson E.L., Staufacker M., Gingerich, S.; A Comparison of the Effectiveness of a
Telephone Coaching Program and a Mail-Based Program, Health Education and Behavior.
October 27, 2010.1177
Terry, P.E., Fowles, J., Harvey, L., "Employee engagement factors that affect enrollment
compared with retention in two coaching programs-The ACTIVATE Study" Population Health
Management. DOI: 10. 1089, Vol. 13, No. 3, 2010. P.115-122.
9
See additional StayWell research, publications and reports at www.staywell.com.
Incentives for
Participation or
Outcomes
Terry, P.E., Anderson, D. R. (2011).
Finding common ground in the use of
financial incentives for employee
health management: A call for a
progress-based approach.
American Journal of Health
Promotion, Sept. 2011, Vol. 26, No. 1,
ev-evii.