Wellness remains in focus

Employers, hoping to avoid the so called “Cadillac tax” under the Obama administration’s healthcare law, are beginning to pull back on the more generous health benefits they have traditionally offered, according to a recent New York Timesarticle.

“This reminds us that under new healthcare reform enactments, employees will be taking on greater financial responsibility for their health care present and future, as the inevitable result of employer regulations, such as the Cadillac tax,” says Tony Song, president, Diabetes Care Pharmacy and Health Program Centers, West Covina and Pasadena, Calif. “This sheds new light on the important role patients now must take as leaders of their own health.”

Cadillac plans often have low deductibles and rich benefits, but do carry high premiums. The tax under the Patient Protection and Affordable Care Act (PPACA) will not begin until 2018, and applies to plans with premiums exceeding $10,200 for individuals or $27,500 for a family (not including vision and dental benefits) starting in 2018. Employers are making early adjustments.

Song says for employers, disease management and wellness programs are finally gaining traction as pivotal strategies. Under PPACA, employers will be encouraged to offer incentives for enrolling in a program that helps manage diabetes or other chronic conditions.

The law allows a 30% (of premium cost) incentive for employees for engaging in health activities or taking assessments.

“In the wake of healthcare reform, changes are coming that underscore the urgent call to action to develop disease management and wellness programs, but the ironic thing is this is not a new concept,” Song says.

The key driver of wellness programs is their ability to be accountable to patients, insurers, hospitals, medical groups, and IPAs-to provide measureable clinical results in terms of decreased complications and hospital admissions, and increased quality of life to sustain the patient’s ability to contribute to society-working, contributing to the economy, shouldering their share of healthcare premium costs, according to Song.

“Consider that millions of dollars are spent every year on disease management and wellness programs that may or may not work and in many cases are not held accountable for outcomes and ROI,” he says.