Workshop D. 1:00 pm. to 2:30 p.m.

Transcription

1 Workshop D Advanced Practices Significant Impact of the Affordable Care Act on Participatory Wellness Programs, ROI, and Compliance with Regulations Effective January 1st 1:00 pm. to 2:30 p.m.

2 Biographical Information Rich Siegenthaler II, MEd, CBP President & CEO-Integrated Wellness Solutions Siegenthaler has been in the HR Benefits and Wellness Industry 23 years. Now serving as President & CEO of Integrated Wellness Solutions, LLC., strategic leadership is his passion. Siegenthaler s company has saved his clients millions of dollars since Siegenthaler and IWS are aggressive in assisting organizations to mitigate risk then leveraging healthcare carriers to reduce costs based upon performance. Siegenthaler sat as the Chair for Governor Taft s Advisory Board on Fitness, Wellness and Recreation responsible for spearheading Smoke Free Ohio. Licensed in Health, Life and Annuities, Siegenthaler has a strong skill set to work with organizations in developing long term group health and wellness strategies. EDUCATION Masters Degree of Education: Ashland University Bachelors Degree of Education: Ashland University Certified Benefits Professional: World at Work Licensed Health, Life and Annuities Agent Ergonomic Certificate Series: University of Cincinnati, College of Medicine Nutrition Specialist: ESA Medical Exercise Specialist: ESA Personal Training and Exercise Prescription Specialist: ACE Strength and Conditioning: AAHPRP Post Rehabilitation Specialist: AAHRP Certified Health Care Reform Specialist TRAINING Leadership Development: Westfield Group (Change Management, Profit Specialist, Human Resources, Business Development), Public Speaking Expert (Club Industry Conference, National Association of Employee Recognition Conference, Healthy Ohioans Conference, Ohio Schools Conference, Ohio Bureau of Workers Compensation Conference, Cincinnati Bridging the GAP Conference, Ohio Safety Congress, National SHRM Conference). PHILOSOPHY If you are fortunate enough to have your health, you have ZERO excuses but to be the best you can be! Life on this world is precious, go get it! Paul Kolodzik, M.D. MBA is the Medical Director of Integrated Wellness Solutions. He is an emergency physician with 20 years of clinical experience. After completion of his Emergency Medicine residency he served as an Emergency Department Medical Director for over 10 years. He subsequently acted as the Chief Medical Officer for a group of over 300 Emergency Physicians who provided services at 40 emergency departments. He has served as the Chief Operating Officer of the same physician group. Dr. Kolodzik has also been the CEO of a medical billing company processing over one and one half million claims annually. After many years of Emergency Medicine practice, and seeing the clinical crises that occur at the end stage of preventable chronic disease, he has developed a passion for impacting lifestyle, health status, and medical costs. As the Medical Director of IWS, Dr. Kolodzik is currently working with corporations, insurance carriers, insurance brokers, and hospital systems to optimize the effectiveness and ROI of corporate wellness programs.

3 Compliance, ROI and Wellness under Healthcare Reform Presented By: Rich Siegenthaler II President IWS

4 Rich Siegenthaler II, MEd, CBP: President & CEO IWS Masters Degree of Education Ashland University Bachelors Degree of Education Ashland University Certified Benefits Professional World at Work Licensed Health, Life and Annuities Agent Ergonomic Certificate Series University of Cincinnati, College of Medicine Nutrition Specialist ESA Medical Exercise Specialist ESA

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6 Source: 2011 National Worksite Health Promotion Study (n=1,544 businesses surveyed) Among senior management, the top concern was Health Care Costs 25% a concern 69% a major concern 94% overall were concerned

7 Healthcare Reform indicates WELLNESS to be a major focus according to Crain s Survey of 4,000 employers 2012

8 If you are a SELF FUNDED organization in the healthcare reform era, WELLNESS is a NO BRAINER! Rod Reason: President Healthiest Employers May 15, 2013

9 Should people with healthy lifestyle behaviors pay less for health insurance? A Majority of US Adults Agree 25% 75% Agree Disagree 70% 60% 50% 40% 30% 20% 10% 0% Employers rewarding or penalizing employees based on measured health results 7% 14% 41% 65% Employers rewarding or penalizing employees based on measured health results Hewitt Associates National Business Group on Health Survey 2010 Towers Watson Report Health Care Changes Ahead, Oct 2011

10 Average Health Insurance Premiums and Worker Contributions for Family Coverage, $4,247 $1, % Premium Increase 128% Worker Contribution Increase $9,860 $3, Employer Employer Contribution Employee Contribution Worker Contribution Note: The average worker contribution and the average employer contribution may not add to the average total premium due to rounding. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits,

11 Why is this important? $5 of every $6 spent on health care is paid for by someone other than the person receiving the care: Insurance Companies Employers The Government (Medicaid and Medicare) 75% of Health Care Spending is BEHAVIORALLY RELATED & 60% can be CONTROLLED Aging Workforce (50% of Ohio Employees are over 45) HealthCare is the #2 expense for organizations Obesity and Workers Comp ( increase in claims 1.5-2, increase 3-13 time away from work, increase cost of claim ) HealthCare Reform has emphasized wellness AND has provided protection for organizations who engage properly

12 So what does this all mean when devising bona-fide wellness strategies?

13 Wellness Provisions Under Health Care Reform Coverage of Preventative Services Without Cost Sharing Requirements Permit Employers to Offer Employees Incentives of Up to 30% of the Total Cost of Coverage 50% when tobacco programming is in place

14 What Does the IRS Permit us to do? If the incentive is contingent upon the satisfaction of a health standard Organizations CAN structure wellness programming with incentives/consequences not exceeding 30% of total coverage cost. (50% with tobacco programming) - includes premium - includes deductibles - includes co-pays - includes co-insurance Appeals can be decided on a case by case basis

15 30% of deductible: Single deductible set at $1,000 could be $1,300 30% of total premium cost: $500 per month employee could be $150 per month 30% of co pay: Co pay set at $20 could be $26 HRA Structure: $1,000 with compliance/completi on or $700 without compliance/ completion 30% of premium after contribution: $500 per month employee/employer contribution 70% making monthly employee premium $150. You can add 30% to that number or $45 per month which equals $540 per year

16 And Tobacco.? If your wellness plan includes a tobacco surcharge, you can increase the incentive from 30% to 50% (additional 20% devoted to tobacco) HOWEVER If you have a tobacco surcharge in place. YOU MUST provide a tobacco cessation course fro the entire plan year, at your expense, for employees to engage at any time. IF, an employee completes that tobacco cessation program at any time during the plan year, EVEN if they remain a tobacco user, you must reimburse that employee the entire amount of that surcharge back to the beginning of your plan year.

17 AND.Reasonable Alternatives Each and every facet of your wellness program must have a reasonable alternative in place for participants to achieve success or earn credit. BMI/BF% Lipids Blood Pressure Flexibility Tobacco Employers who try to implement programming internally and by themselves fail 90% of the time. Oswald

18 What Does HIPAA State? 1. Wellness programming must be re-assessed at least once per year. 2. Wellness programming must be designed to promote health and wellness. 3. Wellness programming may not exceed 30% of the total cost of coverage offered. 4. Wellness programming must be available to ALL similarly situated individuals while appeals and reasonable alternatives must be offered. 5. The availability of the appeal must be disclosed in all plan materials.

19 What about Healthcare Reform? ACA now states that all individual premiums must be equal or below 9.5% of an employee s wages. When the government says you can incent UP TO 30% Of the total cost of the plan they mention in SMALL PRINT that it still must all equal or be lesser than 9.5% and your plan must pay a minimum of 60% of all expenses! Let s take a look..

20 Hourly Rate of Pay = $10.00 X 130 Hours = $1, X 9.5% = $ Per Month MAXIMUM Hypothetically: The total cost to the plan for a single employee is $ per month You contribute 75% of $ which equals $ YOU and $ EMPLOYEE per month Because you can only charge this employee a MAX of $ per month due to Healthcare Reform, your MAX incentive for this employee would be $23.50 per month or 5.9% which is nowhere near the 30% threshold they say!

21 Plan Designs are Critical! You must design a plan that is 60% of actuarial value as a base plan Some Examples - 57% $5000 Ded HSA, 80% Plan, MOP $6000 EE - 60% $4750 Ded HSA, 100% Plan - 60% $2500 Ded PPO, 80% Plan, MOP $5000 EE, 10/30/60 RX, $25/$50 OV, $100 UC, $250 ER - 65% $1000 Ded PPO. 80% Plan, MOP $6000 EE, 10/30/60 RX, $25/$50 OV, $100 UC, $250 ER - 71% $2500 Ded HSA, 100% Plan

22 Now Think About This. We just reviewed the 9.5% rule as it relates to premium differentiation under ACA. The total MAX premium differentiation in our example was $23.50 per month or 5.9% of total 30% opportunity Once you determine your plan VALUE as shown in the previous slide. YOU can take the difference between your plan value (say 71% plan and the minimum value of a 60% plan then apply it to the deductible) In this case equals another 11% on the deductible for those not complying or participating in your wellness program! In this case $2500 Deductible x 11% = additional $ to the employee deductible

23 Now what do we have? $23.50 per month x 12 months = $ $ additional deductible Now your wellness incentive is $ on the line for those who are not partnering with your organization to mitigate risk.

24 You need to determine what you want out of wellness Do you want wellness to simply be a benefit that has no baring on the bottom line, however a gesture of gratitude by leadership? Do you want wellness to have average participation (20%-30%) to qualify as effective? Do you want wellness to be a corporate initiative that drives cost and places accountability on the employees with high participation and measurable ROI?

25 What does ROI mean to you? Are you an organization that feels ROI means you just want to provide an opportunity for employees to be healthy and have no concerns about expense? Are you an organization that feels ROI will come over the next 3-5 years if you put in place strong initiatives and support with little incentive? Are you an organization who wants maximum participation, employee engagement, a program paying for itself and ultimate long term ROI regarding claims?

26 Analyze this. Option 1: Option 2: Option 3: You will receive 12%-20% participation with zero return on investment. Your thought is I just want to provide opportunity understanding it is not important. You will receive 21%-30% participation while giving out some gift cards and or discounts. You will have little to no quantitative ROI but those employees will appreciate your efforts. You will receive 60%-80% participation with quantitative ROI of 1.6:1 ROI years 1-3 until claims catch up to strategies. Your broker and health insurance carrier are involved.

27 What am I trying to say? If you are going to implement wellness, do it right or do not do it! Wellness is an expense, Wellness is relevant, Wellness is the only way for you as an organization to protect yourself long term!

28 OK, now that I have confused you, let s simplify! Health Plan Design: You need a strong broker/health insurance consultant Wellness Partner: You need to have a partner who understand s health insurance, attached to you broker and has credibility with the health insurance carriers COMPLIANCE is Key: Do not try to do it yourself in the era of healthcare reform.

29 Did you know? If you keep your plans in place THEN simply add an affordable plan, you need not worry! Those employees who do not choose the affordable plan (estimate 4%), employees must play by YOUR RULES regarding wellness to stay in their desired plan! (BROKER) 30%/50% is in place! Make it simple! Do not implement complicated programs (Wellness Partner) The day of biggest loser, walking programs and other quick hitters are over! There is a place for micro incentives, however, they hold zero credibility with carriers! (Wellness Partner)

30 Wellness Program must include Biometrics: You must provide personal data to employee to begin engagement and credibility Health Coaching: You must provide support for employees to engage. Employees need direction and hand holding! Preventative Exams: Carriers hold certain exams very credible Financial Incentive: Third reason why people change behavior! Measurable: Objectivity is key! Credibility means everything!

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32 High Touch Wellness Strategy PERSONALLY devised SOLEY for your employers/employees. Developed to COLLECT YOUR data for customized tracking and reporting for your company. User Friendly/SIMPLE, Concise, Robust and PERSONAL. Provides confidential opportunity for employees to communicate with their PERSONAL IWS Coaches and or Managers at any time for engagement. NOT a do it yourself portal, however, structured for the employees PERSONAL needs and or requests. CONFIDENTIALITY! Employees do not want their organization knowing anything about them NOR are you permitted to know anything personal about them!

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36 Questions Please