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Are hospitals really soaking the poor with high prices?

Are hospitals really soaking the poor with high prices? | Healthcare Economics |
The Centers for Medicare and Medicaid recently released its compiled data on what over 3,000 hospitals across the country charge for 100 of the most common discharge diagnostic codes under the diagnosis related group (DRG) system, and boy did the...

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Affordable Care Act and Social Media: Can You Sell Healthcare Insurance with Social Media?

Affordable Care Act and Social Media: Can You Sell Healthcare Insurance with Social Media? | Healthcare Economics |

The jury is still out on the results, but the government is using social media to try and drive enrollment on the healthcare exchanges. The focus is on getting younger people to sign up – a necessary ingredient for the success of the exchanges. The insurers are counting on younger, healthier people enrolling to reduce the risk pool. is using all of the most popular social sites to get out the message. The content is similar across their selected social sites: Facebook (310,000 Likes), Twitter (158,000 followers), YouTube (5,400 subscribers) and Google+ (126,000 followers). They seem to trying to reach their audience wherever they can.

At the heart of these posts are both images and well over a hundred videos featuring average young people and celebrities. One recent video features the basketball star LeBron James urging young people to #Getcovered and that video has been viewed more than 74,000 times. Added to that, President Obama appeared in a faux interview with comedic actor Zach Galifianakis that has been viewed more than 17 M times.

The images and posts are meant to catch attention and – hopefully – be shared. Both Facebook and Twitter statistics show that images increase the engagement (comments, likes, shares, retweets) of posts. On Facebook the engagement goes up by 39% and tweets with images received 150% more retweets than those without images.  And the #Getcovered hashtag has maintained a strong presence on Twitter since the rollout of the healthcare exchange.

 It's a bold approach. But will it be effective? We can only wait and see if the social media message engages enough young people to make a difference to the bottom line results of the Affordable Care Act.


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Medicare Overview

More free lessons at: Sal talks with Professor Laurence baker of Stanford Medical School.
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Health Economics

Hi, my name is Dr. Sanjay Sharma. I am a Professor of Ophthalmology and Epidemiology at Queen's University. As a researcher, I am very interested in a partic...
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Are Workplace Wellness Programs Legal?

Are Workplace Wellness Programs Legal? | Healthcare Economics |

On the one hand, workplace wellness programs are openly endorsed by the Affordable Care Act. On the other, how they’re constructed and implemented is critical in determining any potential benefit or legal risk.

“There are at least 10 different Federal laws and numerous state laws that employers need to be aware of relative to any company sponsored “wellness program.” Most of the employers that come to us for a legal review of their program are shocked at the significant complexity ‒ and are in violation of at least one of these legal requirements ‒ often more than one. Of course, there are thousands of companies that simply choose no legal review at all. I can count on one hand the number of employers I’ve seen who have gotten this right on their own.  Kate Ulrich Saracene ‒ Partner ‒ Nixon Peabody’s Health and Welfare Employee Benefits practice

The global law firm recently published an alert on the topic ‒ Wellness Programs after the Affordable Care Act (Part II) ‒ which included this chart highlighting the individual Federal regulations and their applicability by plan type.


Released earlier this year, Fidelity Investment’s fifth annual wellness survey (here) shows just how popular workplace wellness programs have become.

95% of companies plan to offer some kind of health improvement program for their employeesCorporate employers plan to spend an average of $594 per employee on wellness-based incentives this yearCompanies offering incentives to participate in these initiatives has increased from 57% in 2009 to 74% in 201493% of companies indicated they plan to expand or maintain funding for their program over the next 3-5 years44% of companies said they plan to maintain or increase their investment in wellness programs, even if their company were to move away from direct involvement in employer-sponsored health coverage

But it’s a potentially toxic combination that’s ripe for abuse. Employers eager to control exploding healthcare costs and vendors eager to sell programs claiming big ROI with little scientific evidence and no legal review.  What could possibly go wrong?

Earlier this year, a CVS cashier filed a class action lawsuit against the retail healthcare giant for a “Wellness Exam” she claims included questions on sexual activity and blood testing for “a variety of medical conditions.” The survey was required in lieu of an annual $600 fine.

Another program raised a faculty firestorm at Penn State (New York Times here) which quickly prompted the university to suspend their annual $1,200 non‒compliance fee (here).

In a desperate effort to find an elusive ROI, wellness vendors are pushing all the boundaries ‒ including legal and privacy. We should absolutely expect to see more employee pushback with lawsuits like the one at CVS and public relations disasters like the one at Penn State. Shifting age-old paternalism from the clinical side to the employer side is really antiquated thinking ‒ and will fail spectacularly. Tom Emerick ‒ Co-Founder of Edison Health and former Vice President, Global Benefits Design for Walmart Stores, Inc.

That elusive ROI is getting ever harder to find too. Last year The RAND Corporation concluded their 5-year analysis with this assessment.

“Our statistical analyses suggest that participation in a wellness program over five years is associated with a trend toward lower health care costs and decreasing health care use. We estimate the average annual difference to be $157, but the change is not statistically significant.” RAND ‒ Workplace Wellness Programs Study ‒ Final Report (PDF here).

In January, Reuters had this quote highlighting similar results after a 7-year RAND study at PepsiCo PEP -0.56%.

Released on Monday in the journal Health Affairs and based on data for thousands of PepsiCo employees over seven years, the findings “cast doubt on the widely held belief” that workplace wellness programs save employers significantly more than they cost concluded Soeren Mattke of the RAND Corporation and his co-authors. “Blanket claims of ‘wellness saves money’ are not warranted.” PepsiCo’s workplace wellness study fails the bottom-line study (Reuters)

Vik Khanna has studied the industry at length and co-authored (with Al Lewis) a book on the topic and industry.

The entire wellness charade, including the potentially actionable behaviors of many vendors, could easily be avoided by adherence to one simple fact: you cannot make people well by shoving more medical care down their throats. The fundamental flaw of the wellness industry is that, much like the government that empowers it, all it can conceive of are “programs.” The successful long-term pursuit of health within a company is exactly like it is within a family: create positive atmospherics, make choosing healthy the right, easy and happy thing to do, and have leaders who live and breathe the philosophy, with no expectation other than that their people will feel better and appreciate the support. Not a single one of those things has any legal impediments. Vikram Khanna ‒ Co-Author of Surviving Workplace Wellness … with Your Dignity, Finances, and Major Organs Intact

Not satisfied with their tepid results, chip giant Intel INTC -2.74% is embarking on an even more aggressive approach. After ten years of applying traditional levers like workplace wellness, Intel announced a program last year that engages “directly and deeply in benefit design, plan design, and delivery optimization for employees and dependents at its Rio Rancho, New Mexico, facility.”  Intel White Paper (pdf here)

Brian DeVore, director of healthcare strategy and ecosystem at Intel, said Intel’s new direct contracting initiative follows the company’s previous efforts to slow spending and improve workers’ health through consumer-directed health plan designs, wellness checks and biometric screening. “I think we’ve done what most employers have done,” he said. “We realized that wasn’t going to bend the trend.” Intel adopts narrow network to better manage care ‒ Modern Healthcare, July 2013 (registration required)

The challenge for all programs is a risk/reward profile that almost demands an aggressive approach ‒ regardless of clinical efficacy, ROI or legal risk. It comes as little surprise then that the popularity of the “stick” approach over the “carrot” is growing.

As we get closer to the end of the year and employers realize the mandate [for providing health coverage] and the fines are here to stay, there is going to be a big shift to the “stick’ and “penalty” approach in wellness. Employers who aren’t offering health insurance now, and do so to avoid the fines, will implement the stick approach simply as a cost savings approach and to shift some of the burden and responsibility to employees. Since the ACA doesn’t reduce healthcare or insurance costs, those with existing wellness programs are going to be forced to consider and utilize the stick/penalty approach simply as a long term way to make employees accountable and to cost shift. Jonathan Edelheit ‒ Director of Corporate Health and Wellness Association

But is any of this truly in the best interest of employees ‒ or is it simply another desperate measure to control the runaway economics of healthcare? A PayScale study (here) shows that about 400 of the Fortune 500 companies have a median employee tenure of less than 5 years. That means that any accrued health benefits to an employer would likely be lost completely ‒  potentially to a competitor. Similarly, the employee loses any long term benefit of coordinated and continuous health coverage. According to that PayScale study ‒ Intel’s Median Employee Tenure is 4.3 years.

Actual healthcare delivery is definitely a new approach for many employers eager to grab hold of the healthcare tiller, but it also raises a lot of legitimate questions about our “accident of history” ‒ Employer Sponsored Insurance (ESI). Perhaps the largest single question ‒ as highlighted recently in the Berwell v. Hobby Lobby Supreme Court decision is simply this: Who’s health insurance is it?



Via Technical Dr. Inc.
Eric Muller-Borle's curator insight, August 6, 2014 8:16 AM

Wellness programs are put in place for many good reasons, but their implementation creates new risks, including legal risks. Whilst the above article deals with the situation in the US, all wellness programs in all countries may generate similar issues. So, why bother with wellness? Well, for all we know, NOT providing an employee wellness program of some sort might give rise to future liabilities as well (lack of proper care, etc?).

What is one to do? The sensible course is probably to provide wellness programs anyway as it is the "right thing" to do, and to be proactive with respect to the risks generated thereby. On the bright side, wellness programs are still a relatively new concept and with time passing and experience accumulating, risk mitigation will become less of an ordeal. What risks there are should not distract from the fact that properly designed and executed wellness programs are good for employers and employees alike, as well as for society at large.

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(EN) - Obamacare glossary: A consumer's guide to understanding the Affordable Care Act |

(EN) - Obamacare glossary: A consumer's guide to understanding the Affordable Care Act | | Healthcare Economics |

"Here are terms commonly used when discussing the Affordable Care Act, also known as Obamacare."

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