How health care reform will affect wellness initiatives Featured

7:00pm EDT December 26, 2010

One of the big questions arising from national health care reform is how wellness programs and disease prevention initiatives will be affected.

The comprehensive health care reform legislation includes a robust array of provisions promoting wellness and prevention. Sally Stephens, president of Spectrum Health Systems, says the bill creates a new emphasis on fitness, physical activity, good nutrition and disease prevention — all designed to keep people out of the hospital.

“One of the fundamental challenges facing health care reform is taking a system that has focused on sick care and shifting it to one focused on wellness and prevention,” Stephens says. “By reforming our system to focus on fighting and preventing chronic disease, we have a huge opportunity. We can save hundreds of billions of dollars and dramatically improve the health of Americans.”

Smart Business spoke with Stephens about how health care reform will affect wellness.

How will the new health care reform affect wellness and prevention initiatives?

There are several provisions in the new health care reform that affect wellness:

  • The new reform will provide grants for up to five years to small employers that establish wellness programs beginning in 2011.
  • It will provide technical assistance and other resources to evaluate employer-based wellness programs, as well as conduct a national survey of worksite health policies and programs to assess employer-based policies and programs within two years of enactment.
  • The new reform will permit employers to offer employees rewards in the form of premium discounts, waivers of cost-sharing requirements or benefits that would otherwise not be provided of up to 30 percent of the cost of coverage for participating in a wellness program and meeting certain health-related standards. Employers must also offer an alternative standard for individuals for whom it is unreasonably difficult or inadvisable to meet the standard. The reward limit may increase to 50 percent of the cost of coverage if deemed appropriate effective 2014.
  • Last, the new reform will establish 10-state pilot programs by July 2014 to permit participating states to apply similar rewards for participating in wellness programs in the individual market and expand demonstrations in 2017 if effective.

In addition, the law requires chain restaurants and food sold from vending machines to disclose the nutritional content of each item within one year of enactment.

What do businesses need to know about health care reform?

The law will require qualified health plans to provide, at a minimum, coverage without cost sharing for preventive services recommended by the Preventive Services Task Force. These include recommended immunizations, preventive care for infants, children and adolescents, and additional preventive care and screening for women.

Employers will also be faced with the decision to keep their current health plan in place (a grandfathered plan) or choose to offer a qualified health plan that could cost more. If a new qualified plan is offered, it must comply with all new insurance market reforms, including the new IRS nondiscrimination rules. An employer may also choose to terminate coverage.

The new law will not affect an employer’s ability to offer voluntary worksite benefits such as accident, disability, vision or dental plans, as well as cancer and hospital indemnity insurance.

Another provision includes limits of $2,500 on health flexible spending accounts. Anything above this amount will now be taxable as gross income.

Why should businesses consider implementing wellness or preventive initiatives?

The reasons are numerous. Employers have the opportunity to educate and inform workers of the importance of wellness, thus driving both overall employee health and productivity while keeping high medical costs at bay. Productivity losses related to personal and family health problems cost employers $1,685 per employee per year. Promoting wellness can help prevent those illnesses and injuries by encouraging proactive health practices.

Healthier employees can also create a competitive advantage for an employer because they are absent from work less often. And finally, healthy employees are more productive, which helps the business’s bottom line.

How does health care reform help businesses implement wellness or prevention programs?

Provisions in the new health care reform will accelerate the evolution of health promotion. The bill will develop a national health promotion plan, enhance health promotion research and provide technical assistance to enhance evaluation of workplace health promotion programs. And grants to pay a portion of the cost of a comprehensive workplace wellness program will be available to small employers that may not have had the resources to implement programs in the past.

As mentioned earlier, employers will be able to offer premium reductions of up to 30 percent to employees who meet certain health criteria. The law allows employers to establish greater accountability among their employees.

While there is still much debate regarding health care reform, there is no question that it presents an opportunity to change the paradigm. We have the opportunity to give our citizens access to a 21st century health care system — one that is focused on preventing obesity and disease, and that helps us live healthy, active, productive lives.

Sally Stephens is president of Spectrum Health Systems. Reach her at (317) 573-7600 or