Proud to say you have 80% participation in your company's wellness/health promotion program? Not to rain on your parade, but that number may be misleading, according to Dr. Jeanne L. Wendel, professor of economics at the University of Nevada (Reno).

Wendel sat on a panel discussion examining employer-based population health management at the recent Forum '10 and Integrated Care Summit sponsored by the Care Continuum Alliance, the National Association of Manufacturers and Center for Health Value Innovation.

Participation rates in health promotion programs can be misleading in that employers sometimes are preaching to the choir - in other words, gaining employee-participants who already are invested in wellness of their own accord. Employers must keep in mind, said Wendel, that increasing participation is about widening the net.

Her team recently conducted a study for a public employer that wanted an assessment of its health promotion programs. After analyzing claims and participation data, Wendel found that women mainly fill out health risk assessments and attend worksite health fairs.

In addition, high-income workers were more likely to participate in the programs than workers with low weekly pay. The research also revealed that people who routinely undergo preventive screenings are more likely to participate in similar programs than individuals who don't.

"If all you are doing is getting some workers to participate in the programs, then the programs are not having an effect on your entire workforce," Wendel said.

Will the real wellness experts please stand up?

The event also featured Dr. Dee W. Edington, director of the health management research center at the University of Michigan.

Edington told attendees that he had recently spoken at a business conference where he conducted an informal survey of the audience. He asked all audience members to stand up, then said: 'If you believe your senior leadership doesn't know any metrics around safety, sit down.' No one sat down. I then asked, 'Sit down if your senior leadership doesn't know any metrics around quality.' Again, no one sat down," Edington recalled.

When he asked attendees to sit down if their senior leadership "knows a few metrics around health," everyone sat down. The message is clear: Continuing education and training for CEOs has to involve courses on health promotion programs, Edington said.

Achieving ROI

To achieve positive return on investment in health promotion programs, "you have to walk up the ladder," said Dr. Ron Goetzl, vice president of applied research at Thomson Reuters, during his Forum '10 session on evaluating health promotion programs.

"You have to increase awareness about health issues in the workplace. You've got to have high participation rates, because there is a direct correlation between participation and health and costs outcomes," Goetzl said.

In addition, employers will have to increase their knowledge of the skills needed to change behavioral attitudes through motivation and reduce employees' risks and utilization. (See a related story on Page 1 about how one employer is applying the science of behavioral economics in its benefits portal.)

Furthermore, achieving a solid ROI means conducting a comprehensive health promotion program using evidence-based practices involving individualized risk-reduction counseling within the context of a healthy company culture, Goetzl said.

"If you do all of those things and you measure them along the way, there is a growing possibility you will achieve a positive ROI," he said.

Besides, health promotion programs in the workplace have had a strong impact on productivity in terms of decreasing absenteeism, he added.

Embracing health IT

Dr. David Blumenthal, national coordinator of health information technology at the Department of Health and Human Services, addressed Forum '10 attendees about leveraging health technology in wellness and case management programs. Health IT can support optimum care, care coordination and continuum of care, he said.

"An evidence- and science-based system like our health care system should be using health information technology. It's not going to be easy, but it's inevitable that the nation embrace a health IT system," Blumenthal said.

Although he noted that storing health information has not changed since the time of Hippocrates, health professionals have made a fundamental psychological change in the last year to adopt health IT, because the "federal government has put the writing on the wall," Blumenthal said, explaining that the government continues to address some barriers around a health IT system, such as issues around privacy, security and funding.

NAIC reclassifies preventive care

Also at the Forum '10 event, the National Association of Insurance Commissioners announced it has classified disease and case management activities as services that improve health care quality.

"This will be a significant change for NAIC," said Tracey Moorhead, president and chief executive officer at the Care Continuum Alliance.

NAIC recently finalized a proposed regulation regarding minimum medical loss ratio definitions and calculations as a result of the Patient Protection and Affordable Care Act.

Before the law, CCA had been working with NAIC for several years to reclassify wellness, preventive and care management services as medical expenses. Historically, the insurance group had considered the services as administrative expenses.

With the enactment of PPACA, a third category, "activities that improve health care quality," emerged in which NAIC could consider for classifying wellness and population health services.

CCA, which represents the wellness and health industry, recommended to NAIC that their member services should fall under either the medical or quality improvement categories.

NAIC decided to classify wellness, preventive and care management services within the MLR definitions for activities that improved health care quality. Putting the services under activities that improve health care quality allows insurance companies to count them toward the MLR minimum.

The Department of Health and Human Services has to certify the final language of the proposal; Moorhead and her colleagues are hoping the agency will do by the end of the year.

"We are extremely pleased with the work to date of NAIC to include wellness, disease and case management, care coordination and health information technology as part of their definition of activities that improve health care quality," Moorhead said.

The new MLR definitions and calculation methods by NAIC represents an enormous opportunity for the wellness and health promotion industry, because in part, it recognizes that "our members and the population health industry do in fact impact health outcomes, and their services are akin to the clinical and medical expenses utilized as part of the MLR calculation," she added.

The MLR provisions under PPACA also require that the minimum percentage of revenue earmarked for medical costs and quality improvement measures be 85% for large plans and 80% for individual and small group plans.

Best practices on health promotion

Lastly at the event, CCA also released the fifth volume of its "Outcomes Guidelines Report," examining industry consensus and guidelines on population health management programs during the summit.

The report, available for free on CCA's Web site (, incorporates guidance from earlier volumes of the group's research on developing transparency and sound metrics for wellness and disease management programs.

"The guidelines represent the work of some of the best minds in program evaluation," said Moorhead. "This is critically important expertise to have as we look to new models of care and seek to determine what care strategies provide the best quality and value."

The report also discusses guidelines for using health information technology, focusing on key measures necessary for a fully connected population health management program.

"Chronic-condition prevention and care strategies have evolved significantly and continue to improve through innovation and new technologies," explained Moorhead. "Our guidelines keep pace with that change and remain the industry standard for evaluating program performance."

Overall, the report provides a conceptual and procedural framework for population health management. For example, the guidelines provide a checklist and flowchart to determine whether a program should be classified as a wellness, population health or disease management program.

CCA launched the research series to ensure consistency and evidence-based measures for health promotion programs.

"With each new version, the guidelines increase their utility and relevancy to the broad variety of programs available," Moorhead explained. "With health care reform and federal HIT initiatives demanding increased quality and accountability, the guidelines make a valuable contribution to understanding the best approaches to care."

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