Health Care Summit: Cost-saving measures need top-down support

by Chase Castle

Wellness programs and accountable care organizations can reduce companies’ health care costs, but executive leaders must promote and accommodate those programs in order to yield results, according to industry analysts and health care executives at the Corridor Business Journal’s Health Care Summit.

Among the provisions of the Affordable Care Act (ACA) were multiple incentives aimed at increasing workplace participation in wellness programs, which involve various strategies for employee health promotion and disease prevention. Although businesses with group health plans stand to receive financial incentives for implementing wellness programs, many workplaces struggle to find support for the programs outside of human resources personnel.

“I can’t tell you the number of times, working as a health coach … I would hear, ‘You know, my manager gives me a hard time about coming in to my [fitness] sessions,’” recalled Jennifer Musick, a partner and chief health and wellness officer with Cedar Rapids-based Health Solutions LLC. “As much as the CEO and senior leadership want wellness to be successful, without management support, it can be an extreme challenge.”

Jeff Russell, president and CEO of Delta Dental of Iowa, said that in order for employers to capitalize on health care savings, program values must be stressed to senior leadership in order to maximize the number of participating employees.

“Part of that is about changing the culture and changing the dynamic of the conversation, but from a pure CEO perspective … it’s got to create an economic value and not a human value.”

Along with wellness programs, many employers are working with accountable care organizations (ACOs), which typically include a network of physicians, specialists, hospitals and clinics that are financially rewarded for coordinating all aspects of patient care.

Unlike a health maintenance organization (HMO), ACOs are not insurance companies, and allow patients also can select their own physician. Patient participation in an ACO is also strictly voluntary.

Laura Jackson, executive vice president for health care innovation and business development for Wellmark, said her company began to establish ACOs in 2012.

Ms. Jackson said that although ACOs existed before the ACA, the law’s expanded Medicaid access meant increased demand for health care services and lowered reimbursement rates. In response, her company has worked with provider organizations to develop new contracts, payment systems, data management strategies and more.

“We give the providers back the majority of the savings they create, and whatever’s left over we pass on to our members,” Ms. Jackson said. “The goals of an ACO in this type of a contracting situation are really intended to improve quality, improve the patient experience and ultimately reduce the rate of increase of health care costs.”

Some efforts to control health care costs, however, have encountered problems.

A pending lawsuit filed by the Equal Employment Opportunity Commission (EEOC) against Honeywell International regarding its wellness program was filed in October. The suit alleges that the commercial and consumer goods company violated the Americans with Disabilities Act and Genetic Information Nondiscrimination Actwhen it required employees and their spouses to submit to medical tests or face financial penalties up to $4,000.

Thomas Wolle, an attorney with Simmons Perrine Moyer Bergman PLC, said that in any situation where an employee expresses concerns about program participation, management needs to listen.

“One of the easiest kinds of cases for an employee to prove is retaliation,” Mr. Wolle said. “So thank the employee for bringing the concern to you, ensure that the employer won’t enter into any kind of retaliation and look into it.”