Late last month, the Centers for Medicare and Medicaid Services (CMS) announced that the Medicare program will cover preventive services in an effort to combat obesity. In the past year, the federal government has launched a number of programs and funding initiatives to address the growing waistlines of Americans of all ages. The goal is to help us to live longer and healthier lives – along with reducing the cost associated with treating disease and managing chronic illness. Many of these campaigns have been fueled by the Patient Protection and Affordable Care Act (PPACA). These efforts mirror recent trends by health insurers and employers in the private sector to promote health and wellness.
“Obesity is a challenge faced by Americans of all ages, and prevention is crucial for the management and elimination of obesity in our country,” said former CMS Administrator Donald M. Berwick, MD, in a press statement. “It’s important for Medicare patients to enjoy access to appropriate screening and preventive services.” Other preventive services provided by Medicare include screening for colon cancer, diabetes, breast cancer and flu shots. Berwick recently announced that he is stepping down as the interim head of CMS, but these prevention programs will continue to be implemented under the next administrator.
As BenefitMall stated in a previous blog, “Wellness care is aimed at overall health and fitness, unlike preventive care programs, which are specifically designed to target a specific condition, illness, or disorder. Examples of preventive care programs include immunizations; cancer screenings (mammograms, colonoscopies, etc.); blood pressure; diabetes and cholesterol testing; counseling for smoking cessation; eating healthier; reducing alcohol use; and pregnancy screenings; while wellness care might include membership to a fitness club.”
Although wellness and preventive benefits may have higher immediate costs, studies have shown that participation in plans with these programs actually lowers long-term costs. A study performed by Highmark, Inc., a subsidiary of Blue Cross Blue Shield, demonstrates that health care costs rose at a 15% slower rate among those who participated in wellness plans.
The new Medicare preventive care coverage initiative complements the Million Hearts Campaign, which is a joint effort between CMS, the Centers for Disease Control (CDC) and the Department of Health and Human Services (HHS). Million Hearts is a national initiative to prevent one million heart attacks and strokes over the next five years.
According to a recent report from CDC, obesity has become a national epidemic, with over 30% of the population estimated to be obese. Obese individuals have a tendency to also suffer from heart disease, diabetes, and other chronic conditions. The report further states, “People who were obese had medical costs that were $1,429 higher than the cost for people of normal body weight. Obesity also has been linked with reduced worker productivity and chronic absence from work.” By encouraging obese individuals to participate in wellness plans, which promote personal responsibility for behavioral and lifestyle changes, employers empower individuals to make better choices that will lead to a healthier work force.
According to a recently published article, “Research has shown that 87.5% of health care claim costs and 70% of all chronic health problems are directly linked to an individual's lifestyle. As health and wellness programs work to modify lifestyle, they can have a direct impact on acute and chronic health conditions, and therefore offer an opportunity to reduce medical costs. In fact, studies have shown that these programs can return between $3 and $5 for every $1 spent.” With that being said, by encouraging employees to participate in wellness plans and improve their lifestyles, employers can help lower health care claim costs.
PPACA includes several incentives to encourage employers to adopt wellness plans, including offering wellness grants for small businesses. These grants, available to employers with fewer than 100 employees who work 25 hours or more per week and who did not have a workplace wellness program in place as of March 23, 2010, will provide a strong incentive for small businesses to adopt new wellness plans.
To further back these efforts, HHS allocated $750 million for preventive care in February of this year to “help prevent tobacco use, obesity, heart disease, stroke, and cancer; increase immunizations; and empower individuals and communities with tools and resources for local prevention and health initiatives.”
Final Thoughts
The role of brokers and agents in identifying wellness and prevention coverage can add real value for employers, their employees and other individuals looking for a better policy. A wellness plan can generate returns ranging from $3 to $5 for every $1 spent by a company. However, securing this “ROI” is dependent on creating, implementing and maintaining an effective and efficient wellness program.
It also is nice to know that the federal government has joined in the battle to fight the rising epidemic of obesity in the United States.
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This is a very interesting
This is a very interesting article. It's about time the federal government participates in the fight against obesity. This is certainly encouraging news!
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