Two of the hotter topics in today’s health landscape are wellness care and prevention care. Both are highly controversial for all stakeholders in the health care industry as insurance providers and employers decide what benefits to offer employees. Is there truly a financial incentive for these groups to provide wellness and prevention care? It’s certainly a topic worth exploring.
Health Reform and Preventative Care Programs
Health reform is helping to spur a new renaissance in America’s preventative care model. This February, Health and Human Services (HHS) Secretary Kathleen Sebelius announced that the organization would be investing, as mandated by PPACA, $750 million in programs designed to fight preventable conditions through the Prevention and Public Health Fund. “This investment is going to build on the prevention work already under way to help make sure that we are working effectively across the federal government as well as with private groups and state and local governments to help Americans live longer, healthier lives,” Sebelius said in a press statement.[1]
Wellness Care Also on the Rise
A focus on employee wellness is also on the rise. In a 2010 study by MetLife, researchers found 37 percent of employers currently offer a wellness program. That’s up from 33 percent in 2008 and just 27 percent in 2005. And another study sponsored by Highmark that examined 10,000 employees enrolled in a wellness program offered by their employer found there are financial benefits as well: health care costs rose 15% more slowly for those that participated in wellness programs versus nonparticipants. Over the course of the study, this amounted to $332 per person. Dr. Donald R. Fischer, Highmark’s Chief Medical Offer, was quoted as saying that “keeping employees healthy is not just good for the business, it's also good for the bottom line."
Wellness vs. Prevention
So what’s the difference? Wellness care is aimed at overall health and fitness, unlike preventative care programs, which are specifically designed to target a specific condition, illness, or disorder. Examples of preventative 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.
But the two are not mutually exclusive. In the same Highmark study, researchers also found that enrollment in wellness programs led to participants seeking out preventative care, including mammograms, and cancer screenings, for example.
Hidden Risks: What’s the Verdict?
Though individuals who fail to participate in prevention programs "represent hidden risk," according to Jennifer Grana, Highmark’s Director of Health Promotion, she says “preventative care costs more in the short term because participants were utilizing more resources than the population who did not see a doctor for mammograms and colorectal and other screenings.” This is one of the major dangers of wellness and prevention programs.
The potential for saving money and improving care is there. But employees, employers, brokers and health plans must carefully weigh the true “costs” of providing wellness and prevention programs against the potential “benefits.” Because initial costs are high for providing these programs, spending money on a worker who might not stay in the company for long may not be the best financial decision. However, choosing to invest in wellness and prevention might just pay off for an employee who will be at a firm for an extended period of time.
As new benefit designs are introduced in the future, wellness and preventative coverage will continue to garner attention from providers, patients, health plans and others. Brokers are encouraged to stay on top of the latest research in this area.
BenefitMall will keep you updated on future trends related to wellness and prevention.
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