“What are the requirements of the Affordable Care Act (ACA) in regards to supporting health/diet counseling, obesity counseling, or tobacco use counseling for our employees?”
“Do my current programs meet the requirements?”
We hear these questions often! There’s a lot of confusion that surrounds current wellness program offerings and ACA.
While it’s critical that one receive advice from legal counsel, there are really two components that will affect most employers: what services is an employer required to cover and what are the changes to any financial incentives that may be in place for those services?
ACA requires that a health insurance plan or policy cover 15 specific preventive services without one having to pay a copayment or co-insurance or meet one’s deductible. The list of 15 services includes: diet, obesity and tobacco use. However, this requirement applies only when these services are delivered by a network provider.
What does this mean? If a physician in your plan’s network provides diet, obesity or tobacco counseling, there can be no cost to your employees for those services.
So, how does this relate to a company’s separate wellness programs if weight and tobacco programs are included as “essential benefits” under ACA? We often explain it to clients as follow: At minimum, ACA requires that you cover physician visits for these services. ACA doesn’t preclude you from offering other wellness programs that:
- Are actively promoted within the workplace
- Are more intensive than a one-time physician visit
- Offer individualized support for healthy behavior development
- Create a culture of health within the company
- Provide aggregated reports on engagement and outcomes
As noted, in addition to laying out minimum coverage, ACA also provides clear guidelines on how incentives can, and can’t, be offered in conjunction with a wellness program.
The guidelines differentiate between two types of programs, “participatory” and “health contingent.” “Participatory” simply means that anyone who participates qualifies for the incentive, regardless of outcome. An example would be offering a financial incentive for completing a health risk assessment (HRA).
“Health contingent” means that the incentive is tied to some sort of (positive) change in one’s health status. Examples would be requiring individuals to be tobacco-free or have a certain BMI to obtain the incentive.
Given the government’s concerns regarding the potential for this type of design to be used in a discriminatory manner, these programs must meet the following five conditions:
- The total reward for such wellness program offered by a plan sponsor does not exceed 20 percent the total cost of coverage under the plan (effective 1/1/14 this increases to 30% with an additional 20% increase for health contingent wellness programs designed to prevent or reduce tobacco use).
- The program is reasonably designed to promote health or prevent disease. For this purpose, it must have a reasonable chance of improving health or preventing disease, not be overly burdensome, not be a subterfuge for discriminating based on a health factor, and not be highly suspect in method.
- The program gives eligible individuals an opportunity to qualify for the reward at least once per year.
- The reward is available to all similarly situated individuals. For this purpose, a reasonable alternative standard (or waiver of the otherwise applicable standard) must be made available by any individual for whom it is unreasonably difficult due to a medical condition to satisfy the otherwise applicable standard during that period (or for who it is medically inadvisable to attempt to satisfy the otherwise applicable standard).
- In all plan materials describing the terms of the program, the availability of a reasonable alternative standard (or the possibility of waiver of the otherwise applicable standard) is disclosed.
Weight and tobacco wellness programs should be evaluated independently of the minimum need for physician coverage of preventive services and care should be taken that all “health-contingent” wellness programs meet the requirements above.
What ACA requirement are you trying to meet with your weight or tobacco programs; simple coverage of preventative services or an active wellness program? Are you considering a “health contingent wellness program” approach or a simple participatory approach?
Sure, genes matter. We all know lifelong smokers who never exercised a day in their lives or put a fork in a salad and still lived to a ripe old age. But studies are piling up suggesting that folks who adopt healthy habits, even in middle age, enjoy better health and longer lives than those who don’t.
Given that a healthier workforce is a less expensive, more productive one, these studies have important implications for any company seeking to reign in healthcare costs.
One new study, conducted by Johns Hopkins researchers, tracked 6,200 men and women, ages 44 to 84, for nearly eight years. Those who followed the Mediterranean diet, exercised, maintained a normal weight, and did not smoke had a whopping 80 percent lower death rate compared to participants who had adopted none of those healthy behaviors.
Reporting in the American Journal of Epidemiology, the researchers concluded that combining the four behaviors protects against heart disease and the early buildup of calcium deposits in heart arteries. The lead researcher, Haitham Ahmed, M.D., said, “While there are risk factors that people can’t control, such as their family history and age, these lifestyle measures are things that people can change and consequently make a big difference in their health.”
A second study, conducted at Loma Linda University in California, found that people who ate little or no meat were less likely to die over the seven-year study period than regular meat eaters. This study, published in the Journal of the American Medical Association (JAMA), used data from 73,000 Seventh-day Adventist church members. Church doctrine prohibits eating pork and shellfish, among other foods, and about 37 percent of Seventh Day Adventists are vegan or vegetarian, compared to about 5 percent of the American public.
The JAMA study doesn’t mean we need to ban turkey sandwiches from the lunchroom or quit grilling burgers at the company barbeque. Compared to the meat-eating participants, the vegetarians were thinner, more highly educated, more likely to exercise, and less likely to smoke, so it’s not clear how much meat restriction contributed to the results.
That being said, the study adds to the evidence that a plant-based diet is more protective against chronic disease than a meat-heavy diet.
At Alere Wellbeing, we know change isn’t easy. Experts endlessly debate how to nudge American culture in a direction that is more physically active and less dependent on tobacco and junk food.
But with our 25 years of experience in corporate wellness, we’re confident that changing a company’s culture is feasible. Whether your company wants to focus on tobacco cessation, weight control, or both, we are well equipped to help you get started.
You know how a lousy school report card can mean a smart kid isn’t applying himself? Well, our nation’s latest lifestyle report card, issued by the U.S. Centers for Disease Control (CDC), suggests something similar may be going on with U.S. adults. In a recent post we looked at the report’s smoking statistics, but now let’s examine the weight and exercise data.
No doubt everyone knows it’s important to stay active and maintain a healthy weight. Yet, the CDC’s latest Health Behaviors of Adults report indicates that Americans are maintaining unhealthy lifestyle habits — the very habits that have led to epidemic rates of diabetes, heart disease, and other chronic and costly conditions.
Only 36 percent of Americans are at a healthy weight, according to the report, which was based on 77,000 interviews conducted between 2008 and 2010.
This isn’t surprising, given the low levels of physical activity reported to the CDC interviewers. Only 19 percent of adults interviewed reported meeting federal guidelines for both aerobic activity and muscle-strengthening exercise.
About 46 percent of adults met the guidelines for aerobic physical activity — that is, at least 150 weekly minutes of moderate, leisure-time activity (or 75 minutes of vigorous activity or some combination of the two). About 23 percent reported doing muscle-strengthening activity two or more times a week, as the government recommends.
Nearly 34 percent of adults reported engaging in no aerobic leisure-time activity at all. This doesn’t mean they don’t go to the gym; it means they never walk round the block.
At Alere Wellbeing, we know folks today are well informed about the need to stay active and eat healthfully. The problem: They aren’t inspired. That’s where our Weight Talk® program can help. Our expert coaches work individually with employees, providing information when it’s needed but also providing accountability and motivation.
Our nation may be decades away from receiving an excellent CDC report card, but we’re confident we can get your workforce to the top of the class far sooner than that.
Would your workforce exercise for 19 minutes three days a week?
According to a new Norwegian study[i], that may be all it takes to trigger significant health benefits, as long as the workout includes 4 minutes spent huffing and puffing.
In the study, published in PLOS One, overweight, inactive men walked or jogged uphill on a treadmill for 4 minutes at 90 percent of maximum heart rate; in other words, they pushed hard enough that they couldn’t talk in complete sentences. This short, high-intensity bout was sandwiched between a 5-minute warm-up and a 10-minute cool-down.
The men, ages 35 to 45, performed this workout three days a week. After 10 weeks, their VO2max — the maximum amount of oxygen one can utilize during intense exercise — improved, on average, 10 percent. VO2max is a key measure, as it strongly predicts physical fitness and mortality.
In the same study, another group of sedentary, overweight men completed 40-minute workouts that included not one but four of the 4-minute huff-and-puff bouts, interspersed with 3-minute low-intensity bouts. The 40-minute group saw V02max increases of 13 percent, on average.
Both groups experienced similar decreases in blood pressure and fasting glucose, though only the 40-minute group lost weight.
Overall, the researchers were impressed with the fitness gains generated by such a minimal commitment to exercise. Yes, longer workouts clearly produce more weight loss. But the reality is, most Americans aren’t following the government’s recommendation to exercise moderately 150 minutes a week.
So, shorter, more intense workouts may be a viable solution, or at least an excellent starting point, for folks who are too busy or unmotivated to fit in longer workouts.
At Alere Wellbeing, we’re committed to getting even the most reluctant employees moving. Our expert coaches are up on the latest research and can help match your employees with workouts that suit them, whether that’s a short, intense lunchtime workout on a hill near the office or a longer, more leisurely stroll after work.
The nation’s latest report card on health behaviors just came out, and, well, Mom wouldn’t be proud. In three key areas — smoking, physical activity, and weight —we’re not making the grade.
The report, issued by the U.S. Centers for Disease Control (CDC), was based on interviews with 77,000 adults and conducted between 2008 and 2010. In this post we’ll offer our take on the report’s smoking statistics. A future post will consider the exercise and weight data.
According to the report, adult smoking rates remained stubbornly around 20 percent, lower than the 1990 rate of 25.5 percent but nowhere near the government’s goal of 12 percent for 2020. Particularly troubling: Of the 20 percent who currently smoke, only about 46 percent had tried to quit in the previous year. The government’s goal is for 80 percent of smokers to attempt quitting each year.
The gap is troubling because we know from other research that about 70 percent of smokers want to quit. Why are so few would-be quitters not even trying? The CDC report didn’t delve into that question, but after 25 years of helping smokers quit, we have plenty of ideas.
Here’s what tends to hold smokers back from trying to overcome their tobacco addiction:
- They fear failure. Many smokers with past failures give up trying because they don’t want to disappoint themselves and their families. They figure: If I don’t try, I can’t fail. They don’t realize it usually takes multiple attempts before a smoker succeeds and that every failed attempt gives them insight and skills to draw on for the next try.
- They fear nicotine withdrawal. Many smokers equate quitting with physical suffering. They don’t realize that medication, when used properly, can drastically reduce withdrawal symptoms like headache, nausea, and irritability. They also don’t realize cravings pass within three to five minutes.
- They fear they’ll fall apart under stress. Truth is, smoking creates stress rather than relieving it. With the right guidance, smokers can learn stress-relief strategies that don’t poison their bodies and are more lasting and satisfying than cigarettes.
- They fear they’ll gain weight. In truth, the typical weight gain averages just 5 to 10 pounds; 16 percent of smokers actually lose weight when they quit. Often former smokers feel so empowered by quitting that they take up exercise and cut back on junk food. There’s much smokers can do to minimize gaining weight when they quit.
- They believe they don’t have the willpower to quit. These folks don’t realize success isn’t about willpower at all; it’s about having a plan.
Our highly experienced Quit Coaches can help these smokers overcome their fears and venture into a quit with confidence.
Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years.
In this episode of Weight Talk® with Dr. Lovejoy, we talk to Dr. Jennifer Lovejoy about what natural sugars are in whole foods like apples and oranges, and work our way through the differences between fructose, sucrose and glucose. Podcast host Reed Dunn talks to Jennifer Lovejoy, PhD, to learn how sugar fits into a daily diet, and what role artificial sweetners play.
Jennifer Lovejoy is a clinical expert specializing in nutrition, chronic disease, and weight loss through behavior change. She leads the clinical team who developed Alere Wellbeing’s Weight Talk program.
Give smokers a financial incentive to quit, and they’re more likely to follow through. But will money motivate obese people to exercise?
Apparently so, according to a year-long study[i] that followed 6,500 obese people insured by Blue Care Network of Michigan. Blue Care offered eligible participants a choice: walk 5,000 steps a day or pay 20 percent more for coverage.
Some 43 percent chose to enroll in the pedometer-based walking program. Of these, 97 percent met or exceeded the goal, averaging 6,523 steps a day — about 3 miles, or enough to be considered “low active” as opposed to sedentary.
Even participants who called the program “coercive” met the step goal, according to the study. People unable to exercise because of medical conditions could opt out of the program with a doctor’s waiver.
The incentive offered in this study was substantial; for some families, the additional out-of-pocket cost of failing to meet the insurer's fitness requirements was nearly $2,000. The study’s authors, from the University of Michigan Health System and Stanford University, concluded that financial incentives clearly hold promise for getting overweight people to exercise.
This is an important finding for any organization struggling to contain health-care costs. Inactivity and obesity are linked to debilitating and costly medical conditions, including heart disease, type 2 diabetes, and high blood pressure. What’s more, when sedentary people become active, they take fewer sick days, experience better moods, and lower their risk for depression.
Look for incentive programs like this to become more popular. And look to Alere Wellbeing for help to address obesity at your organization. Learn more about Weight Talk®, our personalized weight loss program offered in collaboration with the American Diabetes Association.
Here in the U.S., tobacco use has plummeted in the last 50 years, from 42 percent in the mid-1960s to 19.3 percent today. We’ve come a long way from the “Mad Men” days of smoking at meetings, on the elevator, in the lunchroom, even in the hospital. And we’re light years ahead of, say, Russia, where today 60 percent of adult men smoke, or China, where 53 percent of men light up.[i]
But with World No Tobacco Day approaching — mark your company calendar for May 31 — we’re reminded that we still have a long way to go. More than 45.3 million U.S. adults smoke, and 443,000 Americans die each year from smoking-related causes. Smoking remains the leading cause of preventable death in the United States. Half of all smokers die from their addiction to tobacco, and many more live diminished lives because of it.
The theme of this year’s World No Tobacco Day campaign is "Ban tobacco advertising, promotion and sponsorship.” We are, of course, strongly in favor of banning all three. But we’d like to add our own twist to the theme: Ban workplace tobacco.
For most smokers, death by cigarettes doesn’t happen in the prime working years. But the toll smoking takes during these years hits both smokers and their employers hard. The direct medical costs of tobacco use are staggering: $4,350 per tobacco-using employee per year. When you add in lost productivity due to illness and smoking breaks, you’re looking at $7,874 per employee per year, an extra $21 per smoker per day.
If your workforce includes smokers, you are subsidizing treatments for cancer treatments, hip fractures, respiratory infections, infertility and numerous other costly conditions that can be directly caused by smoking.
But these are not costs that any organization needs to bear. With the right policies and smoking-cessation programming and a savvy campaign to inspire smokers to quit, you can dramatically reduce your company’s costs while giving your employees who smoke the gift of health.
The turnaround can happen quickly. When smokers quit, their risk of having a heart attack drops — in just one day. Within a few months, smokers are less prone to infection. They’re no longer plagued by episodes of bronchitis or sinus congestion, and they show up at work, more often and with more stamina and more focus. Within a year, their risk of developing heart disease is half that of a smoker’s. Within five years, their odds of developing various cancers drop by half.
But can you really persuade your tobacco-using employees to quit? Many organizations worry about throwing their company’s money away — that their smoking population is unreachable. We understand this concern. You can’t force smokers to quit, and indeed, more than 90 percent of smokers who try to quit without support fail.
That’s partly because the way tobacco is grown and processed these days has made cigarettes more addictive than ever before. But the main reason so many smokers fail is that they don’t get the right treatment. When smokers are offered expert coaching, medication, and step-by-step guidance, even the most hardcore tobacco users can quit. We know, because at Alere Wellbeing, we’ve helped thousands of them.
To mark World No Tobacco Day, we’re encouraging organizations to post flyers with the World Health Organization’s inspired campaign: Imagine a world with no tobacco. You can make it happen.
Yes, this may be pie-in-the-sky thinking. Given the unbelievably high smoking rates in Russia, China, and other parts of the world, imagining a world with no tobacco may take mental superpowers.But a workplace with no tobacco? That’s easy to imagine. We can help you make it happen.
Learn more about how to implement a positive incentives program at your workplace by downloading our free White Paper and check out Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years.
The Obesity Society, the largest non-profit organization in North America representing researchers and clinicians who address obesity, has just announced a new campaign called “Treat Obesity Seriously”.
In the introduction to the campaign, the Society notes: “To combat the obesity epidemic, we must shift the dialogue from blame to solution, and treat obesity as we do other serious health conditions like heart disease and cancer.” Organizations can heed this call to action on two fronts: by helping combat the stigma of obesity and by supporting employees with comprehensive weight loss programs.
In the workplace and in society in general, people affected by obesity are often stigmatized – in part due to a cultural belief that obesity is a “lifestyle choice” rather than a serious medical condition. While it is true that unhealthy lifestyle choices can worsen obesity, and lifestyle change is key to its management, the same can be said for type 2 diabetes and high blood pressure. Yet individuals with these conditions are not usually viewed as undeserving of serious medical treatment; nobody suggests they “just need to push away from the table.” Obesity stigma is a major issue and has been called “the last socially acceptable form of discrimination in our society.”
When obese people experience stigma, research shows, they’re actually less likely to engage in healthy behaviors, and they may even overeat as a coping mechanism. So addressing obesity stigma and bias – both overt and subtle – can go a long way in the workplace. Especially when trying to motivate folks to participate in employer-subsidized weight-loss and wellness programs.
What can organizations do to reduce the stigma and promote a supportive environment? Most organizations probably already have programs and training in place that support diversity in the workplace and let employees know that bias against coworkers due to gender, race or religion will not be tolerated. Sometimes the simplest step to take to reduce obesity bias is just to overtly add it to the list of unacceptable attitudes at the workplace. Studies show that simply learning about obesity bias and its effects, as well as about the true medical basis for obesity, significantly reduces bias. Great free resources are available online through the Yale Rudd Center.
In addition to fostering a culture of understanding and support, it’s important for organizations to know what it will take to effectively treat obesity, a serious medical condition that increases risk for more than 30 other diseases. General wellness programs, including those designed to simply increase physical activity through walking clubs or exercise competitions, just aren’t enough.
What’s needed to produce clinically significant weight loss and reduce healthcare costs is intensive lifestyle treatment involving at least 12 sessions offered by trained counselors. Like diabetes and hypertension, obesity requires ongoing management, not just a quick-fix diet or “biggest loser contest.” Offering overweight employees ongoing coaching and a weight-loss maintenance program can protect your initial investment in your employees’ health.
Fortunately, it doesn’t take huge changes to reap big cost savings. In one study, researchers estimated that if Americans consumed 100-fewer calories a day, we’d have about 71 million fewer cases of overweight/obesity and save $58 billion annually. And numerous studies indicate that among overweight and obese people, losing just 5 to 10 percent of their body weight profoundly reduces the risk of diabetes and other costly health conditions. In a 2009 report, Humana analysts estimated that every pound of excess weight increases health-care costs by $19.39 annually.
Chances are, two-thirds of your employees are overweight or obese. Imagine what even a 5- to 10-pound weight loss among them might do for your bottom line.
If you are ready to start “treating obesity seriously,” learn more about the Obesity Society’s new campaign, and consider offering your employees Weight Talk, a program that will reduce the risk of illness among your workforce while significantly reducing your organization’s health-care costs.
Electronic cigarettes (e-cigs) continue to be a hot topic on news wires and health blogs. Those in support of the products argue that smokers should be offered these products as a tool to quit smoking traditional cigarettes, while those who are unconvinced argue that they should not be offered until we have good data that tells us they are both safe to use and effective in helping smokers quit. I doubt that any rational person would argue against the premise that traditional combustible cigarettes are probably the most dangerous form of nicotine delivery available. The annual death toll in the US and worldwide is enormous and growing. Counseling support plus FDA approved pharmacological treatments are effective in helping smokers quit, but the problem is that relatively few smokers use evidence-based treatments to quit. This problem is compounded by the fact that tobacco use and dependence is very difficult to treat and many have tried and failed.
The recently published article by Dr. Katrina Vickerman and colleagues has been misinterpreted by many who have written about it. It was never intended to assess the effectiveness of the e-cig as a mechanism to quit. Instead the analysis was intended to gain insight into e-cig use by those who enrolled in public tobacco quitline services and were contacted seven months later to determine whether or not they were quit. The Alere Wellbeing study shows smokers who got help through quitlines who reported using e-cigs (to quit or for other reasons) were less likely to succeed during their current quit attempt than those who did not. The data showed that 21% of e-cigarette users were tobacco-free after seven months, compared with 31% of those who didn't use e-cigs. Many are misinterpreting it as saying that e-cigs did not help those who enrolled in QL services to quit. The analysis was never intended to answer that question.
The issue continues to be whether we should turn to a device like the e-cig to reduce the disease and death caused by traditional smoking. Many advocate for a harm reduction approach that would use e-cigs as a tool in that process. In general, harm reduction is a strategy that helps to reduce death and disease from a behavior until the person engaging in that behavior is willing to cease it entirely. The question is whether the e-cig will serve this role, or whether the product might actually create more problems than it fixes. This issue always seems to play into any discussion around harm reduction strategies, whether they be condoms for teens or clean needles for heroin addicts.
I think most will agree that the e-cig is highly unlikely to cause the same amount of damage to the body as traditional cigarettes. The question is whether e-cigs will cause damage that is new and different from that caused by traditional cigarettes. To date we have no evidence that this is the case. The problem is that there is very little data that informs the safety of long-term use of e-cigs or whether they are effective in helping smokers quit traditional cigarettes. Both safety and effectiveness are standard measures that need to be demonstrated in order for a treatment, such as e-cigs, to be adopted by tobacco treatment professionals.
Currently e-cigs are being advertised as a product to use “when you can’t smoke”, or as a cheaper and safer alternative to traditional cigarettes. When used for “when you can’t smoke” the person becomes a dual user. Current scientific evidence shows that those who use two or more tobacco products (dual users) have more difficulty quitting than those who use a single tobacco product. So if we promote e-cigs as a harm reduction product do we run the risk of creating a bigger problem than we fix? The answer is that we do not know.
So, until we have good scientific evidence about the safety of long-term e-cig use or their effectiveness in helping smokers quit, it is extremely likely that the debate will go on. Those who are concerned about making the problem worse will be reticent to endorse e-cigs as a public health policy, while those who are convinced that e-cigs are safe enough will continue to advocate for wide spread adoption.
Learn more about our evidence-based and proven tobacco cessation services.