STATES AND PRIVATE EMPLOYERS TAKE AIM AT CHRONIC CONDITIONS

Volume 28, Issue 484 February 5, 2007

Amy Wintefeld

In a mutually beneficial relationship, states are working with private employers to promote healthy behaviors. Why the focus on preventive care and wellness? “We have a finite amount of resources to spend on health care,” said Hawaii Rep. Josh Green, an ER doctor. “The only way to afford the things we must have is to focus on preventive health measures and screening. We’ll always need trauma centers…but that means we need to be smart about other health costs.”

If conditions like diabetes aren’t prevented, delayed or well-managed, the results could be devastating for public and private budgets. Treatment for chronic diseases accounts for 75 percent of annual national health-care spending, including about 83 percent of Medicaid spending and 96 percent of Medicare costs. Here’s a sampling of what states are doing.

In 2006, Michigan enacted legislation that requires insurers, HMOs and nonprofits that offer group health insurance to give premium rebates when a majority of employees or health plan members enroll and maintain participation in group wellness programs. The rebates apply to individuals and families with their own policies who participate in approved wellness programs too.

Indiana Sen. Beverly Gard sponsored a bill that would allow employers to offer financial incentives to reduce employee tobacco use. “This seemed like something we could do that would give employers an opportunity to provide employees with incentives for healthy behavior,” Gard said. Rather than penalize smokers, Indiana amended its smokers’ bill of rights to allow employers to add to employer-provided health benefits financial incentives to reduce employee tobacco use. “We wanted to take a more positive approach,” Gard says.

New Hampshire lawmakers in 2004 permitted small group and individual insurers to use a rating factor to discount premium rates for plans, giving monetary incentives for participants in wellness or disease management programs.

Over the past few years, wellness tax credits have been proposed in at least seven states including Hawaii, Iowa, Mississippi, New Jersey, New York, Rhode Island and Wisconsin. The idea is to provide employers—especially smaller businesses—with income, franchise or corporate tax credits for wellness programs such as nutrition counseling and smoking cessation, or purchasing or maintaining fitness equipment.

According to Blue Cross-Blue Shield’s “Survey of Health Plans” for 2005, specific preventive benefits required by states include alcoholism treatment (44 states), blood lead screening (7 states), bone density screening (15 states), cervical cancer screening (29 states), colorectal cancer screening (24 states), diabetic supplies or education (47 states), mammography screening (50 states), morbid obesity care (4 states), prostate cancer screening (28 states) and well child care (32 states).

In addition, states are promoting healthy behavior in public programs.

In Connecticut, the state’s Medicaid managed-care plans pay for obesity-related services (including gastric bypass surgery) if they are medically necessary. Nutritional counseling, exercise programs and behavioral health services are covered under Medicaid and SCHIP if they meet the necessity criteria.

In 2005, 38 states covered some tobacco-dependence counseling or medication for all Medicaid recipients. Four more states offered coverage only for pregnant women. Oregon is the single state offering all smoking cessation medication and counseling treatments recommended by the U.S. Public Health Service.

West Virginia has some of the nation’s highest rates of obesity, diabetes, heart disease and smoking. In three pilot counties, Medicaid patients will be asked to sign contracts agreeing to do their best to stay healthy by doing things such as having routine screenings and keeping appointments. Those who comply will be eligible for rewards such as smoking cessation and weight loss classes and additional prescription medications.

NCSL’s Amy Winterfeld tracks wellness and obesity. For more, go to: http://www.ncsl.org/programs/pubs/slmag/SLWeeklyFeb1_Wellness.htm or

http://www.ncsl.org/programs/health/healthyeatingpaoverview.htm