The Vitality Institute Health Promotion Forum: Empowering Change Through Policy – Part I of II
Is the Affordable Care Act (ACA) successfully promoting health? This question was at the heart of “Empowering Change Through Policy,” a recent health promotion forum co-hosted by the Vitality Institute and the Milken Institute School of Public Health at the George Washington University. Vitality Institute Director Derek Yach, Milken Institute School Dean Lynn R. Goldman and Vitality Institute Commission Chair William Rosenzweig were all on hand to welcome the audience and emphasize the critical juncture at which health care communities find themselves.
The first half of the event featured short presentations from scholars whose research focused on the intersection of policy and preventive health, followed by a Q&A session.
Jennifer Pomeranz, J.D., M.P.H., assistant professor in the Department of Public Health and the Center for Obesity Research and Education (CORE) at Temple University
Naomi Seiler, J.D., associate research professor in the Department of Health Policy at the Milken Institute School
Moderator: Jeffrey Levi, Ph.D., executive director of Trust for America’s Health and a professor in the Department of Health Policy at the Milken Institute School
Expanding the Reach and Regulation of Workplace Wellness
Jennifer Pomeranz spoke first, exploring the viability of workplace wellness programs. Successful iterations, she explained, offer a unique opportunity to incentivize working-age adults to take advantage of preventive health care measures — such as education, wellness activities, screenings, etc. This, in turn, can help reduce rates of chronic disease and the rampant health care spending that results from them. Pomeranz highlighted two types supported by the ACA:
- Participatory programs don’t track an individual’s health status, but they offer incentives such as reimbursing the cost of a fitness membership or rewarding employees for taking health assessments.
- Health-contingent programs reward individuals for meeting a prescribed standard of health —e.g., achieving a certain cholesterol level or taking specific steps in pursuit of that standard.
One major hindrance to the evolution of these programs is that small businesses — which employ more than half of the U.S. workforce — do not have the resources to fund or coordinate workplace wellness programs. What’s more, most of these programs aren’t subject to federal requirements or evaluation — meaning that we don’t always know what’s working and what’s not. So how can we make workplace wellness programs available to more people and ensure that they benefit employees in a meaningful way? Pomeranz suggested that employer-funded research at big companies with established programs might be a good place to start. Entities such as the Community Preventive Services Task Force (CPSTF) can then draw upon these findings to develop recommendations for small businesses.
From Legal Stipulation to Comprehensive Coverage
Naomi Seiler’s presentation adopted a more clinical perspective, beginning with a brief review of Section 2713 of the ACA, which details covered preventive services. The idea behind these services is increased access without cost sharing (the share of costs covered by your insurance that you pay out of your own pocket), she explained. “Cost sharing is a barrier to medical care in general, and in particular to preventive services.”
How coverage actually works will vary significantly by type of insurance, though; specifically, whether a plan is required to cover those benefits and, if so, how and to what extent. For instance, if your provider bills the service separately from the visit, you may be on the hook for the visit itself. Or say the original appointment addressed an entirely different condition — you can still be billed for the visit because its primary purpose was not the preventive service. These challenges prompt a lot of big questions:
- From a policy perspective, how do we convince states to cover these services?
- Can we broaden the services offered for Medicaid beneficiaries?
- Considering that state insurance commissioners are largely responsible for the enforcement of private plans research-wise, how are issuers interpreting the law? How are patients experiencing it?
- Are providers getting appropriately reimbursed? How does coverage intersect with bundled payments?
- Is this coverage actually increasing uptake of preventive services, and is that uptake improving health?
And even if health care professionals and experts generate satisfactory answers to these questions, how do they communicate the information to patients?
Q&A Session: Translating Policy into Practice
Though many conversations surrounding the ACA have revolved around insurance, Pomeranz’s and Seiler’s respective bodies of research consider a more holistic view of health as it’s being achieved — or undermined — via the law.
It is not just health agencies that have an impact on health and wellness. How do we translate — even when it’s evidence-based recommendations — into practice in a meaningful way? – Dr. Jeffrey Levi
Seiler felt there would be a couple of variables to consider: If we created a separate entity from the United States Preventive Services Task Force (USPSTF) to determine recommendations, how independently should they operate? And would those recommendations be mandatory (i.e., require legislative action)? Pomeranz suggested that the answer for workplace wellness programs could be twofold. 1) The CPSTF could offer specific evaluations and recommendations based on data derived from large employers, and 2) the marketplace could also prove helpful — as employers utilize private workplace wellness providers that have been evaluated by a separate accreditation system. In this case, though, should we let the market also determine the effectiveness of those programs?
Funding for prevention programs — and evaluating their success — remains problematic. Many major health organizations, for example, have directed the majority of their financial resources toward cures. Audience member and Emory University Research Professor Ron Goetzel also pointed out that funding for applied research is “zeroed out” in many communities.
Organizations dedicated to promoting awareness of a specific disease are often the ones most invested in prevention of their particular disease. “Some of the impetus, if not the funding, will come from the advocacy world,” Seiler said. “Which is not necessarily a bad thing, but it raises a question about diseases for which there is less funding.” Pomeranz felt that research funded through academia and large, private-sector companies would help alleviate the financial burdens for smaller employers.
Stay tuned for our upcoming recap of part two, or watch the entire forum here.
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