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Peer Responses – Health and Wellness Initiatives

OriginalQuestion: Read the article Be Healthy and Get Rewarded Incentives Driving Engagement in Health and Wellness. Taking into consideration some of the significant changes to health insurance policies, please review the article and address the following two questions.
As described in the article, what options do patients with preexisting health conditions have in regards to wellness initiative compliance?
Are the new health plans truly helping consumers to live a better and healthier lifestyle or are they actually hindering consumers ability to freely pursue getting proper treatment, if needed, due to the fear of high deductible costs?
Response1 .5 pg: Maricar
To engage patients with pre-existing health conditions to be more active in their health care, one option is to take advantage of incentives and rewards to stay healthy, engaged and rewarded. Incentives such as a free annual well care visit and free transportation to and from appointments improves behavioral health and reduces the patient cost. An incentive system rewards patients when they are active participants in their health care, thus providing an alternative to a wellness initiative compliance. As Nosta states, health rewards are predicted to be one of the top five health solutions in 2014, and is the fastest growing solutions in health care. Since wellness initiatives vary greatly in terms of health concerns, the programs to providing options includes financial incentives that are participation-based and that are awarded upon completion of the wellness program.
Society has a vested interest in helping our community live a better and healthier lifestyle. Thus, health plans should offer wellness programs that are common and easily accessible, especially to the disadvantaged communities. According to Altarum, there is very limited evidence of effectiveness of such programs. The article suggests that wellness efforts of health plans should focus on initiatives that strengthen the health care plans programs, and build a stronger foundation for the health infrastructure designed to provide wellness compliance in society. Sometimes, due to fear of high deductible costs or privacy concerns, consumers may not have the ability to freely follow up getting proper treatments. In this case, wellness incentives and non-discrimination laws such as the Affordable Care Act (ACA) includes regulations that banned medical underwriting across all forms of health insurance and allows continued wellness programs to tie incentives to health care costs. In effect, health care plans can provide wellness initiatives and incentives without passing the cost on to consumers. Accordingly, health care programs that do not use incentives or tie incentives to participation in wellness activities have limited requirements under the ACA. Consumers can get proper treatment without fear of paying higher cost as compared to their counterparts who participate in such compliance initiatives.
Response2 .5 Page: Nicole
In a perfect world, all insurance companies would accept patients that have preexisting conditions. However, that is not the case. Insurance companies do not want to take on the potential high costs involved in treating a patient with a preexisting condition. For example, a pregnant patient starting on a new plan that has a preexisting clause will not have the birth of the child covered by the plan. Health plan should offer incentives to all enrollees to receive rewards for healthy behaviors. My current employer offers wellness discounts for our employees on the cost of their plan premiums. Employees and their spouses must complete an annual routine check-up visit with their primary care physician and pass a wellness screening that looks at blood pressure, glucose, cholesterol, etc. If an employee or their spouse does not successfully complete both of these items, they will not receive the discount to their premium per pay period. If either of them smokes, they will also receive a surcharge per pay period. It is an incentive for the employees to have better health and wellness.
Leonhardt reported in the beginning of 2020, prior to COVID, that 22% of Americans avoided medical care due to the cost involved. It was not because they could not find care; it was simply because they did not want to pay out of pocket for the services due to financial reasons. The trend is that organizations are moving towards high deductible health plans as it puts more of the financial responsibility back on the enrollee versus the organization. The plans offer lower premiums but have higher deductibles that are required to be met before the insurance plan pays at the allotted percentage. The advantage to a high deductible health plan is that enrollees are offered the ability to enroll in a health savings plan (HSA). They are tax free plans and are not the old style of use-it-or-lose-it either.

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