Wellness Programs Flashcards
(34 cards)
How does the strategy behind the concept of consumerism help contain increases in healthcare?
When applied effectively, healthcare consumerism does more than simply shift costs; it more appropriately helps engender greater responsibility on the part of the health plan member for decisions involving lifestyle, healthcare consumption and cost.
What are the objectives of employer-sponsored wellness programs?
The objectives of employer-sponsored wellness programs are to promote healthy lifestyles among employees by targeting the risks that result from poor nutrition, lack of physical activity, excessive stress, tobacco use and other unhealthy habits. These risk factors can lead to expensive chronic diseases and health issues that also affect workforce productivity, absence from work, safety and employee morale.
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Over the years, researchers have observed that preventable illness makes up a significant portion of the total cost of healthcare
Provide examples of modifiable health risk factors.
Nutrition, weight control, physical activity, cholesterol, blood pressure, tobacco use, safety and mental well-being. Health promotion programs seek to reduce these risk factors by promoting healthy lifestyle choices and by discouraging behaviors and attitudes that are detrimental to good health.
What is the role of incentives in wellness programs?
Incentives are a tool to help focus attention on health risks and to motivate desired behavior changes. People generally do not change their behavior without good reasons that outweigh the pain and annoyance associated with giving up long-standing habits. The purpose of wellness incentives is to help provide those good reasons.
What is an optimal incentive program?
An optimal incentive program utilizes the simplest, most cost-effective incentives that cause the maximum number of individuals to move from a state of contemplation to action. Also the best incentives will promote long-term lifestyle changes to such a degree that, even when the rewards are removed, desired behaviors will continue due to intrinsic reinforcements. These reinforcements are the consequence of several factors, including successful goal achievement (such as weight loss or smoking cessation), as well as the boost and well-being and self-esteem that often accompanies health improvement activities.
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Unfortunately, the prospect of living a longer, healthier life does not motivate individuals to adopt healthy behaviors. Research shows that among heart attack patients, for whom behavior change is an immediate life and death issue, 90% do not change their unhealthy habits even one order to do so by their doctor.
What are three key motivators that employers should use to help their employees adopt and maintain healthier behaviors?
One of the key motivators is education. It plays a role in raising awareness and building a desire for change.
A second motivator is pure pressure as well as other intangibles both in the workplace, where individuals seek a sense of belonging and accomplishment; and at home, where they feel a sense of accountability to those they love.
A third motivator, the tipping point that moves individuals from in action to action, is the use of external incentives.
What are some advantages of incentives?
Among the advantages of incentives is their potential to have powerful behavioral effects. When incentive rewards and rules are well-designed, they can induce a significant change in behavior for a significant percentage of the target population. They also can be flexible, relatively simple to comprehend and easy to administer. Additionally, incentive rewards can be combined to increase motivation, for example, combining a tangible reward (cash) within in tangible reward (recognition).
What are some disadvantages of incentives?
Possible disadvantages do exist. For instance, with certain reward approaches some individuals may exploit the program by gaming the system or being dishonest and self reporting such as smoking cessation. Also, some incentives may inadvertently reward unhealthy behaviors, for example, a per pound weight loss incentive could encourage unhealthy or hazardous weight-loss practices. Finally, desired behavior may last only as long as the reward does.
Most employers are not prepared to use severe punitive tactics in their health promotion programs and most experts agree that pleasure or reward is a more effective long-term motivator then fear or punishment. List and describe types of positive incentives that are tangible.
Tangible incentive rewards include:
Cash
Merchandise
Vacation days
Avoidance of costs (such as health care premiums or deductibles)
List and describe types of incentives that are intangible.
Intangible incentive rewards include:
Recognition Personal challenges A sense of accomplishment Group competition A sense of belonging Acceptance and approval of peers
Group competition
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Another technique for more closely aligning incentive rewards with the cost of healthcare benefits is to reduce health care premiums for deductibles and copayments.
For employers that use health care premium discounts as an incentive reward, it is important that employees perceive the premium reduction amount to be significant. One technique for boosting this perception, referred to as play or pay, involves first increasing health plan premium contributions and then forgiving a substantial part of the contribution for those who participate in the wellness program
Based on the type of behavior is rewarded, there are three types of wellness incentives. What are the three categories?
1) . Activity incentives
2) . Achievement incentives
3) . Adherence incentives
What are activity incentives?
Activity incentives reward employees for participating in, or completing, specific activities, including:
Attending an educational session Participating in a contest or challenge Completing a health risk assessment Completing online activities Attending a health fair Completing a certain number of activities over a defined period (e.g., 30 minutes of physical activity four days/week for six weeks).
What are achievement incentives?
Achievement incentives require more than just participation. In order to receive a reward, the individual must demonstrate achievement of specific goals or metrics, such as:
Maintaining low-cholesterol, or reducing it by 10 points if appropriate
Stopping smoking, or remaining tobacco free
Maintaining body mass index (BMI) below 25, or reducing it by one point if optimal
Maintaining healthy blood pressure, or reducing it if appropriate
Maintaining healthy blood glucose level or reducing it if appropriate
What are adherence incentives?
Adherence incentives reward longer term maintenance of lifestyle goals. For example:
Remaining tobacco free for 12 months
Maintaining a target BMI for 12 months
Maintaining other biometric measures within healthy range over a defined period of time
Maintaining a target accident rate at work
Working three out of four calendar quarters without an unscheduled leave day
What are some of the advantages and disadvantages of activity rewards?
One advantage of activity rewards is that it motivates incremental action toward healthier lifestyles. Also, an activity reward might be more readily achievable for all individuals.
Two key disadvantages of a reward based on activity are: (1) performing specific activities is not necessarily enough to decrease health risks; and (2) activity-based incentives are the easiest to game out of the three types of rewards presented.
What are some of the advantages and disadvantages of achievement rewards?
The key advantage of achievement rewards is that they provide a clear, objective basis for measurement, thus allowing a focus on individual accountability for personal health management.
These rewards’ disadvantages include: (1) additional costs if biometric testing is used; (2) excessive employee focus on measurement techniques, accuracy, scoring methodology; and (3) considerations regarding health insurance portability and accountability act (HIPAA) requirements and limitations come into play.
What are some of the advantages and disadvantages of inherence rewards?
A monkey advantages of adherence rewards are that they provide motivation to sustain long-term lifestyle improvements, they reinforce the important determinant of wellness return on investment (ROI), and they also allocate the greatest reward to those contributing the greatest value to the program.
There are disadvantages include longer time requirement before an incentive is awarded, the multiyear time frames possibly complicating the administration of the program, and finally HIPAA compliance must be considered.
The process of determining the optimal incentive amount is an art and a science. Explain.
Success with incentives requires understanding the culture of the company, the related benefit structure and other aspects of the covered population. To maximize its perceived value, and incentive should be designed so that participants perceived value is high relative to the employers actual cost. Such an approach might lead one employer to offer lump sum cash rewards, another to utilize raffles for high-value prizes and another to offer highly visible discounts on health benefit premiums.
Some experts recommend setting incentives, especially cash rewards, at as low a level as possible while still retaining their effectiveness. The optimal reward amount should be just enough to tip the scales. Individuals who have been moved to the “contemplation” stage by wellness program communications and education may look at a small incentive amount as a “token” - not really meaningful enough on its own to motivate a behavior change. However, when combined with factors such as aggressive education, that token become sufficient reason to make a change now rather than waiting for a better reason. The reward amount should be commensurate with what the individual is being asked to do in return. Finally, when designing an incentive program, the possible tax consequences for tangible rewards should be considered.
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Because of a lag in health class savings from lower utilization, most programs take several years to develop a positive ROI. Therefore, employers must be willing to design their programs with a multiyear horizon, spreading incentives, program costs and expected savings over several years.
What are the five basic requirements that wellness programs must meet under HIPAA when the wellness incentives are based on health status related factors?
1) . The total rewards must not exceed 20% of the cost of employee only coverage (or 20% of the total cost of coverage if dependence can participate in the program).
2) . The program must be reasonably designed to promote health and prevent disease.
3) . Individuals eligible for the program must be given the opportunity to qualify for the reward at least once per year.
4) . The reward must be available to all similarly situated individuals. The program must allow a reasonable alternative standard (or waiver of the initial standard) for obtaining the reward to any individual for whom it is unreasonably difficult due to a medical condition, or medically inadvisable, to satisfy the initial standard.
5) . The plan must disclose in all materials describing the terms of the program the availability of a reasonable alternative standard (or the possibility of a waiver of the initial standard).
NOTE: The 20% total reward limit noted above was increased to 30% (up to 50% under certain circumstances) by the patient protection and affordable care act (PPACA) effective 2014. PPACA also mandated that the department of health and human services develop criteria for a comprehensive workplace wellness program and create a five-year program to award grants to certain small employers for implementing wellness programs.
Under the Americans With Disabilities Act (ADA), in general medical examinations and screenings of employees are prohibited. What two ADA requirements permit under a wellness program these prohibited practices?
The two ADA requirements that permit under a wellness program the prohibited practices are: (1) that any medical records acquired as part of the wellness program must be kept confidential and separate from personnel records; and (2) more importantly, that the program must be voluntary, defined as a program in which an employer “neither requires participation nor penalizes employees who do not participate”.
