PPCA makes strange bedfellows: Medicare, corporate wellness

By Lydell C. Bridgeford

Under the Patient Protection and Affordable Care Act, the Centers for Medicare and Medicaid Services is required to provide, with no co-payments or deductibles, Medicare beneficiaries with an annual wellness visit and a personalized prevention plan.

The success of the new services, which go into effect on Jan. 1, 2011, may result from whether a beneficiary, as an employee, had access to workplace wellness programs and services.

"The success of the Medicare wellness initiatives under health care reform is clearly linked to employer-sponsored wellness programs,” said Paul Bonta, associate director of policy and government affairs with the American College of Preventive Medicine, at the fifth annual forum on "ROI for Wellness and Sustainable Behavior Change."

Ideally, by the time the employee is eligible of Medicare, he or she should be familiar with participating in a wellness program, Bonta explained yesterday to attendees at the Washington, D.C. event, which was sponsored by the World Research Group.

"The participation in the annual wellness visit and personalized prevention plan will be enhanced considerably if we work to increase access to workplace wellness programs and promote wellness prior to patients joining Medicare,” he added.

The PPACA rules issued by CMS also require that the annual wellness visits include a health risk appraisal standardized by the Department of Health and Human Services.

"With respect to the HRA, it is important that we monitor this because the June 26 rule by CMS states that PPACA requires that an HRA be included in the annual wellness visits beginning on Jan. 1, 2011,” said Bonta. So far, HHS hasn’t created the standardized HRA, but the rules state that the Secretary of HHS has a year to create one.

"From our perspective, the use of an HRA in a wellness program is critical, so to move forward with an annual wellness visit that does not require the use of an HRA is something we would not support,” he added. “Some have pointed out that the National Committee for Quality Assurance already has a standardized HRA. We will probably advocate that the HHS Secretary adopt this HRA, rather than try to create a standardized HRA over the next year,” Bonta added.

ROI fatigue

At the conference, a panel discussion focused on how health reform might influence wellness programs and the concept of return on investment on the programs.

"With health reform, there is some desperation among employers that is driving them to look at positive solutions as to what works for wellness, such as examining their work culture," said Bob Merberg, wellness manager at Paychex, Inc., a New York-based company that provides payroll, human resource, and benefits outsourcing services.

A post-reform environment will bring about a movement where employers are looking beyond cost containment, instead focusing on the bigger picture on health savings costs, he said. "Still, wellness is being held to a different standard, because on some level, a lot of folks really don’t believe in it."

Wellness is part of the health care continuum. "It’s as important, if not more important, than medical procedures in which we spend 100 times more money on and never question the ROI. Our single-minded focus on ROI sometimes stands in our way of fully understanding the potential of wellness programs," Merberg said.