Uncle Sam Wants You to Take Care of Yourself

By ALLISON BELL

Published 6/16/2011 

Federal agencies seem to have developed a new National Prevention and Health Promotion Strategy without getting much obvious advice from health insurers or private wellness program operators.

U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius joined with other federal officials, including Surgeon General Regina Benjamin and Domestic Policy Council Director Melody Barnes, to unveil the program, and a prevention strategy report, at a press conference in Washington.

The Obama administration has developed the national prevention strategy to implement prevention program provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA).

PPACA has created a National Prevention, Health Promotion, and Public Health Council. The council includes the heads of 17 federal agencies. The chairman is the surgeon general.

PPACA also has created an Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. President Obama named 13 members to the advisory group in January and 2 more in April, officials say.

Sebelius, a prevention council member, has been the Kansas insurance commissioner and the president of the National Association of Insurance Commissioners, Kansas City, Mo.

The only member of the prevention council or the advisory group who appears to have significant experience with working for a health insurance or benefits organization is Ned Helms Jr., the director of a health policy institute at the University of New Hampshire, who has been chief administrative office at Blue Cross Blue Shield of New Hampshire.

The prevention council and the advisory group held national and regional meetings and webinars to get ideas about prevention and may have received many comments from members of the health insurance community. The strategy reports offers recommendations for insurers and group health plan sponsors. But, in the press release announcing the national prevention strategy and a fact sheet giving more details, officials make no mention of private insurers or the prevention programs that insurers, employers, benefits consultants and wellness firms have developed.

Everyone agrees that the United States could save tens of billions of dollars per year if the country could address risk factors such as pollution, lack of exercise and lack of proper care for chronic conditions before people become seriously ill, officials say.

Improving wellness programs also could improve the overall productivity of the economy, because common chronic conditions such as asthma, high blood pressure, smoking and obesity each reduce annual productivity by between $200 and $440 per person, officials say.

The strategy includes 2 main goals – building healthy communities and eliminating health disparities – that may not have much effect on health insurers and private health plans.

The strategy also includes 2 other goals – expanding quality preventive services and empowering people to make health choices – could have more effect on private insurers and plans.

Officials suggest, for example, that health care professionals could use tools such as mobile phone applications, personal health records and health websites to encourage patients to take better care of themselves.

Strategy drafters also have identified what they say are 7 “evidence-based recommendations that are most likely to reduce the burden of leading causes of preventable death and major illness.”

The priority areas are:

• Tobacco free living.
• Preventing drug abuse and excessive alcohol use.
• Healthy eating.
• Active living.
• Injury and violence-free living.
• Reproductive and sexual health.
• Mental and emotional wellbeing.

In the prevention strategy report, officials do give 12 sets of ideas about ways employers and insurers could help the country achieve prevention goals.

In a section on community and preventive services, for example, officials suggest that employers can:

• Offer health coverage that provides employees and their families with access to a range of clinical preventive services with no or reduced out-of-pocket costs.
• Provide incentives for employees and their families to access clinical preventive services, consistent with existing law.
• Give employees time off to access clinical preventive services.
• Provide employees with on-site clinical preventive services and comprehensive wellness programs, consistent with existing law.
• Provide easy-to-use employee information about clinical preventive services covered under PPACA.

Officials suggest that insurers can:

• Inform patients about the benefits of preventive services and offer recommended clinical preventive services as a routine part of care.
• Adopt and use certified electronic health records and personal health records.
• Reduce or eliminate client out-of pocket costs for certain preventive services, as required for most health plans by PPACA, and educate and encourage enrollees to access these services.
• Establish reminder systems for preventive services.
• Create linkages with and connect patients to community resources.