Though the Department of Health and Human Services and Department of Labor issued final regulations concerning “Incentives for Nondiscriminatory Wellness Programs in Group Health Plans,”1 employers and health plans must still navigate unresolved inconsistencies between the Affordable Care Act (ACA) and the Americans with Disabilities Act (ADA).
The latest ACA rules indicate that if a plan uses a “health-contingent” incentive scheme, that is employees are to meet certain standards related to a health factor (e.g., losing weight or controlling blood pressure) in order to receive a reward in the form of reduced premiums or deductibles, the plan must satisfy several requirements including offering a “reasonable alternative standard” for those who believe that the standard is not accommodating their unique circumstances.
The EEOC has remained silent on whether they deem wellness programs to be voluntary, a key concern of an agency committed to ensuring that all employees enjoy equal benefits and privileges of employment such as is guaranteed under the American with Disabilities Act (ADA).
Research from the New England Healthcare Institute has the world rethinking what the next great advance in health care will look like. While many of us are only now beginning to hear the noise about medication nonadherence, health care leaders are already hot on the trail to finding effective ways to reduce nonadherence.
At a recent Grand Rounds, a leading clinician medical ethicists told of a meeting with members of the family of a critically ill 6 week old boy who had been in a neonatal intensive care unit since birth. At the meeting were the mother and father, both sets of grandparents, an and aunt and uncle, three members of the hospital ethics committee and physicians and nurses who were caring for the seriously ill child. The one question that our speaker posed to the parents and any other family members that chose to offer a response:
What we found last week, when the Center for Medicare & Medicaid Services (CMS) released cost information for the 100 most common diagnoses and procedures in over 3,000 hospitals, is beyond Alice’s imagination. Some of the cost differences for the identical billing diagnoses qualify for “you cannot make this stuff up.”
We know Watson, the supercomputer, for its vast fund of knowledge and thinking prowess when machine bested man, defeating the all-time Jeopardy champ for games won, Ken Jennings (74), and Brad Rutter, Jeopardy’s highest money winner ($3,470,102), and winning against Jennings in a head-to-head Tournament of Champions. Now, Watson is flexing her considerable problem-solving muscle in medicine, and, more specifically, in clinical decision support. Indeed, the British edition of the online magazine Wired reports that “IBM’s Watson is better at diagnosing cancer than human doctors.”
In September 2011, IBM and Wellpoint announced an agreement to create the first commercial applications of the IBM Watson technology to improve patient care. Watson has been a diligent medical student for the past two years, with a voracious — perhaps insatiable — appetite for both structured and unstructured data, including human language.
Those seeking some clarity regarding the future of health care policy in the UK will be forgiven for being baffled by recent events. First up was an abortive attempt by the government to introduce a requirement for National Health Service commissioners (known as clinical commissioning groups –see my article on “Health Care Reform in England” in the August, 2012 issue of Managed Care to undertake formal market testing of services.
Earlier today, I was speaking with a physician colleague about his commitment to continue to improve person-centered care in his primary care practice and to enhance patient experience. We talked about the potential value of greeters in the practice, of a patient council to offer feedback and recommendations, and, with training, increasing the scope of service of medical assistants to allow nurses, advanced practice nurses, and physicians to spend more time with more complex care.
In April of last year, I wrote about the first release of recommendations from the American Board on Internal Medicine Foundation in conjunction with nine medical societies as part of a campaign: Choosing Wisely. The campaign aims to draw attention to and call into question commonly ordered tests like chest x-rays before surgery, frequently performed procedures like colonoscopies, and frequently prescribed treatments like antibiotics for upper respiratory infections.
Amgen is making a huge bet on biosimilars and helping to define the market.
The company announced that it is targeting 6 biotech blockbusters and will start selling them as biosimilars in 2017. The initial targets: Avastin, Herceptin, Rituxan, Erbitux, Humira and Remicade. That’s over $40 billion in product. Even a small savings, like 15% to 20%, would result in a huge change in premiums.
It is still unclear what hurdles will need to be cleared from the FDA and/or other regulatory bodies, but a few other things have become very clear:
The Department of Labor has issued new guidelines concerning the wellness provisions of the Affordable Care Act (ACA) that relate to the use of financial incentives, and the Office of Health Plan Standards and Compliance Assistance is seeking public comment. This document proposes “amendments to regulations, consistent with the Affordable Care Act, regarding nondiscriminatory wellness programs in group health coverage." These regulations increase rewards for wellness participation or outcomes from 20 to 30% or up to 50% related to reducing tobacco use.