Tag Archives: Strategic Wellness & Insurance Management

Health Policy Is Vital to Tax Reform Policy

Today the House Ways and Means Committee is scheduled to hold a hearing on improving the competitiveness of American businesses. It should consider health policy as well as tax policy in its deliberations.

There is strong bipartisan support in Congress for cutting the corporate tax rate to improve competitiveness. If done in a revenue-neutral manner, as the Tax Reform Act of 1986 was, that simultaneously gets rid of inefficient tax loopholes that distort business decision making, this would be a good thing. But what is really holding back the international competitiveness of American businesses isn’t so much the tax code as our health system.

The United States is unique among major countries in that health insurance for the working population is provided almost entirely by employers.  And until the Affordable Care Act, they weren’t even required to do so; small businesses are still not required.

No one ever sat down and thought up this system; it came about by accident during World War II. Because of wage and price controls, employers couldn’t raise wages. But because so many young men were in the military and the large demand for war production, many businesses had an acute labor shortage.

To provide additional compensation to get the workers they needed, some businesses started offering health insurance on top of cash wages. Before the war, health insurance was rarely provided.

Although obviously a form of income to the worker, the Internal Revenue Service nevertheless ruled that it was not taxable, although businesses could still deduct the cost. This anomalous tax treatment was a fabulous tax loophole for both businesses and workers, especially at a time when tax rates were historically high.

Eventually Congress codified the I.R.S. ruling and we have been stuck with an employer-based health insurance system ever since. Although from time to time, politicians have suggested getting rid of the exclusion for health insurance and using the revenue to create an individually based health insurance system, such efforts have been short-lived and unsuccessful.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

New Advice to Move More After a Concussion

When young athletes sustain concussions, they are typically told to rest until all symptoms disappear. That means no physical activity, reading, screen time, or friends, and little light exposure, for multiple days and, in severe cases, weeks.

Restricting all forms of activity after a concussion is known as “cocooning.” But now new guidelines, written by an international panel of concussion experts and published this month in the British Journal of Sports Medicine, question that practice. Instead of cocooning, the new guidelines suggest that most young athletes should be encouraged to start being physically active within a day or two after the injury.

“The brain benefits from movement and exercise, including after a concussion,” says Dr. John Leddy, a professor of orthopedics at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, and one of the co-authors of the new guidelines.

There has long been controversy, of course, about the best ways to identify and treat sports-related concussions. Twenty years ago, athletes who banged their heads during play were allowed to remain in the practice or game, even if they stumbled, seemed disoriented, or were “seeing stars.” Little was known then about any possible immediate or long-term consequences from head trauma during sports or about the best responses on the sidelines and afterward.

Since then, mounting evidence has indicated that sports-related concussions are not benign and require appropriate treatment. The question has been what these appropriate treatments should be.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Wellness Efforts Need to Address Five Important Risk Factors

Employer-sponsored health plans cover more than half of the country’s nonelderly population, which is approximately 147 million people. Half to 70 percent of employers now offer high-deductible health plans, which encourage employees to take an active role in deciding the type of care they need. This requires employers to educate employees to become smarter healthcare consumers and to become motivated to take action.

Workplace wellness programs have the ability to help employees take action in the right direction toward healthy living. They have the potential to keep employees healthy and productive, avoid illness and absenteeism, and save them money by consuming fewer healthcare resources. Workplace health promotion programs that can do all that will provide value to employees and now just need to be cost-effective at the same time.

Many small and mid-size companies are unsure if they have resources to support a comprehensive program. However, more and more experts suggest looking to scientific evidence to gain a best practices approach to developing company-wide wellness initiatives. By focusing on five major risk factors, it is believed that employers of all sizes can positively impact overall health and productivity at work.

Five Wellness Initiatives to Target in 2017

According to the 2015 From Evidence to Practice: Workplace Wellness that Works Study an effective wellness program needs to address the following five basic health concerns through creative and empowering strategies: exercise, nutrition, tobacco cessation, stress management and sleep.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

 

You Can Take Steps to Lower Your Breast Cancer Risk

Fear of breast cancer is widespread, yet many women don’t realize that adopting protective living habits may help keep it at bay. The habits described below may also help to ward off other life-threatening ills, like heart disease and diabetes.

Certainly, women have ample reason to worry about breast cancer. The disease is very common. One woman in eight in the United States will develop it in the course of a lifetime. The American Cancer Society estimates that this year 252,710 new cases of invasive breast cancer will be diagnosed, and 40,610 women will die from the disease.

Regular screening is touted as the most effective way to reduce breast cancer deaths, although experts continue to debate who should be screened, how often and at what ages. But not nearly enough is said about what women can do on their own to lower their risk of getting breast cancer in the first place.

One of the most important actions is an inaction: not smoking. The incidence of smoking has fallen significantly in the last half century, yet every day on the streets of New York I still see young women and teenage girls smoking. A decades-long study conducted among 102,098 women in Norway and Sweden found that, compared with nonsmokers, those who smoked 10 or more cigarettes a day for 20 or more years had a third higher risk of developing invasive breast cancer, and girls who started smoking before age 15 were nearly 50 percent more likely to get breast cancer.

An editorial in The Journal of Clinical Oncology last year stated that as many as 20,000 women in the United States continue to smoke even after a diagnosis of breast cancer. The authors, Dr. Barbara A. Parker and John P. Pierce of the University of California, San Diego, said breast cancer patients who quit smoking can add significantly to the benefits of postoperative chemotherapy and radiation.

Another important factor under personal control is weight. As body mass index, or B.M.I., rises, so does a woman’s risk of developing breast cancer, especially if she carries much of her excess weight around her waist. That’s because abdominal fat is particularly metabolically active, producing growth factors and hormones, including estrogen, that can stimulate the growth of breast cancer cells.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

 

House to vote Thursday on GOP Obamacare repeal bill

WASHINGTON — After wooing GOP moderates with extra money for patients with pre-existing conditions, House Republicans said they would vote Thursday on a revised bill to repeal and replace Obamacare — setting the stage for a high-stakes showdown on one of President Trump’s top priorities.

House GOP leaders announced the vote Wednesday night after weeks of negotiations, hours of wooing wavering Republicans, and a last-minute sweetener added to the bill: an $8 billion amendment to help patients with pre-existing conditions pay for higher premiums and out-of-pocket costs.

Republican leaders suggested they would have enough votes to pass the bill in the House, although the vote could be a down-to-the-wire squeaker. The decision to schedule the vote will ramp up the pressure on a clutch of still-undecided lawmakers, and Republicans clearly had momentum on Wednesday evening.

“I support the bill with this amendment,” said Rep. Fred Upton, R-Mich., after meeting with President Trump at the White House on Wednesday morning about his proposal to beef up funding to help individuals with pre-existing conditions. Upton is an influential player on health care policy, and he had previously opposed the bill amid concerns it would put insurance out of reach for those with chronic illnesses and other health conditions.

Another holdout, Rep. Billy Long, R-Mo., also switched from a “no” to a “yes” after meeting with Trump and working with Upton on his amendment.

The biggest sticking point so far: the provision in Obamacare that bars insurance companies from discriminating against those with pre-existing conditions. The current GOP bill would dramatically weaken that, by allowing insurance companies charge people with pre-existing conditions —anything from cancer to pregnancy — higher premiums than other consumers.

That change prompted Upton’s push to add the extra $8 billion to help sicker patients pay their premiums and other health care bills. Upton and Long both sit on the House Energy and Commerce Committee, which has played a central role in drafting the GOP bill, called the American Health Care Act.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

An Hour of Running May Add 7 Hours to Your Life

Running may be the single most effective exercise to increase life expectancy, according to a new review and analysis of past research about exercise and premature death. The new study found that, compared to nonrunners, runners tended to live about three additional years, even if they run slowly or sporadically and smoke, drink or are overweight. No other form of exercise that researchers looked at showed comparable impacts on life span.

The findings come as a follow-up to a study done three years ago, in which a group of distinguished exercise scientists scrutinized data from a large trove of medical and fitness tests conducted at the Cooper Institute in Dallas. That analysis found that as little as five minutes of daily running was associated with prolonged life spans.

After that study was released, the researchers were inundated with queries from fellow scientists and the general public, says Duck-chul Lee, a professor of kinesiology at Iowa State University and a co-author of the study. Some people asked if other activities, such as walking, were likely to be as beneficial as running for reducing mortality risks.

High-mileage runners wondered if they could be doing too much, and if at some undefined number of miles or hours, running might become counterproductive and even contribute to premature mortality.

And a few people questioned whether running really added materially to people’s life spans. Could it be, they asked rather peevishly, that if in order to reduce your risk of dying by a year, you had to spend the equivalent of a year’s worth of time on the trails or track, producing no discernible net gain?

So for the new study, which was published last month in Progress in Cardiovascular Disease, Dr. Lee and his colleagues set out to address those and related issues by reanalyzing data from the Cooper Institute and also examining results from a number of other large-scale recent studies looking into the associations between exercise and mortality.

Over all, this new review reinforced the findings of the earlier research, the scientists determined. Cumulatively, the data indicated that running, whatever someone’s pace or mileage, dropped a person’s risk of premature death by almost 40 percent, a benefit that held true even when the researchers controlled for smoking, drinking and a history of health problems such as hypertension or obesity.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

 

Should 15,000 Steps a Day Be Our New Exercise Target?

Taking 10,000 steps per day is often suggested as a desirable exercise goal for people who wish to improve their health. But a new study of postal workers in Scotland suggests that that number could be too conservative and that, to best protect our hearts, many of us might want to start moving quite a bit more.

It has been almost 70 years since the publication of the London Transit Workers Study, a famous work in which researchers tracked the heart health of London bus drivers and conductors. They found that the conductors, who walked up and down bus aisles throughout the workday, were substantially less likely to develop or die from heart disease than the drivers, who sat almost constantly while at work.

This study was one of the first to persuasively show that being physically active could lower someone’s risk for heart disease, while being sedentary had the opposite effect.

Since then, countless large-scale studies have substantiated that finding, and at this point, there is little doubt that moving or not moving during the day will affect the health of your heart.

So for the new study, which was published this month in The International Journal of Obesity, researchers at the University of Warwick in England and other institutions decided to refer back to but also advance and expand upon the results of that foundational Transit Workers Study by examining another group of employees whose workdays involve mostly walking or sitting. They turned to postal workers in Glasgow, Scotland.

The Glaswegian mail carriers generally cover their routes on foot, not by driving, and spend many hours each day walking, the scientists knew. But the mail service’s office workers, like office workers almost everywhere, remain seated at their desks during the bulk of the workday.

This sharp contrast between the extent to which the workers move or sit during the day could provide new insights into the links between activity and health, the scientists felt.

They began by recruiting 111 of the postal-service workers, both men and women, and most between the ages of 40 and 60. None had a personal history of heart disease, although some had close relatives with the condition.

The researchers measured volunteers’ body mass indexes, waist sizes, blood sugar levels and cholesterol profiles, each of which, if above normal, increases the chances of cardiac disease.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

A Positive Outlook May Be Good for Your Health

“Look on the sunny side of life.”  “Turn your face toward the sun, and the shadows will fall behind you.”  “Every day may not be good, but there is something good in every day.”  “See the glass as half-full, not half-empty.”

Researchers are finding that thoughts like these, the hallmarks of people sometimes called “cockeyed optimists,” can do far more than raise one’s spirits. They may actually improve health and extend life.

There is no longer any doubt that what happens in the brain influences what happens in the body. When facing a health crisis, actively cultivating positive emotions can boost the immune system and counter depression. Studies have shown an indisputable link between having a positive outlook and health benefits like lower blood pressure, less heart disease, better weight control and healthier blood sugar levels.

Even when faced with an incurable illness, positive feelings and thoughts can greatly improve one’s quality of life. Dr. Wendy Schlessel Harpham, a Dallas-based author of several books for people facing cancer, including “Happiness in a Storm,” was a practicing internist when she learned she had non-Hodgkin’s lymphoma, a cancer of the immune system, 27 years ago. During the next 15 years of treatments for eight relapses of her cancer, she set the stage for happiness and hope, she says, by such measures as surrounding herself with people who lift her spirits, keeping a daily gratitude journal, doing something good for someone else, and watching funny, uplifting movies. Her cancer has been in remission now for 12 years.

While Dr. Harpham may have a natural disposition to see the hopeful side of life even when the outlook is bleak, new research is demonstrating that people can learn skills that help them experience more positive emotions when faced with the severe stress of a life-threatening illness.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Pop a Pill for Heartburn? Try Diet and Exercise Instead

Many Americans would rather take a drug than change their habits to control a persistent ailment. Yet, every medication has side effects, some of which can be worse than the disease they are meant to treat. Drugs considered safe when first marketed can turn out to have hazards, both bothersome and severe, that become apparent only after millions of people take them for a long enough time.

Such is the case with a popular class of drugs called proton pump inhibitors, or P.P.I.s, now used by more than 15 million Americans and many more people worldwide to counter an increasingly common ailment: acid reflux, which many people refer to as heartburn or indigestion.

These medications are now linked to a growing number of complications, ranging in seriousness from nutrient deficiencies, joint pain and infections to bone fractures, heart attacks and dementia. While definitive evidence for most of the risks identified thus far is lacking, consumers plagued by acid reflux would be wise to consider an alternative approach, namely diet and lifestyle changes that can minimize symptoms and even heal damage already done.

Acid reflux is more than just a nuisance. It involves the backward flow of stomach acid into the tissues above it. It results when the lower esophageal sphincter, a ring of muscle between the esophagus and the stomach, fails to close tightly enough to prevent the contents of the stomach from moving up instead of down. Sometimes the upper sphincter, between the esophagus and the throat, malfunctions as well.  Acid reflux is a serious disorder that can and must be treated to prevent symptoms and stave off potentially life-threatening consequences. Known medically and commercially as GERD, the acronym for gastroesophageal reflux disease, repeated bathing of the soft tissues of the esophagus with corrosive stomach acid can seriously damage them and even cause esophageal cancer, which is often fatal.

Contrary to what many believe, heartburn is but one of the many symptoms of GERD, and failure to recognize the others when heartburn is not among them can result in harmful untreated reflux. In addition to indigestion, GERD can cause a persistent dry cough, sore throat, frequent throat clearing, hoarseness, burping or hiccups, bloating, difficulty swallowing and a sensation of a lump in the throat.

If, when faced with such an otherwise unexplainable symptom, your doctor fails to think of GERD as a possible reason, you might suggest it yourself. An examination of the esophagus may be the only way to find out if someone without obvious heartburn has acid reflux but doesn’t know it.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Aetna, UnitedHealth show increasing appetite for value-based care contracts

The biggest health insurers are moving quickly towards value-based care arrangements, their recent earnings reports show.

While Aetna has long-held a goal to reach 75 to 80 percent of its medical spend in value-based relationships by 2020, Aetna’s medical spend is now 45 percent tied to value, CEO Mark Bertolini said during last week’s fourth quarter earnings call.

“One way we measure our success is by how well we are able to keep our members out of the hospital and in their homes and communities,” Bertolini said. “For example, in 2016, we reduced total acute admissions by approximately 4 percent, and we deployed predictive modeling to target members at the greatest risk of readmission.”

Aetna has achieved a 27 percent reduction in readmission rates using multidisciplinary care teams that engage facilities to develop effective discharge plans, he said.

“Collectively, these clinical programs have driven a best-in-class Stars readmission rate among national competitors,” he said.

Aetna sees more opportunities for reducing utilization over the long-term in readmission rates, and in a reduction in inpatient days. Unit price is still the driver in value-based purchasing, Bertolini said.

“I think value-based contracting is going to continue to be encouraged by even the current administration as a way of getting a handle on healthcare costs,” he said. “We have a healthy pipeline of opportunities. They will not all be joint ventures. I think there are other models emerging.”

UnitedHealthcare is increasingly helping states manage care for their complex, vulnerable and most costly populations, as well as assisting employers with programs to support the needs of retirees and employees with chronic conditions, according to CEO Stephen Hemsley in the insurer’s earnings report.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary