Real World Health Care Blog

Tag Archives: benefits

Live Updates from 15th Annual Patient Assistance & Access Programs

Because this blog is all about increasing access, lowering costs, and improving patient outcomes, we think there’s no better place for us to share ideas that work than to report live from the 15th Annual Patient Assistance & Access Program, in Baltimore, March 5-7.  Check back often as we publish updates from sessions, and follow all of the developments by following #PAP2014.

UPDATE 9:45  Resources for navigators: www.nationaldisabilitynavigator.org; patient advocacy groups such as AIDS Institute are publishing helpful sites.  Also marketplace.comment@cms.hhs.gov is a place you can send questions. This is monitored 24/7 with staff – not interns – but people who really know how to help.  These are triaged and go up to leadership when there are problems or trends.

UPDATE 9:40 Lessons learned:

  1. Partner’s are critical to success of ACA implementation; reach out early, often because plan selection often isn’t a one step process.  Patients need to come back many times before ready to sign up.  Very real “huge” health literacy gaps.
  2. Things to come: we are in closing days of enrollment.  March Madness may be a great opportunity for outreach; then we’ll reach out to those most in need; final week will be “here we are.”  So theme weeks continue.   After window closes Mar 31, you’ll soon start seeing promotion of the new window.

UPDATE 9:25 25 states and DC have indicated they will expand Medicaid.  About 85% of Americans already have minimum essential coverage.

UPDATE: 9:15 Health care law saved $8.9 M in drug costs for Medicare, said Janet Miller, Division of Strategic Partners, Office of Communications, Centers for Medicare and Medicaid Services.  2014 changes: no discrimination due to pre-existing conditions, annual limits on insurance coverage eliminated, small business tax credit increased; more people are eligible for Medicaid in some states.

Essential benefits include at least 10 general categories such as emergency services, hospitalization, maternity and newborn care, prescription drugs, mental health and substance abuse, lab services, preventive and wellness  services and chronic disease management.

Categories: Access to Care

Patient Advocacy Group Shares Solutions to Fuel Greater Participation in Workplace Wellness Programs

Workplace wellness is not a new concept, but it is definitely one that is recently gaining more importance.

With non-communicable diseases on the rise, many people are becoming more concerned about what lifestyle choices can be made to avoid them and stay healthy. Furthermore, businesses recognize the cost of stressed, out of shape, non-productive employees: increased health insurance costs,absenteeism, retention problems, and loss in productivity. Trying to take a more active role in the health of their employees, employers are creating and implementing wellness programs that encourage healthy behavior. Through incentives and rewards, companies are encouraging their employees to make healthy lifestyle choices like eating well and exercising regularly.

Melissa Kostinas

Melissa Kostinas

Despite the benefits of these programs, their success and sustainability can only be achieved through employee participation – which has been a challenging feat for many employers.  Without high participation, programs will result in limited return on investments for employers and might discourage them from implementing other programs in the future.  Because of this risk and the tug of war between cost and benefits, some companies find it too difficult and futile to implement workplace wellness programs.

Fortunately, there are solutions that help employers increase participation. First and foremost, companies should be focusing on the employees themselves – their needs, schedules, and interests – and design programs tailored to these considerations.

Employers should ask their employees: What gets you healthy? What motivates you to do what everyone knows is healthy behavior? We all have reasons for not doing what we know we should – time, access, knowledge, and cost. All these factors contribute to our denial.

Employees are busy, so the more a company can incorporate healthy eating and activity into existing schedules the more likely they are to embrace them. Easy access to workplace wellness programs makes a big difference. Onsite, or nearby programs offered during breaks or outside work hours also are great ways to tackle the time and access excuses.

Information and knowledge, while seemingly obvious, helps to motivate employees too. Of course we know we should exercise, but do your employees know that physical activity helps to prevent back pain?  It increases muscle strength and endurance, and improves flexibility and posture. With this knowledge, maybe the next time they get that twinge in their lower back they might think about exercise instead of painkillers. Providing reduced or no-cost programs will also boost participation rates. Coupled with incentives, like bonuses or rewards (e.g. allowing employees to trade in some of their unused sick days at the end of a year for an extra vacation day), rates of participation are likely to increase.

There are also management steps that can be taken to increase and maintain participation.

Unless employers are committed to employee wellness, the workplace wellness program becomes another ineffective plan that sounded good on paper but never achieved the anticipated results. The executives at Valley Health System understood the importance of managerial commitment. When they created Valley Health Workplace Connection the program managers worked closely with the health system’s managers to make sure all higher-level staff understood the importance of their involvement. Today, Valley Health Workplace Connection is a very successful workplace wellness program with high participation and employee satisfaction.

To ensure such success, workers from all levels should be actively engaged in programs. Planning should include processes to maintain communication with staff and the creation of program committees to guide intervention, observe participation, and adjust programs accordingly.

Additionally, program designers should consider all the major health risks in their targeted population as well as their business’ needs. Different programs should be offered at different levels, depending on characteristics of the recipients. The key is integrating health into the business. Policies governing the workplace wellness program should align with the organization’s mission, vision and values. They must affirm and communicate the value of good health and show commitment to engage workers in health enhancement. Again, a program is only effective if it reaches the intended audience and motivates them.

Pfizer recognized this and found that using programs like Keas got their employees more involved because it was engaging but less invasive. By making wellness a challenge and incorporating games and goals into the plan, Pfizer overcame the primary challenge in any wellness program — participation.

The bottom line is that wellness programs are gaining steam, but there are challenges. Having the support of management and creating a program that meets your employees’ needs will allow your program to overcome those challenges.  Be creative and remember: Wellness can be fun.

Filling the Financial Gap When Health Insurance Isn’t Enough

You can’t escape the headlines: rising expenses and high unemployment. And even for the employed, a sharp reduction in health benefits – coupled with a steep increase in out-of-pocket costs, including deductibles, copayments and coinsurance – is making access to life-saving and life-sustaining therapies out of reach for many Americans.

For some individuals and families, these out-of-pocket expenses can total thousands of dollars each month – much more than many folks earn.

When people in these circumstances need help, many turn to Patient Assistance Programs (PAPs), while others apply for financial assistance through independent non-profits such as The HealthWell Foundation. PAPs – which are offered by state governments or drug makers – are designed for those who cannot afford the cost of medication. Groups like Partnership for Prescription Assistance, NeedyMeds, RxAssistRxOutreach, and the National Center for Benefits (provided by the National Council on Aging), empower individuals to sort out their options and get connected to the PAP that’s right for them, sometimes even helping applicants fill out their paperwork.

What do all these organizations have in common? They focus on addressing the financial strains confronting individuals with health insurance who need important medical treatments but cannot cover their associated out-of-pocket costs and premiums.

Individuals like Marianne of Tarpon Springs, Florida, for example. For Marianne, living frugally her whole life didn’t help. Even though she had health insurance, paid all her bills on time, and once earned a good living as a librarian, the 70-year-old breast cancer survivor could not afford the medicine she needed to keep the cancer from coming back.

With no other alternatives to the $500-a-month life-saving medicine, the fixed-income senior citizen didn’t know where to turn. Until her doctors pointed her to the HealthWell Foundation.

Two years later, and thanks to the financial assistance she received from HealthWell, the still-healthy Marianne travels, cycles, and enjoys the life that continues to “delight and amaze” her.

“I am so fortunate,” she says. “I’ve always been glad to give back to others, and now that I’ve needed the help, I know just how precious it is to receive the kindness and compassion of others.”

Marianne is one of many Americans who benefit from organizations like HealthWell, which has provided copayment assistance to more than 164,000 patients since 2004. Without these critical funds, many of those living with chronic and life-altering illnesses would not have the treatments they need in order to live healthier lives.

No child or adult in the U.S. should go without health care because he or she cannot afford it.

How can charitable copayment assistance organizations partner with businesses, government and other stakeholders to achieve lower costs for health care treatment?

The HealthWell Foundation sponsors this blog.

Get the conversation going in the comments section.

Categories: Cost-Savings