Last week when I took my kids to the dentist I felt for the first time in the health insurance minority. Since starting my own law firm, the Center for Health Law Equity, LLC I no longer have employer-based health insurance; rather, I bought my coverage through the "Exchange" or healthcare.gov.
(For an interesting debate on whether the Affordable Care Act creates more opportunities for people like me to venture off on their own, read this article.)
When providing my new insurance information, the dental receptionist immediately asked for the name of the employer sponsoring the insurance, to which I replied, "I purchased this coverage through the Exchange." The receptionist looked dumbfounded, asking me to explain the Exchange. "Really?", I thought. How could a person working in health care, over a year into the health insurance marketplace with all the media coverage need explaining about the Exchange?
Regardless of the failings of my kids' new dentist in educating their front line staff of different insurance options, it is possible that I will not be in the health insurance minority for much longer. According to a a recent article by Bloomberg View, the number of people with job-based coverage has been steadily declining, from 59.2% in 2009 to 57.1% in 2013. Moreover, Obamacare is accelerating the trend: according to the Congressional Budget Office, by 2018 8 million fewer people will have job-based coverage.
As with anything new, people are apprehensive. But so far, other than my encounter with the dental receptionist, my personal experience with the Exchange has been satisfactory. It will be a shame if the US Supreme Court rules that subsidies are not available in federally-operated exchanges, which are the majority of exchanges in the U.S. As pointed out by Professor Tim Jost Congress could fix an adverse Supreme Court ruling through technical amendments, politics permitting.
In my opinion, widespread coverage through the Exchange would not be a bad thing. More people in the Exchange means a more robust individual insurance market, and more opportunities for creating a culture of health and wellness. Section 1201 of the Affordable Care Act (PHSA Section 2705(l) creates demonstration projects to expand health promotion programs in the individual insurance market. The demonstration project starts with 10 states, but expands to other states in 2017.
Creating more access to wellness programs in the individual market may open doors of opportunity for wellness providers to broaden the meaning of wellness in the United States. In a recent article in the Journal of Health Politics, Policy and Law, authors Heather Elliott, Jennifer Bernstein and Diana Bowman observe that in the United States, wellness is uniquely tied to the workplace; in other countries, such as Germany and Australia, wellness is embedded in their public health insurance systems and seen as a right for all. By expanding wellness to the individual insurance Exchange, the Affordable Care Act provides the United States with an opportunity to move wellness beyond worksite benefits that address diet, exercise or biometric goals. Through Exchange coverage, wellness efforts could encompass prevention programs such as transportation safety, preventive screenings, dental care, mental health as well as the social determinants of health. This is because wellness would no longer be tied to employer return on investment. Longer term investments could occur through Exchange wellness programs.
Expanding the breadth of wellness beyond current workplace programs could also widen the types of persons and providers involved in wellness. These providers might include community health workers, public health officers, holistic and alternative care providers in addition to health promotion professionals, personal trainers and dietitians. It is time to start the conversation on how collaborations of diverse providers can improve population health and wellness through the unique opportunities the Affordable Care Act presents.
Tuesday, January 20, 2015
Friday, January 9, 2015
The Principle of Imperceptible Success
A recent article from Modern Healthcare about the Affordable Care Act's population health efforts, available at http://www.modernhealthcare.com/article/20150108/blog/301089997&utm_source=AltURL&utm_medium=email&utm_campaign=am?mh, pointed out that the investment in these efforts may take time to see results.
So it goes with mostly all efforts to succeed. Whether it is investing in the health of populations or one person, or investing in yourself through education or a new venture, very rarely do the results happen overnight. Achieving success in health or business is like turning around a large ship: it takes a vision of where you want to go, and sustained effort and dogged commitment to getting there. Eventually, you achieve your goal even though the landscape in front of you seems to never change. But it is changing, little by little in imperceptible ways.
Take exercise as an example. On January 1, you set a goal to slim down and get in better shape. Each day you go to the gym and work out for your allotted time. After a few weeks, you step on a scale and see disappointment. Perhaps the scale moved, but not by what you had hoped. Or, perhaps it didn't move at all. You scratch your head, thinking about how much effort you have put into each work out, the perspiration and shortness of breath.
The truth is, by exercising, you are improving your fitness, such as your heart rate, blood pressure and glucose processing. See http://www.health.harvard.edu/newsletters/Harvard_Health_Letter/2012/July/exercise-helps-the-heart-even-if-it-doesnt-cause-weight-loss. Unless you are putting these measures to the test, you would not likely know you are succeeding.
Another example is found in building a business. When first starting out, there are many days where you may feel like all those meetings, pitches, speeches, articles, or other business development activities are not paying off. The phone isn't ringing, and no one is reaching out. But, you are making progress. All those efforts are whetting the appetite of your future customers. Persistence and a clear vision will pay off, eventually. And when it does, it probably won't hit you like a ton of bricks, but just feel completely natural. That's because you had been succeeding all along.
So it goes with mostly all efforts to succeed. Whether it is investing in the health of populations or one person, or investing in yourself through education or a new venture, very rarely do the results happen overnight. Achieving success in health or business is like turning around a large ship: it takes a vision of where you want to go, and sustained effort and dogged commitment to getting there. Eventually, you achieve your goal even though the landscape in front of you seems to never change. But it is changing, little by little in imperceptible ways.
Take exercise as an example. On January 1, you set a goal to slim down and get in better shape. Each day you go to the gym and work out for your allotted time. After a few weeks, you step on a scale and see disappointment. Perhaps the scale moved, but not by what you had hoped. Or, perhaps it didn't move at all. You scratch your head, thinking about how much effort you have put into each work out, the perspiration and shortness of breath.
The truth is, by exercising, you are improving your fitness, such as your heart rate, blood pressure and glucose processing. See http://www.health.harvard.edu/newsletters/Harvard_Health_Letter/2012/July/exercise-helps-the-heart-even-if-it-doesnt-cause-weight-loss. Unless you are putting these measures to the test, you would not likely know you are succeeding.
Another example is found in building a business. When first starting out, there are many days where you may feel like all those meetings, pitches, speeches, articles, or other business development activities are not paying off. The phone isn't ringing, and no one is reaching out. But, you are making progress. All those efforts are whetting the appetite of your future customers. Persistence and a clear vision will pay off, eventually. And when it does, it probably won't hit you like a ton of bricks, but just feel completely natural. That's because you had been succeeding all along.
Monday, January 5, 2015
The Appeal of Morbidity Compression
In the dark, cold wintry months of December I had the privilege and pleasure of listening to the WELCOA 7 Benchmarks presentation - a four-week long course that teaches successful wellness program design. You can learn more about that webinar series as well as others by going to: https://www.welcoa.org/events/?showcategory=41.
David Hunnicutt, the presenter, offered fascinating information and tips. One of the most interesting pieces of information were graphs that showed how one could compress his or her "morbidity" or sickness level until the very end of one's life. In other words, by choosing healthy behaviors, you have a better chance of living a healthy life, free from major illness, for most of your life, even while others who did not make such wise choices suffer from debilitating pain. According to Mr. Hunnicutt, 50% of an individual's health status is attributed to health behavior and that after age 40, most people are unable to "ride the crest of youth" to feel healthy despite their behavior.
Providers and organizations that invest in and deliver wellness services to others have so much potential in making a significant difference in quality of life. As a society, we must pay more attention to these providers and organizations by integrating them into health care delivery solutions and supporting them with laws and policies that increase access. The Affordable Care Act (ACA) is a start. The ACA creates a number of incentives to collaborate with wellness providers, such as the Medicare Shared Savings Program and Community Health Teams. It also provides grants to expand workplace wellness programs. These are good things that should be touted and leveraged. Health Care That Matters, Inc. aims to find providers and organizations who are taking advantage of these initiatives and spreading wellness to the masses. If you know of someone who fits that description, please contact us.
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