health care

PBN summit shows value in health reform, health and wellness programs

Posted 11/1/11

(Updated, 6:54 p.m., Nov. 2)

PROVIDENCE – The design and function of Rhode Island’s new health insurance benefits exchange – as well as how workplace health and wellness programs can improve the bottom line – took center stage Tuesday morning at the Providence Business News Summit on Health Care and Business.

Nearly 250 business leaders and human resources managers attended the event at the Providence Marriott Downtown.

In the first session, discussion focused on the soon-to-be created R.I. Health Benefits Exchange and how it will impact the health insurance equation.

The panel of experts included Lt. Gov. Elizabeth H. Roberts and R.I. Health Insurance Commissioner Christopher F. Koller, two of the leading architects of Rhode Island’s health insurance benefits exchange. They were joined by William Devereaux, a partner in the Providence-based law firm of Pannone Lopes Devereaux & West, Kristin Lewis, vice president of government affairs, public policy and compliance at Tufts Health Plan and Monica Neronha, vice president of legal services at Blue Cross & Blue Shield of Rhode Island, with Providence Business News Editor Mark S. Murphy serving as moderator.

The new exchange will serve as an online health insurance marketplace, according to Roberts. It will help Rhode Islanders better understand buying health insurance – what she called “the biggest purchase [consumers] make that they don’t understand” – which, at $16,000 to $20,000 a year, is like “buying a new car every year.”

As an information clearinghouse for consumers, the new exchange will be a resource for about 850,000 Rhode Islanders – anyone who does not participate in Medicare, according to Koller. He estimated that the exchange will also serve as the portal through which about 170,000 Rhode Islanders buy health insurance – including roughly 70,000 Rhode Islanders who will receive subsidies.

Tufts Health Plan’s Lewis offered what she saw as the lessons learned from the Massachusetts’ health insurance. “Overall, it has worked well,” she said, but said greater flexibility and collaboration was needed in working with health insurers to develop products suited for small businesses.

Blue Cross’s Neronha said that Rhode Island was ahead of the curve in implementing many of the new mandates under health reform, in particular, the development of patient-centered medical homes and the emphasis on primary care.

Devereaux said that health reform – and in particular the new reimbursement requirements for Medicare – have created what he called “a target-rich environment” to pursue fraud. He noted that there has been a dramatic increase in fraud-related prosecutions being brought by the federal government against providers.

The new exchange may grow the tools available to individuals and business, but by itself, it will not result in a big reduction in the cost of health insurance, according to Koller. The main driver of health insurance increases are medical costs, which are 90 percent of the bill, he said. As an example, he pointed out that primary care providers receive about 120 percent of the rate of Medicare reimbursements, while many specialists receive about 350 percent of the rate of Medicare reimbursements. “There needs to be more transparency in contracts between health insurers and providers,” he said, to make the disparities in rates more visible.

The second session, on the economics of health and wellness programs in the workplace, featured presentations by Anne Marie Ludovici-Connolly, Dr. Rajiv Kumar, founder and chairman of ShapeUp, the largest statewide wellness program in Rhode Island, Mark Converse, the regional health and wellness expert at USI Insurance of New England, and Dr. Paul Kasuba, senior vice president and chief medical officer of Tufts Health Plan.

Ludovici-Connolly offered an overview of how to develop a strategic approach to implementing wellness campaigns in the workplace, championing the need for senior management to lead the charge. She told of how she helped Yahoo!, one of her corporate clients, use a “Go Healthy” campaign to increase employee participation, taking advantage of the go-green corporate culture.

Converse discussed his experience in implementing a health and wellness program at AAA, saying that these programs were an evolution and not a revolution, and that they needed to be evaluated as a long-term investment. He also stressed the importance of tying potential increases in health insurance costs to employees’ decision to participate.

Kumar described the importance of using the social network of the workplace to encourage participation, in order to make it fun for employees, rather than seem like a transaction. He also said that as a selling point, the importance of building a healthy working environment to attract and retain talent is a cost-effective argument.

Kasuba also said that it was important to have more than a plug-and-play approach to health and wellness, building a plan that is sustainable.

At the summit, PBN announced a new program to recognize employers that have strong, effective health and wellness programs in the region. Winners of “Healthiest Employers 2012,” conducted in partnership with Healthiest Employers Inc., a third-party national research firm, will be recognized in April 2012. The recognition program is sponsored by Tufts Health Plan. Employers in Rhode Island and Bristol County in Massachusetts are eligible to apply.

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