PEBB Moves Forward with New Health Engagement Model
The goal is to reduce costs and improve the health of state employees
May 20, 2011—The Public Employees Benefit Board (PEBB) is on the verge of creating a health plan designed to encourage people to take greater responsibility for their health.
The plan will be available to 150,000 state employees and their dependents starting next January. Kaiser Permanente and Providence Health Plans will provide the benefit coverage. Although open to anyone, the plan is primarily aimed at people with chronic health conditions.
Called a “health engagement model,” members will complete a health risk assessment and biometric screening. Then, depending on their health risks, they may have to enroll in a smoking cessation or weight management program.
No one will be required to lose weight or stop smoking, emphasized Joan Kapowich, PEBB’s administrator. The goal is to provide classes and other information enabling people to develop closer relationships with their providers and make healthier choices.
The state of Illinois offers a similar program as does Intel. Its wellness program, known as “Health for Life,” gives employees access to “wellness ambassadors” who provide coaching.
By offering such a plan, the goal is to reduce healthcare costs and help people become healthier, said Rocky King, vice chair of PEBB and interim director of healthcare purchasing for the Oregon Health Authority. “You engage individuals in managing their own health.”
Other board members agreed.
“It’s a more holistic approach,” said Jeanene Smith, administrator of the Office for Oregon Health Policy and Research.
“It’s exciting,” said Rich Peppers, who chairs PEBB and is the assistant executive director of SEIU Local 503. “It’s a really ambitious program.”
Kapowich believes “most people want to do the responsible thing” when making healthcare decisions. But they don’t always follow the advice of their provider. For example, someone with diabetes may not choose to eat healthier foods or exercise regularly.
This health engagement model could help them understand the consequences of their choices and, hopefully, change their habits, Kapowich said.
Those who don’t follow through with the program’s requirements will be forced to leave and face higher out-of-pocket costs for their healthcare.
At PEBB’s next board meeting, on June 15, more details will be available about the specific services and programs, Kapowich said.
There are risks, King said, because it’s not clear whether PEBB will actually be able to reduce costs. “No one has done it on the scale of 150,000 people. There’s not going to be immediate benefits. It’s common sense that it ought to cost less. The question is when.”
“It’s a different way to invest in their health improvements,” acknowledged Smith. “It’s a long term investment,” Smith said.
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Pure Socializm on the part of PEBB. What gives them the right to penalize me for doing something that is legal? Not only that but PEBB does not not have the authority by the constitution to try and regulate commerce which the Federal Government has already said Health Insurance is Commerce. Looks like they are just jumping on the band wagon of Obama Care. BTW the Appelite Court said the ACA is unconstituional anyways because of the penatly and mandatory aspect of the law. When the Supreme Court upholds the Appelate then this program, or should I say WW2 area Germany tatic will be unlawful.
What a joke!! If you work in government you know that just the development of this "plan" (throw definition out window) cost a lot of money. I'm sure there was a task force formed and I'm sure they were paid for their time. I'm sure that they had some catered meals and/or snacks, maybe rented a place to hold the meetings and maybe even some use of a state vehicle or some sort of allowance. The waste of papers and ink and administrative services must have been fairly high, after all the plan appears to be pretty lengthy. Then the implementation. Again, time to discuss, prepare, etc... roll it out. The the onslaught of upset state workers and tax payers in general. Let's not forget the cost of actually enforcing the plan. How many people were hired to deal with people who don't meet their deadline, lie or call to inquire about incorrect information; you know that will be the highest percentage of calls. It's stupid and very big brother like. As if people don't have enough in their lives to deal with, now this maintenance! Meeting someone's criteria?! I'm not saying that healthcare costs aren't going up while budgets are getting smaller. But why does the person that's paying the bill have to pay more? Could money be saved other places? Why don't people on welfare have to jump through such hoops? Why do people that can't show up to work 40% (not joking) get raises? What about programs like this? There's your waste! PEBB will be lucky if they don't get sued. Thanks for spreading it out the responsibility equally. I cannot wait to move out of this state!
So the choice is clear: Submit to their invasion of privacy and be treated like a child or pay an extra fee each month for keeping one's privacy and dignity.
Those who don’t follow through with the program’s requirements will be forced to leave and face higher out-of-pocket costs for their healthcare.
This says alot. If you do not do what you are told to do, you are out on your own. I am so glad that we have health insurance through our employer.
As far as I'm concerned the only person with the training and knowledge to tell me if I'm healthy or not is my family doctor. You cannot get the full picture of a persons "health" from a "one size fits all" form. For example, if PEBB employs the BMI (Body Mass Index) to determine if someone has a "healthy weight" then they are forgetting that some athletes tend to have a BMI in the "overweight" category because they have more muscle. A more accurate way to measure how much fat someone has is to get a "body composition scan" which costs $200. So, is PEBB willing to pay for such scans? What about people with high LDL (bad cholesterol) that is genetic and not diet related. Will those people be told what to eat and a year later be charged higher rates for their health care when they still have high LDL levels? I guess they could take medication for the problem, but will PEBB cover this?
While it is fine to encourage people to have a healthy lifestyle you cannot penalize them for having bad one. It will not work. So here's an idea PEBB. Try positive reinforcement and reward those of us who do have a healthy lifestyle. I'd love to get a rebate for maintaining a healthy weight and not smoking. It would help pay for my gym membership.
Edited my input:
This plan will cost way more in every way. Who has the knowledge to implement higher charges for patients who "could have prevented their condition by healthier living practices?" Opening the door to endless scrutiny of a person's medical condition, more tests and evaluations and more of the provider's and patient's time fighting for exceptions to all this invasive monitoring is not customer friendly. Added Stress to defending your health's condition is not a healing factor .I am positive it would cost more than less on all fronts, and deprive both providers and patients from forming the trust and team work that is needed to heal properly. Third party opinions and judgments cause untold misery in every walk of life.
No one has the right to judge a person's health; medicine is for healing, not demeaning people.
Thanks
This plan will cost way more in every way. Who has the knowledge to implement higher charges for patients who "could have prevented their condition by healthier living practices?" Opening the door to endless scrutiny of a person's medical condition, more tests and evaluations and more of the provider's and patient's time fighting for exceptions to all this invasive monitoring is not cuctomer friendly. Added Stress to defending your health's condition is not a healing factor.I am positive it would cost more than less on all fronts, and deprive both providers and patients from forming the trust and team work that is needed to heal properly. Third party opinions and judgements cause untold misery in every walk of life.
No one has the right to judge a person's health, medicine is for healing, not demeanin people
I think in theory that this might be a good model, but there needs to be careful planning before they really put it into action. With all the pay cuts looming for state workers, encouraging more close relationship with healthcare providers will require more visits to the doctor's office with more co-pays and higher out of pocket expenses. I understand the premise and appreciate that we should take more action on our part to care for ourselves, but don't forget that despite having health insurance, many people don't have it in their budget to pay for more frequent Dr. Visits and lab testing for "progress" reports. Something to think about...
That's classic. Cut out all benefits for treatment of painful foot conditions like neuromas, bunion, hammertoes then tell state employees to go out and get some exercise. The PEBB board cracks me up.
Dealing with unsustainable increases in health care costs in the US aboslutely requires more from the insured: (a) expect to pay more out-of-pocket and (b) take more responsibility for dealing with one's health as reported in USA Today, March 23, 2011 (Don't demand unnecessary care / Do your homework / ect.).