Medicare Coverage of an Annual Wellness Visit to Establish a Personalized Prevention Plan, A Good Idea if Implemented Correctly


One of the most interesting pieces of legislation in the new Health Reform Bill is the Medicare Coverage of an annual Wellness Visit Providing a Personalized Prevention Plan. This legislation establishes a new type of office visit for a Medicare beneficiary and provides the beneficiary and their provider with some unique information and services. The key features of this new office visit will be:

1) A Health Risk Assessment (HRA)
2) A Visit with their physician
3) The completion of an individual’s medical and family history
4) A List of risk factors
5) The establishment of a screening schedule for the next 5-10years based upon both appropriate screenings for a general population as well as those based on the individuals specific risk factors
6) The furnishing of personal health advice and appropriate referrals to coaching and other health education

This is the first step and a major one to establishing a prevention focused approach to health care for Medicare beneficiaries. It is important that CMS establish this program appropriately. In the current proposed language, CMS is delaying the implementation of key features of this planned Wellness visit, in particular the implementation of an HRA along with the visit. For a truly new type of office visit focused on Wellness, how does one expect to get a Personalized Prevention Plan without the use of a Health Risk Appraisal to assist in the identification of a patient’s risks? Furthermore, a study in the Journal of Occupational and Environmental Medicine, (The Savings Gained From Participation in Health Promotion Programs for Medicare Beneficiaries, Ozminkowski et al, 48:11 p. 1125-1132 Nov 2006) stated the following conclusion:

Health promotion programs that were founded on HRAs saved Medicare money, often hundreds of dollars a year, due to reductions in medical expenditures. Those who participated in programs that involved the use of an HRA saved more than those who did not. Moreover, program participation that was not guided by the HRA usually did not reduce costs. Thus, the HRA should be the center or guiding force for subsequent participation.

For this new Wellness Visit to truly benefit the Medicare beneficiaries and their physicians, CMS should fully implement the program as per the legislation. The comment period for the current CMS proposed rules ends August 24, 2010. If you would like more information or to comment on these rules, please feel free to contact me at (904) 281-0006
The outcomes of these visits could well lead to a reduction in health risks and health care costs as has been demonstrated in employer populations resulting in More Good years for those with Medicare.


Author:

 

Frederic S. Goldstein

President

U.S. Preventive Medicine, Inc.

904.281.0006  Office

904.613.1224  Cell

FGoldstein@USPreventiveMedicine.com

 

Follow me on Twitter @ www.twitter.com/fsgoldstein

 

Accredited in wellness and health promotion by NCQA & disease management by URAC

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Last week, I had the chance to travel almost coast to coast discussing Prevention.  Leaving from Jacksonville, Florida, I started the week in Nevada where we are launching The Prevention Plan for the state’s public  employees through their Live Well, Be Well program.

 There I presented on how prevention can improve the health, lower costs and improve the productivity of the workforce to members of the Governor’s staff and his cabinet.  The presentation was well received and it was heartening to see the responses of the various agency leaders to the data presented on the total value of health. 

As the states face ever tighter budgets and are asked to do more with less, demonstrating that improved health results in improved productivity is a message that resonates with those responsible for curbing costs .

Following this presentation I flew into Washington, DC for a meeting with First Lady Michelle Obama’s staff on the Let’s Move Campaign. This program, whose goal is to solve the epidemic of childhood obesity within a decade, is a great start. The First Lady has gotten the attention of this country and it is now up to all of to work together to achieve this program’s goal.  You can learn more about the Let’s Move campaign at www.LetsMove.gov and also visit www.ahealthieramerica.org to learn about The Partnership for a Healthier America, which is supporting America’s move to raise a healthier generation of kids.


By Fred Goldstein, President, U.S. Preventive Medicine, Inc.
    

 

        

 

Southfield, MI / May 21, 2010 -- U.S. Preventive Medicine, Inc. has chosen to renew its three-year partnership with Summit Health to advance the company’s national preventive health agenda.

Under the contract, Summit Health will continue to provide worksite health screening programs for U.S. Preventive Medicine. A workplace screening is the foundation for the company’s high-tech, high-touch prevention benefit called The Prevention Plan. Summit Health's biometric screening is a crucial component in helping The Prevention Plan to identify a participant’s top health risks, provide a personalized plan to improve and sustain his/her health status, and to reduce the risk of disease onset and progression.

"Our partnership and ability to integrate with U.S. Preventive Medicine gives employers the seamless, high-touch, and high-quality integrated health management that is vital for long-term employee engagement and return on wellness investment,” said Richard Penington, president of Summit Health. “I’m delighted that we will continue to work with U.S. Preventive Medicine and support their important mission of prevention."

“The Prevention Plan is a complete program based on high-tech, high-touch assessments and interventions that help people understand and tackle their health risks,” said Christopher Fey, Chairman and CEO of U.S. Preventive Medicine. “Blood tests and biometric screenings are an integral component of this customized program and Summit Health has been instrumental in helping us take this program into the worksites of many of our national clients.”

“Employers, government agencies and individuals finally understand the power of prevention in lowering health care costs, and we’re pleased to work with Summit Health as our growth accelerates,” Fey added.

About Summit Health, Inc.
Founded in 1999, Summit Health is now the nation’s highest rated provider of on-site wellness programs, including health screenings, immunizations, coaching, and educational seminars. This focus on quality of service has earned Summit Health customers that include all leading health plans and over 80 Fortune 500 companies. Summit Health supports all sizes of companies in every zip code. Summit Health differentiates itself through excellence in regulatory and quality compliance, program management, data and claims expertise and the participant experience. For more information, visit www.SummitHealth.com.

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As we begin to see health care reform trickle down into our daily life, one item may be a wake-up call—the calorie counts on our favorite fast food meals. Section 4205 of the Affordable Health Care Act requires restaurant chains with 20 or more locations to disclose the number of calories in each menu item, along with suggested daily caloric intake and the availability of additional nutritional information. The information must be located on the menu and menu board or, for self-service restaurants, on a sign near each food offered. Even vending machine operators must provide a sign disclosing the number of calories in each food item offered.

The idea is that knowing the calorie counts of different options may encourage people to make healthier choices. Will you choose that when 703 calories (almost 400 of them fat) are staring you in the face? Your legislators are betting not. They have good reason to think so. A Stanford University study found that New York City Starbucks customers selected items with six percent fewer calories after the city began requiring chain fast food restaurants to post calorie counts. People who tended to buy high-calorie foods changed their habits more than the average Starbucks customer, lowering their calories by 26 percent.

Whether or not this experiment will translate into improved health nationwide, making healthier selection when eating out will most certainly become easier. If you’d rather not wait until January 2011 when the calorie-posting requirements kick-in, you can find out calorie counts in your favorite foods with a few mouse clicks. Most restaurant chains already provide this information online. Simply, go to a particular restaurant’s website to review the nutrition content of their foods. If you’re already in the restaurant, you can also ask the wait staff or manager for the calorie information of their menu.

Of course, nutrition information is just as important for the meals you make at home. If you want to make healthier food choices, read the nutrition label of foods you buy in the supermarket. You can also this information find many books that contain calorie and fat counters for a wide selection of foods. If you’re concerned about the foods you and your family are eating, you can also consult with a local registered dietitian on how to make healthier food selections.

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DALLAS, TX and CARSON CITY, NV (April 27, 2010) — State of Nevada public employees are taking steps to get healthier and feel better by participating in The Prevention Plan™, a U.S. Preventive Medicine® program designed to encourage healthy behaviors, detect disease in the earliest stages and manage chronic conditions before they progress. The program is projected to save Nevada taxpayers several million dollars over the next four years.

The Prevention Plan benefit is part of the “Live Well, Be Well” initiative by the State of Nevada Public Employees’ Benefits Program (PEBP), which promotes improved health to 44,000 employees and retirees. The Prevention Plan is open to PEBP PPO participants, who will receive a health assessment, one-on-one health coaching, personalized action plans and timely, relevant health information. PPO participants and their spouses or domestic partners with diabetes will receive intensive care management from The Prevention Plan. PEBP PPO Participants will begin enrolling on July 1, 2010.

“We are charged with two critical functions here at PEBP. One to deliver a quality health care program that is responsive to the individual’s specific needs and the second is to provide fiscal soundness for the long-term viability of our program,” said Jon Hager, chief financial officer of the Nevada Public Employees Benefits Program. “We consider The Prevention Plan a forward thinking program that will help us accomplish both goals and succeed in an increasingly difficult realm.”

The Prevention Plan will help Nevada PEBP employees and retirees:
1. Identify top health risks through an online questionnaire and biometric health screening.
2. Follow a personalized action program to reduce health risks, including one-one-one health coaching by registered nurse advocates and other prevention coaches.
3. Access a personalized website to store medical information, complete educational programs, receive reminders about needed screenings and track personal progress.
4. Understand and take advantage of the company’s health benefits and incentives.

PPO Participants who enroll in the program, complete a Health Risk Appraisal and receive a biometric screening will receive a $25 gift card. By taking healthy actions throughout the year and increasing their “Prevention Score,” a Prevention Plan innovation that helps members confidentially tally their personal efforts, members also can earn up to a $360 annual reduction in their health insurance premium beginning July, 2011.

“U.S. Preventive Medicine is very excited about partnering with the State of Nevada Public Employees’ Benefit Program. Nevada is ahead of the curve in providing this level of preventive health care services to reduce costs and improve people’s lives,” said Christopher Fey, CEO and chairman of U.S. Preventive Medicine. “This program can inspire employers throughout the state, as well as other states, to invest in the health of their employees and use the power of prevention to lower health care costs.”