Wellness

Residents of D.C. love to talk about their Safeways. Apparently, so do Members of Congress.

During the mark up of Senate Finance Committee's bill in September, Senators John Ensign (R-NV) and Tom Carper (D-DE) introduced an amendment that increased the financial rewards companies could offer their workers for meeting certain health goals and criteria such as losing weight, lowering their cholesterol or quitting smoking. Pushing hard for this change, were companies like Safeway which puts a great deal of stock in their efforts to help manage and improve their employee's health, as explained this week in by the LA Times:

Nationwide, 25,000 nonunion employees in Safeway's health insurance plan are eligible for the premium-reduction program, most of them in California. The company says that 74% have signed up.

Once a year, participants submit to tests of four health risk factors: smoking, obesity, blood pressure and cholesterol. If they pass all four, they receive a $780 annual discount, which is 20% of the total cost of their insurance. If they do not pass initially but make progress in some areas -- quitting smoking or losing 10% of their weight -- they can get a premium rebate.

This post appears on the National Journal's Health Care Experts Blog where you can also see what other health policy analysts have to say about ways to promote wellness through health reform.

This is another example for which both God and the Devil are in the details. No one disputes that some behavioral choices -- smoking, diet, regular exercise, age and condition-appropriate screenings -- affect health status, expected health costs, and therefore, our collective average premiums. It seems perfectly reasonable, especially to economists and to those who make good choices already, to use incentives to encourage socially responsible choices and to discourage those that impose costs on others. At the same time, smoking is addictive and extremely hard to quit for some people who really want to, obesity can be caused or exacerbated by genetics and often comes with co-morbidities like depression that make financial incentives ineffective, and some people can only afford to live in neighborhoods with no stores that sell fresh fruits and vegetables and with little safe walking space. So how to reward good behavior without punishing the unlucky?

Former Senate Majority Leader Bill Frist was in town the other day, and we had a chance to talk for a bit after he took part in a distinctly nonpartisan discussion about social determinants of  health (and how much of it comes down to education). While he isn't closely involved in the health reform efforts in Washington, he is watching from afar - and he sounded a lot more encouraged as an outside-the-Beltway Republican than some of his colleagues sound here inside.

Frist divides his between teaching at Vanderbilt, work in global and public health, and his affiliation with a private investment firm focused on the healthcare industry.

Truth be told, we are not exactly sure what a "fryolator" is, but it's probably a good thing that the Somerville, Mass high school no longer has one.

With bike lanes and pedestrian crosswalks on its streets, healthful food in its school cafeterias, and cheap salsa classes offered by its recreation department, Somerville has become a model "Fit City." Healthy policy, the town has found, creates healthier people, and other communities are paying attention, the Boston Globe reported this week.

Five years after the Boston suburb embarked on an ambitious collaboration with Tufts University called Shape Up Somerville to see whether systemic changes that encourage healthy eating and physical activity would help children stave off obesity, 10 communities across the country have begun testing whether they can replicate Somerville's success. In a separate initiative, the Robert Wood Johnson Foundation plans today to name Somerville one of nine "leading sites" for a $44 million "Healthy Kids, Healthy Communities" program that will spread to 70 communities. The state expects to launch a wellness program informed by innovations in Somerville and elsewhere.

A few months ago we wrote about a provocative study that questioned whether job-based wellness programs really paid off—and if so when, and for whom. If a business pays for wellness and prevention in 2008, would any of the workers still be on that payroll when the health-savings accrued years in the future (assuming that the investment did pay off in better health and lower costs?)

It's going to take more than one more study to answer that question, but new research from Blue Cross and Blue Shield of North Carolina does provide some encouraging results. According to a report in the Raleigh News and Observer, companies willing to make even modest investments in wellness initiatives—such as health screenings in the workplace or giving workers paid time off for doctor's visits—saw a healthy return (pun intended) within a few years.

"The things that employees value the most aren't always the things that cost a lot of money, and in fact, it can be just the opposite," Don Bradley, chief medical officer for Blue Cross told the newspaper. "You don't have to build a gym, but just give the opportunity to get outside and do some exercise."