July 2011  |  Volume 2, Number 7

Contracts, Compliance and Research Updates

Series to Explore Health Reform and the Private Insurance Market

The Kaiser Family Foundation has launched a new series of short notes that will dissect and help explain the implementation of the Affordable Care Act (ACA) and the private health insurance market. The series, "Notes on Health Insurance and Reform," will feature timely posts that clarify complex regulatory and insurance topics, provide context for ongoing policy debates, and foreshadow significant implementation challenges. The series is part of the new Kaiser Initiative on Health Reform and Private Insurance which will examine the implications of changes in the private insurance market under the ACA and inform federal and state policymakers as they implement provisions of the health reform law.

There is growing interest in how many employers will continue offering coverage to their full-time employees once the ACA is fully implemented in 2014.


Some key points that will inform employers' decisions include:

  • What benefits larger employers would need to offer to meet the employer requirement;
  • How "nondiscrimination" rules will work; and
  • What the structure and scope of benefits will be for coverage offered through new insurance exchanges.

Employers offer health benefits to attract and retain workers, how employers react will ultimately determine how workers will weigh the cost and quality of the different options.


Click here to view the full employer health benefits balance sheet.
For more information on the Kaiser Initiative, click here
Comparing Health Care Quality
A National Directory
In every community across America, both good and bad care is being delivered in doctors' offices and hospitals. Bad care causes medical errors and poor outcomes, and wastes resources and money. That's why it is important to know if health care providers deliver high-quality health care by making sure patients get the right tests or the right treatment at the right time. Measuring and publicly reporting on the quality and cost of care physicians and hospitals provide is crucial to improving the quality and lowering the cost of care nationwide. This directory provides access to publicly available, free reports with information about the process of delivering care (for example, did patients get all the recommended care?), actual outcome for patients (for example, did patients die or have to return to the hospital?), what patients said in surveys about their experience with physicians or hospitals, and/or cost.

Click here to view the full article.
In This Issue
Contracts, Compliance and Research Updates
Comparing Health Care Quality
Wisconsin Updates


More information regarding Health Care Reform and other benefit resources is available on the HR360 website, available to BSG clients under the "Resources" menu of their HR Express website. HR360 includes new features including step-by-step interactive guides which make the processes of hiring, termination, COBRA and FMLA so much easier in addition to the new online tools such as job description builder and salary benchmarking tool.

BSG subscribes to this service for your benefit. If you would like more information regarding this resource please contact your account management team at BSG. 
Wisconsin Updates
Judge Upholds Wisconsin Domestic Partnership Law

Monday, June 20, 2011, a Dane County judge ruled that the state's Domestic Partner Registry does not violate the state Constitution. In a 53-page decision, Circuit Court Judge Daniel Moeser said the registry, which went into effect Aug. 1, 2009, does not violate the Marriage Amendment to the state's Constitution passed in 2006.

  • The Wisconsin Family Action group plans to appeal the ruling.
  • Chicago attorney Christopher Clark of Lambda Legal, who represented Fair Wisconsin, the state's largest gay rights group, and the five couples who intervened in the case, said the registry "creates a very limited set of rights for same-sex couples," such as, who can marry and who can join the Domestic Partner Registry. He also stated that there is a national movement toward protecting people's relationships and the families they create.
  • In addition, Clark said assertions during the campaign before the referendum by proponents of the Marriage Amendment, including Wisconsin Family Action, it would not prohibit the kinds of benefits the registry provides.
  • Republican Gov. Scott Walker and Attorney General J.B. Van Hollen do not plan to defend the registry because they feel it is unconstitutional.


Click here to view the full article.


Sound Bites: 2011 Chicago Health and Welfare Plan Management for Mid-Sized Employers Conference

The Chicago conference was held June 7-10, 2011. Gerald W. Frye, President, and Michelle Spehr, Wellness Manager, conducted a workshop titled: Green Light, Yellow Light: Starting a Wellness Program with a Yield for Health Care Reform. This session provided the nuts and bolts on how to get a sustainable wellness program revved up and running smoothly. Below are a few highlights from this program.   


Why Employee Health Status is of Growing Importance to Plan Sponsors:

Business Intelligence - Drivers

 Click here to enlarge image.


The main drivers of benefit plan performance can be segmented into four domains: employee health, employee behavior, market/provider behavior, and plan sponsor behavior. Macro drivers consist of corporate actions and culture, and the benefits marketplace. Micro drivers include activity in the plan, employee behaviors and utilization.


Weight of Drivers

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While the plan sponsor's strategic vision must focus on the four primary drivers of health care costs, not all domains carry the same weight. Employee health status drives an estimated 70% of health care costs. Actions that positively affect employee behavior can lead to improvement in health status, the ultimate pot of gold for lowering health care costs and improving productivity. However, improvement in employee health is also the most difficult driver to influence, due to variables including age, genetics, lifestyle choices, and access to quality care.


Effective Strategies to Improve Employee Health

AMSO Model

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Developing and implementing an effective wellness program that has a positive impact on employee health status can be intimidating and complicated. In an attempt to simplify an entire body of knowledge and literature relating to what we know about health behavior and lifestyle change, Dr. Michael O'Donnell, Editor and Chief of the American Journal of Health Promotion, developed a simple framework (the AMSO Model) that can help plan sponsors plan a new, or evaluate an existing, worksite wellness or health promotion initiative. What works best in promoting health? It all comes down to four simple components.

Improve Awareness (A): Raising employee awareness about health by providing health information is one aspect of an effective worksite wellness program. Awareness building tools can include Health Risk Assessment Surveys, health screenings, health fairs, posters, and education sessions. The relative importance of awareness is about 5 out of 100 points in the behavior change process.


Enhance Motivation (M): When it comes to behavior change, we have learned that little happens without some form of motivation. Financial incentives are one tool for engaging employees and, when well-designed, can often boost participation rates to more than 90%. The relative importance of enhancing motivation is about 30 points out of 100.


Build Skills (S): Unfortunately, the wellness program design for many plan sponsors stops with improving awareness and enhancing motivation. However, in order to influence meaningful changes in employee health, comprehensive programs must also provide opportunities for employees to build skills. This component is worth about 25 of 100 points of the framework. It's not enough to explain why you should change. It is also important to explain how to do the desired behavior and provide the answer to the question, "Am I doing it right?" Examples of skill building activities include expert instruction with practice, demonstrations, mentoring, or field trips.


Provide Opportunity (O): The final element of the model is creating a supportive environment that provides an opportunity to practice the behavior. This is the most important component, worth about 40% of the total. There are a number of powerful examples of how individual choice is influenced by our environment. Providing opportunity, according to O'Donnell, "is having access to the environment that makes choosing a healthy behavior the easiest choice." Examples include policy development (i.e., smoke-free workplaces), safe and convenient places for engaging in physical activity, and developing cultural norms that support health.



If you would like to learn more about how to define or refine your wellness program for optimal results, Gerald W. Frye and Michelle Spehr will be conducting a Webinar on July 21, from 1:00 - 2:00 p.m. CDT. 
Gerald Frye will also give an additional Webinar explaining the key driving concepts of the health care revolution and the employer's role in transforming health care on July 26, from 1:00 - 2:00 p.m. CDT.


For more information, please click here.

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The preceding is not intended to be and is not offered as legal advice. We are prohibited from the practice of law. Compliance is the responsibility of the employer or Plan sponsor and affected employees who should seek their own legal counsel regarding questions about information presented in this newsletter.

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