Wellness is a dynamic industry, and trends change quickly as health care evolves, technologies emerge, and innovations become best practice.
At my company, WebMD Health Services, we’re watching several key areas as we work with some of the world’s leading organizations to help them manage their population’s health and wellness.
1. The incentives evolution
Health care reform is making its mark on wellness, most recently with the government’s final regulations concerning the maximum rewards employers can offer under wellness programs beginning in 2014.
Some of these were expected, such as raising the maximum reward to 30 percent of the total cost of coverage for health-contingent wellness programs, and 50 percent for tobacco cessation programs.
But they also presented new concepts, including greater deference to an individual’s physician to determine whether a plan’s “reasonable alternative standard” is appropriate.
These clarifications are important as we see organizations moving toward more progressive incentive programs that focus on achieving specific health outcomes.
2. Integrating transparency with wellness
The Patient Protection and Affordable Care Act (ACA) has also put healthcare transparency at center stage. Under the ACA, certain routine preventive care services are now mandated.
They can, however, have significant price variations. So can more complex services.
The industry is in full agreement that consumers need better cost transparency to make informed decisions. But price shouldn’t be the only factor – and shouldn’t exist in a vacuum.
We’ve long believed it’s important to integrate consumer guidance solutions – including cost, quality, news, alerts, educational content, and social networks – together with wellness.
As ACA requirements take shape, we’re working with customers to provide a holistic view of health and benefit information and resources.
3. A lifestyle approach to chronic conditions
To address healthcare costs and to boost productivity and quality of life, our customers are increasingly focusing on condition management.
Based on data derived from my company’s 2012 clients, consisting of over 225 of the country’s larger employer and health plans, about 15 percent of an employed population will have a chronic condition, and these individuals will drive 75 percent to 80 percent of health care costs.
We’re seeing more companies move away from traditional disease management and toward a lifestyle-oriented approach.
Building good habits like healthy nutrition, regular physical activity, and tobacco avoidance—along with medication adherence and routine monitoring—can help people with diabetes, heart disease, and other conditions live healthily and avoid complications.
4. Measurement and ROI
In business the bottom line always matters, and wellness is no exception.
While many programs initially measured participation only, more organizations are calculating true return on investment – and their methodologies are rigorous. Increasingly, we’re seeing customers take one of two approaches: claims-based ROI, or risk-based ROI.
Study design varies; a randomized control trial is the gold standard, but matched control assessment or population trend assessment can also be highly effective. Across WebMD Health Services 2012 clients, we saw per-person, per-year savings of $207 for total populations and $546 for coaching participants. That’s a powerful message to take to senior management when making the case for wellness.