US government is to promote “wellness” among its employeesBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1995 (Published 30 March 2011) Cite this as: BMJ 2011;342:d1995
The US government has vowed to lead by example in introducing a “new era” of health promotion and illness prevention among federal employees.
John Berry, director of the government’s Office of Personnel Management, said that the federal employment health benefits programme “will be the innovation leader in employer based healthcare” for wellness and prevention.
Speaking to executives from health insurance programmes serving government employees, Mr Berry said that he wants them to offer “concrete incentives to participate in wellness and prevention activities” from the start of next year. Priority areas will be to reduce the prevalence of obesity and ethnic disparities in health.
The federal government has already changed its health insurance policies in some areas. It now requires that plans offered to its employees do not charge copayments for preventive care. Smoking cessation programmes are particularly important. Plans must cover the cost of up to two tobacco cessation attempts, which must use FDA approved treatments, and up to eight counselling session a year.
“The latest peer reviewed science is clear: comprehensive cessation programmes can reduce hospitalisations for heart attacks and coronary heart disease by nearly 50%,” Mr Berry said. “I encourage you to please promote this benefit.”
Mr Berry has also required vendors operating catering services in federal buildings to offer fresher, healthier food options than in the past for the 2.65 million civilian employees across the country.
The new health plans have an even broader reach, covering an estimated eight million people, including workers’ families and people who have taken early retirement.
Mr Berry was understandably vague as to what types of programmes might qualify as “wellness,” leaving room for insurance plans to be creative. About 250 plans qualify for the federal employment health benefits, though only about 20 are nationwide in scope. They are run by for-profit insurance companies, health maintenance organisations, trade unions, and employees’ associations.
The plans are not allowed to discriminate on the basis of health risk and must meet other threshold criteria of coverage set by the government. But they are otherwise allowed to compete on the basis of additional benefits they might offer and the rates they charge. The worker pays one third and the government two thirds of the cost of the premiums.
Under this “managed competition” new benefits that prove popular in one plan are often quickly adopted by other plans. As a result only about 5% of employees change their plan in any given year.
Competition has kept the growth in costs well below that of Medicare, the government insurance programme for people over the age of 65. Medicare does not allow for competition.
Paul Ginsburg, president of the non-profit Center for Studying Health System Change, told the BMJ, “Wellness has become almost a new fad that companies have been very earnestly pursuing over the last three years.”
Although the federal government is behind some larger employers, he said, “it isn’t that far behind, and it certainly is ahead of smaller employers.” The goals of these programmes are to directly save money and also to encourage a more productive workforce.
Dr Ginsburg said that the most successful company wellness programmes have been those “with pretty broad and strong company leadership.” There is usually just a single health insurer. And the package often includes a change in management attitudes and in bricks and mortar by adding gyms and showers on site to encourage physical activity.
The federal government is much more fragmented than a company in terms of vision and health insurance providers. “So in a sense, the federal government is not well positioned to really pursue wellness with vigour,” Dr Ginsburg said.
Cite this as: BMJ 2011;342:d1995