PBN summit to explore navigating health reform

A summit sponsored by Providence Business News will bring together leaders from the legal, health insurance, regulatory and workplace-wellness communities to explore how businesses can better navigate health care reform and the new requirements of the Affordable Care Act.
The summit, to be held on Nov. 1, from 7:30 to 11 a.m., at the Providence Marriott, will also examine how companies can build wellness programs in the workplace that can increase productivity and help to create a healthier work force.
Panelists include: Lt. Gov. Elizabeth H. Roberts; R.I. Health Insurance Commissioner Christopher F. Koller; Monica Neronha, vice president of legal services at Blue Cross & Blue Shield of Rhode Island; William P. Devereaux, attorney and partner at Pannone Lopes Devereaux & West LLC; Kristin Lewis, vice president, government affairs, public policy and compliance, Tufts Health Plan; Dr. Paul Kasuba, chief medical officer, Tufts Health Plan; Dr. Rajiv Kumar, founder and chief medical officer of ShapeUp; and Mark Converse, regional health and wellness expert at USI Insurance of New England.
Moving forward with health care reform, Roberts told PBN the establishment of the new R.I. Health Benefits Exchange is a “very important benchmark.” The exchange, she said, will function “more as a dot.com, than a dot.gov approach, with investments to build an entirely new technology platform.” Roberts said that a nationwide search is under way to find a director for the new exchange, with the expectation that the person will begin work early in January.
Koller concurred with Roberts about the importance of the new exchange. “The health-benefits exchange, when operational, will give people a place to shop for health insurance,” Koller said. “They will be able to compare prices, products and insurers, and pick the best one for them. In addition, if people qualify for RIte Care or federal subsidies, the exchange will be able to match them up.” When asked what employers can do to help to lower health insurance costs for businesses in Rhode Island, with medical costs rising 9 percent a year, Koller said there is a need to change the way medical care is paid for, organized and used. “Eighty-five percent of your premium pays for medical care.” Koller said. “Businesses can support the work that is going on in Rhode Island in three ways: purchase smart insurance products that encourage use of a patient-centered medical home by employees; tell employees to sign up for currentcare – the state’s health-information exchange; and support OHIC’s work for comprehensive rate-review and provider-payment reform.”
Change will not be easy, Koller continued. “To improve the accessibility, affordability and quality of Rhode Island’s health delivery and insurance system, [it] will require changes in provider, insurer, purchaser and consumer behavior,” he said.
Tufts Health Plan’s Lewis said that “insurance expertise” is critical to the success of Rhode Island’s exchange. “It’s extremely important to develop a collaborative process between health insurers and the exchange staff to ensure that the plan designs, the systems and the process are appropriate and consumer-friendly.”
Beginning in 2012, there are several provisions of the Affordable Care Act that are scheduled to go into effect, said Blue Cross’ Neronha. These include a provision that insurers issue a summary of benefits and coverage and uniform glossary to consumers. The goal, she continued, is “to provide consumers with easy-to-understand, consistent and comparable information about their health plan benefits and options.” In addition, these documents will include up to six coverage examples to illustrate how the health plan would cover services in different situations, such as managing a chronic condition like diabetes or having a baby. Quality-of-care reporting requirements will be put into effect over the next year, she continued. They will require health insurers to report on covered benefits and health care provider reimbursement as they relate to improving health outcomes, including preventing hospital readmissions, improving patient safety, reducing medical errors and promoting health and wellness activities.
From the business perspective, the tax credit available to small businesses that provide health insurance to employees continues to be a good way for such companies in Rhode Island to offset a portion of their health care spending, according to Neronha.
Tufts Health Plan’s Kasuba sees the summit as an opportunity to promote the concept of health wellness to both individuals and employers. It is always a challenge to demonstrate the benefits of wellness programs in the workplace in terms of special health outcomes, he said. “We have worked with New Balance and EMC in Massachusetts, which both have very active and robust health and wellness programs, and we have seen a reduction in absenteeism, and a growing sense by employees of ‘healthiness,’ ” he said. “People are less absent from work, more productive, and have a general sense of well-being; they’re happier.”
The secret to success is for management to be engaged, according to Kasuba. Employers, he said, have to “set the standards for the company, embrace the concept, move it through the corporation and change the culture.”
Shape Up’s Kumar says that buy-in from senior leadership in the company is critical. “Because the workplace is not a natural environment for health promotion, it’s important that companies work toward building a culture of health.” &#8226