Employee Health Promotion
in Massachusetts:
Federal and State
Regulatory Landscape
Tom Hubbard
Senior Program Director, NEHI
April 30, 2010 ● Waltham, MA
For Discussion
• Employee Health Promotion – Why Now?
• The Regulatory Landscape – Federal and State
• Key Questions
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Employee Health Promotion: Why Now?
Projected Changes in MA Working Age Population, 2005 – 2015
200,000
150,000
100,000
50,000
0
-50,000
16-19
20-24
25-29
30-34
35-44
-100,000
-150,000
-200,000
Number of people
Source: Trust for America’s Health; MassINC and Northeastern
University Center for Labor Market Studies, Mass Economy:
The Labor Supply and Our Economic Future, December 2006
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45-54
55-64
65+
Where Are the Employees Located?
MA Employers and Employees by Firm Size
60
56.9
48.3
50
%
40
% of Employees
% of Employers
30
19.6
20
13.4
9.9
10
8.5
13.7
13.1
8.6
8.1
0
<10
11 to 24
25 to 99
100 to 999
Employees
Source: Medical Expenditure Panel Survey, 2008
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1000+
The Regulatory Landscape – Federal and State
Self-Insured
Fully-Insured
Fundamental Concern:
Non-discrimination on the basis of health status
and pre-existing conditions
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The Regulatory Landscape – Federal and State
Self-Insured
Fully-Insured
 Incentives allowed for employee
participation in
wellness/prevention programs
AND for health status
 Premium discounts for small
employers allowed based on
employee ‘usage’ of wellness
programs
 Value of incentives capped at 20
percent of cost of coverage
 Employers (small and mid-sized)
may grant employees premium
discounts, based on usage of
wellness programs
 Other conditions apply – to
protect against discrimination on
basis of health status
-6-
The Regulatory Landscape – Federal
Self-Insured
Federal Health Care Reform
 Incentives allowed for employee
participation in
wellness/prevention programs
AND for health status
 5-year grants to small employers
 Increase value of employee
incentives to 30 percent of overall
premiums per employee
 Value of incentives capped at 20
percent of cost of coverage
 10 state pilot projects
 Other conditions apply – to
protect against discrimination on
basis of health status
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Key Questions
• How do we expand adoption among both self-
insured and fully-insured employers?
• How should we incorporate the use of
incentives?
– Among self-insured employers
– Among (state regulated) fully-insured employers
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Employee Health Promotion:
Opportunity and Challenge
for Massachusetts
April 30, 2010
Waltham, MA
www.nehi.net
Panelists
Phyllis Yale
Partner, Bain & Company
Director, Employers Action Coalition on Healthcare (EACH)
Thomas Hawkins, MD, SM
Dena Broderick, RN
Medical Director for Health Informatics,
Blue Cross Blue Shield of
Massachusetts
VP of Clinical Programs & Development,
Tufts Health Plan
Marie Chalmers
Alan G. Macdonald
Principal,
Advisory Enterprise Market Leader,
Mercer Health & Benefits
Executive Director,
Massachusetts Business Roundtable
Judith Frampton, RN, MBA
Eileen P. McAnneny
Senior VP of Government Affairs,
Associated Industries of Massachusetts
VP of Medical Management,
Harvard Pilgrim Health Care
Kerry Hands
Lynn Nicholas, FACHE
Vice President,
Small Business Solutions,
The Bostonian Group
President and CEO,
Massachusetts Hospital Association
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Employee Health Promotion:
Opportunity and Challenge
for Massachusetts
April 30, 2010
Waltham, MA
www.nehi.net