Wednesday, December 10, 2008

Mental health parity legislation a civil rights victory, but price concerns remain

by Elena Skoura, Graduate Intern, bWell-informed

Congress passed a great victory for civil rights on October 3, 2008—the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Act. Named after the deceased Democratic Minnesota senator and the retiring New Mexico Republican senator, the law (HR 1424) requires group health plans of 51 or more employees to cover mental illnesses to the same extent as physical diseases. It is considered a fundamental step towards eliminating the stigma and prejudice the 113 million Americans suffering from mental illness have faced.

The new legislation, which goes into effect for most health plans on January 1, 2010, will extend mental health services to 82 million Americans who live in states that have not already passed mental health parity legislation.

This legislation requires health insurance companies to charge the same deductibles, copayments and out-of-pocket expenses for mental health treatments that they do for physical conditions. Plans are not obliged to offer mental health coverage or cover every mental health condition—but for what they do cover, the costs must be equivalent.

To address concerns that small businesses would find it hard to afford mental health coverage for their employees and might choose to eliminate it altogether, the legislation applies only to group health plans with more than 50 workers. However, small businesses may still be required to offer mental health parity if required by the laws of the state in which they operate.

While MHPA also doesn’t apply to insurance coverage in the individual/non-employment based market, the victory may ultimately impact consumers in the individual market as well. Legislative changes in group health plans often "trickle down" to other types of coverage. If the legislative changes were to apply to individual coverage, consumers could see prices rise considerably to cover the new levels of coverage. To keep plans affordable, some insurers might opt not to offer any mental health coverage at all.

While price remains a concern, the new legislation encourages hope that in the future, human welfare will be approached in a open-minded way. Mental illness should be acknowledged and treated with respect and concern, following the ancient Greek saying: “You shall have a healthy mind in a healthy body”—and vice versa.

Wednesday, December 3, 2008

For private Medicare insurers, the honeymoon is over

by Mary Hobson, CMO, bWell-informed

Way back in 1982, Congress fell in love with the idea of allowing private insurers to offer competitive HMO products as an alternative to traditional fee-for-service Medicare options. Seen through rose colored glasses, the marketplace was the cure for all Medicare’s woes. Through the magic of competition, private insurers would provide greater choice, reduced cost, and better quality service.

The legislative body was still in love with the idea in 1997, when it expanded the products private insurers could offer to Medicare eligible to include preferred provider organizations (PPOs), provider-sponsored organizations (PSOs), and private fee-for-service (PFFS) plans. And the love-fest showed no signs of abating even as late as 2004, when the Medicare Modernization act passed, raising payment rates to private providers.

Today, however, with an incoming Democratic regime, the Hill’s long-term romance with “free market” Medicare could be at an end. Helping the “breakup” along? A recent report issued by the respected health policy journal Health Affairs which indicates that taxpayers are actually paying more to subsidize private Medicare plans. Says Marsha Gold, senior fellow at Mathematica Policy Research who authored the report:

“Clearly, the Medicare Modernization Act (MMA) has expanded choice and the private-sector role. But it also has added to Medicare's complexity and costs and has created potential inequities, without apparent improvements in quality.”

While legislators’ ardor is likely to cool substantially, Medicare customers are still flocking to the plans in droves. Today, one in three Medicare beneficiaries with Part D now gets their coverage from private third party providers. Almost a quarter of all Medicare beneficiaries, more than 10 million people, are enrolled in private plans.

Ironically enough, the extra funding these plans receive--according to the report, they are paid 12 percent more on average--is one of the biggest reasons for their popularity. The added value averages more than $1,100 a year per patient, and some of that money goes to provide extra benefits like reduced cost-sharing or reduced premiums for add-on benefits like vision and dental care. A large percentage, however, goes to insurance company profits.

And while some Medicare recipients enjoy a few additional benefits, the overpayments have resulted in an overall rise in Medicare’s costs—with taxpayers and traditional Medicare plan beneficiaries picking up the tab.

2009 looks to be a year in which Congress takes a stand, with support from the White House. On the campaign trail, President-elect Barack Obama called for eliminating the excessive subsidies and paying private plans only what it would cost to treat the same patients under traditional Medicare. Whatever happens, it’s clear that additional monitoring, oversight, and accountability will mean the honeymoon is over for private Medicare insurers.

To download the PDF version of Marsha Gold's report, "Medicare's Private Plans: A Report Card On Medicare Advantage", click here.

Friday, November 21, 2008

Healthcare's Influence on Bailout Mania

by Phil Micali, CEO, bWell-informed

This week we saw the CEOs of the Big 3 automakers embarrass themselves with their tin cups in hand on Capitol Hill after flying into Washington on expensive private jets.

The American automakers have two major problems: they don't make competitive products, at least in the US market, and they have let too much health insurance coverage instill negative behaviors in their workers and associated families. Management and unions of the Big 3 have done well to provide health insurance coverage to attract loyal workers, however they have jeopardized our entire economy by allowing that coverage to foster unhealthy personal habits of the same workers and other beneficiaries. Costs have escalated more than any other service or product in our economy. Companies and individuals have lost their competitiveness because of it. Bailout mania is scaring the living daylights out of experts and the common folk. Our sorry state of health coverage and cost of health care is to blame.

Those unhealthy habits may explain why the automakers do not produce cars that consumers demand, like greener cars, smaller cars, longer lasting cars, cars that offer more value. So here we are again on this blog tying health movement with the green movement. It's a virtuous circle (a good one) when green industries and products grow, which produce a healthier environment and people within. A healthier workforce is more likely to produce greener industries and products. Few would argue that this is what makes sense for improving our daily lives and longterm prospects as a person, a family, a nation, and a global community.

With Citigroup announcing 53,000 job cuts this week, and more to come, it is clear lots of people will be looking to learn about something they often take for granted - health insurance. Not only will they become more sensitive to the premium to get health insurance, they will soon learn that in order to afford the premium and the protection against catastrophic, the costs of what they have been demanding in the way of illness care would be better spent on an ounces of prevention.

Health insurance for people that have it needs to be rightsized. For those that don't have it, coverage needs to be provided, either through personal means of paying the premium or eligible private or public programs subsidizing it.

More than any $700 billion dollar bailout, or what is yet to be decided in early December on an additional automaker bailout, universal coverage and prudent spending within and focus on prevention will leave the word bailout less iterated in our daily lexicon.

Tuesday, November 18, 2008

Once the income’s gone: health insurance options after a layoff

by Elena Skoura, Graduate Intern, bWell-informed

“My husband's just lost his job and with it our health care benefits.”

In challenging times like these, quotes like the above are becoming increasingly common. But even if they’re not unusual, each and everyone hide a personal or family drama for those who find themselves out of work. One of the biggest causes of drama after a job loss is the uncertainty of losing health care coverage for the employee and his/her family.

The decisions that the newly unemployed must face are not easy emotionally or financially. Those lucky enough to have a coverage option through a family member or spouse still have to act quickly—the terminated employee must apply for insurance through their family member’s insurance within a month of losing the old coverage or the option may no longer be available.

Less frequently, unemployed individuals may find insurance through a trade group or even their church. But such alternatives are usually much more expensive, even though the coverage may be substantially less. Individual policies usually do not include coverage for pre-existing conditions.

The most attractive alternative for many recently laid-off workers is often COBRA. COBRA stands for the Consolidated Omnibus Budget Reconciliation Act, a policy that extends the same group health benefits to former employees for up to 18 months after a layoff. Businesses with over 20 employees must offer a COBRA option; for smaller businesses, state laws may provide similar options.

To be eligible for COBRA, the individual must have been enrolled in the employer’s health plan, which must continue to be active for current employees. An unemployed individual can apply for COBRA once he or she has experienced a “qualifying event” resulting in the loss of health care coverage—including voluntary or involuntary termination of employment for reasons other than misconduct or reduction in the number of hours of employment.

If the individual needs to extend his 18-month COBRA coverage for a longer period of time, he must prove that he has become disabled within the first 60 days of COBRA and send the plan a letter from the Social Security confirming this fact.

COBRA can be a good alternative, especially for those undergoing a medical treatment. However, it can also be very expensive. While employed, the individual typically has to pay only a fraction of their health insurance premium costs, with the employer picking up the rest. Under COBRA, they must pay the entire premium, which can be hundreds per month for an individual, and even thousands for a family.

The options for health coverage after a layoff are few and unappealing. That is probably the main reason why, out of the 2 million people who lose their job every month, 90% average at least a month without any health coverage.

Even though the short term financial implications can be grave, the longer-term threat posed by the possibility of experiencing an expensive health complication when uninsured is worse. And the health implications from lack of health care may be the worst of all.

The bWell-informed Health Plan Forecaster has been designed to help individuals find affordable and appropriate health insurance coverage, whether they’re facing a job loss or simply do not have coverage available through their employer. Visit www.bwell-informed.com today for more information!

Monday, November 3, 2008

bWell-informed interviewed at Health 2.0 Conference in San Francisco

bWell International was excited to be a sponsor of the Health 2.0 conference in San Francisco this past October 22-23. CEO Philip Micali and CMO Mary Hobson attended the event, and were thrilled to engage with healthcare and tech industry leaders from around the country. Featured action-packed demos of new services and tools, the Health 2.0 conference was a powerful look at how new technologies are transforming the healthcare industry.

Phil Micali was interviewed by ICYou producer Rebecca Fox on the ground at Health 2.0:



The next Health 2.0 conference is being held in Boston April 22-23 and will be a joint conference with the Center for Information Therapy. The theme will be "The Great Debates on the Next Generation of U.S. Healthcare." We hope to see you there!

Monday, October 27, 2008

CEO Philip Micali appears on Fox Business News

bWell-informed.com CEO Philip Micali appeared on Fox Business News in two segments this morning. He discussed the cutting edge bWell-informed Health Plan Forecasting tool, as well as provided important insights on the state of health care coverage in today's unstable financial environment and heated political climate.

Click to watch the videos below:

Friday, October 10, 2008

bWell International Launches New Online Health Plan Forecaster

NEW YORK, Oct. 9 /PRNewswire/ -- bWell-informed(TM) Health Plan Forecaster, a free health insurance comparison resource for individuals, goes live today at www.bwell-informed.com. The tool allows a user to project costs associated with his or her unique health risks and select the most appropriate health plan option based on those risks.

Based on the award-winning software application previously available only to employers, the bWell-informed(TM) Health Plan Forecaster is the first and only tool that allows individual consumers to truly make the connection between physical wellbeing and financial wellbeing. The tool includes robust education about a wide range of plan types, a built-in online Health Risk Assessment, as well as tax status and risk tolerance assessments. With the data entered in these assessments, users can explore plan suitability, examine financial scenarios associated with predicted healthcare usage, and compare health insurance options based on their projected health risks.

Once they've compared their options, users can purchase a plan directly through eHealthInsurance.com, the leading online source of health insurance for individuals, families and small businesses. More than one million policy lives have been insured nationwide through eHealthInsurance, which brings together thousands of health plans from more than 180 health insurance companies in all 50 states and the District of Columbia.

The bWell-informed Health Plan Forecaster is ideal for consumers such as college students, the self-employed or unemployed, those coming off COBRA insurance and/or retirees. And with the start of open enrollment season, the tool is also a boon for consumers who find themselves hit with additional cost sharing from their employers.

"We created bWell-informed to help Americans take control and instill confidence when buying health insurance," said bWell CEO and Founding Principal Philip Micali. "We're in a time of great change, with individuals demanding more information and more control. Finding the right health care coverage consists of balancing personal wellbeing and the family budget -- and we're proud to have created a tool that helps consumers do that."

With the bWell-informed(TM) Health Plan Forecaster, individuals and families can:

  • Prepare by learning about many commonly-available health insurance options that are available to individuals.
  • Safely share information about themselves and their family members, including information about health risks and financial factors.
  • Compare plans based on the data entered, and examine various financial scenarios associated with predicted health care usage.
  • Get answers to questions about the health plan options.
  • Get quotes for health insurance plans.
About bWell-informed (http://www.bwell-informed.com)

bWell-informed empowers individuals with healthcare resources and tools that help them better manage both health and medical costs. bWell-informed is the flagship product of bWell International (http://www.bwell-inc.com). Founded in 2004, bWell International is a health benefits education and consulting company. The company's interactive tools and guidance help clarify health benefits and boost employee confidence in the complex decision-making process surrounding health plan selection and health risk management.

SOURCE bWell International

Friday, August 29, 2008

Green is the Color of Wellness

by Radhika Ramesh, graduate intern, bWell International

What is the color of wellness? I say Green. Because green symbolizes the natural world. Because green stands for fertility, growth and prosperity. Because it also stands for money. Because green is the color of life.

And the Earth is rather brown-grey at the moment. Sooty fumes and emissions from our cigarettes, vehicles, factories, satellites, and airplanes, together with chemicals, aerosols and particulate matter have resulted in large scale pollution, ozone depletion and global warming. Even if you don't believe Al Gore, it is hard to miss the tell-tale signs of trouble: declining biodiversity, devastating floods in Malaysia, earthquakes in China, landslides in Pakistan, droughts in Kenya and wildfires in Portugal. The symptoms of a very sick Earth. An Earth that is neither well nor green.

Sometime in the mid-twentieth century, the growing awareness that human beings were wrecking the environment and the recognition of the magnitude and implications of this damage led to the modern environmental movement and the race to restore order to our ecosystem. Thus, Greening of the Earth is about more than just a pretty, green landscape. Greening is renewal and revitalization. Greening is a call for a well Earth. It is also a necessity for well Earthlings.

In his book, Beyond the Land Ethic (1999), J. Baird Callicott, who taught the world's first course in environmental ethics, asserts that the Wellness movement in America is ancillary to the environmental movement. How else could it be? World War II left behind a legacy of new generation pesticides, heavy duty combustion engines, the miracle of atomic fusion and a booming cigarette demand that blanketed America in a heavy, grey smog. While the Environmental movement sprang up to attempt to undo the damage done to the Earth, the Wellness movement arose to try to undo the damage done to people. For how can we be healthy if the Earth is miserable?

The National Wellness Institute, one of the oldest wellness organizations in the United States, has developed the Six Dimensional Model of Wellness that emphasizes the social and environmental aspects of wellness, in addition to the physical, emotional, intellectual, spiritual and occupational dimensions. The interrelatedness of these different dimensions is apparent. How can you be emotionally well if your career is not satisfying? How can you expand your intellectual curiosity if you have a nagging pain in your stomach all the time? How can you feel happy and content when you are constantly under attack by fumes from vehicles, cigarettes and burning tires? How can you be disease-free if your neighborhood is built on a toxic dump? How can you be healthy if the Earth is not? How can Greenness and Wellness be any different? How can America be the health capital of the world if it is also not the environmental capital?

The United States is the highest consumer of fossil-fuel energy in the world. The combustion of fossil-fuels, which are a non-renewable energy source, is known to result in ecologically destructive outcomes. A report outlined by the National Research Council (NRC) notes that each year, 76 million gallons of petroleum seep into North America's oceans. Apart from large scale oil-spills and accidents in transport, human caused releases from cars, trucks, personal watercraft, urban street runoff, improper disposal of petroleum products and other sources contribute to the oil in our oceans. The damage to our ecosystem is often irreparable. Furthermore, a study by the University of Cincinnati shows that more than 30% of American public schools are within 400 meters of major highways and thus in close proximity to environmental pollutants and susceptible to respiratory diseases. But there is more. A report from the American Lung Association claims that around 137 million Americans breathe unhealthy amounts of smog. While the Earth chokes, so do we.

Over the past decade or so, the definition of wellness has changed from the narrow concept of absence of pain to being proactive about health and prevention. The modern wellness movement has taught us that the absence of illness is hardly a health goal and empowered us to take charge of our health and lifestyle. As the connection between individual well-being and environmental context becomes clearer, we need to be proactive about our planet as well, and act when we still have the time.

Awareness of this direct correlation between the social milieu and the ecological milieu also brings with it an understanding of the importance of preserving the beauty and balance of nature and of building a living space in harmony with our environment. We are but one of the many components of this ecosystem which need to function co-operatively to co-exist. We need to respect the earth's limits and think in terms of sustainable products and systems. Because a healthy earth means a healthy us.

Because Wellness is Green.