• DRAFT
Health Engagement Model Joint Labor-Management Committee
Preliminary Recommendations
HEM JLM Committee Approach to Prioritizing Recommendations
o Issues immediately affecting members (split between 2012 and 2013)
o Communications for employees from PEBB
o Evaluation of the HEM
o Shared savings and employee wellness
o Investment of savings from HEM to further the wellness of PEBB members
Preliminary Recommendations: Immediate Issues Impacting Members
6. Recommendation: Continue proactive, frequent, visible communications and wellness support for PEBB members throughout the year.
Rationale: For PEBB members to be supported in taking charge of their health and making health improvements, a proactive health promotion effort needs to be carried out on an on-going basis for all state agency worksites. This can include communications, creating workplace environments that support employee health, and working with Staywell coordinators and agency wellness committees.
7. Recommendation: Assess and communicate about the link employee wellness to lower health benefits costs.
Rationale: Safe and healthy workplaces are not a luxury for state employees. Workplaces that support health through education, supportive benefits (e.g., tobacco cessation services), and supportive environments (e.g., healthy foods in vending machines and worksites that promote physical activity through stairwells and onsite exercise facilities) can help lower health benefits costs. Oregon should evaluate assess its progress around healthier worksites for State employees, health benefits that support health, and HEM, and should serve as a national leader on these issues.
8. Recommendation: Do not charge the fees in 2012 for not joining the HEM.
Rationale: Use the year to evaluate all impacts and promote the reasons and benefits then determine if fees are necessary for 2013. PEBB members will be more ready for change following a period of education.
9. Recommendation: If fees cannot be eliminated, provide an amnesty period for signing up for HEM – suggest until February 29, 2012.
Rationale: This allows time for proactive communication and needed start-up time for a significant new activity for PEBB members. Members will have seen two paychecks with surcharges, if applicable, and should be given a chance to opt-in for this very valuable but really, really new activity.
10. Recommendation: Proactive communication in early January 2012 needs to provide information on 1) the rationale for the questions in the Health Assessment – why the questions are being asked and how they relate to health improvement and taking charge of one’s health, and 2) the security of the information - who will have the information, how it is stored and for how long.
Rationale: Many PEBB members are challenging the value of the questions in the Health Assessment and don’t see the relationship to improving their health. This a great time for PEBB members to learn about health risks and how to take charge of their health, it’s a very teachable moment. PEBB members are very concerned about privacy and security of their health information. These concerns need to be addressed very early on.
11. Remove the surcharge in 2012 for missing deadlines for doing the Health Assessment and e-lessons, start imposing it in 2013.
Rationale: PEBB members who are not already signed up with their insurers to access medical information electronically will have to figure out how to do that before they can access the on-line Health Assessment and e-lessons. It can take a week or longer just to get signed up for electronic access (for instance passwords are mailed). Then PEBB members will have to find the Health Assessment, take it, review the results, find the e-lesson choices, choose and then do the e-lessons. This is a new activity, will be time consuming, and won’t have as much value if it has to be rushed in order to meet deadlines that occur pretty early in 2012. PEBB members need the opportunity to practice and to have a positive experience learning about possible health risks and how to address those risks.
12. Recommendation: Change the surcharge for couples with one non-HEM participant to $20/month rather than $35.
Rationale: The current surcharge structure provides no incentive for at least one person in a couple to participate in the HEM. Current surcharges: individual member non-HEM is $20/mo, couple with one non-HEM is $35/mo, couple with two non-HEM is $35/mo. Where spouses are disabled, illiterate, separated or estranged, the PEBB member is penalized for their inability to communicate with their spouse or the spouse’s inability to access or use a computer to complete the required questionnaires and e-learning.
13. Recommendation: Establish a mini-enrollment" period in March when people get the opportunity again to sign up for HEM.
Rationale: Some people may decide to participate once they know more about the privacy protections and the actually requirements of the HEM. If the overall goal is increased employee wellness and lower healthcare costs, allowing individuals to participate at any point will assist in meeting these goals, both for PEBB and for the employee.
14. Recommendation: Educate HEM participants about the rationale for the HEM questions.
Rationale: Many PEBB members find the questions in the HEM questionnaire and particularly the focus on waist measurement intrusive and unnecessary. Educating PEBB members before and as they take the questionnaire about the link between the questions and their health could both improve the perception of PEBB and help employees become healthier. For example, many PEBB members are likely unaware that questions about first menstrual cycle are asked as a means to access breast and other cancer risk. Similarly, members are likely not aware that waist size is a proxy measure for Body Mass Index and other measures of obesity, which can predict risk for cancer, diabetes, heart disease, and other debilitating and deadly conditions.
15. Recommendation: Remove the requirement to provide waist size from the health assessment survey. PEBB has generated much negativity by singling out only one indicator of health as a required answer - waist size. Until PEBB members are educated on the why behind the questions in the health risk assessment and can see the risk assessment as providing a more complex view of their overall health, requiring a response on only this one risk indicator will not help PEBB members believe that PEBB has their total health in mind.
16. Recommendation: Pro-rate HEM surcharges for part-time workers. Part-time workers are hit twice as hard as full time workers around all of the PEBB surcharges. Pro-rating the HEM surcharge is a fairness issue – part-time workers have to pay a pro-rated share of their insurance costs or sign up for a plan with fewer benefits and still must pay a much larger portion of the premium on this reduced plan compared to full time workers. Given that part-time workers already pay a disproportionately large amount toward their health care compared to full time workers, they should get a break on the surcharges.
Tobacco Surcharge Recommendations
17. Recommendation: Remove the tobacco surcharge for 2012. Start imposing the surcharge in 2013.
Rationale: Tobacco users need to have ample opportunity to quit and lots of support to do so. Prior to imposing a surcharge, a proactive, highly visible effort needs to be conducted to help smokers quit and stay quit. This can be done with very visible and frequent promotion of PEBB cessation benefits, how to access the Tobacco QuitLine by phone or on-line, and with implementing tobacco-free grounds for state agencies.
18. Recommendation: Allow any PEBB member who quits smoking to avoid paying the tobacco surcharge in subsequent months.
Rationale: Individuals who choose to quit smoking should be rewarded for their decision to quit and should not be required to wait until the next benefit period. Allowing a mid-year change to the surcharge provides an incentive to quit when a person is ready and able to do so and is in line with the HEM philosophy to get people to make positive decisions around their health.
Spousal Insurance Opt-Out Surcharge Recommendations
19. Recommendation: Do not charge the spousal insurance option penalty in 2012 for spouses who have other potential sources of insurance coverage.
Rationale: Not all insurance coverage is the same. Some spouses have access to insurance that does not provide certain basic benefits or preventive services, undermining a families efforts to become and stay healthy together.
20. Recommendation: Allow any PEBB member who has a spouse whose other insurance options change during the year to not pay the spousal insurance penalty in subsequent months.
Rationale: When a spouse’s employment situation changes or their benefits change, particularly when the spouse loses their benefits, a PEBB member should have the opportunity to avoid paying a surcharge that is no longer applicable.
