Letter to Clients
There's Still Time: How You Can Influence Health Care Reform
A recent Towers Watson report¹ shows the top three employer goals for health care reform are containing costs, encouraging healthier lifestyles and improving the quality of care. Unfortunately, few employers think current legislation will achieve these goals.





Of the 650 benefit managers surveyed:

• Only 14 percent think health care reform will help contain health care costs.
• 25 percent think health care reform will encourage healthier lifestyles.
• 20 percent believe health care reform will improve the quality of care.

Yet, there is still time to educate federal agencies about how health reform may impact the real world and influence where the law requires further deliberation.

The Executive Branch is currently interpreting and establishing regulations for the recently enacted Patient Protection and Affordable Care Act based on something called "congressional intent." However, the path to identify congressional intent of the health reform legislation has its obstacles.

Because of the unique manner used to pass the reform bill, these laws came out of Congress without the usual vetting process achieved from melding a House bill and Senate bill into one bill. These laws also came out of Congress without the traditional congressional reports relied upon for determining congressional intent. As a result, it is unclear what documents the federal agencies are using to determine congressional intent.

Due to these factors, we are likely to hear how something in the health reform act is "ambiguous." And it's these areas of ambiguity that offer opportunities for employers and stakeholders in the health care industry to influence regulations before federal agencies put pen to paper.

To read the latest insights on health care reform, I encourage you to visit the National Business Group on Health's Website (www.businessgrouphealth.org) and the American Health Insurance Plan's Website (www.ahip.org). HealthFitness is an active member of these and other organizations that are on the steps of Capitol Hill, advocating on behalf of employers' interests. Each industry organization also has staff who can direct you toward the relevant board or commission to have your comments about health care reform heard.

Going forward, we remain committed to providing you with updated information on these evolving regulations to help you respond quickly and thoughtfully to the complex implications of the provisions before they take effect.

Yours in good health,

Gregg Lehman

¹ "Health Care Reform: Looming fears mask unprecedented employer opportunities to mitigate costs, risks and reset total rewards," Towers Watson, May 2010. http://www.towerswatson.com/assets/pdf/1935/Post-HCR_Flash_survey_bulletin_5_25_10(1).pdf

Inside HealthFitness
Results Are In: EMPOWERED Health Coaching Motivates Employees to Change Behaviors
Effective health coaching educates and empowers employees to make smarter decisions about their health. Aggregate results from participants of 45 clients show that HealthFitness' EMPOWERED™ Health Coaching is doing just that.

Of the more than 20,000 participant surveys submitted:

• 87 percent were satisfied overall with EMPOWERED Health Coaching.
• 84 percent reported making progress in the behavioral Focus Area they opened.
• 83 percent agreed that the Focus Area they participated in helped them make progress toward their primary reason for enrolling in coaching (such as to lose weight, improve eating habits, etc.).
• 76 percent agreed that new lifestyle choices resulting from participating in EMPOWERED have positively impacted their personal productivity.

With EMPOWERED, participants choose from 13 Focus Areas in four main areas: healthy eating, physical activity, smoking cessation and stress management. Coaches help participants link these Focus Areas to their overall healthy vision, which may also include managing risks related to blood pressure, blood cholesterol, obesity, sedentary lifestyle, tobacco use, and/or pre-diabetes.

To maximize participation, EMPOWERED gives employees the freedom to choose how they interact with their coach-face to face (where available), telephone, Web or a combination of these methods.

For more information on EMPOWERED Health Coaching, click here or talk with your program manager.

Best-in-Class Practices and Awards
GE Challenges Employees to 20,000 Workouts
In 2009, GE launched HealthAhead, a comprehensive initiative to create a culture of health at each of its locations. As part of HealthAhead, GE's Fairfield office issued a challenge to their fellow 695 eligible employees.

The challenge was this: If employees could log a total of 3,000 workouts in November and December 2009-a 25 percent increase compared to the prior year-the fitness center would be free for all employees. Members previously paid a membership fee of $15 per month.

According HealthFitness Program Manager Audra Gillis, final numbers tallied for November and December 2009 showed that members surpassed the original goal, completing nearly 3,500 workouts during the two months.

"This is an increase of more than 1,000 workouts beyond the number of workouts logged for November and December 2008," she explained.

For 2010, employees are now challenged to meet a stretch goal of 20,000 workouts to keep fitness membership free. To date, members are surpassing the target of logging 1666 workouts each month at the 7,200-square-foot, full-service facility. As an additional benefit, the challenge is also attracting new members; 55 percent of the Fairfield population is currently a member of the fitness center.

GE's HealthAhead initiative has eight key components in which each GE site strives to achieve certification. These eight components include: leadership and wellness committee; education and prevention; healthy nutrition; tobacco; physical activity; stress management; health coaching; and health-related absences.

Fairfield is one of nearly 600 GE worksites working toward a HealthAhead Worksite Certification. In 2009, the physical activity element was the only element that the Fairfield location scored 100 percent on the pre-certification.

HealthFitness Helps Mercedes-Benz Employees De-stress
The health toll of workplace stress is well-documented. Research shows that stressed workers are at higher risk for heart problems and depression, among other things.

For example, a British study tracking 6,000 workers for 11 years found that those who regularly worked more than 10 hours a day had a 60 percent higher risk for heart disease than those who put in seven hours.¹

To help employees manage workplace stress and improve productivity, HealthFitness Program Manager Jerome Scaturro at the Mercedes-Benz Fitness Center provides two targeted programs:

• Stretch/stress breaks. On a bimonthly basis, Scaturro visits departments and conducts 10-minute stretch/stress breaks that cover breathing strategies and stretching techniques they can perform at their desk. Typically, 30 to 40 employees attend each session.
• Stress/stretch seminars. Once per quarter, Scaturro conducts a seminar that combines tips for mental imagery and stretches to relieve stress.

Feedback from attendees proves that the programs are gaining traction.

"The stretching exercises are invigorating. I really like the exercises because they give me an opportunity to clear my mind," said one attendee. "Not only is the stretching good for the body, it is also good for the mind and builds camaraderie amongst team members," added another.

HealthFitness has managed the 4,000-square-foot Mercedes-Benz Fitness Center in Montvale, N.J., since 2003.

¹ "Overtime work and incident coronary heart disease: the Whitehall II prospective cohort study," European Heart Journal, March 23, 2010. http://eurheartj.oxfordjournals.org/content/early/2010/05/04/eurheartj.ehq124.abstract

Industry Insights
Buzz from Recent Research
Smoking and Other Habits May Combine to Bring an Earlier End to Life
Do key lifestyle choices-whether people exercise, eat right, do not smoke and do not overindulge in alcohol-affect how long they live?

A new study in the Archives of Internal Medicine found the answer to be yes.

Researchers interviewed 4886 individuals in the United Kingdom who were at least 18 years old in 1984 to 1985. A health behavior score was calculated and participants received one point for each of the following poor health behaviors:

• Smoking
• Fruits and vegetables consumed less than three times each week
• Less than two hours of physical activity each week
• Weekly alcohol intake of more than 14 units of alcohol (equal to eight standard U.S. drinks) for women and more than 21 units (equal to about 12 standard U.S. drinks ) for men

During 20 years of follow up, 1080 participants died: 431 from cardiovascular disease, 318 from cancer and 331 from other causes. Study results found that individuals with all four poor health behaviors had about three times the risk of dying from cardiovascular disease and cancer and four times the risk of dying from other causes when compared with people who have none of the poor health behaviors.

Researchers commented that the overall death risk among those with all four poor health behaviors is equivalent to being 12 years older.

Source: Kvaavik, E, Batty, D, Ursin, G, et. al. Influence of Individuals and Combined Health Behaviors on Total and Cause-Specific Mortality in Men and Women. Archives of Internal Medicine. 2010;170(8):711-71.

Cost-Effectiveness of Diabetes Screening
A new study, commissioned by the American Diabetes Association, has shown that early diabetes screening is highly cost effective. Early screening reduces diabetes-related complications such as heart disease, stroke, kidney failure, blindness and amputations, and it also reduces mortality.

Researchers used a mathematical model to estimate the cost-effectiveness of nine different simulated screening strategies for type 2 diabetes. The model simulated 325,000 people who matched the U.S. population in age, sex and health behaviors. Strategies differed by age at initiation and frequency of screening, ranging from no screening to beginning screening at age 30 and repeating every six months. The simulated population was followed for 50 years or until they died.

Compared with no screening, all screening strategies reduced the rates of heart attacks and diabetes-related complications, and increased the number of quality-adjusted life-years (years of perfect health) added across 50 years. Additionally, most of the strategies proved to be cost effective. As a result of the intervention, the cost was about $10,000 or less per quality-adjusted life-year added. The simulated model also found that the older a person is when they start diabetes screening, the greater the cost.

The American Diabetes Association recommends screening start by at least age 45 and that the test be repeated every three years. Adults with diabetes risk factors, such as obesity, family history of diabetes, high blood pressure, or a history of heart disease should talk to their doctor about starting diabetes screening earlier.

Sources: Kahn, R, Alperin, P, Eddy, D, et al. Age At Initiation and Frequency of Screening to Detect Type 2 Diabetes: A Cost-Effectiveness Analysis. Lancet. 2010 Apr 17;375(9723):1346.
American Diabetes Association. Screening for Diabetes Highly Cost Effective, Study Finds. http://www.diabetes.org/for-media/2010/screening-for-diabetes-highly-cost-effective.html

Where We'll Be Next
HealthFitness looks forward to seeing you at this upcoming event:

America's Health Insurance Plans Institute 2010
June 9-11, 2010
Las Vegas