PPACA Confusion: Benefits Education & Wellness Programs Can Help

July 17, 2014

A focus on the Patient Protection and Affordable Care Act (PPACA) has caused disruption, and in some cases panic.

Although President Obama has been re-elected and some of the uncertainty has been removed, questions remain. Public or private health exchange? Should I change my current plans? Will prices increase? Will my benefits change? Are deductibles increasing? The questions go on and on.

Now that people have choices, carriers and employers have determined that there’s a critical need for education before, during, and after enrollment. Benefits, insurance, and health education may very well be the best way to clear up confusion and reign in spiraling costs.

1. Before Enrollment: For employers, this will be easier to satisfy. HR departments hire benefits consultants, carriers and staff specialists that introduce open enrollment with the all the hallmarks of a marketing campaign. To increase engagement, they create a brand and theme, as well as conduct open enrollment meetings. Additionally, employees that enroll through work are offered a limited number of plans or even just one, which makes education more directed and customized for that organization.

Well, what if you seek benefits outside of your employer? Some employers may require part or all of their staff to sign up for insurance and benefits on a public or private exchange. So now employees will be faced with making choices outside of a group plan open enrollment process. So does the education stop? Not at all. It just gets different.

2. During Enrollment on a Health Insurance Exchange: Whether the employer has chosen a set menu of benefits or has allowed full access to all plans, most likely the individual employee has many more choices than what’s provided under an employer group plan. In general, plans will vary by cost based on coverage. Individuals and families must carefully weigh options based on their budget and current health conditions and fortunately, the PPACA, requires most preventive services to be covered without any co-pays, deductibles, or co-insurance. However, beyond this, there are many coverage differences and without selection assistance, users might choose something that underinsures or select too much for their needs.

There are tools to help.

Such as MetLife’s benefits simplifier tool, which discusses HMO and PPOs and voluntary benefits selections. Additionally, several benefits enrollment technology providers such as eHealth and Benefitfocus provide decision support tools like videos, side-by-side comparisons, and emotionally engaging virtual assistant navigation.

3. After Enrollment: Some could argue even before enrollment, the need for a health assessment is critical to selecting the right insurance and benefits choices that support wellness engagement and disease management options.

Consider these statistics, according to Infinite Health Coach:

  • Preventable illness makes up at least 70% of all illnesses and the associated costs.
  • The total cost of obesity to the U.S. employers is $13 billion each year.
  • Obese Americans spend about 36 percent more on health services & 77 percent more on medications than people of healthy weight — that’s more than heavy smokers or drinkers!
  • Job stress is estimated to cost $200 to $300 billion annually in absenteeism, tardiness and lost productivity.
  • Workers’ compensation costs for a smoker averages $2,189 compared to only $176 for a nonsmoker.

So it’s logical that employers are seeing the impact wellness plans can have on healthcare utilization rates, not to mention employee productivity. In a recent EBN article, the Farmington Company increased wellness participation by nearly three-fold through an effective communications plan. That being said, encouraging ongoing participation is a challenge. Once the employee is signed up, how do you keep them engaged and on a path to improved health outcomes?

Many companies have started using online health engagement and disease management tools. In a groundbreaking study, researchers at Point-of-Care Partners, found that when patients used a web-based health management portal, they showed increased engagement and self-care through pre and post patient activation scores. Additional findings revealed that a personalized experience based on the patient’s condition would increase activation scores. Overall, the researchers concluded that web-based intervention may result in more activated patients who are more proficient and confident in managing their chronic conditions.

The statistics all point to one thing – people who are unhealthy contribute to higher costs. What conclusions can we draw from this?

  • Providing a health wellness program for employees will encourage a healthier lifestyle.
  • An engaging wellness program, when used regularly, can contribute to lower costs.
  • Healthier individuals will be more productive.

Wellness programs that provide health risk assessments have many benefits.  According to a number of statistics, if companies do not offer this option, they are wasting resources and unnecessarily spending money.

“Health Risk Assessments are one of the most important tools used in a corporate wellness program.  Health Risk Assessments and the resulting aggregate report provide the roadmap for the wellness program.  Without utilizing a health risk assessment it would be virtually impossible to accurately gauge what interventions make the most sense for your employee population.” Infinite Health Coach

How can a company provide an engaging and informative health assessment? Click on the image above to read our guide and learn how the CIVA Benefits Advisor intelligent virtual assistant solutions can help. Depending on organizational need, a CIVA solution becomes a benefits virtual concierge, a health advisor, or a lifestyle wellness coach.



“Health Risk Assessments”, Infinite health Coach http://www.infinitehealthcoach.com/health-risk-assessment.html

Mantz, D. “Giving wellness programs a shot in the arm”, Employee Benefit News, Be Advised Blog, October 22, 2012 http://ebn.benefitnews.com/blog/beadvised/giving-wellness-programs-a-shot-in-arm-mantz-2728463-1.html

Michael Solomon, MBA, PhD, “Effects of a Web-Based Intervention for Adults With Chronic Conditions on Patient Activation: Online Randomized Controlled Trial”, Journal of Medical Internet Research, February 21, 2012 http://www.jmir.org/2012/1/e32/

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