A provision in the newly enacted health care reform legislation could provide primary care physicians in small communities with a unique opportunity.
Section 10408 of the Patient Protection and Affordable Care Act(www.opencongress.org) allows HHS to provide grants to small businesses
-- those with fewer than 100 employees -- to create comprehensive workplace wellness programs based on evidence-based research and best practices.
The provision authorizes the appropriation of $200 million for fiscal years 2011 through 2015.
Martin Sepulveda, M.D., vice president of integrated health services for IBM Corp., said the grants could offer primary care physicians in rural areas and small communities a chance to partner with local businesses.
"If you're in New York City, those 100 employees are probably going to 100 different places to get care," he said. "On the other hand, if you're in a community with a small number of primary care practices and you know you have a significant proportion of an employers' 100-person workforce in your practice, then you really have an opportunity ... to try to collaborate with the employer to pursue funds to enable things to be done in the workplace or the practice or delivered by practice team members."
IBM knows about operating wellness programs on a large scale. The technology giant has been offering standard screenings and risk assessments since before Sepulveda arrived in the mid-1980s.
The company's wellness program has expanded and evolved under his direction, switching to digital technology delivery vehicles about 10 years ago. An online portal provides resources, tools and access to on-site programs for healthy behaviors, screenings, vaccinations and counseling based on factors such as a person's age and gender.
Sepulveda said as many as 80 percent of IBM's U.S. employees participate in health risk assessments. The company focuses on helping employees change the risk factors they can control, such as diet, exercise, resilience and smoking.
"We know that smokers cost us between $200 and $300 more per year in health care claims alone," he said. "We also know that people who are physically inactive cost us $500 to $600 more in health care claims. We've learned that if you can shift people in those modifiable risk factor categories from higher risk to lower risk, there is a lot of money to be saved."
From 2004-08, IBM's wellness initiatives helped reduce its high-risk population by 60 percent, Sepulveda said. Its low-risk group grew by more than 20 percent during the same period.
"We saved about $112 million, and we saved it by providing opportunities and incentives for people to do things in those areas and have them actually be successful," he said.
IBM isn't offering a wellness program blueprint for others to copy, and Sepulveda said numerous other factors played a role in the company's success, such as the fact that IBM employees receive preventive care at no cost.
However, Sepulveda said small employers could benefit from the grants, and physicians could help.
"There's an enormous wellness industry out there," he said. "You have all these people hawking services and wares. The small employer doesn't have time to sort the wheat from the chaff, so to speak. If they had a trusted source they could work with -- and I think primary care physicians in the communities are trusted sources -- that would be invaluable."
The Wellness Council of America estimates that wellness programs save employers $1.50 to $3 for every dollar spent on such programs. That return on investment, which typically begins after three years, has dipped somewhat in recent years as employers have invested more money in such programs.
HHS has not released specific criteria for the grants or details of the application process, but the legislation outlines the following requirements for workplace wellness programs:
- health awareness initiatives, including health education, preventive screenings and health risk assessments;
- efforts to maximize employee engagement, including mechanisms to encourage employee participation;
- initiatives to change unhealthy behaviors and lifestyle choices, including counseling, seminars, online programs and self-help materials; and
- supportive environment efforts, including workplace policies to encourage healthy lifestyles, healthy eating, increased physical activity and improved mental health.
Companies that established wellness programs before the health care reform bill was signed into law are not eligible for the grants.
Family physician Alan Falkoff, M.D., of Stamford, Conn., said getting patients to buy in to a wellness program can be difficult. Falkoff started his own wellness program, partnering with a nutritionist and a physical therapist in an initiative that offered his patients wellness plans tailored to their individual health and lifestyle needs.
Falkoff said he kept brochures in his waiting room and talked to his patients about prevention for years, but the wellness program never took off.
"You have to have a really committed group of patients," he said, "and that's uncommon in most practices.
"Most will talk about wellness, agree it is a good idea but won't follow through no matter how supportive and convincing and helpful the physician is. It just isn't in our culture."