July 22, 2011

PEBB'S HEALTH ENGAGEMENT MODEL (HEM)

(For a later report go here.)

Can anyone seriously believe that PEBB's Health Engagement Model (HEM) will work over the long haul to bring public employee healthcare costs down?

The arguments in favor of the HEM from some on the labor side of the table are that other, even more negative, changes will be implemented, or may be implemented if HEM doesn't work or isn't eased in; that the gap between PEBB's current and projected funding levels needs to close and that this helps do that; that this "value-based" change heads off worse changes; this fits well into PEBB's long-term plan or vision; and it's going to happen anyway. These are hardly convincing arguments and it's disappointing to hear them from labor people. We slid down the slippery slope when we walked away from supporting national healthcare. We have not given single-payer in Oregon a fair shot or much support. Now we're talking about, and tepidly supporting, "value-based" changes to PEBB. I believe that the door is opening to more serious and prohibitive changes in public employee healthcare with the advent of HEM. Anticipate increased out of pocket payments, new and higher deductibles, increased co-pays, restrictions on the "overuse" of some medical procedures, additional restrictions on doctors and higher co-insurance rates. At the end of the day this is what "value-based" means for most of us.

The Statesman Journal stories on HEM are a break with that paper's usually poor reporting because they have gotten most of the essential details about HEM right.

PEBB participants will have the option of signing up for a higher-cost plan that will supposedly come close to closing the PEBB funding gap. Another option for PEBB participants will be signing up for the HEM. This will require participants and their adult dependents to sign individual contracts with PEBB and/or their Plan. This is a lower cost plan that comes with its own contract. An annual Health Risk Assessment must be done with the participant's doctor or health consultant/coach. The plan then puts this together with the member’s medical record and history with the idea that the participant will work with their doctor/consultant/coach to reduce their health risks. It will require plan participants to stay in line with the professional's program and has "in compliance" language. Participants have to work at losing weight, for instance, or will be judged out of compliance with the HEM and moved involuntarily to the higher-cost plan for coverage. A series of "what-ifs" naturally arise here in the minds of many potential participants and shines the light on the more onerous details of the plan that we won't go into here. 

The best hope here is that integrating things like Weight Watchers and eating peas into your diet and healthcare will make you less costly to the system---a system that wants your money but really doesn't want you. This system has found a clever way of attempting to cut costs by changing the make-up of the insurance pool without actually excluding anyone---yet. If we accept the logic of the free market in healthcare, this may in turn lead to unions and their allies pushing the healthcare corporations---really, the healthcare monopolies---to clean up their shoddy billing practices and costly duplications of services.
 
The push for these hoped-for positives are taking the place of a real debate on healthcare in the US and in Oregon and they take us further away from national or state single-payer healthcare.

This sort of plan or project was all the rage in the private sector twenty or thirty years ago and it did not work then and there. What we saw was that these plans either did not get off the ground or divided workers when they did. Supposedly "in shape" workers blamed supposedly "out of shape" workers or parents or people with genetic predispositions to certain illnesses and medical problems or older workers for higher healthcare costs, taking the heat off of the insurance companies and the medical establishment. We lost retiree healthcare in the private sector thanks in some part to this charade.

Do we need more divisions among public workers?

One additional and very serious point: public workers are being squeezed by the state and will have much less money to spend on healthcare, gym memberships, eating right, etc., etc. A worker can feed a family for ten dollars at McDonald's but that money won't go as far at, say, Lifesource or another health food store. The Safeway by the Salem Capitol Mall sells mainly cheap or bad-for-you food because the owners know their customers and what they can afford and what they need to make it through the day. Workers at OSH probably account for much of the business being done at that store in energy drinks. It's too bad that there are not more state offices and PEBB plan participants near the upscale and healthier Salem Roth's Vista store, but that's capitalism for you---where you work and how much you make determines in a real and immediate way what you eat, where you live, whether you have healthcare or not and, ultimately, how long you live. It's simply wrong from a working-class point of view to hold public workers to new health standards and higher healthcare costs while cutting their pay. and benefits





3 comments:

Lucy Longtale said...

The health of working people won't improve significantly - even with HEM - as long as people work a 40-hour week.

There just isn't enough time in the day for 8 hours of work, family, and significant exercise for many. Especially when work gets our prime time.

Anoush said...

This situation with people providing personal detailed medical information to PEBB is very disturbing. I have been told that within 1-2 years we will be required to provide blood test results and other private medical information to this board.If they deem them bad - we have to pay money. A bit thick in the thighs - well here's a bill. Who are these people and why do they want my test results. How is this going to save me money. Even if it did save me money, I don't want people I don't know to have my personal information in their data base. These people are not my doctor. I feel so violated. I can not believe that this is legal.They are going after the smokers and overweight people first. But people are delusional if they think PEBB will stop there.Let's not be sheep. This is a horrible violation of our privacy.

The Daily Trigger said...

People are not lacking in information. For years we have had nutrition labeling on foods and still people make poor food choices. This is just another plan to create more government, more red tape, more bureaucracy.