Conference

UPDATES & REVIEWS

December 3, 2009

Featured Wednesday Session

GINA and Family History:  Hurting the Ones We Love
Authored by: Randall K. Abbott

Practice Leader at Watson Wyatt Worldwide

Speaker at IHPM's 10th Annual International Health & Productivity Conference

(Additional Featured Sessions by Randall Abbott)

Pre-Conference Academy Feature - Monday morning - March 29

Executive Summary of the Status of Value-Based Health

Featured General Session - Monday afternoon- March 29

Rewards and Punishments: Incentive and Cost-Sharing Strategies

The Genetic Information Nondiscrimination Act (GINA) has received considerable attention, primarily as employers and health plans rush to modify Health Risk Appraisals (HRAs) so that HRAs tied to open enrollment can continue to be used and incentives can be offered for completing them.

The primary compliance “fix” is removing family medical history and other questions that would elicit genetic information.  Typical questions that are being removed include family history for cancer, diabetes, heart problems, high blood pressure, high cholesterol and – specifically for women – breast cancer and cervical cancer.

Health plans and many health management specialty firms have indicated that removal of the questions will have little or no impact on risk scoring under the HRA or on their coaching activities. The reality is that a strong correlation often exists between family history and health risk.  This correlation can influence HRA feedback to the participant, better equip clinical outreach counselors and potentially alert an individual to a risk that is beyond the population norm -- encouraging a proactive dialogue with their   physician.

Family history has long been recognized as a vital aspect of risk assessment by the Centers for Disease Control (2004), the U.S. Preventive Services Task Force (2001-2005) and the American Academy of Family Physicians (2005).  Having a positive family history for a specific disease can substantially increase individual risk versus a population norm.  Conversely, a negative value for family history can decrease an individual risk compared to the norm.

GINA’s effects have now been exacerbated by the recent announcement from the United States Preventive Services Task Force recommending later and less frequent screenings for breast cancer and the subsequent announcement by the American College of Obstetrics and Gynecology that later and fewer screenings are recommended for cervical cancer detection.

While the new guidelines suggest that reduced frequencies are appropriate, both recommendations make clear that family history should strongly influence the patient’s decision.  The irony is clear:  at a time when female patients are being presented with a need for a more proactive and deeper understanding of family history to gauge their risk for breast or cervical cancer, GINA is reducing the ability of health plans and employers to help educate on family history, identify those with a heightened risk and empower them with guidance on how to effectively take action. Absent this, the patient is left to self-education or, hopefully, the guidance of their primary care physician.

The unfortunate reality is that many patients – especially younger ones – do not have primary care physician relationships.  Many also come from families of divorce or far-flung relationships and may be unable to readily learn their family health history.  Others may know but have chosen to minimize the potential risk out of youthful optimism or simply fear of the unknown.  Others simply may not “connect the dots.”

It is precisely these individuals who can benefit from the power of a health risk assessment that organizes and quantifies family history, identifies personal risk and encourages specific action.  Now, GINA will preclude this, potentially hurting the ones we love.

While GINA’s intent is laudable and its concerns about potential misuse of genetic data are both proactive and legitimate, its unintended consequences are real.  So, what can we do?  Here’s a short list:

• Promote primary care relationships.  Family information is regularly collected in the clinical setting and is a vital consideration in differential diagnosis.
• Educate employees and their families on the importance of knowing family medical history.  The American Medical Association offers a pocket guide on patient self-compilation of this data.  A print or web-based tool is also available as part of the U.S. Surgeon General’s Family History Initiative.  (For those interested in the development of a family pedigree, see the August 1, 2005 issue of American Family Physician for “Family History:  The Three Generation Pedigree.”)
• Create communication materials that provide a “mini-” family history checklist with related clinical considerations.  Encourage employees to complete it and discuss it with their doctor, but make clear that completion is voluntary and results should not be shared with the employer.

Let’s work to fix GINA, but in the meantime let’s also work to remediate the unintended consequences it has created, especially in the light of more liberal screening guidelines for women.  Family history matters – now more than ever – for our mothers, sisters and daughters.

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IHPM's10th Annual International Health & Productivity Conference

Hyatt Regency Grand Cypress, Orlando, Florida

March 29-31, 2010

Managing, Marketing, Measuring

the Value of Health & Productivity

The Institute for Health and Productivity Management is pleased to announce its 10th Annual International Health & Productivity Conference, an event that draws attendees from around the world as the Institute continually expands its global reach.

Activities will get underway on Monday morning, March 29th.....

Pre-Conference Academy on Value-Based Health,  chaired by Steve Priddy, Director of IHPM’s Value-Based Health (VBH) initiative. The Academy will open with an Executive Summary of the Status of Value-Based Health by Randy Abbott, Practice Leader at Watson Wyatt Worldwide, for large employers and by Jack Bastable, Practice Leader at CBIZ, for small employers.  Next will be sessions on value-based benefit design for three critical chronic diseases that account for a huge share of employers’ total workplace burden of illness – Depression, Diabetes,  and Chronic Obstructive Pulmonary Disease (COPD).  The Academy will conclude with a presentation of an award-winning integrated value-based health management strategy by a public employer – Manatee County, Florida.

The Conference itself opens the afternoon of the 29th with the annual presentation of IHPM’s President’s Award.  Sessions for the rest of the opening day will focus on:

1. HPM  as a Global Business Strategy– Cathy Baase, MD, Global Director of Health for Dow Chemical and Tami Graham, Global Benefits Design Director for Intel.  Two of the acknowledged international leaders in managing health as human capital talk about how they built their integrated strategies and how they implement them worldwide.
2. Measurement: Digging Deeper and Reaching Wider to Make the Case for HPM, with Debra Lerner, PhD, Senior Scientist from Tufts Medical Center, Brent Pawlecki, MD, Corporate Medical Director for Pitney Bowes, and Joe Leutzinger, PhD, Principal of Health Improvement Solutions
• measuring the impact of caregiving on workplace productivity
• measuring the health of a corporate culture
3. 10th Annual Corporate Health and Productivity Management Awards (sponsored by Novartis) and presented by Joe Leutzinger, PhD, President of IHPM’s Academy
4. Understanding Your "Customer":  Using Consumer Marketing Strategies to Engage Employees in Health and Wellness Programs, featuring Steve Cook (accomplished Sr. Executive with P&G, Coca-Cola and Samsung) and Bob Isherwood (former Worlwide Creative Director for Saatchi & Saatchi) Principals from i.e. healthcare
5. Rewards and Punishments – Employer Panel Discussion of Incentive and Cost-Sharing Strategies led by Randy Abbott of Watson Wyatt

Tuesday Morning, March 30th, will feature sessions on:

1. Technologies to Bring Greater Value to Health Management, such as Dossia, Healthy World,  and DeskActive
2. The Meaning of “Value” – Multistakeholder (Employer and Health Plan) Panel Discussion led by Steve Priddy from IHPM’s Value-Based Health Initiative (VBH) and featuring VBH award winners Intel, Procter & Gamble, John Deere, and Aetna
3. 3rd Annual Value-Based Health Awards presented by Steve Priddy and Jack Bastable of VBH
4. Manatee County, Florida – Value-Based Health Management that Reaches the Community, presented by Bob Goodman and Kim Stroud
5. Does Prevention Save Money for Employers? – a cool-headed debate on a very “hot” issue!  Chaired by Sean Sullivan, JD, President of IHPM.

Tuesday Afternoon, March 30th, featured sessions:

1. Launch of IHPM's Workplace Center for Respiratory Health
• COPD:  The Next Epidemic for Employers
• Economic Burden of COPD on Employers; William Bunn, MD, VP for Health, Safety & Productivity, Navistar International
• Smoking Cessation - Doorway to Respiratory Health - Ken Glover, Director of Health & Wellness & Ergonomics, CSX
• Update on Pay for Performance initiatives for COPD
2. Workplace Center for Behavioral Health, co-chaired by Richard C. Bedrosian, PhD, Director of Behavioral Health, HealthMedia and Ed Jones, PhD, Executive Vice President, ValueOptions (program tba)
3. Workplace Center for Metabolic Health
• Washington State's Healthy Worksite Initiative, Scott Pritchard, Director of Integrated Employee Health & Productivity
• Chronic Kidney Disease (CKD): Breakdown of Metabolic Health

Tuesday Evening, March 30th, featured session:

Tuesday evening features the Annual Public Policy Dinner (sponsored by Pfizer) with opening remarks from Pfizer Senior Vice President Rich Bagger followed by the return of a health policy “star” from the 2008 Annual Conference, Grace-Marie Turner, President of the Galen Institute, who will speak on Health Reform: Looking Back and Ahead.

Wednesday, March 31st, the conference will conclude with these sessions:

1. The “Two Pens:” Engaging Physicians with Employers,  a panel discussion chaired by Ray Fabius, MD, Principal with AB3 Health
2. Coaching – New Path to Better Health - Victor Strecher, PhD, Founder & Chief Vision Officer, HealthMedia
3. Designing, Implementing and Evaluating Employer-Based Health Intervention Programs, presented by Grant Skrepnek, PhD, from the University of Arizona College of Pharmacy
4. Legal Threat to Health and Productivity Management:  The Unintended Consequences of GINA (Genetic Information Nondiscrimination Act) - Randy Abbott, Watson Wyatt
5. Health and Productivity in Asia:  Significant new findings from IHPM's first-of-its kind comprehensive health and productivity assessment with the Hong Kong Hospital Authority

Please email bonnie.jean@ihpm.org for more information or to register.

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