Harvard Pilgrim Acquires Health Coaching Company

Harvard Pilgrim Health Care of Wellesley, Mass., announced Friday it has acquired an Arkansas company that helps large employers improve the health behavior of their workers.

Harvard Pilgrim's subsidiary, Health Plans Inc., acquired TrestleTree of Fayetteville, Ark. Health Plans is the part of Harvard Pilgrim that acts as a third-party administrator for large companies. Large employers tend to be self insured, meaning the company pays for its workers' medical costs. Large employers hire a third-party administrator to establish a network of clinicians and to manage the medical costs. Smaller employers tend to be fully-insured, meaning the employer pays a premium to an insurance company, which in turn pays for workers' medical expenses.

TrestleTree will be a service marketed to large employers who are self-insured and want to reduce medical expenses by improving the health and health-related behaviors of their workforces.

TrestleTree offers health coaching and lifestyle management, which means helping people to quit smoking, maintain a healthy weight, manage stress and exercise. The program also analyzes gaps in medical care a person is receiving, according to Harvard Pilgrim. The program has achieved measurable change for workers and has reduced health-care cost for employers, the insurer said.

TrestleTree has been in the lifestyle-and-wellness management business for more than 10 years and it has been successful in changing behaviors by the most reluctant of participants, said Health Plans President Deborah Hodges.

"They've got over 10 years of demonstrated outcomes where they've really been able to show that they've had savings and have made an impact," Hodges said.

Harvard Pilgrim and Health Plans Inc. have some internal wellness programs and lifestyle management programs, but the TrestleTree is a different model based on proprietary training and coaching different from other similar programs, she said.

"So, now everybody within the last couple years is talking about wellness and wellness coaching and lifestyle coaching, but they were doing this 10 years ago when nobody else was really talking about it," Hodges said.

TrestleTree President Ted Borgstadt said in a statement: "Our new relationship with Harvard Pilgrim allows for a broader expansion of TrestleTree's core expertise: helping less motivated individuals measurably change difficult health behaviors that results in lower cost and better health."

Harvard Pilgrim Health Care offers group plans in Connecticut, and is a relatively new entrant in the state's health insurance market. The Massachusetts nonprofit started selling small-group health plans through the Chamber Insurance Trust, an alliance of about 60 chambers of commerce in Connecticut, in July. Harvard Pilgrim is evaluating the costs and benefits of entering Connecticut's public health insurance exchange.

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Harvard Pilgrim Acquires Health Coaching Company

Why we need to liberate Americas health care

Photo by Andrew Harrer/Bloomberg via Getty Images.

Editors Note: Our health care debate, Robert Graboyes says, is trapped. Caught in the back-and-forth over insurance coverage, both the proponents and opponents of the Affordable Care Act are missing the point. To Graboyes, a senior research fellow at the Mercatus Center, distribution of health care is not the problem. Its the creation of better health care that will save more lives and cut costs.

And while his thesis resonates with the laissez-faire, pro-market attitude most often heard on the political right, he implicates both sides in holding Americas health care hostage in his recently published paper Fortress and Frontier in American Health Care. Americas health care has been allowed to languish, denied the opportunities to take the risks what Graboyes and his colleague call permissionless innovation that have allowed the information technology industry to flourish, and with it, all Americans. To get health care caught up to IT, he argues, we should rethink federal grants for innovation (theyre often counterproductive, he thinks) and decentralize regulatory institutions.

But Graboyes assessment of how and why IT has made such strides isnt universally accepted. We need to rebalance the story we tell about who the innovators really are, says Mariana Mazzucato. Author of The Entrepreneurial State, Mazzucato wrote on Making Sen$e last year that Apple didnt build your iPhone; the government and your taxes did. How is technology fostered, she asked? Far from the obscure figures in garages Graboyes credits with IT success, more often than not, down through history, Mazzucato argued, innovation has stemmed from government investment, from the roads of ancient Rome to the Internet of modern America.

Graboyes paper, out a year after Mazzucatos essay, sees consumers and producers taking the risks, leading the way toward a changing health care industry. Graboyes teaches at the medical centers at Virginia Commonwealth University and the University of Virginia. He produces a twice-a-month health care policy newsletter and is on Twitter at @Robert_Graboyes. Read more from him below.

Simone Pathe, Making Sen$e Editor

Health care is the surliest corner of American politics. For decades, a bitterly partisan debate dueling monologues, really has hung like smog over public discourse. Facts, misconceptions, half-truths and non sequiturs have congealed into conflicting sets of pre-packaged talking points.

Nearly five years after President Barack Obama signed the Affordable Care Act (ACA) into law, the rancor and accusations still swirl, turbulent but immovable, like the Great Red Spot of Jupiter. Maddeningly, the perpetual storm barely touches the great issues that actually determine our health and what we spend to acquire that health.

This is a pity, but the upside is that it suggests an enormous opportunity to shift the debate, dissipate reflexive partisanship, and in doing so, save lives, ease suffering and cut costs.

In short, since World War II, the health care debate has focused almost exclusively on coverage the number of people with insurance cards. Quality of care and improvements in health have been afterthoughts.

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Why we need to liberate Americas health care

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5 ways to slash health-care costs

While discontinuing group health insurance can be a hard sell to employees, they may be better off if you do. The average worker's contribution to a family plan for 2014 was $4,823, according to the Kaiser Family Foundation. If, hypothetically, a moderate-wage team member is contributing $5,000 annually toward the cost of family health care obtained through your firm, that employee might be better off financially with an individual plan bought through the exchanges set up under the Affordable Care Act, said Michael Stahl, senior vice president at HealthMarkets Insurance Agency, a national insurance marketplace based in North Richland Hills, Texas.

If you shifted to the individual market, the employer contribution would disappear, he noted. Meanwhile, if workers qualified for subsidies, he said, they would pay, on average, less than $100 per month to cover their premiums. The Centers for Medicare & Medicaid Services (CMS) found that the average for 2014 plans, after subsidies were subtracted, was $82. Some employers offset that by giving the workers a pay raise, though this is counted as taxable income, he explained.

It is possible that the quality of plans provided on the exchange might also be better than what your firm can now afford to offer, as well, though that depends on whether you have been offering a so-called Cadillac plan with very rich benefits or one that is more limited with high deductibles.

"Every employer with under 50 employees should be offering money to buy individual plans vs. group plans," according to Paul Zane Pilzer, author of the book "The End of Employer-Provided Health Insurance: Why It's Good for You, Your Family, and Your Company," and founder of Zane Benefits, a firm in Murray, Utah. Zane Benefits helps small businesses reimburse employees for the cost of health care." Employers can do this by giving a raise or stipend or setting up a reimbursement plan under current federal rules, said Pilzer. The reimbursement plans operate under the premise, "Buy health insurance; show me the receipt; I'll pay you," he said.

However, employers need to be aware that under a recent guidance from the federal government, they cannot tell employees that a raise or stipend needs to be spent on health care, said Martin Haitz, vice president in the Corporate Benefits Group of Marcum Financial Services LLC. "Some employers were saying I'll give you X dollars or your health care," Haitz said. "Now they can't say, `You won't get the money if you don't use it on health care.'"

Instead of shifting to the individual markets, some firms prefer to opt for a high-deductible group plan and set up a health reimbursement arrangement (HRA) to help offset employees' medical expenses. The employer can dictate the expenses they will reimburse for in the plan document and therefore limit their out-of-pocket exposure.

The advantage of an HRA over a health savings account (HSA) is that the plan can be structured so that if an employee does not use the money in an HRA, the money will still belong to the company. An HSA is another option, but it gives employers less control over how the money in an account is spent; the funds are made available to employees whether or not they incur any medical expenses, said Haitz.

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5 ways to slash health-care costs

KSA health care firms to record high growth

Saudi Arabias health care sector will continue to register high growth as companies expand their capacities, Al-Rajhi Capital said in a recent report. It also said that 2015 is expected to be a year of mixed sentiments for Saudi Arabia. There is high optimism among investors as the Kingdom plans to open up its equity market to qualified foreign institutional investors (FIIs) for direct ownership, while on the other hand, oil prices have dropped significantly and recovery is expected to be sluggish, said the report titled Saudi Arabia: Equity Market Outlook. A countercyclical budget for 2015 despite the drop in oil prices is likely to boost the nonoil sectors. Favorable demographics and an increase in wages will benefit the consumer-oriented sectors, especially the food sector. The health care sector will continue to register high growth as companies expand their capacities. The ongoing spending on housing and infrastructure will boost the cement sector, although the labor crisis and the high level of clinker inventories are likely to pose impediments. However, if oil prices do not recover, the petrochemical sector can see a decline in earnings as its product prices are linked to oil prices, said the report. Since the petrochemical sector contributes to around a third of the earnings in the Tadawul All Share Index (TASI), the overall earnings growth in 2015 is likely to be low. High dividend yields are likely to support the current price levels but any further decline in oil prices is a key risk. Our top picks are: SABIC, SAFCO, STC, Herfy, Al-Othaim, Maaden and Shaker, said Al-Rajhi Capital. Year of mixed sentiments: Saudi Arabia is likely to allow foreign investors to have direct ownership of stocks in 2015, which has heightened the optimism among investors. The TASI jumped 15 percent in the weeks following the announcement in mid-2014 and if empirical evidence is to be believed, the TASI is expected to climb again prior to the formal implementation. However, we feel any rally would be largely driven by sentiments rather than fundamentals. Meanwhile, the recovery in oil prices is expected to remain sluggish, which is likely to weigh on investor sentiments. Countercyclical fiscal expenditure: Despite the drop in oil prices by 50 percent in 2014, the fiscal expenditure for 2015 has been budgeted at SR860bn, the highest-ever for the Kingdom. This shows the Saudi governments intentions to continue investments for diversifying its economy. The large budget comes at a time when the overall growth has slowed down in Saudi Arabia as well as in many other countries. Therefore, we believe the move is countercyclical and is expected to boost the non-oil sectors. Outlook for nonoil sectors: Defensive sectors such as health care and food will witness healthy growth in 2015. Hospitals are expected to announce more expansion programs to their already rapidly increasing capacities. We do not expect a quick turnaround in the cement sector because of the huge existing inventories, restricted gas allocation issues, labor issues in construction etc. We are Neutral on the retail sector given its slowing same store sales growth and high valuation multiples. Net interest income of banks would benefit if the US Fed hikes its rates, while non-interest income would see mixed impact from lower consumer loan fees and higher brokerage fees in 2015. Outlook for petrochemical sector: The petrochemical sector is expected to see a decline in earnings on account of sluggish oil prices and demand slowdown in key economies. Since the Petrochemical sector contributes to around a third of TASIs earnings (and 20 percent of TASI Index) the overall earnings growth of the Saudi market is likely to be low. The sectors cyclical nature makes it wise to invest during troughs; however, we expect a sluggish recovery for oil prices and thereby, for the Petrochemical sector. However, we believe this is one of the most attractive entry points for a long-term investor. Top picks: Overall, 2015 is expected to be a year of mixed sentiments for Saudi Arabia. The countercyclical fiscal expenditure and high dividend yields are likely to support current price levels but further decline in oil prices remains the key risk. Among the companies, our top picks are SABIC, SAFCO, STC, Herfy, Al-Othaim, Maaden and Shaker. Al-Rajhi Capitals report also said: Even if the drop in oil prices continue, we believe that the government can sustain the current levels of expenditure even as budget turns into a deficit for longer periods considering the Kingdoms negligible public debt-GDP ratio and large government reserves built up over the years. In the medium term, the governments focus is likely to remain on building physical and social infrastructure and enhancing employment opportunities for citizens. It added: The health care sector will continue to remain one of the priority sectors for the government and private hospitals will rapidly scale up their capacities. However, we think the performance of the retail sector will slow down slightly given the sluggish same-store sales growth and high valuation multiples. The report said: The telecom sector is expected to continue facing low growth issues due to intense competition and saturation in market subscribers. However, the sector will continue to be an attractive dividend play in 2015. The issues around Mobily and Zain KSA have impacted the share price of STC as well. We think this is unjustified given that the company has been gaining strength over the past few quarters. We favor STC as one of the top picks for 2015. The report pointed out that all the listed hospitals have announced significant expansion plans and new projects across the Kingdom over the next 4-5 years. Despite these initiatives, demand continues to outpace supply. The sector will experience rapid growth as long as waiting periods at hospitals continue to remain high. It said: Mandatory insurance has been instrumental in the growth of private health care firms. Unlike Dubai or Abu Dhabi, insurance has so far been made mandatory to only expatriates and Saudi nationals (along with families) working in private firms. We believe that it is only a matter of time before insurance will be made mandatory for nationals as well.

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KSA health care firms to record high growth

Minister promises better health care services

During a tour of a number of health facilities in Al-Kharj, Health Minister Muhammad Alhayazie vowed to provide the best possible health care for the nation. The minister, accompanied by other high-profile health officials, inspected the areas health care facilities to understand the patients needs and the services provided to them, as well as the centers workflow, a ministry spokesman told Arab News. Alhayazie talked to hospital staffers about the governments efforts to meet the shortage in professionals in some specialties and committed to improve the health care system in the country. As part of the tour, the minister visited King Khalid Hospital and Prince Sultan Hospitals soon-to-be launched Cardiac Center. The tightly scheduled visit included a stopover at a new mental health hospital in the area and a new obstetrics and gynecology hospital, where the official was briefed on the facilitys medical equipment. The health minister lauded efforts made by the staff in these centers, but also urged them to provide the best medical care to patients and visitors so as to improve the countrys health. Citizens in the Al-Kharj governorate welcomed the minister's visit, saying it will help advance the health care system in the area. The visit will boost medical care services provided in these facilities and I am sure we will see marked improvement, said Mohammad Zeyad, a university student at Al-Kharj.

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Minister promises better health care services

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