Compliance Still Critical for Maintaining Health and Wellness

As the new Affordable Care Act (ACA) takes hold this month, there’s a lot of confusing news and information swirling around about options, smart choices and next steps. There’s also a fundamental shift taking place in healthcare today, which is the realization that Americans do not comply effectively with direction provided by their physicians or medical practitioners, and often take their prescribed medications improperly if at all.

Part of the reason for this failure is a lack of understanding or the ability to translate complex medical directions into simple, recommended action which is often referred to as “health literacy.” But that’s not the entire problem. People are forgetful, or have a tendency to stop following directions or taking their meds when they’re no longer in crisis or start feeling “better.” The ACA includes money and program guidance for addressing health literacy issues, and is targeting wellness as an important opportunity to help Americans improve their health and help reduce medical costs.

Studies have shown that non-compliance causes 125,000 deaths annually in the United States, leads to 10 percent to 25 percent of hospital and nursing home admissions, and is becoming an international epidemic. The magnitude of this problem is obvious when you consider that 32 million Americans use three or more medicines daily, and that as many as 75 percent of patients (and 50 percent of chronically ill patients) fail to adhere to or comply with physician-prescribed treatment regimens.

The reasons behind this failure are varied, ranging from simple forgetfulness to confusion to ambivalence, but the problem costs an estimated $290 billion in emergency-room visits and other avoidable medical expenses in the United States every year.

What we can each do better

People confront situations that involve life-changing decisions about their health every day. These decisions are made in places such as grocery and drug stores, workplaces, playgrounds, doctors’ offices, clinics and hospitals, and around the kitchen table. Obtaining, communicating, processing, and understanding health information and services are essential steps in making appropriate health decisions; however, research indicates that today’s health information is presented in ways that are not usable by most adults, and people often can’t find and use the health information and services they need.

Without clear information and an understanding of the information’s importance, people are more likely to skip necessary medical tests, end up in the emergency room more often, and have a harder time managing chronic diseases like diabetes or high blood pressure.

Each of us can improve our overall health or the health of those we care for by following these simple steps:

  • Ask questions. Your physician, nurse, or other medical professional wants you to get better, so don’t be afraid to ask questions. We often remain silent because we don’t understand directions, don’t want to appear dumb, feel like we’re “wasting their time,” or think we can figure it out on our own after we leave the doctor’s office, clinic, hospital or pharmacy. If something isn’t clear, ask about it!
  • Take your medications as prescribed. Studies show that Americans who take one medicine a day comply up to 75 percent, but with three or more medications daily, that compliance level falls to under 50 percent. Read the directions, leave yourself notes, purchase daily pill dispensers, ask others to remind you, or establish a daily time or other discipline for making sure you remember your meds.
  • Understand how your meds work. Some medications need to be taken with food, others before you eat. Some are taken in the morning, others before you go to bed. In many cases, you have to be aware of potential reactions when mixing drugs and certain foods, alcohol or behaviors such as driving or working. Read labels and make sure you understand how to use your medications properly.
  • Don’t stop taking your meds when you start feeling better…unless you’ve been told to stop. Some prescription medications, like antibiotics, require the complete seven- or 10-day dose to ensure your body has fully recovered from an illness or infection. If you stop early because you’re feeling better or dislike potential side effects, you run a high risk of becoming sick again, or infecting others.
  • Practice conformity with medical recommendations. This is about your health — why go half way? If your doctor suggests walking or changing your diet, reducing alcohol consumption or not smoking, choosing not to comply is as foolish as not taking your prescription medications. It’s often these choices we make that determine our ability to recover and improve our longer-term health and wellness.


Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Wellness programs move center stage in healthcare reform efforts

As the healthcare reform debate presses on, a number of new policies and compliance requirements approved as part of the Affordable Care Act (ACA) — and as addendums to existing HIPAA regulations – are already being implemented, or will become effective January 1, 2014.  It is important to be aware of recently adopted federal regulations about wellness programs and how the new regulations may affect your existing wellness program as well as what they mean for those interested in starting a wellness program, says Jennifer Herz, assistant counsel, CBIA.

“Part of federal healthcare legislation is shifting health coverage attention to targeting prevention and promoting healthy behavioral changes,” Herz explains. “Some employers already use wellness programs to support such healthy behaviors and other employers may take advantage of the increased attention to help promote and reward employees for participation in healthy lifestyle programs, goal setting, health screenings and proactive wellness efforts that benefit them and their families.”                            

“Free” preventive care is one of the positive changes already in place. Changes of special interest to small employers address participation in wellness programs, educational outreach, and efforts to increase self-management behaviors.

The bottom line, Herz stresses, is that the new regulations are a good opportunity to remind employers about the benefits of wellness programming to support a healthier workforce, which increases productivity, while also working to reduce premium costs.

What is changing

Wellness programs come in all shapes and sizes, and these programs attempt to address body, mind, and pocketbook, helping employers reduce benefit costs and lost work time, while increasing employee productivity and satisfaction. For example, a wellness program might create incentives to encourage employees to adhere to a particular course of treatment or to otherwise better manage their health.

The Departments of Labor, Treasury, and Health & Human Services have issued final regulations and modifications which, among other things, reflect changes made by the ACA to wellness programs subject to the HIPAA nondiscrimination rules. As a result, companies currently offering wellness programs will need to determine if any design changes are necessary. The regulations are effective for plan years beginning on or after January 1, 2014. Read the final regulation here.             

Click here for an expanded version of this article with additional details on the ACA’s wellness program provisions.

CBIA will continue examining healthcare legislation changes that affect your policies, and will offer periodic ACA updates and explanations of program changes and opportunities. This information will be available through CBIA’s Health Connections Resource Center,

# # #