Whelan Legislation to Encourage Better Management of Chronic Illnesses Approved by Senate Committee

Senator Jim Whelan, D-Atlantic, speaks on the floor of the State Senate.

Legislation Would Create Value-Based Benefit Pilot Program for State Employees

TRENTON – In an effort to lower the cost of health care and realize long-term savings for those with chronic health conditions, legislation sponsored by Senator Jim Whelan that would create a pilot program to provide comprehensive preventive care to chronically-ill state workers was approved today by the Senate State Government, Wagering, Tourism and Historic Preservation Committee.

“Rather than treating medical emergencies that are the result of chronic conditions, we should be working to manage the condition at the core of the problem. This pilot program would begin to do that by shifting the way we view care for chronic health conditions,” said Senator Whelan, D-Atlantic and Chairman of the Committee. “The success of this program is not just limited to the participants having better control over their chronic conditions, but can lead to real cost savings for the state from reduced health care costs and more productive state workers who are not in and out of the office due to illness.”

The bill, S-1132, would create a three-year pilot program using a value-based benefit design under the State Health Benefits Program (SHBP). Value-based benefit design insurance typically provides financial incentives to participants to increase their interaction with appropriate health care providers, and encourage use of those health benefits that specifically relate to the employee’s chronic health condition.

The program, which would target those with chronic diabetes, high cholesterol, hypertension and asthma, would pair up program participants with a licensed pharmacist, who would work with the participant’s primary treating physician to coordinate medication therapy management services for the participant.

Under the program, costs directly related to the diagnosis, care, mitigation or treatment of the condition would be covered under the program including all costs for medical condition self-management classes attended by the participant; costs associated with visits to the assigned pharmacist; costs for medical devices or supply deemed medically-necessary; costs for laboratory testing; and all copayments for prescription drugs.

Companies throughout the United States are already adopting value-based insurance design programs.  According to an article in the Washington Post, Pitney Bowes – a Connecticut-based mailing equipment manufacturing company – has provided employees with free or reduced cost heart disease, asthma, diabetes and high blood pressure medication for more than 12 years. Since the inception of their program, the company has seen increased usage of cholesterol lowering medication and blood clot inhibitors as their employees have taken effective steps to control their chronic illnesses.

The State Health Benefits Design Committee would be charged with selecting one Department, Division, Office, Agency, Bureau or other unit of the state with more than 500 and less than 1,000 employees who are eligible, based on their chronic conditions, to participate in the pilot program. Participation in the program would be voluntary.

The bill was approved by the Committee with a vote of 5-0.  It now heads to the Senate Budget and Appropriations Committee for further review.