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The New Jersey Health Wellness Promotion Act (HWPA) became law on November 6, 2000. It requires that every HMO and other managed care organizations pay for the components of the Healthful Life Program (see Human Tune-Up). Private health insurers are also required to include the Healthful Life Program as part of their basic policies. The HWPA is included under Medicaid and applies to the Medicare recipients who are enrolled in HMOs. The Act provides for a consultation period at the annual prevention examination that is, in part, patient/participant driven - a 15- to 20-minute period during which a participant can bring up topics related to health promotion/disease prevention. SO YOU WANT TO DEVELOP POLICY FOR A HEALTH PROMOTION-DISEASE PREVENTION PROGRAM HERE ARE THE GUIDELINES 1. Keep it simple 2. Make it reasonably comprehensive, but still spartan. 3. Keep it reasonably inexpensive - the quickest way to ruin health promotion disease prevention is to make it too expensive. 4. Include only reasonably documented and defensible tests and actions. 5. Protect it from irresponsible additions - protect its integrity. 6. Build in flexibility so time lines can be changed, so there can be additions or deletions as more evidence becomes available. That requires some sort of effective advisory board. 7. Include a consultation period for discussions of health promotion disease prevention issues of interest to or concern about for the consumer 8. Build in continuing evaluation so you assess its efficacy and make sure it helps all segments of the community. 9. Create a structure that plans for the future when there will be more health promotion disease prevention tests than we can afford in any given year. 10. Provide information for consumers in between annual examinations and, where appropriate, appropriate resources for behavioral change. 11. Work with as broad a coalition as possible, including health insurers and managed care organizations. Try and avoid an adversarial environment. After all, an annual prevention examination should benefit everyone. 12. Establish the principle that that which is fully documented in health promotion disease prevention will, in general, if possible, be included. Those who want more will be expected to pay with supplemental insurance, co-payment, or out of pocket. 13. Be sure to pay the health care providers adequately or the whole program will fail. TEN ARGUMENTS FOR THE NEW JERSEY ANNUAL PREVENTION EXAMINATION1. It is the right thing to do. Every adult should be entitled to this annual prevention examination. 2. It helps people take charge of their own medical destinies. 3. It improves consumer-provider relationships. 4. Where it is provided by employers or employer policies, it will almost surely improve morale and productivity. 5. In the long run, it will reduce health costs. 6. It establishes what is and what is not accepted health promotion disease prevention policy. This is critical. 7. It establishes the principle that we will pay for proved health promotion disease prevention tests; for extras, there should be co-payments, supplemental insurance, or out of pocket expenditures. 8. The New Jersey approach helps avoid well intentioned, but ill advised legislative actions that are undocumented or unfunded and could destroy health promotion disease prevention by making it too expensive. 9. The New Jersey law includes provisions to protect the integrity of the health promotion mandate. 10. The New Jersey Law provides a structure for the future when we have more documented health promotion disease prevention tests than can be accommodated within a realistic cap at a given annual prevention examination. By adjusting time lines for tests, health care provider and consumer can work together to formulate the optimal set of tests for that individual at that annual examination, given the monies available.
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