July 30, 2014

Autism at a Crossroads – Part II

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

This is the second installment of a three-part series entitled Autism at a Crossroads. In Part III, we will review autism research news, review therapies and discuss the challenges of autism at school.

 

In part I of Autism at a Crossroads, we talked about the alarming increase in the number of children diagnosed with autism spectrum disorder, which the Centers for Disease and Prevention, the CDC, says went from 1 in 150 in the year 2000 to 1 in 68 in 2010. Additionally, the autism diagnosis has been retooled in the latest diagnostic manual, the DSM-V, and we discussed options for covering autism-related medical expenses.

The CDC describes autism as “a group of developmental disabilities that can cause significant social, communication and behavioral challenges.” Those with autism may also have low IQ’s, fine and gross motor problems and a host of other complications.

Since there has been such a rapid rise in new cases and much debate over the nature, treatment and causes of ASD, it has been a challenge for families with ASD to navigate their way to a successful plan of action.

For one, autism has to be identified. Sound simple? This is actually one of the biggest hurdles. ASD typically manifests itself in childhood. But because symptoms are so diverse and because not all children develop at the same rate, many parents overlook the signs.

“Despite our being able to reliably diagnose autism as early as 24 months, many children are still going undiagnosed until grade school,” said Amy Daniels, assistant director of public health research for the advocacy organization Autism Speaks, citing its research review. “By recognizing and addressing the factors that delay diagnosis, we ensure that many more children get the quality early intervention that we know can transform lives.”

The Autism Speaks blog notes several studies have shown children with other medical and psychological conditions tend to be diagnosed later than average. “Such conditions included hearing impairment and attention deficit disorder,” the blog said. “Similarly, two studies associated delayed diagnosis with parents mistaking autism symptoms for other behavioral problems such as being ‘stubborn’ or ‘spoiled.’”

Many families turn to Birth to Three  to obtain evaluations, assessments and therapy at little or no cost. Sometimes known as early intervention, Birth to Three is a program under the Individuals with Disabilities Education Act – IDEA 2004 – Part C.  The IDEA site describes Birth to Three as a federal grant program “that assists states in operating a comprehensive statewide program of early intervention services for infants and toddlers with disabilities, ages birth through age 2 years, and their families.”

Birth to Three is not the only way the government has helped defray the cost of caring for those with autism, but the goal of curing autism remains stubbornly elusive.

The United States spent almost $2 billion on autism in the last decade. The Interagency Autism Coordinating Committee, or IACC, was formed in 2006 under the U.S. Department of Health and Human Services to support the Combat Autism Act law, or CAA. The IACC’s job is to monitor and create a strategic plan to understand and treat autism.

But according to a USA Today article two years ago, more than $1 billion has been spent over the past decade searching for the causes of autism. “In some ways, the research looks like a long-running fishing expedition, with a focus on everything from genetics to the age of the father, the weight of the mother, and how close a child lives to a freeway,” the article said.

Later this year, a new bill will be put forth to reauthorize the Combat Autism Act (CAA), and increase the budget. But how to best spend the money for something we know so little about?

Florida representative Bill Posey had quite bit to say about that in a blog in The Hill: “At a recently called House Oversight Subcommittee meeting, Dr. Insel, Director of the National Institutes of Mental Health and the National Institutes of Health, admitted that after eight years and spending $1.7 billion, the programs developed in the CAA have failed to determine the causes of the enormous increase of the prevalence of autism, failed to prevent a single case of autism, failed to produce any new biomedical treatment for autism, failed to materially reduce the age of diagnosis of autism, failed to ensure appropriate medical care for the co-occurring health problems faced by many with autism, failed to ensure even basic safety protocols for people with autism who “wander,” unfortunately some to their deaths, and overall, failed the families facing autism – most especially the approximately one-third of families with children most severely affected by autism, who literally cannot speak for themselves, and whose severe disabilities portend one of the largest unfunded federal fiscal liabilities of the 21st century.”

To underscore the point, we are not even sure how to approach autism. Advocates have lobbied successfully to change the reauthorized law’s name from the Combat Autism Act to Autism CARES – Autism Collaboration, Accountability, Research, Education, and Support Act of 2014.

What this suggests is that among all the uncertainty and debate, some people are just trying to figure out how to live with autism, learn out more about it and get the right support. And this is very much a work in progress.

July 23, 2014

Autism at a Crossroads — Part I

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

This is the first installment of a three-part series entitled Autism at a Crossroads. Part II will look at autism hurdles, government funding and a renamed law. In Part III, we will review autism research news, review therapies and discuss the challenges of autism at school.

 

In a story in New York Magazine this year about autism spectrum disorder , or ASD, author Benjamin Wallace noted that references to this developmental disability are coming up everywhere. It has been suggested that personalities as diverse as Mitt Romney, Bill Gates, Dennis Rodman, Warren Buffet and even President Obama have autistic traits.

The author goes on to say that “Every generation has its defining psychiatric malady.” In the days of Woody Allen, the label “neurotic” was tossed around;  more recently, it’s “narcissistic personality disorder”, “OCD”, “ADD” and “bipolar”. Now, Wallace concludes, everyone is on the spectrum.

While there has been an explosion in the use of the term, statistics on autism do support a significant increase in this disability. The Centers for Disease Control and Prevention claims that in 2010, 1 in 68 children was diagnosed with ASD. In 2008, it was 1 in 88 and in 2000 it was 1 in 150.

Approximately 2 million people overall are affected in the U.S. alone.

The CDC describes autism as “a group of developmental disabilities that can cause significant social, communication and behavioral challenges.” Plus, those with autism also may have low IQs, fine and gross motor problems and a host of other complications.

Greater awareness of autism, an increased acceptance of people with disabilities and the inclusion of so many disparate but connected symptoms under the spectrum umbrella all played a part in ASD’s presence in the headlines and the public consciousness. Nevertheless, a real and significant increase has occurred.

Yet last year, the autism diagnosis itself changed, potentially restricting the number of people who qualify for the diagnosis by a third, which would mean that from 2012 to 2013 approximately 700,000 people suddenly don’t have autism.

So what is going on? There are few conditions – even in the field of behavioral health – more baffling and hotly contested than autism. There is great disagreement on causality, prevention, therapies and treatments. It is particularly difficult for families because it is a childhood-onset disease. There is no universal cure, and improvement, recovery or a total lack of progress can happen rather randomly.

“This year’s revision of the diagnostic criteria for autism is among the most contentious of any,” wrote author and Duke University pediatrician and medical historian Jeffrey Baker in the New England Journal of Medicine in 2013. “It reflects one of the central themes in the history of autism: a debate over where to set its boundaries.”

This revision in the Diagnostic and Statistical Manual of Mental Disorders – the DSM-V – was major news, as hundreds of thousands of families last year scrambled to understand the new guidelines and what they could mean to them.

The Autism Research Institute offered the following explanation: “One of the most significant changes is that the separate diagnostic labels of Autistic Disorder, Asperger’s Disorder and PDD-NOS will be replaced by one umbrella term, Autism Spectrum Disorder. The new criteria are more thorough and strict compared to the old criteria.  One of the biggest concerns is that some who are higher functioning will no longer meet the more strict diagnostic criteria and will therefore have difficulties accessing relevant services.”

Access to services, i.e., therapies that are covered by insurance, was a particularly worrisome item to families. According to a study last year in the journal Pediatrics, a child with ASD had an average $3,020 in additional health-care costs (and this may be a low estimate.)

Although not always widely known, there are ways to mitigate the costs of therapy and treatment. Currently, many states mandate that autism therapies be covered under health insurance, just as with any other diagnosis under behavioral health. More states are transitioning to make the same change.

According to Autism Speaks, the world’s leading autism advocacy group, there may be a benefit for those newly diagnosed with ASD to take advantage of the Affordable Care Act, also known as Obamacare, primarily because no one can be turned away for having a pre-existing condition. Additionally, a policy may be purchased solely for a child if the family’s private insurance does not have appropriate ASD coverage.

This year, Medicaid directed the states to cover treatments for autism, including speech, occupational, physical therapy and applied behavioral analysis – ABA.

Clearly, autism is developing story. But despite the controversies surrounding ASD, there are some options to get some of the medical expenses covered. It is worth doing some digging to ease the economic burden.

Next: PART II: Autism hurdles, government funding and a renamed law.

July 14, 2014

Company Wellness Programs Aim for Fitter Employees and a Fatter Bottom Line

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

Employee wellness programs have been a staple of corporate America for some time, designed to promote a healthy lifestyle and increase morale and productivity while decreasing health insurance costs. Research shows healthier employees spend fewer days away from work due to illness and are not as likely to change jobs.

For example, Johnson & Johnson, the world’s sixth-largest consumer health company, uses wellness in the workplace to create a “culture of health that, in turn, can offer a high return on investment,” according to an Employee Wellness News article entitled “Preventive Measures Can Help U.S. Workforce, Save Billions.”

“We do see health as an investment for our people rather than people and health as a cost,” said Dr. Mark Cunningham-Hill, J&J director of the global solutions center and head of occupational medicine global health services. “We understand that healthy people are more productive people and more successful, both at work and at home.”

According to a 2013 survey by the National Business Group on Health, 93 percent of U.S. employers have some kind of wellness program, “from in-house yoga to help quitting smoking.” An employer survey conducted by Fidelity Investments and the National Business Group on Health said corporate employers this year plan to spend an average of $594 per employee on wellness-based incentives – 15 percent more than in 2013. According to market researcher IBIS World, those employers spend $2 billion annually on employee wellness programs, according to a BusinessWeek article entitled “Employers Love Wellness Programs. But Do They Work?”

Winners and finalists in the 2013 Healthiest Employers in Central Florida survey all credited wellness programs with contributing to a more productive and healthier workforce, lower insurance rates and enhanced morale. The survey, which focused on employers in Orange, Osceola, Seminole and Lake counties, was conducted by Healthiest Employer LLC  and reported in the Orlando Business Journal.

Gunster, a law firm with 11 offices throughout the region, took top honors in the survey’s Medium Division. The firm rewards its employees for participating in its wellness program and achieving goals. Rewards include paid time off, cash prizes and recognition.  The firm’s Wellness Committee chair, Dorothy L. O’Guin, credited the program’s simplicity and effectiveness.

PLC Construction Services Inc., with its philosophy “to help balance one’s self, home, work and community.”was named winner of the survey’s Giant Division.  Amanda Melton, PLC wellness leader and manager of human resources and professional development, said the company looks for “opportunities for employees to stay on top of their health needs” and rotates its wellness committee each year to generate new ideas. Employees are reimbursed for fitness classes, gym memberships, weight-loss counseling, on-site therapeutic massages and smoking cessation tools.

According to Employee Benefit News, some employers are expanding use of employee health savings accounts to drive wellness participation. (Health savings accounts are pre-tax savings accounts paired with high-deductible health insurance plans used to offset the high deductibles.) The magazine illustrated the concept with this example:

  • In the first year, the employer might make a 50 contribution to employee health savings accounts.
  • In the following year, employees might be required to complete a health-risk assessment in order to receive another 50 percent contributions.
  • Employers could continue to impose requirements as a condition for paying ongoing contributions, such as biometric testing and additional health-risk assessments.

While employers say wellness programs can help employees change habits and avoid costly health conditions, there is potential for backlash and criticism when wellness programs begin to involve medical testing and financial incentives to participate.

CVS Caremark was sued after asking employees to undergo free health screening tests that measure weight, body fat, blood pressure and glucose levels. According to the lawsuit, filed by a CVS cashier, employees who decline the test are penalized by a requirement to pay $600 extra for health insurance annually.

In an article entitled “An Inside Look at Employee Wellness Program Strategies,” Employee Wellness News reported that many companies are rewarding employees for attaining specific health outcomes, such as losing 10 pounds. Meanwhile, fewer companies are rewarding workers for simply enrolling in or completing a wellness program.

Meanwhile, it appears employee wellness programs will continue to grow and evolve thanks to the Affordable Care Act, which “increases the maximum permissible reward under a health-contingent wellness program from 20 percent to 30 percent of the cost of health coverage and also increases the “maximum reward to as much as 50 percent for programs designed to prevent or reduce tobacco use.”

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