Whereas 85% of privately insured persons1 and 52%* of the overall US population is enrolled in some type of managed care; and

Whereas appropriate health education plays a vital role in promoting health, preventing, managing, and coping with disease, raising awareness of health risks and providing motivation and skills to reduce health risks; 4 and

Whereas effective management of health and the amelioration of chronic conditions has been achieved through positive change in health behaviors through health education measures; 5-13 and

Whereas most of the top ten causes of death are due to lifestyle behaviors and that patient education concerned with personal health practices are among the most effective interventions in reducing the incidence and severity of the leading causes of disease and disability in the US; 5,14,15 and

Whereas such education services are both cost effective and an integral part of health care;16-20 and

Whereas major insurance associations support patient education services including programs that deal with self-management of chronic conditions such as asthma, diabetes and coronary artery disease; 21-33 and

Whereas health educators possess unique competencies and skills that maximize patient health outcomes and the United States Department of Labor recognizes health educators as a distinct professional in its classification of occupations;34 and

Whereas CDC estimates the total expenditure for all types of prevention programs, including health education, in the US is less than 1%; 35 and

Whereas health education has been identified an integral part in achieving educational and community-based objectives for the nation11 and has been identified as an integral part in helping to achieve the emerging objectives for the next decade,36 and

Whereas the provision of health education services within managed care organizations should include the following: complete health education system that provides for member health education services, clinical preventive services, health education and promotion, patient education and counseling; and

Whereas, The Society for Public Health Education adopted the 1991 Resolution on Incorporation of Health Promotion into National Health Insurance urging that health insurance companies provide coverage of preventive services, including screening, education, and counseling.37

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Therefore, be it resolved that SOPHE

1. Urges Managed Care Organizations to:
   1. Designate at least 3% of each member's premium for prevention and health promotion programs and adequate staffing by health educators, identified by their specific abilities to assess individual and community needs, plan effective health education programs, implement, evaluate and budget for health education program and coordinate the provision of health education services37 to maximize the impact of prevention and health promotion efforts.
   2. Assess and monitor the cost-effectiveness of prevention, health promotion and disease management programs with regard to: measurable health outcomes; policy changes which promote health; appropriate utilization, including prevention and early detection; member satisfaction and provider satisfaction, that contribute to either individual state Healthy People Initiatives or Healthy People 2010 initiatives4.
   3. Specify documentation of health education services including types of services, providers of service, methods of delivery (counseling, group education, etc.), frequency, sites of services, languages offered, education protocols, procedures for documenting participation and outcome, as well as policies, procedures and standards for services explicit to integrated health care delivery systems that contribute to Healthy People 2010 initiatives4.
   4. Employ trained health educators for the administration, program oversight and coordination of such health education services as described in I-2 and I-3 above.
   5. Conduct assessment of members' health practices and behaviors and their knowledge, attitudes, cultural practices, and beliefs about their health and health care, and their literacy level. This assessment will serve as the basis for development, implementation and evaluation of appropriate health education programs for the members.
2. Urges Congress to protect patients’ rights by:
   1. Enacting legislation protecting the patients' rights, which should include the right to information on grievance and appeal procedures, enrollment, disenrollment, covered services, including experimental services, and covered prescription drugs.
   2. Recommending a minimal expenditure for health education by MCOs based on the number of members. Encourage quality assurance outcomes reporting as well as research into evidence-based practices.
   3. Mandating a minimal expenditure for health education by government supported public health departments to include those without or with minimal health insurance. This should include undocumented residents. Encourage quality assurance outcomes reporting as well as research into evidence-based practices.
3. III. Urges performance measure and accreditation groups such as the National Committee for Quality Assurance (NCQA), Foundation for Accountability (FACCT), the Health Care Financing Administration (HCFA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to: Require that Managed Care Organizations include prevention and health education guidelines for health education explicit to integrated health care delivery systems that contribute to Healthy People 2010 initiatives. 4
4. IV. Urges health departments, community-based organizations, corporations and schools to implement the standards required by state health departments (when these standards provide more stringent regulation than federal objectives) or 2010 National Health Objective goals when working with Managed Care Organizations to: Form partnerships, provide technical assistance, and assure the opportunity for consumer input, to address population-based community health education needs.
5. V. Urges SOPHE members, all SOPHE Chapter members, and SOPHE’s affiliates to:
   1. 1.Support requirements to ensure MCOs hire trained professional health educators.
   2. 2.Participate, in coalitions at the national and local levels, to advocate for the inclusion of a professional health educator in the design and implementation of the managed care plan.
   3. 3.Write to newly elected representatives to communicate SOPHE’s platform on health education and managed care.
6. VI. Urges the SOPHE Advocacy Committee and the SOPHE Managed Care Task Force to monitor the implementation of this resolution. *Note: includes privately insured {85%} and the publicly insured comprised of Medicaid {45%} 2 and Medicare {15%}3
   

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REFERENCES

1. Mercer/Foster Higgins. National survey of Employer-sponsored Health Plans, Report 1997, a Stratified Random Sample of all US Employers with 10 or More Employees, 1997.
2. HCFA website, November 24, 1998 (Amy Belote).
3. Stan Hinden. "A Senior's Health Care Wish List". The Washington Post September 27, 1998; The Washington Post October 4, 1998; HCFA, Center for Health Plans and Providers, Personal Communication, E. Nevins 9/24/98 and S.Smith, News and Views, Spring 98, Vol 25, No. 1.
4. The Health Communication Chapter (draft) of the Healthy People 2010: National Health Objectives, Washington, DC: US Public Health Service.
5. US Preventive Services Task Force, Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions, Baltimore, MD: Williams & Wilkins, 1989.
6. Mataruzzo, JD, Weiss SM, Herd JA, Miller NE. Weiss SM eds. Behavioral Health: A Handbook of Health Enhancement and Disease Prevention, New York, NY: John Wiley and Sons: 1984.
7. Mullen PD, Green LW, Tabak ER, Simon-Morton DG, Frandowski RF, et al. Patient education interventions for prevention: a meta-analysis. Paper presented at Prevention 89: April 14, 1989: Atlanta, GA.
8. Green L, Kreuter MW. Health Promotion Planning: An Educational and Environmental Approach. Mountain View, CA: Mayfield Publishing: 1991.
9. Ockene JK, Sorenson G, Kabat-Zinn J, et al. Benefits and costs of lifestyle change to reduce risk of chronic disease. Preventive Medicine. 1988: 17:224-234.
10. Green LW. Determining the Impact and Effectiveness of Health Education as It Relates to Federal Policy (Contract No. SA-7974-75). Washington, DC: Office of the Deputy assistant Secretary for Planning & Evaluation/Health. US Department of Health, Education & Welfare: 1976.
11. Healthy People 2000: National Health Promotion and Disease Preventive Objectives. Washington, DC: US Public Health Service: 1991. 91-50213.
12. Schauffler HH. Disease prevention policy under Medicare: an historical and political analysis. Am J Preventive Med. 1993: 9(2):71-79.
13. Woolhandler S, Himmelstein DU. Reverse targeting of preventive services due to lack of health insurance. JAMA. 1988: 259:2872-2874.
14. American Public Health Association: Resolution 9308. Coverage of Counseling and Patient Education Services and Funding of Health Education Programs under National Heath Care Reform. APHA Public Policy Statements. 1948 to present, cumulative, Washington, D.C. APHA, current volume.
15. McGinnis M. and Foege W. Actual Causes of Death in the US. JAMA, 1993: 270:18.
16. Green LW. The potential of health education includes cost effectiveness. Hospitals:1979: 6:50:57-61.
17. Shepard D., Foster S, Stason W, et al: Cost-effectiveness of interventions to improve compliance with anti-hypertension therapy. Presented at the National Conference on High Blood Pressure Control. Washington, DC. April, 1979
18. Mullen PD, Zapka JG. Health education and promotion in HMOS: the recent evidence. Health Education Quarterly 1981: 8:292-315.
19. Cohen H, Harris C, Green LW, et al: Cost benefit analysis on an asthma self management program for children. J Allergy Clin Immunology, 1979: 63:35.
20. Health Insurance Association of America: Financing In-Hospital Patient Education - Proposed Criteria. New York: HIAA, 1977.
21. Haynes RB, Taylor DW. Sackett Dl (eds): Compliance in Health Care. Baltimore: Johns Hopkins University Press. 1979.
22. Morisky D, Levine D, Shapiro S, Green LW: The impact of a health education program on hypertension-related morbidity and mortality. Presented to the Epidemiology Section at the American Public Health Association 109th annual Meeting, Los Angeles, 1981.
23. Levine DM, Green LW, Deeds SG, et al: Health education for hypertensive patients. JAMA, 1979: 241:1700-1793.
24. Rosenberg SG: Patient education leads to better care for heart patients. HSMHA Health Services Reports, 1971: 86:793-802.
25. Leving PH, Britten AF: Supervised patient management of hemophilia. Ann Internal Med, 1973: 78:195-201. 26.Miller L, Goldstein J: More efficient care of diabetic patients in a county hospital setting. N England J Med, 1972: 286:1388-1391.
26. Logge JS, Massey VM, Vena CL, Reilly BJ: Evaluating patient education: a case study of a diabetes program. Health Education Quarterly, 1980: 7:148-158.
27. Garber AL. Evaluation of diabetes patient-education programs. Diabetes, 1977: 26:61-64.
28. Mannan, LA, Green LW, Gibson G, MacKenzie EJ: Education for self-treatment by adult asthmatics. Jama, 1979: 241:1919-1922.
29. D'Altroy LH, Blissenback H, Lutz D, et al: Drug self-administration can affect compliance. Hospitals, 1978: 52:31-36.
30. Hughey MJ, McElin TW, Young T: Maternal and fetal outcome of Lamaze-prepared patients. Obstet Gynecol 1978: 51:643-647.
31. Blue Cross Association: White Paper: Patient Health Education. Chicago: Blue cross. August, 1974.
32. USDHHS, Public Health Service, Centers for Disease Control. A framework for assessing the effectiveness of disease and injury prevention. MMWR 1992:03:27.
33. Federal Register 1998: 63(150).
34. Estimated Expenditures for Essential Public Health Services. MMWR 1997: 46(7).
35. Healthy People 2010, Section 4-15.
36. SOPHE 1991 Resolution on Incorporation of Health Promotion into National Health Insurance. 38.Joint Committee for the Development of Undergraduate and Graduate Level Preparation (1997). Standards for the preparation of graduate-level health educators. American Association for Health education, Reston, VA.
    

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