A Healthy Community coalition creates a wellness pool for very small businesses as an add-on to coverage through exchanges

Background: Very small businesses are the chief employers in rural areas such as Maine. Their difficulties providing insurance are well documented. Workplace wellness is challenging for similar reasons: limited capacity, poor economies of scale/improvement, financial fragility and privacy concerns. Health reform creates new opportunities and incentives to bridge medical care and wellness, but the difficulty of marketing to “micro-employers” of 5 or fewer renders wellness unavailable to most rural workers. Method: Working through a community health coalition, this project offers "workplace wellness” in the community and allows employers to access financial incentives—insurance discounts and tax credits—designed for larger groups. The project defines (1) micro-worksite wellness add-on to insurance and (2) metrics for evaluating employee participation in a hybrid employer-community program. A grant from the Maine Health Access Foundation simulates financial incentives for microbusinesses. Results: Major insurance carriers, wellness providers, insurance regulators and small businesses form a study group to design a replicable product and propose necessary legal and regulatory changes acceptable to insurers and employers. An evidence-based large business scorecard --Health Enhancement Research Organization (HERO)/Mercer—is being adapted by applying a combination of community and workplace inputs. Conclusion: A community health coalition can function as a pool for the smallest employers to access wellness opportunities under health reform. The community-based coalition addresses administrative and market barriers to create a workplace wellness add-on for very small businesses that can be incorporated transparently into insurance products sold through exchanges under health reform.