Employee benefits are both an attraction and retention tool, helping build loyalty within an employee pool, and healthcare benefits are first and foremost in importance, according to Stephanie Waldrop, a principal with Employee Benefits International. But more and more responsibility for healthcare decisions is being shouldered by the employee. This includes the “skin in the game” concept, which argues an individual will make more carefully considered care decisions if he is at least partially responsible financially for them. It also includes health lifestyle choices, or wellness activities.
The correlation between an employee’s physical and mental well-being and productivity at work is not a new concept. What is new is the widespread attention to this area of healthcare since passage of the Patient Protection and Affordable Care Act. In fact, EBI makes it clear to its clients that “the federal government is increasing the amount of wellness incentives that we are allowed to offer you” specifically as a reward for healthy choices.
Results of a survey of North American employees conducted earlier this year by Corporate Wellness 365™, a division of Spafinder Wellness, Inc., a media and marketing company for the spa and wellness industry, indicate that if businesses want to get workers engaged with, and stick to, new, healthy behaviors, they need to provide them with access to a broader range of fitness/wellness activities that go beyond a traditional gym membership.
The survey found roughly 9 in 10 employees who tried a new fitness/wellness activity felt inspired to not only continue it on a consistent basis (86%) but also try other healthy classes/activities (93%). More than 90 percent returned to the new activity, with 33 percent continuing it regularly. Of those who made it a regular health regime, 85 percent said it made them feel better physically, 72 percent indicated it made them mentally healthier/less stressed, and 38 percent said they were more productive and happier at work.
Empowering Employee Choice
Employees now want to be more empowered about their health insurance coverage, observes Jeff Stelnik, senior vice president of strategy, sales and marketing for Blue Cross Blue Shield of Arizona. This has been fueling a trend to a defined contribution by the employer. “The employer gives a fixed amount, and the employee can choose where to sign up — which is similar to the federal exchange,” he explains. Choices include an HMO product with a tighter network, a health savings account (HSA) program that affords full empowerment, and a lower-deductible PPO that allows an employee to buy up to richer program. “This allows the opportunity to make decisions more individualized at the employee level while giving the employer a better line of sight into the company’s financial obligation. The contribution is same across the board, and is therefore more stable and consistent.”
John Shufeldt, M.D., who serves on the board of managers of Arizona Care Network, notes that benefit design is an important factor for both the employer and the employee. “A lot can be done to help guide patients to the best source of care,” he says, explaining the healthcare coverage can include a higher co-pay for what he terms “perceived convenience” — going to the emergency room when other options exist, such as an appointment at a doctor’s office. If a patient goes to the ER and gets admitted, the co-pay could be lowered; but, he says, “If the person does not get admitted, it’s something that could have been done elsewhere,” and the higher co-pay would stand.
“The patient has a responsibility in the mix, and has to be a willing participant,” Dr. Shufeldt says. He suggests rewarding individuals who are trying to change — not necessarily the ones who are healthy but the ones who are working on their health, he emphasizes. Employers can use biometric screening to identify patients who are at risk, and give incentives to lead healthier lives, such as covering more of the health insurance cost or having a differential co-pay. “Make it easier to get your routine maintenance care, but have a higher cost for going to the ER or out of network.”
A focus of Arizona Care Network is keeping the patient healthy rather than seeing him only when he’s ill. Care coordinators work with at-risk patients to help them be healthy in the most efficient way possible. An example Shufeldt shares is a diabetic who is unexpectedly staying where he does not have his insulin. “It’s cheaper to find a way to get the patient the insulin than have the patient come to the ER.”
Knowledge Empowers Good Choices
Stelnik notes that education is required for consumers to be able to make good decisions, and points out that BCBSAZ provides tools to its customers to facilitate consumer choice.
David Berg, D.C., chairman of Redirect Health, has a similar view of the importance of knowledge — or data — but applies it to the company rather than the individual. “Every employer should ask their broker or insurance company about premiums and pricing,” he says. “Nobody asks for this, but if they did it would dramatically lower their costs.” Employers should ask about their data — who owns it and can they get their own data.
If the insurance company has the information — names, medications, surgeries — it can rate its financial risk more safely than if it doesn’t, Dr. Berg explains. In theory, the insurance company could offer the healthcare premium at a lower cost than other companies, he says, explaining the other companies, lacking the data, have to give themselves a financial buffer. But by keeping the data private, “the current company can price itself the same as others — or just under, to get your business.”
HIPAA regulations is the defense commonly given for not providing the data, but Dr. Berg says that is a misreading of the law. “The law says you can’t have retribution because of the data.”
Data is what controls future prices, and Dr. Berg emphasizes, “Owning your own data give you control over how it’s used.” If the insurance company denies an employer’s request for the data, Dr. Berg says the best leverage is “to leave that insurance company, and maybe create your own system” — which is what Redirect Health does. “All Redirect Health companies own their own data.”
Having actionable data — which includes quality and pricing information at the time care is needed — can enable an employer to lower healthcare costs in the future as well as the current year, Dr. Berg emphasizes. “It’s important to have the data in real time, and understand your plan so everyone knows their own responsibility.”
Series: A Look at Healthcare Benefits
- Healthcare: The Employer’s Role in Employee Choices (Sept. 2014)
- Healthcare: Networks and Coverage (Oct. 2014)
- Healthcare: A Tool to Strengthen Productivity (Nov. 2014)
To reference published segments, please access the archived “Healthcare” articles on the
In Business Magazine website, www.inbusinessphx.com.