Healthier People. How?Tweet
NextLogical has been keenly focused on employee wellness and health promotion since the firm's inception back in 2000. Possibly the strongest evidence of our commitment and expertise is the fact that we employ healthcare clinicians to identify health and wellness needs within our clients' populations; design specific programs/initiatives to meet those needs; and then actively participate in the execution of the programs – on-site and first-hand.
Over the course of many years and hundreds of engagements with clients and employees, we've learned a lot about what works (and what doesn't) in health risk management and wellness.
As a Registered Nurse, Certified Case Manager and Vice President of Medical Management with years of experience in this field, I'd like to share with you 10 key principles to ensure Healthier People:
1) Independently Identify, Assess and Stratify Health Risks – Don't rely solely on your healthplan vendors to identify and stratify at-risk plan members. The fact is, most carriers, Third-party Administrators (TPAs) and even some medical management firms lack the initiative to engage in deep health risk management, as well as, state-of-the-art predictive modeling and risk analysis tools. By simply stratifying members into the four basic risk categories of: Diseased and Diagnosed, Diseased and Undiagnosed, At-risk and Healthy, you can begin structuring a comprehensive plan to improve medical management engagement, diagnosis rates, patient compliance, patient education and overall wellness.
2) Oversee Medical Management Activities – The new paradigm in healthcare cost management includes a refusal to abdicate responsibility for medical management to insurance companies and other Disease Management, Case Management and Wellness/Health Promotion vendors. The independent risk assessment discussed earlier will give you the information necessary to ensure that all members are receiving appropriate support from the medical management systems you're already paying for. So, as a proactive healthplan sponsor, don't assume that all at-risk members are being medically managed; instead, deploy knowledgeable, experienced clinicians to present all identified (and suspected) health risks to your medical management team and then monitor their progress and success.
Can you tell me more about why I shouldn't trust some medical management vendors to perform optimally without this kind of oversight? Click here...
A close examination reveals that health insurance carriers have a financial incentive to allocate the majority of their medical management resources on the very largest claimants, most of whom, because of pooling or stop-loss insurance, are no longer impacting your claims experience or funding; consequently, the carrier's efforts in medical management often benefit them more than you. In order to prevent high claims in the future, it is essential for the medical manager to deploy all available resources to ensuring the compliance of members with chronic diseases. For example, a non-compliant diabetic costing the healthplan $15,000 per year (versus a compliant diabetic at $3,300 per year), may not be an attractive target for the carrier; however, a non-compliant diabetic is far more likely to suffer an exacerbation of their disease and become a high-cost claimant in future years. Consequently, the value of aggressive and persistent disease management is far greater for the employer (who, along with the patient himself, has the only long-term interest in the health and well-being of the member) than for the carrier (who can raise rates or terminate coverage at renewal each year).
3) Increase Physical Activity in the Workplace – A trend that has accelerated recently and shows no sign of abating, is employers providing access to physical training in the workplace. Company gymnasiums, team-building activities (such as walking programs, Biggest Loser contests, etc.), on-site aerobics classes and boot camps are gaining traction with employees because they remove at least two of the greatest hindrances to physical activity: The inconvenience of getting to a gym and scheduling time to exercise. So, help your employees get serious about their health by bringing exercise opportunities and training resources to them.
4) Reward Healthy Behavior – Even small improvements in a member's health are deserving of recognition and reward. Too often wellness and health improvement programs are focused on rewarding employees for having above-average or excellent biometrics. The unfortunate consequence of this approach is that those plan members who are the most in need of engaging in wellness activities are the least likely to do so because the achievement metrics are simply too aggressive. Alternatively, plans that reward members for even small gains in health status and/or the reduction of health risks are much more likely to achieve sustainable results.
5) Encourage Physical Exams – While the value of annual physical exams versus physicals every two years has been the topic of some discussion recently, our findings support the importance of annual physicals for several reasons, not the least of which is the ease of remembering to schedule the physical each and every year. The value of diagnosing disease at the very earliest stages cannot be overemphasized. The average percentage of employees obtaining annual physical exams is a miserable 25%. Consequently, the argument of whether an annual physical is too frequent is simply a moot point – Americans don't get physicals nearly as often as they should. And surprisingly, cost is not a major factor in this decision since nearly all physicals are covered with low copayments or are provided free-of-charge. Employee education highlighting the value of annual physicals, supported by meaningful rewards for obtaining them, is absolutely essential to early diagnosis and long-term cost control. If you have a significant number of employees in one site, consider bringing a physician or other healthcare professional on-site for routine check-ups and minor illnesses. Making primary care services more accessible will improve diagnosis rates, reduce absenteeism, lower healthcare costs and help members establish a meaningful relationship with a primary care physician they can call when they need medical care – thereby improving the coordination of care and possibly averting costly trips to the emergency room.
6) Offer True Preventive Care – It's an old adage: "An ounce of prevention is worth a pound of cure." And it's certainly true in healthcare. And all benefit plans routinely feature coverage for "Preventive Care" including such services as:
- Adult Physicals,
- PSA Testing,
- Routine GYN Exams,
- Pap Smears,
- Well-Child Visits, and
But from a clinical perspective, only one of these services is preventive. The other services are what we more properly define as "Early Diagnosis Services" – which have tremendous value – but they're not preventive.
So, which service is preventive? And what is "true preventive care"? Click here...
The only service mentioned above that in and of itself will prevent disease, is immunizations. In our view, there are five (5) primary activities that have been proven to prevent disease:
- 1. Exercise,
- 2. Nutrition (including supplementation and hydration),
- 3. Rest and Relaxation,
- 4. Immunizations, and
- 5. Avoidance of negative behaviors and situations, such as:
- a. Smoking,
- b. Excessive or binge alcohol consumption,
- c. Stress,
- d. Risky sexual, physical, driving, etc. activities,
- e. Dangerous environmental exposures (i.e. radon, asbestos, mold, sunburns).
The disconnect is obvious: We know that disease prevention is more effective, less intrusive and less costly than the cure or treatment of disease; however, in nearly all benefit plans today, immunizations are pretty much the extent of true preventive care.
The impact of this pervasive preventive care misnomer is more than just semantics – its implications are insidious, including:
- Healthplan members can have a false sense of security in believing that by obtaining a Physical Exam, getting a colonoscopy, etc. they are engaged in disease prevention (because that's what it's called).
- The percentage of corporate and personal financial resources expended on the diagnosis and treatment of disease approaches 99.5%, while the investment in true preventive care may only be ½ of 1%... Paying for physical exams is not investment in disease prevention but because they are categorized that way in the healthplan, reporting misleads employers into believing they are actively engaged in prevention – when in fact they're not.
- The cost of providing health insurance benefits continues to rise as the number of health risks in the population increase and the cost of care with them.
So, how do you get from a misnomer to a solution?
Well, what if:
- Your employee benefit plan reallocated some money from Prescription Drug claims to providing employees with an exercise starter kit (stretch bands, a pedometer and practical instructions written by NextLogical's exercise physiologists, nurses and dietician) along with a month's supply of pharmaceutical-grade vitamins?
- Your employee benefit plan rewarded employees with lower contributions for meeting predetermined health goals – for making progress (under a HIPAA-compliant Standard-based Wellness Plan)?
- Your employees and their families received better benefits (i.e. a lower Out-of-pocket Maximum) for participating in a company-approved, fully integrated wellness plan?
- Your employees began viewing your healthplan as a tool for improving and maintaining their health (a true "healthplan") as opposed to the "plan that pays when I'm sick"?
While I'm not necessarily suggesting that you begin paying for vitamins, on-site exercise classes, massage therapy or the like, I am hopeful that you see the need to expand your investment in true preventive care as part of your employee benefits strategy.
7) Help Employees Cope with Stress – We'll never be a stress-free society. Heck, some people seem to thrive on stress. But in uncertain economic times or when faced with a challenging or life-threatening disease, employee stress can go from annoying to debilitating. In extreme cases, stress can lead to severe work-family conflict, illness or violence. In financial terms, 60% of lost workdays each year can be attributed to stress and an estimated 75% to 90% of visits to healthcare providers are due to stress-related conditions. Total cost to US employers: $200 billion a year. In order to reduce the human and financial costs associated with stress, employers need to help employees cope better. Many of the activities noted in my description of true preventive care will help: Exercise, nutrition, rest and avoiding negative health behaviors (which tend to exacerbate, not eliminate, stress). Offering a quality Employee Assistance Plan (EAP) can help too; however, EAPs are notoriously under-utilized, so active promotion to managers and employees and integration within the healthplan is essential for optimal results. If an EAP is not a consideration, then seminars on relaxation techniques, coping mechanisms and communication skills can be of benefit. Most importantly, make certain that employees know where to go within your company, the healthplan and your community for help when the stress is too much for them to manage on their own.
8) Integrate Health Data from All Sources – The most challenging aspect of ensuring Healthier People, is the failure of component healthplan vendors to integrate key physical, demographic and clinical information across platforms. Even concerned, progressive employers who are focused intensively on employee wellness experience data integration challenges. For example, how well connected are your healthplan's medical claims processing, prescription drug claims processing, disease management, case management, wellness, Health Risk Assessments (HRAs) and Employee Assistance Plan (EAP) functions? You might be surprised to learn that many carriers and TPAs don't routinely integrate prescription drug data with medical data at the member level. Similarly, we've yet to find an employer (other than our own clients) who has a structured clinical data pathway established between their EAP and their medical manager. Data integration across all platforms helps medical managers complete the "clinical puzzle" for your members and more effectively structure programs to ensure quality care and superior treatment outcomes. Without data integration, you're paying more than you should be.
9) Ensure a Consistent Wellness Message – It's not enough to talk about wellness but ignore what's in your company vending machines. Similarly, you can't successfully launch a wellness campaign if employees can't get away from work long enough to get a physical exam (whether or not you provide them on-site). The approval and promotion of wellness by senior management is an absolute must. If employees don't see wellness being supported and reinforced by relevant corporate initiatives, your message will largely be ignored. So, add healthy food options to your cafeteria, vending machines, meetings and company events. Add 15 minutes to lunch times for a brisk walk. Sponsor a company-wide Biggest Loser contest or Walk-a-thon and donate money raised to the winner's favorite charity. Get creative. Have fun with it. Make wellness a daily part of your life and your employees' work experience.
10) Customize Programs for Your Population – There isn't a "one-size-fits-all" solution for wellness – so don't be talked into buying one. Every employer is different because every population is different. Beginning with independent health risk identification, understand which disease states are driving your costs and which are poised to drive them in the future. Next, draft a three-year benefits strategy that includes Health Risk Management (HRM) and wellness programs that fit your corporate mission and culture. Include employees in program development for a breadth of ideas and to ensure buy-in – these employees can become important wellness ambassadors within your organization. Most importantly, take advantage of the Standard-based Wellness Plan provisions of HIPAA and reward employees for taking steps to improve their health. Track meaningful health and wellness metrics and enable employees to earn points towards better benefits, lower employee contributions or Flexible Spending Account (FSA) money. If you're interested in an advanced solution, consider designing a Compliance-based Healthplan which rewards employees for participating with Disease and/or Case Management.
Most importantly, if you haven't already, start implementing wellness within your employee benefits plan. Take small steps at first and look for easy "wins" to build momentum and engage employees. If you already have a wellness plan, challenge your assumptions in benefit plan design, administration, financing and program development in order to improve member health status and lower healthcare costs.
You really can have healthier people and healthier profits.