Benefits

The Fast Track To Better Health
While disease management programs focus on the 20 percent of the workforce that drives 80 percent of health-care costs, population health management programs focus on the remaining 80 percent of employees who are currently healthy. The initiatives provide education and other programs to help healthy employees stay that way.

By John Williams

Health insurance, wellness and disease management programs often originate within HR departments. This makes obvious sense for a number of reasons.

However, as the price of health care soars, more and more companies are asking their risk management departments to step in and take responsibility for these initiatives.

"Health-care costs are negatively affecting bottom lines, so CEOs and CFOs are asking risk managers to do something about it," says Gregg Lehman, CEO of Gordian Health Solutions, a Tennessee-based consulting firm that offers population health management programs.

One organization that involves risk management in health initiatives is the city of Gainesville, Fla.

In 1990, the city's risk management department began reviewing its health insurance premiums. "They saw how much they had increased and were anticipated to increase," recalls Kathryn Parker, consulting wellness director for the city. They found that more than 60 percent of employee health-care claims were lifestyle-related. As a result, the risk management department created a wellness program called "LifeQuest," which has become very popular among the employees. Of the city's 2,200 employees, 2,000 participate in at least one element of the program each year.

Parker recently attended a conference where she talked with a man who had been an intern in the city's budget department a few years earlier. The man related that his supervisor at the time, who didn't believe in the value of the LifeQuest program, asked him to determine the program's ROI. He and two other students did their master's thesis on the program and found that, for every one dollar the city spent on LifeQuest, it saved seven. "Interestingly, that supervisor eventually became the city's risk manager and is now a strong proponent of the program," relates Parker.

Florida's Polk County government is another organization with active risk management involvement in health-care costs. Michael S. Kushner, director, risk management, handles the health plan for the county, which runs about $30 million a year.

"We copied a program that the risk management department in Asheville, North Carolina, created," says Kushner. Asheville created a pharmacist counseling program for diabetics. Results: The cost per year for diabetics who were in the program dropped from about $6,000 a year to just $1,000 a year.

Polk County created a similar program in 2004. Under the program, the county waives all of the costs of medications and tests for diabetics if they participate in an education program that involves counseling with the county's on-site pharmacist. "We found that physicians often weren't providing patients with all the information they needed," explains Kushner. "For example, we found that a lot of our diabetics had never been taught how to use a meter to test their blood sugar."

Many didn't even have a meter, because they didn't know it was necessary to test their blood sugar. The county currently has 200 diabetics in its program. "We don't have hard numbers yet, but I already know we are going to have excellent results, and it will lower our costs significantly," he says. The county plans to adopt similar programs for employees with high blood pressure, asthma andeventuallyhigh cholesterol.

DANGLING THE CARROT
One of the pivotal decisions that organizations must make when introducing wellness programs, disease management programs, population health management programs or other initiatives designed to improve or maintain employee health is whether or not to incentivize employees to participate.

Research seems to suggest that incentives are necessary in order to ensure maximum levels of participation.

John Erb, a senior manager with Deloitte Consulting of Miami, Fla., says it succinctly: "The use of incentives is a no-brainer. The reason is that, if people were actually taking care of themselves in the first place, there would be no need for things like disease management programs." That is, according to Erb, you have to offer some kind of incentive for people to be willing to make the effort to change their behaviors.

Cheryl Agranovich, president of Solon, Ohio-based WellCorp, a population health management program provider, agrees. "While people realize it would be great to have better health, we're like big kids," she admits. "For example, we want to eat a lot and not exercise. As such, incentives are necessary."

And another reason incentives are important: "Employers need to be willing to put their money where their mouths are," adds Erb. "If employees are going to save money for their employers by making behavioral changes, then the employees should be able to participate in some of the savings."

What kinds of incentives make sense? You can give away prizes, but ideally, incentives should be cash-based, according to Agranovich. More specifically, they should be linked to the cost of the health benefits program. "When employers do this, we definitely see higher participation rates." In fact, research conducted by WellCorp shows that, if employers offer incentives worth $50 or more, they can achieve participation rates of 75 percent to 100 percent.

Employers who reduce employee copays by $20 to $30 a month can drive participation rates up into 80 percent or 90 percent, says Gordian's Lehman. ROI improves, too. While a non-incentivized program may generate an ROI of about 1.5-to-1 or less the first year, one employer with which Gordian works that offered incentives was able to realize a 2.75-to-1 ROI the first year.

Since 1996, employees working for the city of Gainesville have been able to participate in an incentive program that allows them to earn points for healthy lifestyle behaviors, such as not smoking, exercising. "Each year, if they earn enough points, we reimburse them $100 on their insurance for out-of-pocket medical costs," says Parker.

Incentives are also important for Polk County. "It is unheard of these days to get diabetic medications and tests for free, but that is what we offer," states Kushner. "Most employees thought it was too good to be true, but it ends up being worth about $100 a month to them." That's $1,200 a year in their pockets, and the rewards have turned out to be very appealing. "We wouldn't be able to get 200 people in our program if we weren't offering this kind of incentive," he emphasizes.

International Truck & Engine Corp. of Warrenville, Ill., operates one of the nation's most well-known, comprehensive and successful wellness programs, called "Vital Lives." While not all of the components of the program offer incentives, many do. For example, the smoking-cessation program offers a $50 reduction in health-care premiums per year. Results? "Two-thirds of people who self-identified as smokers have enrolled in behavior-modification courses to help stop smoking," reports Dan Pikelny, director of health and productivity.

The company also offers a health-club subsidy program, reimbursing employees $30 a month for memberships in certified health clubs, a benefit that is offered at the company's locations around the country that don't have an on-site health club. "We get high participation rates as a result," reports Evelyn Tin-Gluting, wellness and behavioral health manager. "About 40 percent to 50 percent of eligible employees have enrolled."

Polk County's Kushner offers some final thoughts on the importance of risk managers becoming involved in behavioral health initiatives. "As a risk manager, I definitely see the value," he states. "These are really loss-control programs, because they reduce medical costs."

That is, you can't control health-care costs by just transferring the costs to the employees, because the costs will just continue to rise.

"Risk managers don't keep their jobs today by just buying insurance," Kushner continues. "We have to find ways to control costs, and health-care costs are among the largest and where the most opportunities exist."

JOHN WILLIAMS, an Indiana-based freelance writer, is a frequent contributor to Risk & Insurance. He can be reached at mailto:riskletters@lrp.com

The New Face of Occupational safety
Speaking before the National Health Wellness & Prevention Congress in Chicago as part of a panel on occupational health, Darren Hodgdon, CEO of Chicago-based Health IQ Diagnostics, proposed a shift in occupational-health priorities: from prevention of on-the-job accidents to reducing risky health behavior.

"It doesn't do much good to lead the world in workplace safety if we also lead the world in premature employee deaths due to risky behaviors such as obesity, smoking, substance abuse and untreated conditions such as asthma and diabetes. Every manufacturer has posters about proper lifting and eye contamination, but where are the posters about smoking cessation and weight control?" asked Hodgdon, whose company monitors behavior and identifies preventable risk factors.

Hodgdon notes that with 72 percent of all disease preventable and with 50 percent of the population at significant health risk, the ability to understand and control risk is critical.

"Reducing risky health behaviors is a win-win for everyone because it reduces health-insurance premiums, improves productivity and on-the-job performance (which helps reduce accidents), and helps employees feel better," adds Hodgdon.

"U.S. industry needs to lead the world in total employee health, not merely in an accident-free workplace," concludes Hodgdon.

David Brimm
  
  
 

Showing Them the Money
One of the most daring incentive programs has been implemented at the Bank of Geneva in Geneva, Ind. Three years ago, bank management began exploring ways to keep levels of coverage affordable for the bank, while at the same time not having a deductible so high that employees couldn't afford it. "We looked at what it was costing us at that point," recalls Andrew Briggs, president. They estimated a 15 percent health-care cost increase each year, and realized that, in eight years, health- care premiums would equal the salaries that the bank was paying its employees.

In late 2003, the bank developed a program with its insurance carrier that would allow employees to receive reduced deductibles for making lifestyle-related changes in four areas: blood pressure, body-mass index, cholesterol and smoking.

The first step: Raise the deductible from $500 to $2,500. The second step: Allow employees to qualify for up to a $2,000 reduction in deductibles, thus bringing the deductible back to the original $500. That is, being able to qualify as being in the acceptable range in any one of the four areas resulted in a $500 reduction in deductibles. As such, employees who qualified in all four areas saw their deductible drop back to the original $500. As it turned out, most employees were able to qualify for two or three of the four. Some even qualified for all four. Those who didn't, continue to try.

"Employees are aware that a lot of employers are dropping health insurance coverage and that premiums are increasing significantly," explains Jeanne Aikens, HR director. "They realize the opportunity that our program offers to them, so they take advantage of it." The bank sweetened the pot in other ways. It reimburses employees up to $225 a year for health-club membership and offers a reimbursement of 50 percent of the purchase price of home exercise equipment.

"The program has worked well. Several people began to work on improving their health," says Briggs, who used the program to purchase some home exercise equipment of his own.

Tangible results: The bank just received its renewal for next year, and it is relatively unchanged. "That is unheard of these days," he reports.

John Williams