Health care coverage can be a major expense, so companies often search for the least expensive alternative to reduce costs.
Integration of health care processes is crucial to improving outcomes, says Gilbert Burgos, M.D., chief medical officer of Care Choices. Employees receive better overall health care if a plan is utilized that integrates everything from wellness programs to pharmacy, disease and care management programs. This creates more effective leveraging of resources to better serve the patient.
Smart Business spoke with Dr. Burgos about implementing health programs into the workplace and how health care plans can help employers to achieve better overall health.
How can an employer decide what programs to implement into the workplace?
Many health plans identify members who will benefit from disease management and wellness programs by analyzing medical and pharmacy claims as well as information collected through Health Risk Appraisals.
Health plans often have a tool known as a predictive risk modeling to help employers assess future medical costs by quantifying the relative health status of their employees. Therefore, if an employer identifies a large number of diabetics, he or she might decide to implement or provide additional outreach for a diabetes disease management program.
How can employers encourage employees to join programs or lead a healthier lifestyle?
Due to the rising cost of health care, employers are beginning to implement high-deductible health plans, coupled with a Health Savings Account or a health reimbursement account. This means that employees are accountable for more of the cost of their health care.
Additionally, employers are beginning to base the level of employee contribution on health-related issues. For example, smokers may have a higher contribution to premiums than nonsmokers. It is important, however, that employers provide appropriate tools and programs to encourage and help their employees adopt healthier lifestyles if they intend to base financial incentives on those measures.
Another tool that can be used to encourage employees to take control of their health is a Health Risk Appraisal (HRA). The results of the HRA can guide individuals toward disease management or other programs of specific relevance to their current health status.
How can employers motivate employees and implement incentives properly?
The key is to be constructive. Incentives should be used to make people want to participate. A health plan should offer incentives as well as the tools needed to change unhealthy habits such as medications and counseling to help people with addictions to nicotine.
Encouraging people to participate in programs not only to help their overall health but also to cut their cost of health care will help them see a direct correlation between health care programs and their overall health. People need to see the immediate effect their habits are having on their lifestyle to begin to change.
Implementing exercise on lunch breaks or short walks can help improve both health and concentration.
What are the benefits of having healthy employees?
Having healthier employees means less absenteeism and, in general, a healthier, more productive workforce. This can contribute to the overall profitability of an employer.
When employers look at the cost of health care, they tend to focus on the cost of premiums and how much they increase each year. There is another component that is often overlooked but can play a major role in providing efficient health care. Absenteeism and what is referred to as presenteeism — physically being present but not being mentally focused — often are not measured. This is because they are hard to quantify, but there is a correlation between the implementation of health care programs and the improvement of these factors.
Can managed care plans assist in making employees healthier?
According to a 2004 study by the National Committee for Quality Assurance, nearly 66.5 million avoidable sick days — at a cost to employers of more than $9.6 billion — can be traced to the health care system’s routine failure to provide needed care for just five health care conditions: asthma, depression, diabetes, heart disease and hypertension.
Managed care plans usually have disease management programs available to reduce the frequency of expensive hospitalization and disease complications. Once these members are identified, they are provided with disease-specific information through mailings or work site seminars to help better manage their disease.
GILBERT BURGOS, M.D., is chief medical officer for Care Choices, a nonprofit health care organization and a subsidiary of Trinity Health. Care Choices HMO is ranked as No. 12 among 257 commercial plans nationwide and is the top-rated plan in Michigan, according to U.S. News & World Report/NCQA “America’s Best Health Plans, 2005.” Reach Burgos at (248) 489-5004 or (800) 261-3452.
