Integrating health benefits programs

As medical and pharmacy costs
continue to rise, there is an
increasing focus on how to get more value out of employee health
benefits. Sophisticated employers and
their advisers are looking beyond line-item costs and concentrating on
improved employee health, absence,
disability and presenteeism outcomes.

By integrating data, systems and
medical management across the spectrum of benefit products, including
medical, dental, disability, behavioral
and pharmacy, a health benefits carrier can see the individual member as a

“Integration allows us to use clinical
information to identify people who are
most at risk for certain health conditions and take action to see that their
needs are met,” says Bill Berenson,
senior vice president of sales and service for Aetna’s North Central Region.

Smart Business learned more from
Berenson about how integration can
help employers get the most from
their health care benefits.

How does integration work?

True integration delivers a continuum of products and services across
the entire employee population by
seamlessly integrating systems, data
and medical management. The various
disciplines — clinicians, behavioral
health experts, pharmacists, disease
management and disability management staff — all work in concert to
create opportunities for better health
outcomes as well as provide members
with a more coordinated, personalized

It’s looking at a person’s health care
needs as a whole rather than looking
at his or her health issues in silos.

How can integration increase the total
value of investments in health benefits?

The fully integrated care model
improves employee engagement and
drives behavior change to help
employees achieve optimum health —
and it helps improve productivity and
reduce health care and disability

It also supports integrated care management, which could include identifying physician-prescribed individual
care plans and tracking the member’s
progress under that plan.

Finally, comprehensive reporting
that provides actionable information
is key to aligning benefit programs
with business strategy.

How does looking at a person as a whole
positively impact that person’s health?

All aspects of your health — medical,
dental and behavioral — are intricately connected. Medical science is verifying those connections and explains them more fully every day. We know
enough to appreciate that medical care
should be approached holistically.

But even though a whole-person
approach to care makes perfect sense,
it’s not always easy to achieve, in part
because of the way our medical system works and in part because of the
way most benefit plans are designed.
America’s health care system focuses
on episodes of care and their resulting
claim costs. That means indirect
health care costs — disability, absenteeism and the loss of productivity —
receive less attention. Through integration, which connects a member’s
health data, evidence-based medicine
and a health plan’s clinical expertise
across product lines, a health insurer
can bridge together pertinent details
about member health and act to see
that those needs are addressed.

What do employers need to know in order
to maximize the value of integration?

Employers should ask their health
carrier about whether they have ready
and timely access to data and how this
data is being integrated with their programs and services. They should also
ask about how information flows within the carrier’s organization and how
people work together throughout the
organization to deliver services.

At the same time, employers should
educate and encourage employees to
participate in the disease prevention
programs and maximize other clinical,
wellness and lifestyle-management
services that are available from their
health plan.

BILL BERENSON is senior vice president of Aetna’s Small and
Middle Market Business for the North Central Region. Reach him
at (312) 928-3323 or [email protected].