When someone secures a new job, one of the first questions they’re asked by friends and family is “How’s the health plan?”
While our parents and grandparents likely had little if any health care coverage when they entered the working world, today’s employee expects, if not demands, a comprehensive health care plan as part of their compensation package.
“We’ve created in a very short period of time a huge sense of entitlement in this country,” says Tina Antram, vice president of Hilb, Rogal & Hobbs. “We expect our employers to provide health care, but nobody said how they are supposed to pay for it.”
Smart Business spoke with Antram about how employers can maximize their employee health care plan while keeping a close eye on controlling costs.
Where has the industry landed, and where does it appear to be heading?
Employers have stepped up to meet the sense of entitlement by providing health care. But until we grapple with what’s driving the costs, it may become an unrealistic expectation for the employer to continue to do that.
We’ve squeezed nearly everything we could out of managed care over the last decade or two. Employers started cost-shifting just as the government cost-shifts. But you can’t just cost-shift and expect to manage costs. I think employers have been and will continue to put efforts toward managing their plans. They need to perform a continual analysis of their networks, their level of discounts, and new concepts like the tiered networks we are creating based on costs and outcome.
How can employers better determine a global health care strategy?
One issue that should be addressed early is what they want their plan to accomplish. Employers should look at what they’re doing with the population and align their plan with desired behaviors. They should make sure it speaks to what they are trying to accomplish.
Do they want people to make healthier lifestyle choices? If so, are programs in place to help them? If they have a lot of smokers in the population, will they provide smoking-cessation programs? Do they provide 100 percent coverage for preventive care? Employers need to step back and look at this globally.
There’s certain due diligence that should be conducted by every employer to ensure that the provider network they’ve selected is effective in terms of cost and quality and is in line with their desired outcome. They need to manage the specifics where they can — behavioral health, disease or case management, pharmacy plans and the network. They also need to understand how their vendors are interacting with the insurance company. A smaller employer can look at this through its vendor or insurance company just as a large company may have contracts out on its own or through a third-party administrator. The concept applies to all employers.
What about behavioral health and disease management?
Employers need to investigate these primary areas of health care. Behavioral health is a big component in terms of care management. We often find a huge co-morbidity between areas such as heart disease and depression, or between cancer and depression. It’s very common, and often the depression aspect isn’t being treated. Someone may have one of these diseases and still work, but the depression exasperates it to the point where he or she can’t work.
A disease management program can help reduce long-term costs. Different from catastrophic care, it targets conditions like asthma and diabetes that can be controlled and managed to a significant reduction of costs in the long run, but if left untreated and unmanaged can escalate into a substantial impact on the cost of a health plan. Chronic conditions make up roughly 50 percent of health care costs, but they are treatable conditions. These are areas that employers can help their population assess.
What tools should employers provide to maximize their health plan?
More than ever, an employer has the ability to support employees and help them make informed decisions when selecting benefits. Many health insurance companies now provide modeling tools for use with some of the new plan design options that are often referred to as consumer-directed plans. These tools help employees choose benefit levels for items like deductibles and coinsurance.
Additionally, employers can provide health advocate services to assist employees in researching and resolving claims issues, and many tools exist to support wellness initiatives. For example, employers can easily provide newsletters designed to help the population make better lifestyle decisions — creating a healthier work force — and ultimately impacting health care costs.
TINA ANTRAM is vice president at Hilb, Rogal & Hobbs in Tampa. Reach her at (813) 261-7979 or [email protected].
