Integrating health benefits programs Featured

7:00pm EDT December 26, 2007

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 whole.

“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 experience.

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 costs.

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 berensonw@aetna.com.