Why? Because, according to the Bureau of Labor Statistics, health care costs rose just 7.5 percent in 2004, a far cry from the 11.4 percent rise in 2002. But while costs may be rising less dramatically, employers’ health benefits costs remain a challenging financial responsibility as they demand an ever-larger share of overall operating expenses. In addition, health care cost increases continue to outpace pay increases for most employees, making it ever more difficult to afford coverage.
In response to these challenges, health insurers have been proactive in offering employers and employees new tools to manage these costs. For example, there are more plan designs than ever before, including the newest consumer-directed plans, which marry high-deductible coverage to various employee accounts for health-related savings.
In addition to these high-profile plan approaches, there are quieter innovations in the health arena that can deliver significant savings for employers.
Some of the more visible programs available involve the concept of health care management. For example, disease management programs identify and provide targeted services to members with certain chronic illnesses who, based on statistics, are likely to enjoy better health if actively helped with their conditions.
These programs reach out to people with such conditions as asthma, coronary artery disease, chronic heart failure, diabetes and low back pain. They also focus on helping women who are experiencing high-risk pregnancies, helping them stay on a healthy course to avoid unnecessary complications.
Services might include outreach and support from the insurer’s medical management team, all designed to assist the member with getting the right care from her physician every step of the way.
Some of this may sound familiar, but what’s different is how medical data are used to assess risk factors and check for errors, gaps and omissions of care that may help clinicians seize opportunities to improve health and wellness. As they process claims, insurers compile millions of pieces of data related to diseases, treatment paths and costs. The data can help alert physicians to risk factors for serious diseases, such as high cholesterol and obesity, which can lead to heart disease or diabetes.
Alternatively, data may show patterns that might link certain conditions. For example, an insurer’s data may indicate that many patients with chronic lower back pain also experience depression.
With this knowledge, the insurer’s medical staff can work with health care providers to ask the right questions, detect related exacerbating conditions and get patients more comprehensive treatment that can improve their health and help them stay at work or return to work more quickly.
Beyond seizing these opportunities, this powerful data allows the insurer to gain insights into potential treatment conflicts that could escape the attention of the patient’s doctor. In fact, some insurers offer programs that proactively alert doctors to potential areas of concern.
The bottom line is that insurers can now provide practical, timely, clinical decision support to physicians and patients, which can help to improve patient safety and medical quality, reduce medical costs and improve employees’ productivity.
Take a look
Might your company benefit from applying some of these data-enabled health plan approaches? It may be worthwhile to investigate your options by taking a closer look at the options in your existing health plan or by consulting with your insurance broker or consultant regarding the available options in your market. The choice you make might take your plan to the next level of effectiveness and quality improvement, empowering your employees and their doctors with better tools for health and potentially lowering your health plan costs in the bargain.
Thomas J. Scurfield is vice president of sales and service for the Aetna’s north central east region and is based in Cleveland. He has more than 25 years of experience working in employee benefits and holds both the Chartered Life Underwriter and Certified Employee Benefit Specialist designations. Reach him at (330) 659-8020 or ScurfieldT@aetna.com/.