Better health plans Featured

8:00pm EDT July 26, 2008

Selecting the proper health benefit plan can be crucial to any employer as it is both a major financial investment and contributes to a healthy and productive staff. While selecting the basic plan is the first step, employers cannot stop there. It is then important to ask what features or wellness programs can be added to create the most valuable plan possible at the best cost.

Programs such as HealthbyChoice Incentives can help employers save up to 13 percent on premiums depending on the plans they offer, says Don Whitford, director of sales and client services for Priority Health. Such programs are designed to encourage healthy lifestyles for employees.

In part two of the health plan series, Smart Business spoke with Whitford about the success of combining health and wellness plans and how they can save employers money.

What is HealthbyChoice Incentives?

It is a health plan combined with a wellness program that looks at employee behaviors. There are two different benefit designs in this plan: choice and standard. With this plan, qualifications are developed that an employee must meet. If the employee meets the qualifications, he or she is placed in the choice benefit design group and his or her deductibles and co-pays are lowered. If an employee doesn’t meet program requirements, he or she is placed in the standard design plan and has higher co-pays and deductibles.

How does an employee begin the process of HealthbyChoice?

Employees begin by completing a health risk assessment within 90 days of the commencement of the plan. Their physician must fill out a qualification form supplied by the health plan. This form requires the physician to evaluate and confirm that the employee is a non-tobacco user, has a body mass index under 30 and his or her blood pressure is under 140 over 90.

Employees who meet these qualifications are moved to the choice category and are rewarded with lower co-pays and deductibles. If the employee does not meet these qualifications, he or she is not limited to higher co-pays and deductibles. Rather the employee can complete a fasting cholesterol test, a fast blood sugar test and agree to follow a treatment plan designed by his or her physician and still be rewarded with lower co-pays and deductibles. Employees who do not meet qualifications and choose not to follow a physician’s plan will have a health plan with higher costs.

The HealthbyChoice plan is a participation-based wellness program, not an outcome-based program. Therefore, you will not be required to drop 40 pounds overnight, rather you are asked to follow the plan your physician has designed to help you live a healthier life.

How does the difference in co-pays and deductibles affect an employer?

An employer’s rate remains the same no matter the benefit design in which employees are placed. There is still a savings if all employees move into the choice design program. Employees in the choice program are leading healthier lifestyles, therefore requiring less medical care and reducing overall medical costs. It is important for employers to communicate to employees that participation is rewarding, both financially and in life.

Why would an employer want to introduce the HealthbyChoice Incentives plan?

The goal of this plan is to get employees to emulate healthier behaviors and live a healthier life. By doing so, the employer and the employee experience cost savings.

In addition to premium savings of up to 13 percent, HealthbyChoice Incentives is beneficial to the employer because the health plan will evaluate the data collected and provide a comprehensive study for the employer to review and utilize when deciding what plans and coverage to select in the future. The health plan will also help the employer implement programs to improve on areas of employees’ weaknesses detected in the study.

Are there other plans that can help reduce employer costs?

Other programs, such as co-payment alignment, set different prices for different services. For example, a co-pay for a visit to a general physician may be $10, a specialist $20 and the emergency room $100. The point of this program is not to discourage the use of medical facilities but rather encourage people to seek care in the most appropriate setting. It helps discourage people from using emergency rooms for everyday needs.

This concept can be applied by itself or with any other benefit design plan excluding the Health Savings Account. It can save up to 6 percent on premiums alone. It encourages members to see a general physician for a cold or cough to receive the same quality of care but at a fraction of the cost.

DON WHITFORD is director of sales and client services for Priority Health. Reach him at don.whitford@priorityhealth.com or (248) 324-2711.