How to get on-board with the health care transparency trend

The health care system has reached a tipping point — with its lack of price and quality transparency.

Along with the pressure of constant cost increases, consumer expectations and behavior have started to change. Employees and employers are demanding more transparency.

“Health care is the only experience you have as a consumer where you go into it not knowing how much it’s going to cost,” says Abbe Mitze, account executive II at HealthLink. “If you buy anything as a consumer, you know all of the facts, especially in the world of the Internet today.

“But in the world of going and having a MRI, you just go where your doctor tells you to go,” she says. “You don’t research it to find out what the cost difference could be if you actually compared the facilities that you have available within your network.”

Smart Business spoke with Mitze about what more transparency within the health care system means and the new transparency tools that are being added.

What are some of the problems that stem from health care’s lack of transparency?

In-network prices can vary by 300 to 500 percent, or more, for many common procedures. Patients often don’t realize there are such high swings because they don’t see these costs, which are tied to the facility, not the physician.

They also think that higher prices mean you’ll be getting higher quality care, but cost doesn’t always equal quality.

How is this changing?

With higher deductible plans, and higher coinsurance that the member is responsible for, taking time to do research on costs can really pay off, for both the health plan providers and the patients.

Many carriers, third-party administrators (TPAs) and provider networks recognize this, and are creating tools to assist employees with making educated, cost-effective choices when receiving care.

For example, there are websites and apps that let health plan members search facilities and see the cost of the top 300 procedures at the facilities in their network. It’s not necessarily about trying to get patients to switch their doctor, which is a very personal choice. It’s more about using simple cost comparisons for scheduled outpatient procedures at hospitals, outpatient clinics or imaging centers.

Along with these kinds of tools, carriers, TPAs and provider networks will drive employee behavior with a three-tier network. So, members have the choice of tier one, tier two or out-of-network; if they go to a tier-one facility, they pay less out of pocket. The tools can work in conjunction with a multi-tier plan because it helps enable consumers to see costs upfront so they are able to budget for whatever co-pay, coinsurance and deductible they will have for a procedure.

You also can tie in programs with utilization, cash rewards or point programs.

Are health care facilities resisting this kind of transparency because they fear patients will only consider cost, and not outcomes?

There will be an education curve, but employees and employers are demanding this kind of information now. Quality of care is certainly a factor that needs to be included in the ratings or grades that these transparency tools provide.

What have been the results of having more transparency, so far?

Research has shown that transparency, year over year, steadily increases the migration to lower cost providers across all clinical categories. For instance, one study found 27 percent of the health plan’s members used lower cost providers at the start. That increased to 49 percent by year one, and then 66 percent by year two.

Knowledge is power and everyone needs to know what he or she is paying for upfront — just like with any other product. These kinds of transparency tools are expected to become more and more prevalent within the industry.

Insights Health Care is brought to you by HealthLink

How a defined contribution strategy could optimize health care spending

To better manage the rising cost of health care, more employers are moving away from employer-sponsored group health coverage in favor of a defined contribution strategy. While the concept itself isn’t new, many organizations are trying to understand the approach and whether it would work for their health care benefits.

“Many organizations adopted defined contribution years ago with retirement benefits, moving from pensions to 401(k) plans,” says Amber Hulme, Medical Mutual Vice President, Central and Southern Ohio. “It’s the same idea for health care coverage, where the responsibility of the benefits shifts from the organization to the employees.”

Smart Business spoke with Hulme about how defined contribution works, why it might be a good fit for some organizations and what they can do to make sure employees understand their health care options and get engaged in the process.

What does defined contribution mean?

The term refers to an arrangement where organizations give employees a set dollar amount as part of their benefits. It’s the way most 401(k) retirement plans work.

Organizations decide how much they want to give employees each month and employees usually add to that amount by making pretax contributions through payroll deductions. Employees are then free to manage their benefits and use the money as they see fit.

How does it work with health insurance?

Again, employees have a set amount of money allocated to pay for a policy — from their employer, their own contributions or both. Organizations typically work with their insurance carrier to create a selection of plans for their employees, who then use the money to buy a policy that’s right for them. Of course, they have to pay any difference in cost above their employer’s contribution.

Why is defined contribution getting so much attention?

One of the biggest drivers is health care reform — specifically, the Pay or Play rule, which requires some organizations to give employees the chance to enroll in health care coverage. This year, the rule applies to certain employers with 100 or more full-time employees. That includes full-time equivalents, which is a calculation that makes sure part-time workers are reflected.

In 2016, the rule will apply to certain employers with 50 or more full-time employees. Organizations that haven’t offered health insurance may see defined contribution as a cost-effective way to meet the requirement.

What are the main advantages?

Defined contribution can free up resources organizations use to select and administer health benefits for their employees. And because contribution amounts are set ahead of time, they know what their costs will be upfront. In addition, this type of arrangement allows more transparency and gets employees more engaged in choosing their health benefits.

Organizations are always looking for ways to attract and retain good employees, which is one reason they need to offer competitive health benefits. But if insurance costs go up, there may not always be a good way to adjust group coverage to make up the difference. With defined contribution, employees can get the plans they want and employers don’t have to absorb the entire cost.

What else should organizations know?

First, they should know that defined contribution isn’t something you can implement overnight. It takes long-term planning. Organizations need to consult with their broker or insurance carrier before renewing health benefits to determine which options to choose.

There may also be a financial component, depending on the carrier. Medical Mutual offers a defined contribution platform at no charge, but the charges vary across the industry. Those costs need to be taken into account before making any decisions.

Finally, education is critical. Most employees aren’t going to be familiar with purchasing their own health insurance, so they will need help. Organizations should work with their carrier to develop customized communications to help their employees understand the process.

Insights Health Care is brought to you by Medical Mutual

Improving overall employee health starts with good dental hygiene

Good overall health and good dental health are generally considered separately and mutually exclusive. What people do not always realize is the two are related and one impacts the other.

“Research has been done that demonstrates regular dental care not only improves overall health but can also help to reduce medical expenses and hospitalizations,” says Dr. Richard M. Celko, MBA, regional dental director for UPMC Health Plan.

Smart Business spoke with Celko about the connection between dental health and overall health for you and your employees.

Is there any correlation between oral health and overall health?

Good overall health and well-being begins with good dental health. Many people don’t realize the connection the mouth and body have. There is an oral systemic connection, and good oral habits and a healthy mouth can lead to better health and wellness.

For instance, periodontal disease is a bacterial infection. It is now widely accepted that periodontitis has effects beyond the oral cavity. There is literature that associates pregnant women with periodontal disease and low-birth-weight babies as well as preterm deliveries. The bacteria associated with periodontal disease have even been found in the bloodstream and on heart valves.

Is there a connection between periodontal disease and diabetes?

Adults with periodontal disease have an increased risk of respiratory infections, stroke and severe osteopenia, in addition to uncontrolled diabetes.

Plaque can build up on teeth and harden to form calculus. Chronic calculus irritation causes gingival inflammation and, if left unaddressed, leads to further destruction of the supporting tissues and ultimately to the development of periodontal disease. In addition, diabetic patients require longer periods of time for healing following periodontal treatment.

Studies have shown that people with diabetes who were treated for periodontal disease had a 39 percent reduction in hospitalizations, people with stroke had a 21 percent reduction, and people with heart disease had a 28 percent reduction in hospitalizations.

Is there a connection between oral health and heart disease?

Yes, studies show that cardiovascular disease is the most commonly found systemic condition in people with periodontitis. Approximately 90 percent of patients with heart disease also show a degree and presence of periodontitis. By comparison, only 60 percent of people without heart disease have some form of periodontal disease.

What are the dangers for pregnant women?

The presence of periodontal disease in expectant mothers has been an area of research recently. Mothers with a history of preterm delivery or low-birth-weight babies have shown various stages of periodontal disease compared to mothers who have delivered normal size, full-term babies, even after adjusting for confounding factors, such as age, smoking, drug use, nutrition and systemic disease. Furthermore, infection and inflammation can also interfere with a fetus’ development in utero.

It’s recommended that pregnant women have comprehensive periodontal exams to identify if they are at risk and seek treatment accordingly.

Does regular dental care improve overall health?

Research done by the University of Pennsylvania shows that regular dental care not only improves overall health, but can also help to reduce medical expenses and hospitalizations.

For anyone, regardless of the presence of a chronic condition, it’s especially important to be diligent with oral health care at home and to visit the dentist on a regular basis, usually every 6 months. It is recommended to brush your teeth after every meal and floss daily.

Enjoying a well-balanced, nutritional diet with minimal consumption of snacks between meals, partnered with exercise, leads not only to a healthy mouth and a healthy mind, but also to a healthy body.

Insights Health Care is brought to you by UPMC Health Plan

Where does the Affordable Care Act stand now for employers?

2014 was a landmark year for the implementation for portions of the Affordable Care Act (ACA). Employers with 100 or more full-time equivalent employees are now subject to the employer mandate and have to start offering affordable, comprehensive coverage or face penalties.

Those employers are working through the complicated process of reporting back to the IRS, which will substantiate that they are meeting all of the requirements.

“That’s what they are struggling with. It’s not necessarily the insurance or the health care part of it, but rather the administrative side of reporting back to the government and ensuring the information is correct,” says Abbe Mitze, account executive II at HealthLink.

That’s why it’s important that your insurance consultant and tax consultant are working together on this, she says.

Smart Business spoke with Mitze about what employers need to know about the ACA legislation in its most current form, and how to stay up to date going forward.

What’s the latest on who has full-time employee status?

Under the ACA, those who work more than an average of 30 hours per week are considered full-time. Previously, an employer could determine what they considered to be a full-time employee, which most put at 40 hours.

Reducing it to 30 hours has expanded the population of full-time employees, therefore, putting additional expenses on large employers who are now required to provide coverage to these employees, when coverage is required. Legislation has been proposed to change that to either 35 or 40 hours. It passed the House in January, and although the Senate hasn’t voted yet, it’s expected to pass. The speculation, however, is that President Barack Obama will veto it.

This — along with some other proposed modifications — is something to continue to keep an eye on with the upcoming 2016 presidential election.

Everything you’ve talked about has to do with employers with 100-plus employees, what about smaller employers?

Employers with 51 to 99 employees were subject to the employer mandate regulations and subsequent fines for not complying, but were given a reprieve until 2016. Many of the eEmployers with less than 50 employees are taking advantage of transitional relief. They get to keep their non-ACA compliant benefit design, and thus continue to avoid community rating, meaning you can’t use health as a factor in determining premiums. Insurance companies will be able to only use age and tobacco use.

In 2016, both groups — those with two to 50 employees and 51 to 99 — will be considered small group and have community rating apply to them. Right now, it’s estimated that community rating could increase costs 30 to 50 percent for healthy employee groups. Because of this, they definitely need to start looking at all the solutions that are available in the market now to prepare. This includes small group self-funding solutions that don’t have to follow community rating.

So, no changes in 2015 are expected?

No, there’s no true expectation that things are going to change.

But there is one other thing looming on the horizon — 2018 is when the Cadillac Tax is slated to begin. That’s when, if your total premium exceeds a certain threshold — $10,200 for individual coverage and $27,500 for family coverage — a 40 percent excise tax is imposed.

How can employers make sure they continue to stay up to date and compliant with the law?

Make sure you have a very consultative insurance broker that will keep you up to date, in addition to using your own media resources. This can be your insurance carrier, your network, your third-party administrator or your broker. All of your partners who help provide the coverage to your employees really play a critical role in helping you navigate this.

You are so focused on your specific business and making sure that it’s successful, it’s critical to have a trusted adviser at your side.

Insights Health Care is brought to you by HealthLink

How to increase workplace productivity with a broad focus on employee health

Every company needs to understand the value of keeping its employees healthy. According to the Department of Labor, businesses spend $170 billion on costs associated with occupational injuries and illnesses, and that money has a direct effect on company profits.

Workplace injuries and illnesses cannot be eliminated, but the costs associated with them can be curtailed. One method that has traditionally been effective is an occupational medicine approach to the issues that surround workplace injuries and illnesses. But, is there an even better way?

“The goal of occupational medicine is largely straightforward,” says Leonard Eisenbeis, director of Clinical Health Operations for UPMC WorkPartners. “It is to keep a company’s employees healthy, to treat injuries effectively and to reduce a company’s number of lost work days. That is fine, but by using a total health management approach, you can go beyond that narrow focus of workplace health to concentrate more on overall prevention and wellness.”

Smart Business spoke with Eisenbeis about how to use the total health management approach to become more productive.

What is occupational medicine?

Occupational medicine is the prevention and treatment of occupational and environmental injury, illness and disability of workers. This includes prevention of injury caused by working conditions, and protecting workers from risks present in the workplace.

Occupational medicine is considered a subspecialty of preventive medicine because of its emphasis on prevention in regard to short- and long-term hazards in the workplace related to people and disease.

How does total health management differ?

Total health management looks at the employee from a broader perspective. Where occupational medicine is effective in treating injuries that occur on the job, total health management goes beyond that to look at the total health of an employee.

It is as interested in non-work-related health issues as it is in work-related health issues, since, in both cases, the result can be time away from work.

Total health management is a perspective that integrates occupational safety and health protection with health promotion to prevent worker injury and illness and to advance worker health and well-being.

It is broad-based and integrated, and includes issues related to protecting the safety and health of workers in the work environment, preserving human resources through employment practices, and promoting health and well-being for individual workers. Its goals include increasing the awareness and adoption of effective, integrated occupational safety, and health protection and promotion in the workplace. By creating workplace policies that promote integration of occupational safety and health protection and health promotion, it creates a culture of health.

Total health management is designed to address root causes of health issues that impact employees and their families because they ultimately impact the workplace as well.

What does having total health management mean?

The Institute for Health and Productivity Management defines health and productivity management as the integrated management of health and injury risks, chronic illness and disability to reduce employees’ total health-related costs, including direct medical expenditures, unnecessary absence from work and lost performance at work (presenteeism).

Unlike other workplace health promotion programs, an integrated approach addresses the entire spectrum of employee health needs including disease management, disease prevention, wellness and health promotion, health assessment, disability management and absence management.

In short, it’s a comprehensive approach to managing the health, well-being and productivity of employees.

Does total health management work?

Studies have shown that companies that approach employee health from a problem-solving approach, rather than just a cost-containment approach, can be successful in reducing employees’ lost time. It also has been shown that the longer a total health management strategic approach is in place, the greater its impact over time.

Insights Health Care is brought to you by UPMC Health Plan

How to help employees stay healthy and happy during the cold weather

Each winter, organizations are challenged to keep their employees healthy. The holidays have come and gone, leaving the snow, freezing temperatures, short days and long commutes, not to mention cold and flu season. Often, healthy habits are left out in the cold.

“During the winter months, it’s common for employees to neglect their workout routines and eat foods they normally avoid,” says Veronica Hawkins, Medical Mutual Vice President, Government Accounts. “Obviously, those changes in habit can affect an organization’s productivity. That’s why it is especially important to encourage employees to stay healthy this time of year.”

Smart Business spoke with Hawkins about how organizations can help their employees avoid getting sick, stay positive throughout the workday and maintain their activity levels — regardless of what the weather is like outside.

What are some good habits to promote during flu season?

At this time of year, one of the biggest challenges to organizations is their workforce catching the flu. The best way to prevent that is to encourage employees to get their annual flu shots, which can protect them from the three most common strains of the virus.

If employees do get sick, the virus can spread quickly. Employees should be advised to keep their distance from co-workers if they start showing any symptoms. When possible, managers should also allow employees to stay home and rest — especially if they have a fever. They will recover faster and other employees will be less likely to get sick.

It’s also important to encourage good hygiene. Employees should wash their hands regularly with soap and water or use an alcohol-based hand sanitizer with at least 60 percent alcohol. Simply using a tissue when coughing or sneezing will significantly reduce the spread of germs in the workplace.

How can organizations help employees stay active in the winter?

It’s easy for people to become sedentary when the cold weather keeps them indoors. Studies show that employees who exercise on a regular basis have better job performance and lower absenteeism. That’s why it’s important for organizations to encourage their employees not to let the weather derail their exercise routines.

Fitness classes, walking groups and friendly workplace competitions can help organizations incentivize their employees to stay active. Of course, most worksites don’t have a fitness center on-site or space for an exercise program, so many organizations will partner with a local fitness facility to make it easier to help their employees stay physically active.

When employees sit at their desk all day, their muscles can get stiff and cramped. They might even develop back pain. Especially in the winter, it’s important to encourage employees to get away from their desks to stretch their muscles. If you can help your employees avoid physical discomfort, they can stay active — and more productive — during the work day.

What about seasonal depression? Is it a real concern?

It certainly can be, especially for organizations that have night shifts or varying work schedules. It might just be ‘winter blues’ for some, but many people experience actual depression during the winter months. It can be a serious problem for many organizations, considering the symptoms — increased appetite, weight gain, sleep loss, decreased energy and an overall lack of motivation and concentration.

There are plenty of ways organizations can help their employees overcome the winter blues. Sunlight can do wonders to help improve mood and energy levels.

Try to bring natural daylight into work areas and encourage employees to go outside during their lunch and breaks.

Of course, it’s always important to provide employees with avenues to find additional help if they need it. That could be through setting up at-work educational sessions or providing access to trained professionals.

Insights Health Care is brought to you by Medical Mutual

How a workplace wellness program can be convenient and inexpensive

Setting up a wellness program at your company in the new year shouldn’t be burdensome. And if you need some encouragement that it will pay dividends, turn to Rand Corp.’s recent Workplace Wellness Programs Study, which found that for each $1 invested in a workplace wellness program, $1.50 is returned.

There are several levels of activities that you can offer, depending on how involved you want to be, from blood pressure screenings to weight loss to smoking cessation programs.

“It’s important to really assess health risks that are impacting your own employee population,” says Amber R. Hulme, Medical Mutual Vice President for Central and Southern Ohio. “Wellness programs also help with absenteeism — they help make people feel better and make them want to come to work. The better you feel, the more you are engaged.”

Smart Business spoke with Hulme about how to start a workplace wellness program.

Where do you start? Do you check with your insurance provider for resources and incentives?

Yes — do that initially. You want an official baseline of your employees’ health risks. A baseline is easy to achieve with a health screening and health assessment questionnaire, which is often done online.

A health screening is vital so people know their numbers. But the health assessment is where you really get the data behind the screenings. A minimum of 30 employees is a good number to establish a baseline.

Are wellness programs suitable for companies of any size?

Yes. Obviously, the larger the employee base, the more data you can work with. For example, Medical Mutual can provide a report showing the percentage of tobacco users, diabetics or overweight employees based on a large enough sample size. You can then develop a wellness program that addresses the primary concerns of your employee population. The program can include incentives to encourage employees to go to a gym or participate in other fitness-related initiatives.

But a wellness program can work regardless of the size of the company and doesn’t require an on-site gym. If you do have a gym, that’s great, but it doesn’t mean you have to have one. There are plenty of creative ideas that can be used to make a great wellness program.

What about a company culture factor?

Making wellness part of your company culture is important; employees should feel that it’s an initiative from the top. The culture of the organization really needs to change to be more focused around lifestyle behaviors that make employees healthier.

Another thing to consider is how to best communicate with your employees. Survey your employees to find out what type of communications would help drive their performance.

Should a company offer incentives for employees to join the wellness program?

Use your survey to learn about what rewards are worth the extra effort. Don’t just throw a large amount of money at employees with the expectation that it will engage them.

You may be surprised how a small incentive or recognition by the company can promote participation. Allow your employees to participate online to select the wellness programs. Consider having an employee wellness committee. Ask employees to get involved so it’s not just coming from management, but from everybody. Having all levels of the organization involved in trying to improve employee health is important to a company.

What is the final step?

Make sure to have senior management buy-in. If you get your CEO or CIO or whomever involved and active in the wellness program, employees can share in the experience with someone at that level. This upper-level buy-in can encourage participation because employees feel they are all part of the same team. When employees see that management cares enough about wellness to participate, it makes an impact. And that participation can lead to positive communication and interaction.

A good wellness program impacts everybody in the company, no matter their job title. It puts everyone on the same playing field because everyone goes through the same struggles.

Insights Health Care is brought to you by Medical Mutual

How lifestyle medicine gets to the root of disease to improve health

Significant and growing scientific evidence shows that the primary determinant of health or disease is not genetics, but lifestyle. Heart disease, diabetes, stroke, cancer and a wide variety of other chronic diseases are preventable with healthier behaviors. Moreover, they can be better managed, and even reversed, through lifestyle improvements.

In recognition of the connection between lifestyle and health, a relatively new style of treatment, known as lifestyle medicine, is increasingly being seen as an alternative to traditional treatments used on chronic diseases.

“To address the root cause of disease, disability and premature death — and economic costs for all employers seeking a healthy and fit workforce — we need a new paradigm which ‘de-medicalizes’ health,” says Dr. Michael Parkinson, senior medical director for UPMC Health Plan. “What we eat, how we move and how we think are the cornerstones of good health and living a long and productive life.”

Smart Business spoke with Parkinson about lifestyle medicine and how it can impact the health of employees and companies.

What is lifestyle medicine?

Lifestyle medicine is the use of lifestyle interventions in the treatment, management and reversal of disease. As aptly described by Dr. David Katz, director of the Yale-Griffin Prevention Research Center, the interventions consist of:

  • Forks: Incorporating more whole, plant-based foods into our diet. Reducing or completely eliminating refined and highly processed foods, meat and dairy products.
  • Feet: Increasing daily physical activity to at least 30 minutes of aerobic activity.
  • Fingers: Eliminating cigarettes or excess alcohol.
  • Sleep: Ensuring we obtain adequate and deep sleep every night.
  • Stress: Developing healthy coping mechanisms like exercise, meditation or mindfulness for life’s inevitable challenges.
  • Love: Having and developing a commitment to a purpose, person or interest, which gives meaning to our lives.

Scientific evidence shows that lifestyle interventions can be effective in treating chronic disease, and can be equally and often even more effective than medication. Lifestyle interventions also have the benefit of not having as many risks or unwanted side effects.

So, what’s the cost? There is none, except choices, time and effort.

What chronic diseases can be effectively treated through lifestyle medicine?

Lifestyle medicine can both be effective in helping to prevent, but also to treat most chronic diseases. Many diseases affecting multiple organs, like heart disease, kidney disease, hypertension, diabetes, a majority of cancers, dementia and other conditions, are due to diets of modern-day processed foods which are high in added salt, sugars and fats but low in nutrients and micro vitamins. The result can be underlying inflammation, which can promote multiple common chronic diseases.

How does the emerging concept of lifestyle medicine support an employer’s wellness program?

A coordinated worksite wellness program emphasizing healthy behaviors, disease management, aligned policies and supportive environments can reduce total health care and productivity costs.

Loss of productivity from absenteeism and presenteeism can be more costly to a company than health-related costs. Effective workplace wellness programs follow the principles of lifestyle medicine.

Why is lifestyle medicine getting more attention now?

Frankly, we can’t afford to ‘medicalize’ environmentally and behaviorally caused disease with more treatments, tests and procedures. And doctors, frustrated often by lack of progress in treating and reversing disease, are beginning to explore this new approach based on sound science.

The challenge in the near term is twofold: paying for these services (as opposed to usual medical interventions under ‘fee for service’ reimbursement) and improving the skills of providers to provide them.

With the new payment models promoted by the Affordable Care Act and employers’ consistent and constructive engagement, we should begin to see more ways to improve employee and family health.

Insights Health Care is brought to you by UPMC Health Plan

How to utilize the right tools when making health plan decisions

Determining whether it’s worth the disruption to move your employees to a different health plan with a new network of hospitals and doctors is never an easy decision. There are, however, several different health care tools that can help.

These resources also can give you an idea of how much money you may save by moving to a different health plan.

“These are important decisions employers make to keep their employees happy and keep money in the bank that they can use for other things,” says Ann Henry, proposal coordinator, senior, at HealthLink.

Smart Business spoke with Henry about what information GeoAccess reports, disruption analysis and requests for proposals (RFP) provide, and how you can use the data to make better decisions.

What’s the timing for using these tools? 

Timing is very important. Typically, employers request some type of analysis a year to six months ahead of their effective date, which is the date their health plan starts each year. Most employers like to sync this date with their annual budgets.

Some employers wait until the last minute. But to do a thorough analysis and allow time for good decision-making, it makes sense to start the process six to nine months prior to the plan effective date.

The larger the employer, the more time may be required.

What information do GeoAccess reports provide?

A GeoAccess report allows an employer to see if their employees have good access to the network of providers.

The report takes the zip codes of where the employees live and measures how far they will have to drive to get to a hospital or a physician that’s in the network. The report shows what percentage of employees has access to a given number of hospitals, primary care physicians or specialists.

Accessing providers that are in the network is important because it saves everyone money, and some health plans won’t pay claims for a provider outside the network. For example, if an employer requests a GeoAccess report and finds that 10 employees have to drive too far to see a provider that’s in the network, that’s a good indication to keep shopping.

What is a disruption analysis, and how does it specifically help?

A disruption analysis shows an employer how disruptive it will be for their employees to use a different network of providers because most people like their doctors and don’t want to change them.

By looking at the employer’s claims activity for six months to a year, the analysis can match providers used by the employees to the prospective network of providers. This determines what percentage of providers used is participating in this other network.

The analysis can be taken a step further. If the claims data includes the billed amounts of the claims, the analysis also can estimate how much those claims would have cost with the new network. This gives the employer an idea of what kind of discounts they would have received with a different network using the historic claims data. It helps determine if another network of providers will save employers more money.

How can companies get the most out of their RFP process? 

Employers need to think about what they like about their current health plan and make sure that any new plan still has those attributes. They also need to think about what is lacking or where there have been issues and see how a different health plan can lead to improvements.

What else should employers consider when making health care decisions? 

Employers and brokers need to be careful about network discount information. There are lots of ways to calculate a network discount and different definitions can show different results. An employer may think they are making an apple-to-apple comparison when they aren’t. When an employer or broker asks for network discounts, the second question should be, “How was this discount calculated?”

Insights Health Care is brought to you by HealthLink

How the new year is a good time for start a workplace wellness program

Setting up a wellness program at your company in the new year shouldn’t be burdensome. And if you need some encouragement that it will pay dividends, turn to Rand Corp.’s recent Workplace Wellness Programs Study, which found that for each $1 invested in a workplace wellness program, $1.50 is returned.

There are several levels of activities that you can offer, depending on how involved you want to be, from blood pressure screenings to weight loss to smoking cessation programs.

“It’s important to really assess health risks that are impacting your own employee population,” says Amber R. Hulme, Medical Mutual Vice President for Central and Southern Ohio. “Wellness programs also help with absenteeism — they help make people feel better and make them want to come to work. The better you feel, the more you are engaged.”

Smart Business spoke with Hulme about how to start a workplace wellness program.

Where do you start? Do you check with your insurance provider for resources and incentives?

Yes — do that initially. You want an official baseline of your employees’ health risks. A baseline is easy to achieve with a health screening and health assessment questionnaire, which is often done online.

Health screening is vital so people know their numbers. But the health assessment is where you really get the data behind the screenings. A minimum of 30 employees is a good number to establish a baseline.

Are wellness programs suitable for companies of any size?

Yes. Obviously, the larger the employee base, the more data you can work with. For example, Medical Mutual can provide a report showing the percentage of tobacco users, diabetics or overweight employees based on a large enough sample size. You can then develop a wellness program that addresses the primary concerns of your employee population. The program can include incentives to encourage employees to go to a gym or participate in other fitness-related initiatives. But a wellness program can work regardless of the size of the company and doesn’t require an on-site gym. If you do have a gym, that’s great, but it doesn’t mean you have to have one. There are plenty of creative ideas that can be used to make a great wellness program.

What about a company culture factor?

Making wellness part of your company culture is important; employees should feel that it’s an initiative from the top. The culture of the organization really needs to change to be more focused around lifestyle behaviors that make employees healthier.

Another thing to consider is how to best communicate with your employees. Survey your employees to find out what type of communications would help drive their performance.

Should a company offer incentives for employees to join the wellness program?

Use your survey to learn about what rewards are worth the extra effort. Don’t just throw a large amount of money at employees with the expectation that it will engage them.

You may be surprised how a small incentive or recognition by the company can promote participation. Allow your employees to participate online to select the wellness programs. Consider having an employee wellness committee. Ask employees to get involved so it’s not just coming from management, but from everybody. Having all levels of the organization involved in trying to improve employee health is important to a company.

What is the final step?

Make sure to have senior management buy-in. If you get your CEO or CIO or whomever involved and active in the wellness program, employees can share in the experience with someone at that level. This upper-level buy-in can encourage participation because employees feel they are all part of the same team. When employees see that management cares enough about wellness to participate, it makes an impact. And that participation can lead to positive communication and interaction.

A good wellness program impacts everybody in the company, no matter their job title. It puts everyone on the same playing field because everyone goes through the same struggles.

Insights Health Care is brought to you by Medical Mutual