Eligibility audits are not just about who belongs in your benefits plan

A dependent eligibility audit is a critical evaluation of an employer’s health plan to verify that all enrolled dependents meet the eligibility requirements set forth under the plan.

The audit process requires each enrolled dependent’s eligibility be substantiated, and those that fail to meet the eligibility requirements may be removed from the plan.

The primary benefit of an audit to an employer is twofold.

“First, the employer will be in a better position to control costs by eliminating claims paid for ineligible dependents,” says Ron Filice, president and CEO at Filice Insurance. “However, just as beneficial from a compliance standpoint is the important advantage of ensuring that the terms of the plan are strictly adhered to by enrolling only dependents who meet the plan’s requirements for eligibility.”

Smart Business spoke with Filice about the dependent eligibility audit process.

Where does an employer start?

The first step in undertaking a dependent eligibility audit requires a careful review of plan documents, including the Summary Plan Description, and any enrollment materials. These documents set forth the definition of an eligible dependent.

While federal law provides basic guidelines as to who must be included as a dependent, employers often go beyond those basic guidelines and set a more inclusive definition. This definition may appear straightforward, but it is imperative that an employer fully understand who is included and who is excluded as a dependent.

An employer may discover that the plan sets forth an undesirable definition of dependents that encompasses far more enrollees than intended. In this case, an employer cannot retroactively alter the definition or begin an audit using the desired definition.

Instead, the definition of a dependent should be redrafted for the start of a new plan year and the benefit of an eligibility audit may need to be reconsidered.

What does the process entail?

An employer may wish to undertake a comprehensive audit that will require specific documentation to verify dependent eligibility and that will impose removal of any dependent found to be ineligible.

In this case, an employer will be best served by contracting with a qualified third party to conduct the audit.

Alternatively, an audit may be a bit more lax by requesting that employees certify by signing an affidavit that their enrolled dependents meet the eligibility rules under the plan. Employees would have the opportunity to voluntarily remove any dependents who do not qualify.

This method will likely not yield the dramatic results that a more comprehensive audit will, but it may be a better fit for the company culture and for employee morale.

What kind of documentation may an employer request?

The most straightforward manner of verifying dependent eligibility is to require employees to provide documentation to substantiate eligible status.

Marriage and birth certificates are adequate and are often readily obtainable by the employee. Additionally, a current lease, mortgage, or billing statement may properly demonstrate the residence of a dependent.

Just as important, though, is how the employer will handle a situation where the employee is unable to obtain and produce appropriate documentation. The employer should be proactive and plan ahead for such scenarios, and should apply the same strategy each time the situation arises.

What are some other important considerations?

Employers need to diligently plan the process, including whether and to what extent a third party will be involved, how the process will be communicated to employees, the time frame by which the audit will need to be completed, the action to take with respect to ineligible dependents and how the audit process will affect the workplace environment.

Finally, audits implicate various aspects of federal benefit laws. For this reason, employers should always consult with competent counsel prior to undertaking an audit to ensure that the employer will be able to navigate legal issues and remain in compliance. ●

Insights Health Care is brought to you by Filice Insurance

Value-based insurance: Don’t let your consumer-driven health plan be a barrier to necessary care

Consumer-driven health plans (CDHPs) have been increasing in popularity because they appear to be custom-made for this era of health insurance reform. The growth makes sense for a number of reasons. Most of the reasons are related to reduced medical costs and increased engagement by members, including a greater interest in and knowledge of costs and quality of care.

“There is, however, evidence to show that with CDHPs, essential medical services often will be curtailed if individuals have to pay an increasing amount of their own money,” says John Mills, senior director of Consumer Products at UPMC Health Plan. “What is needed is a value-based insurance design element to those plans that would deliver highly valued services at little or no out-of-pocket costs.”

Smart Business spoke with Mills about the concept of value-based insurance designs and how they can interact with CDHPs to make sense for consumers and companies.

What is value-based insurance design?

Value-based insurance design encourages consumers to use high-value drugs and health care services by reducing or eliminating cost sharing for those treatments. This is also known as evidence-based benefit design because the services and treatments have been proven, through extensive research, to be effective.

The plans provide a high level of clinical benefit for the money spent. According to a 2008 study by the American Journal of Managed Care, 20 to 30 percent of large employers implement some form of value-based insurance design.

How do value-driven plans work?

These insurance plans seek to increase health care quality and decrease costs by using financial incentives to promote more cost-efficient health care services and increase consumer choice. Health benefit plans can be designed to include coverage for evidence-based care and services that are shown to reduce costs and improve health.

For example, when a plan covers what is considered preventive care — wellness visits, blood pressure treatments, diabetes medications, etc. — at low or no cost, it can result in savings down the road by avoiding more costly treatments. A benefit plan can also include disincentives for unnecessary or repetitive health choices, or for procedures that produce a positive outcome that could have been produced for a lesser cost.

How can value-based insurance improve CDHPs?

Studies have shown that value-based design improves access to health care services while helping patients adhere to prescribed medical treatments. But research has also shown that when CDHPs require a financial penalty for medical treatment, consumers tend not to make the long-term health care decisions that are necessary to improve care and that, in some sense, CDHPs can create barriers to necessary care.

That’s where a value-based design comes into play. If structured correctly, such plans encourage the use of high-value drugs and health care services by reducing or eliminating cost sharing for those treatments.

What constitutes value-based design?

Value-based insurance design has grown out of the evidence that even modest co-payments can discourage use of a drug or service and that those who have high cost-sharing are less likely to follow treatment regimens prescribed by their doctors. With a lowering (or elimination) of out-of-pocket costs, value-based insurance enables consumers to afford the care they need. This can lead to improved health outcomes.

A 2014 study by the University of Michigan Center for Value-Based Insurance Design found that millions of Americans could benefit from expanded coverage of CDHPs that incorporated value-based insurance design principles in order to better meet the needs of chronically ill persons and those at high risk for developing chronic conditions.

Enrollment in CDHPs has grown from 11.4 million to 15.5 million in 2013, according to America’s Health Insurance Plans, a trade organization. The Affordable Care Act emphasizes increased quality and efficiency in health care through access to preventive services and providing appropriate treatment. Value-based insurance design fits right into that.

Insights Health Care is brought to you by UPMC Health Plan

Integrating pharmacy with medical benefits can help your bottom line

Managing the rising cost of prescription drugs is no easy task for any organization. According to research from Buck Consultants in 2014, employer-sponsored plans spent about 18 percent of their annual health care budget on pharmacy benefits. The trend is leaving many organizations looking for options.

“Prescription drug costs have increased dramatically over the last several years and organizations are feeling pressure to adjust their benefit designs,” says Veronica Hawkins, Medical Mutual Vice President, Government Accounts. “As a result, more organizations are integrating their medical and pharmacy benefits to have a more coordinated approach.”

Smart Business spoke with Hawkins about some of the recent trends in prescription drug costs, what it means to integrate benefits and how doing so could lower overall medical costs and promote better health for employees.

How do prescription drugs factor into rising health care costs?

There are just so many options on the market today. It causes confusion about what people really need. Beyond brand name and generic drugs, there are specialty drugs that are often used to treat rare or complex diseases.

Specialty drugs are usually the most expensive option. According to some reports, they represent about 20 percent of prescription drug spending for organizations that offer pharmacy benefits. This figure is understated, however, because it does not include the growing volume of specialty drugs administered through providers’ offices and outpatient facilities.

Experts predict specialty drug use will increase to 45 percent of all pharmaceutical sales by 2017. That’s why it’s so important for organizations to have the tools to manage these costs.

How can organizations structure their pharmacy benefits?

Organizations typically have two options to provide pharmacy benefits to their employees. Most insurance carriers are contracted with a pharmacy benefit manager (PBM). Organizations can go through their insurance carrier to build pharmacy benefits into their medical plan, or create a direct relationship with any PBM they choose.

Each organization’s involvement is different. Some choose to separate the pharmacy benefit from their medical coverage and work directly with a PBM. They believe it will save them money. This approach can, however, lead to higher costs and misaligned care management policies for the members. With integrated pharmacy and medical claims, organizations work with their health insurance carrier to manage medical and prescription drug utilization and costs in one cohesive package.

What are the advantages of integrated benefits?

From the convenience standpoint, having integrated benefits makes it easier for many organizations to manage their health plan. They only have to work with one vendor, so there is less administrative responsibility. Employees have one ID card and a single online portal to access their health benefits. But it goes beyond convenience. Integration gives organizations the tools they need to take a holistic, coordinated approach to managing the health of their employees.

It also allows insurance carriers to maintain a uniform strategy for managing the physician, hospital and pharmacy needs of its members. Medical Mutual, for example, has programs to manage drug use and costs through medical benefits the same way it does through the pharmacy benefit. These programs make sure members meet specific criteria before receiving costly medications.

What else should organizations consider?

In the past, prescription drug costs didn’t count toward the same out-of-pocket limit as medical costs. That changed for many organizations in 2015. In those cases, employees can use both expenses to reach their limit and have their plan start paying at 100 percent. That may affect how some organizations choose to structure their pharmacy benefits.

In addition, it’s important to realize that the ‘cross accumulation’ of expenses doesn’t happen automatically. Integrating pharmacy and medical benefits into one coordinated approach makes the administration much easier and, in many cases, can reduce costs.

Insights Health Care is brought to you by Medical Mutual

Improve the health of your employees with preventive health reminders

Are you and your employees taking all the right preventive steps to wellness? Unfortunately, you may not realize what you’re missing or how screenings can impact your overall health plan.

As an example, many problems identified at annual health screenings are chronic diseases, such as diabetes and cancer.

According to the U.S. Centers for Disease Control and Prevention, 75 percent of medical spending dollars in the nation go toward chronic disease management. In 2010 alone, cancer cost $157 billion, while heart disease and stroke cost $315.4 billion. In 2012, diagnosed cases of diabetes cost $245 billion, including $69 billion in lost productivity.

Although your health plan may not pay for all of the recommended services and treatments, adopting at least some can help lower your benefit costs.

Smart Business spoke with Toni Collingwood, account manager II at HealthLink, about some preventive health screenings.

What screenings should children be getting?

  • Infants who leave the hospital less than 48 hours after birth need to be seen by a doctor within two to four days. The baby may get vaccines or added screenings for tuberculin or sickle cell anemia, if appropriate.
  • A baby’s blood count should be checked once between nine and 12 months.
  • Lead testing performed at 12 and 24 months, unless you’re sure the child hasn’t been around lead.
  • Babies can be tested for autism at 18 and 24 months.
  • From age 2 to 10, children should have an annual check for height, weight, body mass index (BMI), development and behavior, vision and hearing. Screenings for tuberculin and urine testing can be administered, if appropriate.
  • Starting at age 3, oral and dental health needs to be added and blood pressure should be checked.
  • From ages 11 to 18, annual checkups remain similar.

With adult women, what are some key screenings?

  • Annual screenings should check height, weight, BMI and blood pressure.
  • Cholesterol should be checked every five years starting at age 20, with more screenings as necessary.
  • A breast exam should be conducted every one to three years until age 40, when an annual doctor’s exam needs to be supplemented with a mammogram.
  • For cervical cancer, women should be checked every three years from ages 21-29 and every five years have a Pap test plus HPV test from ages 30 to 65. If the last three Pap tests where normal within the previous 10 years, women can stop screening for cervical cancer at age 65.
  • Sexually active women ages 25 and younger need to be screened for chlamydia.
  • Colorectal cancer and osteoporosis can start to be tested for around age 50.
  • Women born between 1945 and 1965 need to be screened once for Hepatitis C.
  • Pregnant women should see their doctor of OB/GYN in their first three months. Some tests or screenings that could be administered during the pregnancy include diabetes during pregnancy, blood count, Hepatitis B, HIV, Rubella immunity, Rh(D) blood type and antibody testing, syphilis, urinalysis, amniocentesis, chorionic villus sampling, special blood tests and ultrasound tests. Pregnant women should be vaccinated with Tdap vaccine, as well as possibly an inactivated flu vaccine.

What are some important screenings for adult males?

  • Annual screenings should check height, weight, BMI and blood pressure.
  • Cholesterol should be checked every five years starting at age 20, with more screenings as necessary.
  • Colorectal cancer and prostate cancer can start to be tested for around age 50.
  • Men born between 1945 and 1965 need to be screened once for Hepatitis C.
  • Those ages 65 to 75 who have ever smoked should be checked once for abdominal aortic aneurysm.

Insights Health Care is brought to you by HealthLink

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