Take two laps and call me in the morning

We have known for years that patients are more likely to start and maintain healthy behaviors and to better control their medical conditions when their doctor tells them to. We also know that people are more successful at making healthy changes when a health coach  motivates and guides them to stay on task.

So it’s no surprise that people are more successful when those two things are combined, as in when a doctor prescribes coaching to patients to help them follow through on their goals.

“Some health management programs are doing this now and employers are taking notice,” says Dr. Michael Parkinson, senior medical director of UPMC Health Plan and UPMC WorkPartners. “Physicians can now prescribe healthy behaviors, chronic disease management and better decision-making about surgery to employees. Of particular interest to employers, physicians are sending employees to coaching programs and online tools for such things as stress management, maternity support, weight loss, high blood pressure and chronic back pain.”

Smart Business spoke with Parkinson about the latest developments in this trend.

Why are so many employers offering health coaching to their employees?

It’s clear that changing unhealthy habits to healthier behaviors can head off chronic diseases, prevent them from getting worse and even reverse their effects.

While most health care providers would love to continually encourage patients to adopt healthy behaviors and get to the root of their patients’ health issues, most doctors simply lack the time or the expertise and resources needed to do the proper follow-up care. That’s where health management programs can help. They extend a doctor’s influence between office visits and help patients stay on their personalized care plans.

How do these doctor-prescribed health coaching programs work?

Let’s say a doctor prescribes a weight-loss program to help prevent a chronic disease such as diabetes. A trained health coach receives the physician’s prescription order at the same time that it is given to the patient. The coach then provides support and encouragement to help the patient become healthier, more engaged and more competent to manage his or her health. The health coach also provides the doctor feedback, which supports the doctor-patient relationship. Embedding the prescription for health coaching into the doctor’s electronic medical record represents a major breakthrough in increasing the ease and effectiveness of the process.

This arrangement produces better outcomes and usually lowers costs as well. It’s a win-win. The doctor gains additional support while the patient gets the health and medical assistance he or she needs.

Can you talk more about the doctor’s involvement in health coaching?

It’s important to note that these health management programs do not replace the doctor’s care. Rather, they support the doctor’s care. Most of these programs are facilitated by nurses, dietitians, exercise experts and other licensed and trained clinicians, often with medical director oversight. Also, these health coach professionals provide support based on the doctor’s specific recommendations. They will even help patients better prepare for their next office visit. Health coaches can evaluate treatment options and help people improve their skills in communicating their preferences to their doctors. Each patient is in expert hands throughout the process.

What types of health coaching are available?

There are health management programs in behavioral health, condition management, maternity and lifestyle improvement. These programs offer support for a range of needs, including depression and anxiety, substance abuse, diabetes, hypertension, high cholesterol, prenatal care, weight loss and nutrition, stress management and tobacco cessation.

Health coaches also provide support for people who need to make decisions about medical treatments or elective procedures. As an added bonus, most programs have no copays for employees. Better still, many employers incentivize their employees to enroll in and complete health-coaching programs. Finally, to accommodate busy employees, coaches are often available in person or via phone nights and weekends.

Insights Health Care is brought to you by UPMC Health Plan

How to help your employees stay healthy

Preventive care is all the rage in today’s health care world, and for good reason. Staving off chronic disease can not only save money for both employers and employees, it also creates a healthier and happier population.

“In-office fitness centers can contribute to that equation,” says Michael Boyle, manager of Healthy Connections Wellness Center, National Institute for Fitness and Sport, which manages 19 in-office fitness centers for Anthem, Inc. “It’s no secret that corporate fitness is a growing business, healthier employees take less sick time and have more energy, leading not only to more productivity but also to cost savings.”

Smart Business spoke with Boyle about some of the best strategies for engaging and motivating employees with health and wellness programs.

How can employers motivate their employees to stay healthy?

Employers can do several things to motivate employees to take part in health programs and stay healthy. Depending on time and resources, these strategies can be as elaborate as running a company-wide contest, or as simple as placing stickers on the stairs to show how many calories are burned with each step.

The key to successfully motivating employees is to keep participation easy and straightforward so as not to interfere with their already-busy work schedules.

What are some examples of the more complex programs employers can use to motivate employees?

One great program that can be really impactful for employees is a “Know Your Numbers” program in which employees receive incentives and/or discounts if they meet certain health requirements. These requirements can be customized by the employer and include things such as being a certified non-smoker, meeting body mass index, or BMI, requirements or receiving a flu shot.

Another example of a more involved program that employers can implement is participating in Global Employee Health and Fitness month (GEHFM). This international observance of health and wellness in the workplace, which takes place in May each year, was created by two nonprofits with the goal of promoting the benefits of a healthy lifestyle to employers and their employees.

Companies of all sizes are invited to participate in GEHFM by challenging their employees to create healthy habits. Employees can log, track and share their activities on the GEHFM website throughout the month.

While many employers use incentives to encourage employees to participate in programs, the incentives don’t have to be elaborate or cost a lot of money. The main goal for some employees may be to earn the prize, but the employer’s goal should be to promote a healthy lifestyle in efforts to help employees form healthy habits that they will be able to sustain for years to come. Learn more about GEHFM.

Are there programs that are a good fit for employers who are worried about the time and resources needed to engage employees?

Absolutely. Lunch and Learns are very easy to implement with minimal time and resources. Simply invite employees to spend their lunch hour learning about healthy living topics such as how to prevent neck and back injury, or the importance of taking breaks and staying active during the workday.

Starting a walking club is another great use of a lunch hour or an afternoon break and takes little time or effort to get started.

Is there anything else employers should consider?

Being healthy is not just about physical health, it includes mental health as well. With volunteer opportunities including gardening at local schools, working in the food pantry and volunteering with Special Olympics, giving back is a great way to keep people positive and encourage healthy living.

Employers should consider community service and team building activities when appropriate.

HealthLink is a fully owned subsidiary of Anthem, Inc., one of the nation’s leading health benefits companies.

 

Insights Health Care is brought to you by HealthLink

How healthy eating can increase employee productivity

In any business, the productivity of employees is critical to its success.

That’s why many organizations look for ways to keep their employees working at maximum efficiency. From the work environment to managerial support to quality work/life balance, many dynamics contribute — and workplace nutrition is another important factor.

“Many workplace wellness programs focus on fitness and health screenings,” says Veronica Hawkins, Medical Mutual vice president of Statewide Accounts. “Encouraging employees to eat healthy should also play a key role.”

Smart Business spoke with Hawkins about why organizations should promote healthy eating and how they can do it effectively.

How does diet correlate with productivity?

Plenty of studies link good nutrition with better overall health. It makes sense. People who eat well often feel better and have more energy.

Employees who try to follow guidelines of good nutrition also reduce their risk of obesity, heart disease, stroke, diabetes and some types of cancer.

Are there simple things leaders can do to promote healthy eating?

Leaders can set a positive example. If employees see their managers drinking water throughout the day and making good decisions about foods they eat, employees may be more apt to follow suit.

Another way is to implement an awareness campaign that encourages healthy lifestyle choices and includes tips on how to do so. This can include bulletin boards, posters or emails that focus on the benefits of nutrition, offer meal strategies and promote local farmers’ markets or restaurants with healthy menus.

Hosting healthy department potluck lunches also can get employees engaged as they try new foods and share recipes.

These are good ways to start making nutrition part of the workplace culture.

How can organizations create a culture of nutrition?

Any food ordered for meetings should include fruits, salads and other low fat items instead of donuts and pizza. Most organizations provide refrigerators and microwaves, but toasters and blenders can make it even easier for employees to bring food from home that can be prepared.

If your organization has a cafeteria and/or vending machines, make sure plenty of nutritious options are available.

At Medical Mutual, we often work with employer groups to design and implement nutrition programs that focus on healthy eating. This can also include online virtual coaching or a personal health coach through a lifestyle-coaching program.

Offering nutrition classes is another cost-effective way to reach a large number of employees and address multiple topics. These could be one-hour ‘lunch and learns’ that address specific issues, like understanding food label information, or longer seminars that delve into a variety of subjects, like stress, weight loss, etc.

Classes are a good way to bring employees together and help them support each other in making healthier choices.

Are there other resources available for organizations to use?

The Centers for Disease Control and Prevention’s website offers a plethora of nutrition information. There are multiple links to fact sheets, an interactive website about improving fruit and vegetable consumption, downloadable brochures, and links to additional useful sites such as the U.S. Department of Agriculture. These can all be made available to employees.

If your organization makes healthy eating part of the workplace culture, it can go a long way toward keeping employees happy, healthy and productive.

Insights Health Care is brought to you by Medical Mutual

How to support employees with alcohol challenges

Though sometimes hard to detect, alcohol abuse and alcoholism can impact the workplace — from absenteeism and lost productivity to missed deadlines, strained relations with co-workers and outright dismissals from work.

It is important for employers to have policies and plans in place, including support for employees who struggle with these challenges, says James Kinville, senior director of LifeSolutions, an employee assistance program (EAP) and part of UPMC WorkPartners’ suite of services.

Smart Business spoke with Kinville, in recognition of Alcohol Awareness Month, about what employers can do to help.

What can employers do about this problem?

Employers have an obligation to support their employees, but should not base that solely on lost productivity or the company’s bottom line. Rather, employers have a moral obligation to help their employees live healthier, happier, more sober lives. The same goes for employees dealing with family, financial, legal or health problems.

The best way to address these issues is through an EAP. This benefit offering, which is often separate from health insurance, helps employees with personal or work-related problems that impact their job performance. EAPs typically offer short-term counseling, referrals, employer/employee training and education.

How specifically can an EAP help employees with alcohol problems?

Most EAPs offer awareness training so managers can recognize the signs of a problem and know what to do about it. Once a policy is in place, a manager knows that he or she can refer an employee to the program. That’s incredibly helpful and gives a manager peace of mind.

It’s not a supervisor’s job to diagnose alcohol abuse or alcoholism. Even if a manager suspects that alcohol is involved, it’s better to focus on how the suspected alcohol problem is manifesting itself through increased absences, frequent tardiness or a dramatic falloff in work quality. Stick to tangible behaviors, not the alcohol part.

Accusing the employee of having an alcohol problem rarely goes well and it can be very stressful. It’s better to say you have noticed certain ongoing problems, provide the employee with the EAP number and insist that he or she make contact right away.

What about confidentiality? Are some people hesitant to seek help because it could hurt their career if the word gets out?

Whether the employee seeks help on his or her own volition or is referred by a manager, EAPs are extremely confidential. The EAP only divulges to the employer that the employee made contact with the EAP and that there’s a plan in place. No other health or confidential information is shared.

What is the process once the employee makes contact with an EAP?

Most EAPs offer six sessions with a counselor who conducts a comprehensive review and assessment and works with the employee to develop a plan of action. Sometimes, that’s all that’s needed. Other times, the counselor may refer the employee to a therapist or other behavioral health professional covered under the health plan.

What would you tell employers that don’t have an EAP?

Partner with one. EAPs tend to be low cost and even small companies can afford them. It’s a high-value service that employers tend to not need often, but when they do, it makes all the difference.

It’s also important to promote the EAP. Employees need to know about the service and that their organization supports it. EAPs work best when they are promoted internally in a consistent, customized manner, through mailers, lunch and learns, promotional campaigns and worksite presentations.

Any final thoughts on helping employees with alcohol challenges?

You often hear with alcohol or drug addiction that the person with the disease — and these are diseases, not moral weaknesses — has to hit bottom before realizing he or she has to take steps to get better. By utilizing EAPs and other support services, we can raise that bottom so the afflicted person doesn’t have to fall as far. With an EAP, the employee can take action sooner, before a potential crisis hits.

Insights Health Care is brought to you by UPMC Health Plan

The importance of industry experts in a time of health care reform

As the new presidential administration approaches 100 days in office, upcoming health care reform continues to develop.

“The House recently shared its preliminary plan to repeal and replace major components of the Affordable Care Act (ACA), but there will likely be many changes to the bill, titled the American Health Care Act, before it is passed,” says Erin C. Davidson, sales account executive II at HealthLink, Inc. “Once finalized, the new bill will likely have a direct impact on employers who recently transitioned to an ACA-compliant plan, or who were planning to do so in the near future.”

Smart Business spoke with Davidson about what to expect and what employers should know about the future health care reform.

What changes to health care reform can employers expect in the upcoming year?

One significant change is that employers who have ‘legacy plans’ that were supposed to transition to ACA-complaint plans by Jan. 1, 2018, may be able to keep their current plans through December 2018. The Centers for Medicare & Medicaid Services recently announced another one-year extension for transitional (grandmothered) policies. As details of the American Health Care Act are finalized, we should learn more about what changes, if any, may directly affect employers in the next year.

One thing is certain, self-funded plans are not regulated as heavily as fully insured plans, so they are not subject to certain reform regulations and mandates. In addition, employers who self-fund their health plans have been able to minimize the impact of the ACA and eliminate some premium taxes. Therefore, the current uncertainty surrounding future health care reform may have less of a direct impact on employers who self-fund their employee health plans.

With this uncertainty, where can employers get reliable information and advice?

No matter the state of the industry, it is very important that employers have a partner they can rely on for reliable, unbiased information. This could be their insurance broker, or their insurance carrier account manager or representative. For employers who self-fund their health plans, it might be their third party administrator (TPA) or network partner.

In times of change, an established relationship with an industry expert becomes even more valuable as employers have to decide the best option for offering health care benefits to employees. The wisest employers rely on multiple resources to gather information and make decisions. This means self-educating themselves about changes in the industry, gathering input from a variety of industry experts and examining options, such as self-funding, that safe guard their health plan from industry shifts.

However employers choose to make important policy decisions, they should have an industry expert they can rely on for information and advice.

Has the importance of relying on industry experts changed over the past five years?

Since self-funded arrangements come with the ability to customize nearly every aspect of the plan, it has always been important for employers to rely on industry experts to ensure they select the best network and programs for their employees.

In regards to fully insured health plans, health care reform has perhaps deepened the way employers rely on experts. Previously, employers depended on experts, such as insurance brokers, to shop around for them and ensure they were receiving the best coverage and the best rates. Once the ACA took effect, employers began relying on these experts more heavily to not only ensure they receive the best coverage and the best rates, but also to determine which mandates applied to their company and ensure they met requirements.

What else should employers know?

Many network providers and insurance carriers already have established relationships with industry experts that employers can take advantage of when searching for a partner to meet their needs.

Whether it is a broker, TPA or network provider, employers should talk to experts about the state of the industry, upcoming reforms and how their health plan may be affected by changes.

Insights Health Care is brought to you by HealthLink

More employers look to outsource leave management services

Managing employee leaves of absence is becoming more complex for employers of all sizes. Nearly every day, there are updated interpretations and applications of the Family and Medical Leave Act (FMLA) and Americans with Disabilities Act and Amendments (ADA/ADAAA). Plus, the increasing number of states and regions passing additional leave laws, paid and unpaid, make this complicated for all employers.

That’s why more employers, large and small, are looking to outsource leave management services.

Smart Business spoke with Linda Croushore, senior director of Disability Services for UPMC WorkPartners, about how to navigate the challenging proposition of managing absence.

How many companies are currently outsourcing leave management services?

The Disability Management Employer Coalition (DMEC) and Spring Consulting Group found in its 2016 Employer Leave Survey that 34 percent of all employers with 50 or more employees are now outsourcing FMLA management. Employer groups with more than 1,000 employees are outsourcing their programs at a rate of 45 percent, while also looking for help in managing the ADA leave accommodation process.

In general, what are the pitfalls that make employers seek help?

The DMEC study confirmed that one of the most difficult things that managers and supervisors face is accurately tracking intermittent leaves. Employees may also have difficulty accurately accounting for their time away from work. It is frequently a manual process and the timeliness of the reporting becomes an issue.

Failure to accurately account for missed time leads to missed opportunities for the employer to evaluate the validity of the time being requested against the FMLA. Accurate and timely completion of the medical certification needed to support the intermittent leave can also be a stumbling block.

What did the study find to be the major leave management challenges for most organizations?

According to the DMEC study, the top challenges facing organizations are:

  • Managing intermittent leave.
  • Training and education about roles and responsibilities of managers.
  • Integrating with ADA/ADAAA.
  • Managing workers’ compensation leaves in conjunction with the FMLA.
  • Managing short-term disability with the FMLA.
  • Coordinating leaves with attendance policies.
  • Relying on managers for leave enforcement.
  • Keeping up with new federal, state and/or municipal/county laws.
  • Controlling employee abuse.

How can employers streamline the process?

An area of increasing litigation is the end of leave process used by employers in relation to ADAAA. In many cases, employers do not offer an extension of the federally mandated FMLA time as an ADAAA accommodation. In addition to time away from work, other situations may arise where an employee asks for accommodation for a protected disability.

While some requests are straightforward and require little interaction, many of the disabilities for which an employee may request accommodation are not clearly recognized and could easily be ignored. These situations require discussion with the employee and the health care provider to determine functional abilities and possible accommodations. The employer is obligated to provide a reasonable accommodation that allows the employee to function in the workplace. However, the requested accommodation may or may not align with that definition.

What should employers that are considering outsourcing look for?

In seeking a third party administrator, look for one that can provide a streamlined process that centralizes intake, and integrates management of leave and short-term disability claims. Look for one that can act as a single point of contact for employees, their health care providers and front line managers.

Insights Health Care is brought to you by UPMC Health Plan

Decrease workplace stress with a more relaxing, healthier environment

Stress is a critical health issue most employees face at work. It has been called the “health epidemic of the 21st century” by the World Health Organization.

According to the American Institute of Stress, it costs American businesses up to $300 billion a year.

“Stress in the workplace has become a significant issue for many businesses,” says Amber Hulme, Medical Mutual regional vice president for Central Ohio. “Beyond the health care costs involved, employers see a loss of productivity, absenteeism, turnover and disengagement. That’s why it’s important to educate employees about how to manage their stress.”

Smart Business spoke with Hulme about how a stressed workforce can affect your bottom line and what organizations can do to help employees reduce, or at least manage, their stress to make themselves healthier, happier and more productive at work.

Why is stress such a problem in the workplace?

Clinical research suggests that stress is an underlying factor in at least 70 percent of all visits to family doctors, and 30 percent of employer disability claims are behavioral in nature.

Most employers advocate a healthy work/life balance, but in today’s work culture it can be challenging to really put the philosophy into practice. If it’s a priority for supervisors and upper management, however, it can really make a difference.

What activities have been shown to help?

For most people, stress management starts with a healthy lifestyle. Exercise, in particular, can be very effective when it comes to reducing stress levels at work. Employee wellness activities, such as paying for a portion of employees’ gym memberships or running group-wide healthy eating challenges, are good ways to help employees unwind and feel better.

Programs don’t need to be overly complicated or regimented. The process can be as simple as organizing a regular walking group or exercise program. Then it can grow from there.

Medical Mutual, for example, will help organizations develop and implement stress reduction programs that offer employees access to personal health coaches and online options for virtual coaching.

How important is flexibility?

When possible, enabling employees to work remotely or have a flexible schedule has proven to be good for morale. This sort of approach demonstrates trust and allows employees to manage their own time.

It also helps to remove extra stressors that working parents, for example, might face — worrying about child care, sick days or doctor’s appointments.

Of course, it’s important to set clear parameters for employees and make sure they understand exactly what is permitted. It can be challenging for some organizations, but it can have a very positive effect.

What about environmental factors?

That can make a big difference, too. For many employees, their surroundings can have a significant effect on their productivity and overall job satisfaction — both of which factor into stress levels.

Organizations might consider brightening the color scheme, adding a few plants or hanging some artwork. It’s also sometimes helpful to have a space where employees can get away for a few minutes. When employees have the ability to break away, even for a short time, it can help boost their productivity for the rest of the workday.

What else should employers know?

Communication is critical. Managers should be encouraged to be as open and transparent with their employees as possible. When you keep employees informed, it can dramatically decrease their levels of stress and anxiety.

In addition to relieving stress caused by the unknown, having an open dialogue makes employees more likely to share their own concerns, ideas and thoughts. And that will often create a healthier — and less stressed — culture throughout the organization.

Insights Health Care is brought to you by Medical Mutual

Selecting the best specialty coverage for your health plan

When evaluating which specialty coverage — vision, dental, life or disability — to include in their employee health plan, employers may benefit from going back to the basics.

“Employers should remind themselves that while the marketplace always evolves, some aspects may remain the same. They should continually evaluate the latest, greatest differentiators between specialty line carriers to ensure they are getting the best coverage,” says Judy Dawson, Account manager III at HealthLink, Inc.

Smart Business spoke with Dawson about what employers need to weigh when adding specialty coverage to their health plan.

What should employers pay attention to in regards to network access?

When selecting a specialty carrier, employers should look for a strong local and national dental and vision network. They should also look for a vision carrier that has a blended network of independent practitioners — opticians, optometrists and ophthalmologists, the leading retail providers in the marketplace, such as Sears or Lenscrafters, and more regional vendors like Crown Vision Centers and Clarkson EyeCare Centers. A strong mix is important as employees may choose to see an independent practitioner for their eye exams, but prefer the convenience and access that a retail provider offers.

How do contracts need to be set up?

When it comes to contracts for specialty coverage, there is more than meets the eye. For example, many employers tend to focus only on the copayments associated with exams and materials (lenses or eyeglasses), but they may be overlooking additional services that are not covered, but are often preferred, such as polycarbonate lenses or scratch coating. Contracts for dental coverage are evolving, too.

Many carriers are changing the way they cover certain services. For example, crowns and bridges may be covered only every seven to 10 years instead of every five years as it has been in the past. These sorts of changes may seem slight, but they could have a significant impact on employees’ out-of-pocket costs. That’s why it is important for employers to assess the contract associated with their current specialty coverage and then shop and compare other available contracts.

What’s important to know about integrating benefits?

Many leading insurance experts believe there is real value in integrating benefits to provide extra diagnostic and preventive care. For example, regular dental cleanings may detect symptoms that trigger or require further intervention on behalf of that member. By having an integrated benefit solution, a more proactive approach may help get the employee the resources and assistance he or she needs to get on the right treatment track, rather than being passive and waiting for the medical condition to deteriorate. The result is better health for the employee as well as the group, which can lower the costs of the overall health plan.

How do voluntary plans fit into specialty coverage trends?

As medical and other personnel costs continue to increase, many employers are moving away from an employer-sponsored dental, vision, life or disability plan. As an alternative, employers may offer an ancillary program where the employee pays for the benefit. This sort of voluntary plan allows employees to elect the additional coverage that suits their personal needs.

When deciding which carrier is best for their specialty coverage needs, employers should still pay close attention to network strength, contractual provisions and competitive rates. However, it is also important that the selected carrier has enrollment procedures, communication materials and other support they can provide for employees. Whether it is via hard copy informational kits, electronic communications or even phone-based webinars, the carrier should have a process in place to get the plan set up and encourage employees to participate in the voluntary coverage options.

When selecting a carrier to provide employee benefits, employers should feel confident that there is a solid plan in place to ensure the best possible outcomes for employees.

HealthLink is a fully owned subsidiary of Anthem, Inc., one of the nation’s leading health benefits companies.

Insights Health Care is brought to you by HealthLink

Seven reasons why online benefits administration makes a lot of cents

Not long ago, the main reason employers weren’t converting to online-based benefits enrollment was the cost. Now, because of more competition among vendors and other factors, the opposite is true.

“Nearly three-quarters of U.S. companies have moved their benefits administration online because of the cost savings. But to get there, it’s important to look for a vendor with high-touch service to help show you the way,” says Ryan Smith, a sales executive with eBenefits Solutions, a part of UPMC Health Plan.

Still not convinced this high-tech benefits admin approach is the way to go?

Smart Business spoke with Smith about seven great reasons to switch over now — and every single one leads to cost savings.

Reason No. 1: Online self-service benefits administration costs less.

According to a recent CFO.com survey, the average cost for an HR staff to manually enroll an employee in benefits is around $110. The average cost for an employee to self-enroll online is just under $22.

Reason No. 2: Online self-service takes less time for HR staff.

An industry survey found that when employees do their own benefits administration online, it results in a 15 percent time savings by HR staff.

Reason No. 3: Online benefits administration can cut in half the time needed for open enrollment.

Among other things, a self-service site frees up HR staff to focus on more strategic tasks and initiatives, such as wellness or employee engagement programs. These help to create a healthier workforce and reduce overall health care costs.

Reason No. 4: Online benefits administration saves on paper, printing and postage.

Printing and mailing benefits packets can be costly and time consuming. When you convert to online, costs for these ‘three Ps’ can be eliminated altogether.

Reason No. 5: Online benefits administration cuts down on premium payment mistakes.

One recent study found that manual benefits administration could significantly increase the likelihood of monthly premium billing errors — leading to higher employer admin costs.

Reason No. 6: Online benefits administration can lower the number of ineligible employees who are enrolled in coverage.

A recent study conducted by a large benefits consulting firm shows that the cost of ineligible employees and dependents (age 26 and older) who receive benefits is between 2 to 8 percent of the total medical premium cost. When electronic data feeds and system eligibility rules are used, this unnecessary cost is virtually eliminated.

Reason No. 7: Online benefits administration is just plain easier.

Online enrollment means employees can sign up 24/7 from home or office, and can check their selections and benefits any time. It’s also much easier for employees to compare plan options and benefit details when everything is online. Clearly employers benefit from this ease of access as well.

If an employer does decide to switch, what’s important to look for when picking a vendor?

To ensure your online benefits administration runs smoothly, it’s more important than ever to look for a vendor with deep HR experience and a high level of technical expertise. This vendor must be able to offer high-touch customer service to your HR staff as well as individual employees.

And by the way, employees will applaud the switch to online the loudest. It turns their benefits selection process into an easy, retail-like experience akin to an Amazon.com visit. Many online benefits admin platforms even include decision-support tools that help employees determine in real time which products and services are the best fit.

Insights Health Care is brought to you by UPMC Health Plan

How to help your employees better manage their care and costs

As the cost of health care continues to rise, studies have shown that almost half of those costs are unnecessary or avoidable. To reduce those expenses, many organizations want to help their employees make better health care choices on their own.

“When employees understand their health insurance, they can make good decisions that benefit themselves and their employer,” says Veronica Hawkins, Medical Mutual vice president of Statewide Accounts. “That’s why it’s important for organizations to make sure their employees have all the information they need.”

Smart Business spoke with Hawkins about what organizations can do to help their employees take a more active role in their health care decisions.

What resources are most important to help employees understand what’s covered?

Probably the most important resource is their benefits book or certificate of coverage. This is the document that explains what services are covered — and not covered — under the plan. Organizations should make sure their employees receive a copy, or have access to it online. This can help them understand the terms of their plan so there are no surprises when they need a service or supply.

How much does the network of providers factor into costs?

It can be significant. The doctors and hospitals employees choose to utilize factors into how much they pay for services. By choosing doctors and facilities in the insurance carrier’s network, employees may only have to pay their copay and any deductible or coinsurance that applies. Employees receiving services outside the network often have to pay any balance beyond what the insurance carrier has agreed to pay.

Before choosing a doctor for any type of treatment, or a facility for any test or procedure, it’s important to check the network. Even if a doctor or facility was listed in the network previously, that status can change. Employees should make sure their doctor is in network by calling their carrier’s customer hotline or going online and searching the provider directory.

What are some other easy ways to save money?

Many people aren’t aware that doctors and health care facilities charge different amounts for the same services. Often, patients can be charged more for seeing a doctor at a facility he or she doesn’t own, like a hospital-owned clinic. It may cost less to see that same doctor and have the same treatment at a different facility. This can also apply to lab costs, as price differences can be significant. To maximize benefits and minimize out-of-pocket costs, it’s important to shop around within the plan’s network.

Some insurance carriers offer online tools for comparing costs. Price estimates are often available for everything from office visits to X-rays to surgical procedures, and may factor in facility fees and other associated costs. These estimates should be pretty close to what the member will have to pay.

What is the best way to keep employees informed?

Good communication is critical. Organizations can partner with their insurance carriers to create a customized approach for building awareness of all these tools. This could include interactive presentations that use visuals and easy-to-understand language. Short segments with a question and answer period may be a good option to help avoid confusion. After any presentations, refresh the topic by emailing employees with benefit reminders and updates.

The key is to give employees the resources they need. They should know how to reach their insurance carrier, where to look for in-network providers and how to use their benefits book and explanation of benefits.

Insights Health Care is brought to you by Medical Mutual