Employers are confronted with new situations that require evolutionary thinking about new and more effective approaches to health care cost containment.
“Our belief has always been that it is the role of the health plan to help coordinate care between the employee, the provider and the pharmacy,” says Anthony Benevento, vice president of sales and marketing for UPMC Health Plan. “By doing that, you have the best chance to deliver the right care at the right time, and in the most cost-effective manner. Companies are challenged to find health plans that can best do that.”
Smart Business spoke with Benevento about corporate strategies that address health care cost containment.
What cost-containment strategies should employers investigate?
Organizations should invest in their employees by promoting health and wellness. It will not only affect how much you pay for health insurance, but it will impact your whole business. Studies have shown that employees who are overweight and smoke are twice as likely to miss work for health-related reasons, are more susceptible to being hurt on the job and are more likely to have low presenteeism. In addition, these employees are more susceptible to developing chronic conditions that will mean higher health care costs.
By creating a work environment that helps employees modify their behaviors, it not only benefits the employer, but it helps the employees throughout their life.
What tactics can engage employees and lower costs at the same time?
This requires a comprehensive strategy that combines financial incentives and provides the employee with tools, information and incentives to take an active role in changing lifestyle behaviors. Employers often make changes to benefit levels by shifting more costs to the employees. However, by doing so they are not addressing the underlying cost drivers.
What tactics work best for large companies and which work best for small companies?
Regardless of the organization’s size, senior management must take an active lead role in promoting a culture of improved health and productivity. When this is driven at the highest levels of the organization, the success rate is dramatically improved.
The size of the organization usually dictates the resources available for a health and wellness strategy. However, regardless of size, an organization must choose a health plan partner that possesses the expertise and methods that have proven to be successful.
What should employers look for in a tiered pharmacy program?
Employers should look for a pharmacy program that is structured to obtain the lowest net cost while achieving the highest quality of options. This includes the use of generics and mail order, and using proper therapeutic substitutes that produce the same results clinically and the best results financially.
Would hiring pharmacists to educate patients about how to reduce drug bills and avoid dangerous drug interactions help contain costs?
An employer should partner with a health plan that possesses this expertise. The pharmacy arena is very complex and requires constant strategic modifications to ensure the best possible results. In addition, it is critical for care management programs to be in concert with the pharmacy programs.
Would implementing disease management in high-risk pools be helpful?
Absolutely. Comprehensive disease management programs have a significant impact on people with high-risk conditions. Since many people have more than one chronic condition, it is important to work with a health plan that takes a holistic approach. Rather than focus on a specific disease, focus on the member and all of his or her physical and, in some cases, mental conditions.
In addition, it is just as important to focus on people who have the potential to be high-risk in the future. Care management programs often make the mistake of only focusing on members that are considered high-risk today.
ANTHONY BENEVENTO is vice president of sales and marketing for UPMC Health Plan. Reach him at firstname.lastname@example.org or (412) 454-7826.