Follow these tips for your next open enrollment

Open enrollment is a period each year when employees can sign up for their company-sponsored health plan, and as the insurance industry has changed, open enrollment has, too.

“The importance of open enrollment and the enrollment process have changed significantly over the years,” says Carla M. Flamm, sales and retention executive at HealthLink, Inc. “With all the new laws, extensions and even the increased use of electronic filing tools, open enrollment can be quite complicated for the average employer.”

For some employers, this complication is too much to add to their ever-growing list of to-dos, so they opt for the bare minimum open enrollment process. However, by not taking advantage of the unique educational opportunities open enrollment can offer, employers may be missing a chance to help save money for the plan and for their employees.

Smart Business spoke with Flamm about five tips to help employers with open enrollment.

1) Start early

The most prepared employers start planning for open enrollment four to five months before it starts. Employers should start by working with their broker, third party administrator (TPA) and network partner to examine the current plan and its performance. From there, employers can consider changes to make next year’s plan more effective.

Employers should also start planning for the actual enrollment process. They need to make some big decisions early on, such as whether or not they will require each employee to go through the enrollment process so they can collect updated information, or if only employees with changes need to re-enroll.

2) Collaborate with your partners

Employers should work collaboratively with their broker, TPA and network partner to plan for open enrollment early. Together, they should evaluate claim history and spending trends to determine if benefit changes are necessary. They should also compare the current plan offering to similar companies to determine how competitive the benefits are. These partners should be an employer’s trusted go-to resource for ensuring the health plan offering and open enrollment process meets all industry standards and regulations.

3) Educate employees

After making initial benefit decisions, employers should be diligent about educating their employees of their options, any changes that may affect them and how to make good purchasing decisions. Employers should consider giving employees educational materials that focus on selecting a plan that is right for them by encouraging them to evaluate components such as deductibles and out-of-pocket maximums, instead of focusing solely on premiums.

4) Be proactive with information

Employers should send benefit and educational materials to employees no later than two to three weeks prior to open enrollment. Employees need time to be familiar with this information so that they’re prepared to ask questions and make their selections during the open enrollment period. Don’t wait for employees to ask for these pieces, get them out as soon as possible. Proactive education means HR departments can spend more time enrolling employees in their plan and less time answering questions.

5) Consider a health fair

Hosting a health fair is the best way to optimize the open enrollment period and ensure success. Employees can get the information they need to make the best choice for them, and employers can take advantage of the face-to-face time to complete health and wellness screenings and enroll employees onsite, eliminating confusion and saving time. Employers that offer these fairs should be sure that every component of the health plan, including medical, dental, life and disability, etc., are present at the event so employees have a complete understanding. These events should be easy and convenient for employees to attend, with a potential incentive for attending.

Insights Health Care is brought to you by HealthLink

How to talk to your employees about their health

In today’s dynamic health care market, employers continue to look for new ways to curb spending and regain control of their health plan investment. For some employers, this means going directly to the source of the spending: their employees.

“Healthy employees are happier and more productive,” says Bridgette Bock, sales and retention executive at HealthLink, Inc. “Plus, without employee engagement, health and wellness and cost reduction programs are not effective. That’s why more employers are trying to make an impact by talking to their employees about their health.”

Smart Business spoke with Bock about strategies for talking to your employees about their health.

Why is it important to communicate with your employees about their health?

Communicating with your employee population about their health and different strategies for staying healthy is important because it helps keep the cost of care down. The typical consumer is not in the health care industry, so they may not be aware of the impact that their health has on their out-of-pocket health care spending or the impact it has on the cost of the health plan.

Employers that educate their employees about the available programs and services as well as best practices for staying healthy tend to have more success with their cost management strategies. Employers also have the unique opportunity to help their employees become more educated consumers by encouraging them to shop around and ask questions they may not have thought of on their own.

Do today’s employers have more of a responsibility to do this?

Absolutely. When an employer self-funds their health plan, it’s their money paying the claims, so they usually have more of a stake in keeping costs down. Self-funded employers are more likely to promote different incentive programs to engage employees and control costs.

However, with today’s rising cost of health care, even employers with fully-insured health plans should be taking an active role in talking to their employees about their health and educating them about the effect it has on costs.

What information is often misunderstood or not communicated when it comes to health and wellness plans?

Many employees don’t know that the majority of health plans cover standard wellness/preventive services at 100 percent, meaning there is no out-of-pocket cost to them. Employees also wrongly assume that if they never go to the doctor for a checkup, they’re saving money for the health plan. In reality, these employees may cost the health plan even more if they end up with health issues that could have been detected and treated through preventive visits.

Transparency is another topic that is getting more attention, but is still often misunderstood. Employees should be aware of the different transparency tools available to help them determine the costs of services so they can shop around and select the doctor or facility that is right for them.

What are the best methods and means to reach employees?

When deciding which methods may be most successful in reaching employees, it’s best to look directly at the employee population. Who are they? What do they do? Where are they located?

Employers should communicate with employees via the means that is best for the employees. For example, a large company with a diverse employee population may depend on the company intranet site or blog to distribute information. A smaller company may find that posting information in the break room is most effective. The method of communication should be unique to the workforce.

What else should business owners know?

Effective cost management entails more than simply adding a product to your health plan. Engagement really is key to success.

Employees should also understand that just because a doctor or hospital takes your insurance, it doesn’t necessarily mean they are in-network for your plan. If nothing else, an employer should educate their employees about the tools available to them to find in-network doctors and alternatives to the emergency room.

Insights Health Care is brought to you by HealthLink

How self-funding can help correct health care purchasing mistakes

Business owners may feel helpless when it comes to health care because it can seem as if it’s beyond their control. However, self-funded health insurance can actually correct some of the biggest health care purchasing mistakes.

Smart Business spoke with Susan French, director of marketing at HealthLink Inc., about why self-funding may be the answer to your health care concerns.

Mistake 1: Not knowing how much you pay for health care.

Many senior leaders don’t know the itemized cost of health care services used by their employees, even though it’s one of their biggest expenses.

With a fully insured health plan, employers pay a predetermined premium amount to cover medical services for their employees, whether they receive them or not. This leaves most employers without real knowledge of where premiums are being spent. With a self-funded arrangement, employers only pay for the medical services — or claims — that their employees actually receive. Employers who choose to self-fund their employee health plan receive an itemized bill for all the claims incurred by their employees, so they know exactly how much they’re spending and where the money is being spent.

Mistake 2: Believing that health care spending is out of your hands or is just the cost of doing business.

The flexibility that comes with self-funded arrangements makes them ideal for effectively using cost management strategies to save money for the health plan and employees. Employers that self-fund have access to detailed claim and utilization data that they can use to determine where they are incurring the most costs. Employers can sit down with their broker, third party administrator (TPA) or network partner to examine if there is an issue or lack of benefits at the root of high costs.

After there is a solid understanding of where health care dollars are being spent, there is an opportunity to better predict these costs and implement cost containment programs to control health care spending like never before.

While fully insured health plans also feature cost containment strategies, these programs and services remain under the control of the insurance carrier. For some employers, this is ideal. They prefer to take a more hands-off approach by simply paying a monthly premium and letting the carrier take care of the rest.

A self-funded arrangement is more hands-on. Cost containment strategies can be customized specifically to meet the unique needs of the employee group. In the end, the decision of which programs and services to implement, and how to structure the health plan, is up to the employer, not the carrier.

Mistake 3: Being in breach of your fiduciary duty to protect a health plan’s assets.

In a self-funded arrangement, transparency starts with the availability of clinical and financial data that employers can use to uncover utilization trends, high-risk members, inappropriate and/or costly treatments and plan waste. With a self-funded health plan, this data belongs to the employer. They have full access to it and the conclusions that come from it.

In addition, many network providers have developed transparency initiatives designed to help employers and their employees become more educated health care consumers. Tools that help employees look at the costs associated with different procedures and/or facilities, and tools to help employees decide which level of care is appropriate are examples of transparency tools that may be available through different network providers.

Mistake 4: Undervaluing human resources.

An HR department can be an invaluable resource when it comes to selecting and implementing an employee health plan. Often the HR department may have additional insights into the needs of the employee group, which can be useful when determining which benefits should be included in the health plan. The HR department should also be the go-to resource for educating employees and answering questions during open enrollment. Engaging the HR department during the decision-making process and having their buy-in can have a positive impact on the health plan.

Insights Health Care is brought to you by HealthLink

Add maternity management to help cut costs and raise productivity

Integrating a maternity management program into a health plan is a win-win for moms-to-be and employers. Employees and employee spouses who are pregnant or planning to become pregnant can join the program to get the support they need to help them have healthier pregnancies and healthier babies.

“Every pregnancy is unique, that is why maternity management programs offer personalized support from the start of the pregnancy until after the birth of the baby,” says Judy Dawson, HealthLink sales and retention executive. “This support can help keep pregnant employees healthy, reduce their need for unscheduled or emergent care and keep their medical costs down.”

Smart Business spoke with Dawson about the benefits of maternity management.

What are the overall goals of a maternity management program?

The No. 1 goal of a maternity management program is to reduce risks associated with preterm delivery and low birth weight, and encourage employees to be more active in health-related decisions during pregnancy. To achieve this, the program focuses on educating and supporting pregnant employees from prenatal to newborn care.

Employees who enroll are sent educational materials and can receive customized help from nurse care managers so they can understand what is best for them and their babies. They also get access to a 24-hour, toll-free nurse line so they can connect with someone who can answer their questions or direct them to their best option for care.

How does a maternity management program impact employees?

A maternity management program can have a great impact on an employee’s pregnancy and her newborn. Once they join the program, they are assigned a nurse care manager who can provide a number of services, including giving moms-to-be information on healthy eating and exercise, providing education and information on labor options, helping smokers quit, checking for health risks, screening for depression during and after pregnancy, and more.

Every service is focused on healthier moms and healthier babies and can be customized to fit the unique needs of the mom-to-be. The educational materials alone can really impact the decisions a pregnant employee makes during the course of her pregnancy and delivery — and the added support can make a big difference in helping parents-to-be feel prepared and confident as they approach parenthood. For employees who may not have all the support they need at home, a maternity management program can make a huge impact.

What are the benefits to the employer?

Like many supplementary cost-management programs, a maternity management program can help employees achieve optimal health outcomes in a cost-effective and timely manner. This can lower costs for the plan and for the employee. A variety of studies show that maternity management can lower inpatient costs, reduce the number of low-birth-weight babies that require additional care and lower neonatal intensive care unit (NICU) costs by reducing NICU admissions.

In addition to the cost-reduction benefits, offering a maternity management program is a great way to provide additional support to employees as they go through a series of life-changing events. When employees feel supported, it can boost morale and even productivity, and in the case of moms-to-be, it can positively impact their overall health and their transition back into the workforce.

What else should employers know?

Maternity management programs may not be a good fit for all companies. Employers should consider the potential impact offering the program will have on employees before implementing a maternity management program. For example, if a company has a largely older or all-male population, it may not make sense to add the program. Many maternity management programs are purchased on a per employee per month, or PEPM, basis, so it’s important for employers to determine if the outcome is worth the investment.

Employers should talk to their broker or network partner to explore all of their health and wellness and cost management options.

 

Insights Health Care is brought to you by HealthLink, Inc.

How to combine programs to create a superior self-funded benefit solution

One of the biggest advantages of a self-funded arrangement is the ability to customize the health plan to fit the needs of a specific group of individuals. For example, if an employer group has a large number of women who may be at the age to start a family, a maternity management program could be a great tool for them. Or if an employer group is mainly located in a rural area, or is more tech-savvy in how they want to receive medical services, a telemedicine program might be a good fit.

Whichever programs and services meet the unique needs of a group, employers may have the opportunity to bundle those core programs together, lowering costs and reducing plan waste.

“By bundling core programs, employers can be confident that they are not paying for unnecessary extras and their employees will receive the care they deserve at a price the employer can afford,” says Erin Davidson, sales account executive at HealthLink.

Smart Business spoke with Davidson about putting together a custom health plan in a self-funded arrangement.

How does an employer know which programs are best for employees?

Employers can look at past years’ claim data and the demographics and common characteristics of their employee population as a basis for deciding which programs to implement. Employers should also rely on their network account manager to help them review data and draw conclusions.

After employers have a better understanding of which programs and services will be the most beneficial for the group, they can work with their network partner to bundle the selected programs together at a discounted rate, rather than paying for them on an a la carte basis. Plus, when certain programs are bundled and working together, they can help employers control the cost of their health plan and optimize outcomes for employees.

For example, when you bundle network access with a medical management program, you can have a collaborative team of health care professionals working together to better identify employees at risk and offer guidance toward appropriate care management. This integration of the provider network with cost containment services achieves the best possible outcomes for the employee and the benefit administrator.

Many networks already have ‘bundled’ options for some of their most popular programs that they offer at a discounted rate.

Once they have decided which programs they want to offer, what is the next step?

Many employers don’t realize that their network provider offers these supplementary programs and services and when they bundle them with their network access, it may be less expensive. Also, when programs are bundled with network access, employers can ensure that the doctors who are overseeing precertification or case management are in-network.

Employers should work with their network partner to bundle and implement a plan that is unique to their company and their employee group.

Are there programs that work well bundled together? What about any that don’t?

When building a comprehensive plan, employers should aim to have all bases covered. This means medical coverage, as well as some specialty (vision, dental, life and disability) and health and wellness programs. Selecting coverage from each of these components can make bundling the programs easier and more effective.

What else do employers need to know?

Just because your network partner offers a bundled solution, doesn’t mean it’s right for your company. It’s important to do the legwork to decide which programs and services make the most sense for your company, rather than simply assuming packages that have worked for other companies will work for you. Employers should rely heavily on their network partners to help them make these decisions.

Employers should also remember that health and wellness and cost containment programs need engagement to be successful. It’s not enough that employers work to develop a comprehensive benefit plan; they need to be prepared to promote the plan to facilitate engagement.

Insights Health Care is brought to you by HealthLink

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

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

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

How to use customer service to reduce your costs

Most people call customer service when they have a problem or a complaint. But proactively using customer service to get information or ask questions could help employers, and their employees, save on their health care costs.

“While some large group employers may have a customer service line dedicated to their account, small and midsize employers also can benefit from educating their employees about the customer service department,” says Karen Gotsch, manager of Customer Care at HealthLink, Inc.

Smart Business spoke with Gotsch about best practices for customer service in your health plan.

In an ideal world, how should customer service function for a health plan?

Ideally, customer service should function as a go-to resource for employees looking to get the most from their benefit coverage. Customer service can find providers that meet employees’ needs and participate in their health plan, ensuring they receive the highest level of benefits on medical services.

Customer service can also help employees determine what services are covered and whether or not they need pre-certification. Otherwise, employees could end up paying more out-of-pocket if they receive care that isn’t covered.

What’s the reality for many companies?

Many employees are still not well educated about their health plan and the best practices for maximizing their benefits. Employees often assume they’ll receive their full level of benefits, no matter which doctor or facility they choose, which isn’t necessarily true. They don’t always understand or take into consideration that there may be exclusions or limits associated with their health plan.

How should employers educate their employees about customer service?

Employers have a unique opportunity to educate their employees about their health plan benefits. Employers should focus on having the information readily available so it is easy to access when a question arises. Open enrollment is prime time to talk about benefits as most employees are engaged in the decision-making process at that time. It’s also important to use easy-to-understand layman terms and avoid terms that are highly technical when possible.

Employees need to be aware that customer service is available as a resource to help with any questions or concerns.

Do smaller companies concerned about resources and time need to take a different approach?

Employees should be educated about their health plan benefits no matter the size of the company or employee group — and it doesn’t have to take a lot of time and resources. Employers should utilize communication avenues they already have in place, such as their website, employee newsletters and other internal communications. Smaller companies that don’t have a corporate intranet or newsletter could try making benefit education a part of their next scheduled team meeting, or simply send an email out to their employees.

What are the benefits of being proactive?

Using customer service as a proactive resource can positively affect employees in a number of ways. Taking the time to find a provider that is a good fit and that participates in their health plan can lower out-of-pocket costs. They can also utilize customer service to determine what their out-of-pockets costs will be, whether or not certain procedures are covered and if there are pre-certification requirements.

This sort of education can ensure employees don’t receive a surprise bill, and it gives them the knowledge they need to review their Explanation of Benefits (EOB) for accuracy to avoid overpayment.

What else is important to know?

Employers should educate their employees about any self-service options, such as online bill pay or how to search for a doctor. These tools can save employees time and help them get the most from their health plan in a way that is easy and convenient.

Employees should always review their EOBs for accuracy before paying a bill. It is important for employees to understand that they may have different plans for different benefits so they know whom to call with questions. Keeping all of this important information together and easily accessible when calling customer service is also a great way to save time.

Insights Health Care is brought to you by HealthLink

How health care fraud has changed in the electronic age

In the electronic age, fraud is a major concern. As consumers become more engaged in making informed health care decisions, health care fraud has evolved. Your employees’ understanding and concerns about fraud needs to evolve as well.

“Nearly every aspect of life can be conducted online and is susceptible to hacking and theft. The health care industry is shifting toward more web-based services, such as telehealth. More online services provide more opportunities for criminals,” says Howard Levinson, DC, CFE, AHFI, clinical fraud director, Special Investigations Unit, at Anthem, Inc.

Smart Business spoke with Levinson about how employers can impact the risk of fraud.

What fraud are you seeing in health care?

The majority of health care providers submit their claims for payment electronically. More than 1 billion claims are submitted annually to Medicare. Private payers process hundreds of thousands of claims on a daily basis. For the most part, that volume is handled by sophisticated computer software, and in many cases a human eye never sees it.

Fraudsters can generate claims for fictitious patients just by entering data into billing software. They can submit claims for services that were never rendered. Unscrupulous providers, who know a service wouldn’t be covered, may purposefully enter incorrect data. For example, a large sports medicine practice was aware a certain joint injection wasn’t covered by a health plan. In order to have the treatment paid by the plan, however, the provider submitted an alternate code for a service that was covered. The plan’s investigators discovered the scheme during an audit. The overpayment for the miscoded service was nearly $1 million.

In addition, the Affordable Care Act (ACA) mandated electronic medical records (EMR) as the standard. EMRs have proven effective and efficient in documenting patient care but have also created opportunities for fraud. An unscrupulous provider can cut and paste patient visit information that isn’t timely or accurate, or create an entirely fictitious EMR to submit as a claim for payment.

Investigators are challenged by the time it takes to identify fraudulent records. They must review individual records to compare visit information and look for potential duplicates or cloned information. If suspicious information is detected, the investigator then must interview patients, physicians and their staff.

Also, the audit function of most EMR systems keeps track of all patient visit entries, entry changes and every time someone accesses that EMR. While this function helps identify potentially cloned or copied patient visits, lab findings or symptom descriptions, some programs don’t have an audit function or the provider can turn it off.

How can employers help minimize the risks?

Employers should educate their employees about health care fraud, waste and abuse. Federal and state agencies offer educational materials and services, so tap into these and make them readily available to employees.

Employers should ensure their network and systems are secure and adhere to the latest security guidelines. Require company-wide education on computer and mobile security standards and advocate for the use of strong, regularly updated passwords.

Also, educate employees on potential scams such as phishing emails, online pop-up ads or links that seem legitimate but have attachments that shouldn’t be opened.

What are other best practices?

Employees should take the same safety measures they would with their financial information. Also, they should be suspicious of anyone offering anything in exchange for personal and health care information, such as free medical equipment, whether via an unsolicited phone call or what appears to be a legitimate television ad.

They should review all medical bills, Medicare summary notices and explanation of benefits to make sure the medical services listed were received and are being accurately billed. If unusual or questionable charges appear, they should contact their health care provider or health benefits plan.

Criminals are targeting health care and their methods are getting more sophisticated and complex. Make sure you educate your employees on the potential tactics used by criminals and the high cost of fraud, waste and abuse in the health care industry.

Insights Health Care is brought to you by HealthLink, Inc. HealthLink is a fully owned subsidiary of Anthem, Inc., one of the nation’s leading health benefits companies.