How organizations can benefit from healthier employees

The overall success of your organization depends on the people you employ. Without them performing their jobs at a high level each day, productivity — and your bottom line — would most certainly suffer. That’s why it’s so important to keep your employees happy and healthy. A workplace wellness program is an excellent way to help accomplish both of those goals.

“A wellness program can be an effective way to engage employees and promote healthier lifestyles,” says Veronica Hawkins, Medical Mutual vice president of Statewide Accounts. “Plus, it can be tailored to incorporate an array of health-related activities based on an organization’s needs and budget.”

Smart Business spoke with Hawkins about workplace wellness programs and the many benefits organizations can enjoy if they choose to make the investment.

What do workplace wellness programs involve?

Programs can vary in size and scale and offer things like health education, disease management programs, health screenings, fitness classes, fitness center memberships and more.

Offering a health assessment is a good place to start. A health assessment is a survey that asks questions about employees’ health and fitness. Questions about smoking, frequency of doctor’s appointments, exercise habits and health conditions can give your organization an idea of what to include in your program. For example, if there is a high percentage of diabetes among your employees, you may want to offer a diabetes management program.

Additionally, a health assessment can provide you with some insight into what your employees would like in a program. There may be a high interest in fitness classes or fitness center memberships. Or employees might like the convenience of on-site health screenings.

Your organization can also offer incentives to increase participation. By setting goals for your employees and offering rewards for achievement, you can get employees engaged and excited about being involved and getting healthier.

Can these programs help lower health care costs?

Studies show a significant percentage of health care costs could be linked to employees’ poor lifestyle choices. Tobacco use, unhealthy diets and a lack of exercise can increase the risk of chronic disease and lead to a variety of costly health problems. Organizations that invest in a wellness program could see a reduction in medical claims, disability costs, workers’ compensation claims and absenteeism due to illness.

Helping employees learn about their health can help them and your organization save money. The more they understand their risk factors, the more likely they may be to make positive changes to help improve their overall health.

How do employees benefit?

Recruiting and retaining talented people isn’t easy. Many organizations are now looking for unique perks to set them apart from the competition. A wellness program is one way to demonstrate a real commitment to the health and well being of employees. That can result in increased job satisfaction among staff members and stronger retention rates.

A wellness program can also help build camaraderie among co-workers. Employees can participate in a variety of non-work-related activities or simply go to the gym together. Competition and encouragement can go a long way toward helping people change their lifestyles and make better decisions.

What’s the bottom line?

More and more organizations are becoming believers of wellness because they see a difference.

Wellness programs can help employees feel better. When they feel better, it helps improves their morale, their mental outlook and their productivity. It also helps them live healthier lives, which in turn reduces absenteeism and medical claims.

Sure, there is a cost involved in setting up a wellness program, but it’s really an investment in your employees and in the future of your organization.

Insights Health Care is brought to you by Medical Mutual

How stop-loss insurance can reduce the risk involved in self-funding

As more businesses look at self-funding as a way to control their health care costs, it’s not uncommon for stop-loss insurance to be part of the discussion. In fact, according to a recent study from QBE Solutions, 60 percent of self-funded employers now have stop-loss insurance.

While some businesses choose to forgo stop-loss to avoid the extra monthly premium costs that come with it, many others have determined it’s a necessary measure to protect their business from unexpectedly high claims.

“Organizations assume more risk when they self-fund, but most want safeguards in place to protect their business,” says Amber Hulme, Medical Mutual regional vice president for Central Ohio. “While insurance carriers have set products to offer, there is also typically a fair amount of customization involved in terms of the contract. It’s important to get all the pieces right.”

Smart Business spoke with Hulme about how stop-loss insurance works, why it could be a valuable tool for organizations that fund their own health benefits and what types of contract decisions could make a big difference in the long term.

What is stop-loss insurance?

Stop-loss insurance limits risk for a self-funded employer when one employee has a catastrophic claim, as well as when claims for the entire organization are higher than a set amount. It insures the employer, not employees or other health plan participants.

Stop loss policies are initially written as indemnity policies. In others words, the employer pays the claim and the carrier then reimburses them.

How does it work?

Well, there are two types of stop-loss insurance — specific and aggregate. Specific stop-loss limits the amount an organization would have to pay for an individual claim from a specific employee. Usually an organization pays a monthly premium based on how many covered employees it has.

Aggregate stop-loss limits the total amount the organization will have to pay in claims, for all of its employees for the full length of the contract.

Most choose to have both types of stop-loss insurance to cover both scenarios.

Why is stop-loss getting more attention lately?

One reason is because self-funding is getting more attention, especially for small businesses that have 50 or fewer employees. In 2018, those businesses may lose the transitional or ‘grandmothered’ status that has kept them exempt from many aspects of the Affordable Care Act.

Stop-loss insurance is one of the most crucial elements of a self-funded health plan, because it’s the best way to help the plan limit its risk. So, as more organizations take on the financial risk of self-funding their employees’ health care coverage, stop-loss will continue to be a critical component.

What factors should organizations consider?

There are several contract provisions that organizations need to understand and take into account.

One of the most important aspects involves a practice called lasering. When insurance companies give a quote or a rate renewal, they might place a higher deductible on certain individuals or even exclude them from coverage. That’s called lasering. Organizations need to understand their insurer’s policies on lasering, and how it might affect their coverage when it’s time to renew their contract.

Is there anything else to consider?

One of the biggest factors in stop-loss, and self-funding as a whole, is to know your population. Most insurance companies need to know about any employees with a history of high claims or any known health risks before they will even give a quote. It’s a good idea for organizations to be prepared with that information ahead of time.

There are various types of stop-loss coverage available, so start by talking to your insurance carrier or other stop-loss carriers to find out which options make the most sense.

Insights Health Care is brought to you by Medical Mutual

How organizations can become better prepared for open enrollment

Fall is upon us and we’re getting closer to the end of 2016. That usually means it’s time for health insurance open enrollment for the coming year. This can be a confusing and stressful time for many employees. Is there anything organizations can do to make the process go more smoothly?

“Research shows that employees are not as well-informed about their benefits as human resources (HR) professionals might think,” says Veronica Hawkins, Medical Mutual vice president of Statewide Accounts. “There are a variety of ways organizations can communicate better and make the rollout of health care plans easier.”

Smart Business spoke with Hawkins about the ways organizations can help their employees understand the process, while also helping them become better health care consumers.

Why is open enrollment so confusing for employees?

Most employees don’t consider themselves to be very knowledgeable about health insurance. They’re also unsure about when they can make changes to their plans. Less than half know they can change their benefits because of qualifying life events, like marriage, divorce or the birth of a child.

This shows that employers can do a better job of informing employees of their options.

What should organizations ask of their carrier?

After an organization has made the decision about which health insurance plan to purchase for employees, it can be difficult to make sure employees understand what’s available to them. Employees often have a lot of questions during open enrollment.

It’s the carrier’s job to provide a variety of materials and support to help these employees better understand their benefits. Some will schedule on-site meetings with employees to answer questions and review plan benefits. Organizations should definitely take advantage of these options since they can help save a lot of time and effort.

How can organizations communicate better?

Surveys show one-on-one meetings, direct mail pieces and information on the organization’s website are the top three most preferred communication methods. One-on-one meetings won’t be possible for every organization, but a more personal touch throughout the open enrollment process can reduce anxiety and lead to better understanding.

Bringing in a benefits counselor is another good option. This can be someone who works for an employer or is brought in from a broker or third-party benefits administrator, or TPA, to be a point person for all benefits questions. Having an expert available to guide employees through the open enrollment process can improve their experience.

Organizations can use their own Intranet, internal websites and HR platforms to provide employees with important information about their benefits. Some companies even handle their open enrollment online, which younger employees appreciate.

Organizations should also take advantage of any online tools offered by their carrier. These tools can help members better manage their health care, keep an eye on deductibles, find providers and more, to help control their costs.

What are some other best practices?

The open enrollment period shouldn’t be the only time during the year an organization talks about its benefits program. Employers can make an effort to keep an open dialogue and remind employees to take advantage of their benefits. This will help prepare them to select benefit options each year based on their needs and those of their families.

It’s a good idea to write about employee benefits regularly in employee newsletters or on an internal blog. These are easy ways to remind employees of the value of their benefits program.

Insights Health Care is brought to you by Medical Mutual

How organizations can spend less on high-cost specialty drugs

The cost of specialty drugs continues to rise. In fact, it almost doubled from 2003 to 2014, according to a study from UNC-Chapel Hill. While less than 2 percent of the U.S. population used these drugs in 2015, research from pharmacy benefit manager Express Scripts shows they represent 37 percent of the nation’s drug spending.

By 2018, the figure is expected to reach 50 percent.

“Specialty drugs can cost several thousands of dollars for each prescription,” says Amber Hulme, Medical Mutual vice president of the Central Region. “And every year, costs go up, more drugs are released and organizations see their drug spend increase by 20 percent or more. That’s why it’s so important for them to take steps to control their own spending.”

Smart Business spoke with Hulme about the importance of having programs in place to control spending on these expensive, specialty drugs, and what steps organizations can take that will make the biggest impact.

What are specialty drugs?

Specialty drugs are often used to treat very rare or complex conditions that usually affect a very small portion of the population. They are typically biological drugs that are infused, injected or require special handling. Some common examples are those drugs used to treat cancer, multiple sclerosis, rheumatoid arthritis and AIDS/HIV.

What’s the best way for organizations to manage specialty drug costs?

First, make sure a specialty pharmacy is handling specialty drugs for your employees. Specialty pharmacies normally have the best pricing available. A retail pharmacy dispensing a specialty medication doesn’t have enough volume; they may only have one or two patients for certain conditions. A specialty pharmacy, on the other hand, might distribute these drugs across a much larger region and serve many more patients.

So it’s important for organizations to check with their insurance carrier or pharmacy benefit manager to see what specialty pharmacies are available in the pharmacy network. They should encourage — or even require — employees to use specialty pharmacies to help employees get the best possible prices for these expensive drugs.

What services do specialty pharmacies offer?

In addition to better pricing, specialty pharmacies do in-depth patient care and training. Clinicians will often train patients, for example, on how to administer medications that require self-injections. There’s also outreach to patients to make sure they are taking their medications.

One problem with specialty drugs is adherence. When employees take their medications properly, they’re more likely to be able to come to work, and less likely to need costly emergency room trips. This can make a big difference to an organization in terms of overall medical costs.

What other cost-saving measures are there?

Many organizations implement processes called ‘prior authorization’ and ‘step therapy.’ These two programs require that patients meet the appropriate criteria for the medication and first try a proven, but more affordable, drug before a more expensive alternative will be covered.

Another measure is to limit supplies of specialty drugs to 30 days. This helps avoid unnecessary costs that occur when a patient experiences intolerable side effects after the first few doses or the drug is no longer effective. Also, organizations with high employee turnover, for example, may not want to offer a three-month supply of a drug that costs thousands of dollars.

Anything else organizations should know about specialty drugs?

One development that could change the market is the use of ‘biosimilars,’ which are essentially generic alternatives to specialty drugs. It’s the same concept as traditional generics, where other manufacturers can sell the same drug for a lower price — potentially 15 to 20 percent less than the cost of the original drug.

So far, the U.S. Food and Drug Administration has only approved two biosimilar drugs, Zarxio (a drug used in cancer treatment) and Inflectra (a drug used for inflammatory conditions), but it is expected to approve others in the relatively near future.

Insights Health Care is brought to you by Medical Mutual

The importance of cost transparency in medical care

In health care, the consumer mentality continues to grow. Over half the respondents to Deloitte’s 2015 Survey of U.S. Health Care Consumers said they go online to research information about their medical needs. At the same time, only 30 percent of consumers are comparing prices before an appointment or procedure, according to a recent survey from HealthMine.

“Consumers definitely want cost transparency in medical care, but there’s still a disconnect that keeps some people from putting it into practice,” says Veronica Hawkins, Medical Mutual vice president of Government Accounts. “While more insurance carriers have introduced cost estimating tools, employees need to understand what the tools can do and how to use them effectively.”

Smart Business spoke with Hawkins about why cost transparency is so important, how cost comparison tools generally work and how much difference a little research with the right tools can make.

Why is cost transparency important?

With many employers moving to high-deductible health plans, employees are being asked to cover more of their medical expenses. To do that, they need to be able to evaluate their options and make the most informed decisions they can.

That means knowing how much a visit or a procedure is going to cost before they go — not after they get a bill. Most people don’t understand that costs can vary widely for medical services. They are surprised to learn costs can even be different for the same procedure, performed by the same provider at different locations.

How do cost comparison tools work?

Depending on the organization’s insurance carrier and the employee’s specific health plan, each tool will probably work a little differently. Price estimates are often available for everything from office visits to X-rays and surgical procedures. The estimates may factor in facility fees, as well as associated costs like consultations, outpatient visits, medications and rehab. That means the estimates should be pretty close to what the patient will have to pay — at least when there aren’t any complications.

What are some easy ways to save?

They are many services that can include facility charges. These extra charges come into play when you see a doctor at a facility he or she doesn’t own, like a hospital-owned clinic. In many cases, patients can pay much less by seeing the same doctor, and having the same treatment, at a different facility. To reduce the cost of those visits, it’s important for employees to know if facility charges will apply, and whether they can be avoided. These tools can help with that.

Should employees be looking at lab costs, too?

They absolutely should. Many people have their lab work done at the hospital or clinic where they see their doctor. But they have a choice. If their health plan has a cost comparison tool, employees can see how much a standalone option, like an independent lab, will charge for tests they might need. Price differences can be significant.

For example, hospital-based labs sometimes charge up to 70 times more than an independent lab for a simple blood test. If a doctor has an agreement with the lab, the patient may not even have to go to a different facility. A lab technician can pick up the sample from the doctor’s office. They’ll do the test, submit the claim and share the results with the doctor.

What other information is important?

Cost is obviously important, but it’s definitely not the only factor. More people are looking through reviews and ratings to help them make informed medical decisions.

That’s why Medical Mutual’s cost comparison tool, for example, includes patient satisfaction scores and quality ratings for doctors and hospitals in its network. It also includes specific information about the doctors themselves, like how long they have been practicing, where they went to medical school and what languages they speak.

Insights Health Care is brought to you by Medical Mutual

How organizations can benefit from self-funding employee health plans

How to fund health benefits is a major decision for any organization. There are two options — get fully insured through a health insurance carrier or fund it themselves. Until recently, self-funding was only considered for large organizations due to the potential risk involved, but that’s changing.

In fact, according to Pricewaterhouse Cooper’s 2015 Health and Well-being Touchstone Survey, 66 percent of employers with 500 to 1,000 employees are now self-funding their health benefits. That’s up 7 percent from the previous year and up 11 percent compared with 2013.

“Self-funding can be a very effective way for some businesses to control the cost of health care,” says Amber Hulme, Medical Mutual vice president of Central and Southern Ohio. “But it’s definitely not for everyone. Organizations need to evaluate their options carefully to make the right decision.”

Smart Business spoke with Hulme about the basics of self-funded health plans, how organizations might benefit from the approach, and what factors need to be considered before making a switch.

Why has self-funding grown recently?

A decade ago, self-funding was primarily utilized by employers with at least 500 employees. Now, more insurance carriers, including Medical Mutual, have introduced self-funded products for organizations with as few as 50 employees.

In 2018, many small businesses are scheduled to lose the transitional or ‘grandmothered’ status that has kept them exempt from some aspects of the Affordable Care Act. In preparation, even businesses with as few as 10 employees are evaluating the benefits of self-funding.

How does it generally work?

With self-funding, organizations budget for and pay the claims for all employees covered by the plan and any covered dependents, plus administrative fees. Most employers also pay for stop-loss insurance, which limits risk when one employee has a catastrophic claim, as well as when claims for the entire organization are higher than a set amount.

It’s basically the alternative to being fully insured, where the insurance carrier charges a premium and pays the claims — thereby assuming all the risk.

What are the benefits?

Organizations usually decide to be self-funded because it lets them predict costs based on their specific claims history and make any necessary adjustments. If claims are lower than expected, they can invest that money in the business or offer incentives for employee wellness. If claims are higher, their stop-loss insurance can cover it.

There also can be tax advantages to self-funding. Under health care reform, there are certain taxes related to risk that only apply to fully insured health plans. By moving to self-funding, organizations hope to eliminate some of those taxes from their budget.

When isn’t self-funding a good option?

Self-funding introduces more risk, so it’s usually geared toward organizations with more predictable claims. That’s why organizations need to be familiar with their claims history and understand the overall health of their employees when they are making this decision. If the population is relatively unhealthy, for example, self-funding might be a challenge.

Another important factor to think about is their financial flexibility. Some organizations simply don’t have the cash flow available to cover unexpected claims if they come up. Others may need to know their costs ahead of time, and prefer the predictability of being fully insured.

What other factors should be considered?

Self-funding isn’t a short-term solution. It requires a full commitment and a long-term strategy. To actually control costs through self-funding, organizations need to manage their claims effectively. That means committing to keeping their employees healthy through wellness and disease management programs, as well as negotiating with health care providers.

It’s also critical for organizations to know exactly what’s in their contract — and to work with an insurance carrier or a third-party administrator they can trust.

Insights Health Care is brought to you by Medical Mutual

How fitness trackers can motivate employees to be more active

Fitness trackers are popular tools for consumers to monitor their physical activity. According to the Health Enhancement Research Organization, almost half of employers have introduced some version of the device into their wellness program — from simple pedometers to more advanced options.

By 2018, ABI Research predicts that employees will use more than 13 million devices as part of a workplace wellness program.

“Incorporating fitness trackers into a wellness program is a good way to create a long-term culture of health within an organization,” says Veronica Hawkins, Medical Mutual vice president of Government Accounts. “They can help employees stay healthy, plus counteract rising health care costs.”

Smart Business spoke with Hawkins about the benefits of integrating fitness trackers into an employee wellness program, how to encourage participation and why many workers have already embraced the devices as part of their daily physical activity — both at work and at home.

Why are fitness trackers getting so popular?

They can be very useful tools to help people manage their lifestyle. Walking is one of the best ways to get and stay fit, but most people don’t know how much they actually do in a day.

While pedometers served that purpose in the past, the new devices can do a lot more. They typically show your progress in real time, on a smartphone, tablet or computer. So it’s easier, and more fun, for users to track their progress to meet their goals — and eventually, to set new ones.

How can organizations take advantage?

Fitness trackers can usually be integrated into an existing wellness program, where there are multiple opportunities for employees to earn wellness incentives. Through various challenges, employees log data and receive messaging about their progress from their employer as well as the vendor. Employees start connecting online with co-workers, often leading to friendly competition that drives engagement.

Some organizations may even pay for the devices to encourage employees to get started.

What about incentives?

There are definitely a variety of strategies organizations can use, but it really depends on what’s going to motivate their particular employees. Some organizations might offer a day off for meeting a weekly or monthly step goal, or give out monetary incentives like gift cards.

Medical Mutual, which introduced the devices to its wellness program two years ago, contributes money into employee health savings accounts for meeting various step goals.

What else can make the process successful?

The goal of introducing fitness trackers to a wellness program is to help employees reach their fitness goals. But it’s also to affect real behavioral changes that become part of their life style.

To do that, organizations just need to make their programs fun and engaging. Simplicity is also important. The easier it is for employees to participate, the more sustainable any behavioral changes will be.

Are there common obstacles?

With the popularity of fitness trackers, employees are often excited to participate. But there can be concerns about privacy and sharing information with employers. It’s important to be clear with employees that the information is being used to benefit them, not penalize them. And, that only information relevant to the program, like total steps, will be tracked.

There are usually consent agreements employees have to sign to share their data, so they have a choice. But in most cases, this issue isn’t a significant barrier.

What are the first steps?

If organizations want to invest in fitness trackers for their wellness program, it’s a good idea to start with their insurance carrier. Many already have direct partnerships with companies that either make or distribute some type of wearable activity tracking device. There are usually opportunities for discounts, as well as additional benefits.

Insights Health Care is brought to you by Medical Mutual

Why HSAs have become a valuable tool in retirement planning

Health savings accounts (HSAs) have become a popular way to pay for health care. And thanks to a growing understanding of their tax benefits, they are also starting to be seen as a worthwhile addition to any retirement plan.

According to a report from HSA consulting firm Devenir, more than $24 billion was deposited into HSAs in the United States in 2014 — up $5 billion from the previous year. In the same time, the number of actual accounts rose 22 percent to almost 17 million.

“HSAs are a great way to supplement retirement savings, but the concept is still new for some employees,” says Amber Hulme, Medical Mutual vice president, Central and Southern Ohio. “That’s why it’s important for employees to understand how HSAs works, so they can take full advantage.”

Smart Business spoke with Hulme about how HSAs work, why they are getting so popular and what makes them such a valuable tool for employees trying to plan for retirement.

What are the basics of an HSA?

HSAs can be used with certain types of high-deductible health plans. The IRS has rules for which plans qualify. For 2016, plans need to have a deductible of at least $1,300 for individuals and $2,600 for families.

The IRS also limits how much money can be contributed to an HSA per year — $3,350 for a single person, $6,750 for a family. Employees who are 55 or older can contribute an extra $1,000 each year.

Why are they getting so popular?

The biggest reason is the tax advantages. When employees open an HSA, they can defer money from their paycheck into their account tax-free. That also applies to any contributions their employer makes. The money can then be used to pay for approved medical expenses without paying taxes. Any money left over stays in the account, earning interest tax-free.

Eventually, employees can use the money they have accumulated to invest in stocks, bonds or mutual funds. Any profits, whether from dividends or capital gains, are nontaxable. HSA administrators might have rules about minimum balance before investments are allowed, but it’s usually not more than $2,000.

How do HSAs work in retirement?

HSA funds can always be used, tax-free, to pay for approved medical expenses. When employees turn 65, they aren’t subject to the early withdrawal penalty, which is usually around 20 percent. So they can choose to spend the money on other things, like travel, and only pay the taxes.

If they enroll in Medicare, no more contributions are allowed, but the money in the HSA can be used to pay the premiums — with no penalty and no taxes.
Medicare Supplemental (Medigap) policies have different rules, so that option isn’t available.

What are good ways to encourage employees to use their HSA?

Employer contributions are a great way to drive employee participation and gain acceptance in HSAs. That’s especially true for employees who are transitioning from a more traditional type of health coverage to a high-deductible plan.

Otherwise, employees just need to understand how HSAs work and all of the financial benefits they can offer. That’s why education is so important. The organization’s insurance carrier or HSA administrator can provide a wealth of resources to help make sure employees use their accounts as effectively as possible.

Are any other important trends developing?

Traditionally, HSAs have been accessed separately from a member’s health plan, either through a bank or another type of financial institution. But as consumers take more control of their health care, they want more connectivity and ease of use.

In response, many insurance carriers, including Medical Mutual, are moving toward platforms that let members review their HSAs and claims information in one place. This integration will help consumers be more engaged in their health care costs, and more empowered in their retirement planning.

Insights Health Care is brought to you by Medical Mutual

How to help employees manage their chronic health conditions

Chronic diseases are almost as costly as they are common. According to the Centers for Disease Control and Prevention (CDC), half of U.S. adults have at least one chronic condition, while almost one-third have two or more. And treatment of those conditions accounts for more than 80 percent of our health care spending.

“These conditions are some of the most costly causes of death in this country, but many are very preventable,” says Veronica Hawkins, Medical Mutual vice president of Government Accounts. “Fortunately, there are plenty of programs consumers can use that give them the tools, the education and the encouragement they need to really improve their quality of life.”

Smart Business spoke with Hawkins about the types of programs being offered in the market to help people manage their chronic health conditions, and how organizations can benefit as well — by increasing productivity in the workplace and reducing their health care costs.

What types of conditions are considered ‘chronic’?

The basic definition focuses on non-contagious diseases that have a long duration and generally slow progression. Some examples are cardiovascular diseases, diabetes and chronic respiratory diseases like chronic obstructed pulmonary disease (COPD) and asthma. In most cases, depression also falls into this category.

What is disease management?

It refers to ongoing care to help people with one or more chronic conditions. The idea is to prevent or minimize their effects through integrated care.

Many organizations today offer some type of disease management program to help their employees have a better quality of life. Plus, when employees don’t need to visit the emergency room or be admitted to the hospital as often, health care costs go down and productivity goes up.

How do the programs work?

Disease management is included with most fully insured plans. Self-funded employers, which pay their own claims, would likely have to buy into it. The cost structure, obviously, varies among carriers, but it is usually built in to either the employer’s premium or administrative costs.

In most cases, insurance carriers work with an outside vendor that uses claims information to identify members who might benefit from the program. They do outreach to identify members who want to participate, and those who do are usually assigned a health coach. The health coach educates the member on his or her condition and develops a plan to make changes that will improve their overall health.

The programs send educational materials to members even if they haven’t opted in — unless, of course, they decline to participate.

What else might be involved?

A member might use the program to better understand his or her medications or get counseling to quit smoking or lose weight. Depression screening is also very common.

Depending on the needs of the members, many programs offer counseling, home visits, 24-hour call centers and appointment reminder systems. Others allow members to receive their diabetic testing supplies, like a diabetes monitor or test strips, for no additional out-of-pocket cost. There is usually quite a bit of customization, so each member gets the help that he or she needs.

How can organizations get more employees to participate?

Engagement is obviously the most important part of a disease management program — and the biggest challenge. Monetary incentives are relatively common, depending on how the program is set up, either by the carrier, employer or program vendor. For example, participants might get a gift card for completing their first year in a program.

Obviously, each organization is different and the needs of individual members will vary. It takes time and expertise to find the right approach. But it can definitely be worthwhile.

Organization leaders should talk to their insurance carrier if they are interested in implementing a disease management program, or simply want to get more of their employees to participate in the one they already have.

Insights Health Care is brought to you by Medical Mutual

How to reduce health care spending with HMOs

Health maintenance organizations (HMOs) are making a comeback. The plans have grown steadily in popularity since 2014, as the changes brought about by the Affordable Care Act have taken effect. Some studies have even shown that HMOs now account for more than one-third of all health insurance plans. Just a few years ago, it was less than 10 percent.

“More consumers today don’t have a strong preference about the doctor they see for things like minor illnesses,” says Amber Hulme, Medical Mutual vice president, Central and Southern Ohio. “For those types of consumers, HMOs offer a less expensive health insurance option, and their employer saves money in the process.”

Smart Business spoke with Hulme about how HMOs work, what makes the HMO plans currently on the market different from their predecessors and how organizations can save money on health care by offering an HMO option to their employees.

What is an HMO?

HMOs are a type of health insurance plan that offer access to a narrow network of doctors and hospitals. When members go out of network, the plan might not cover the services they receive and they could be responsible for the full cost. The specific rules for an HMO can vary from carrier to carrier.

How is an HMO different from a traditional plan?

The type of plan many people are used to is called a preferred provider organization (PPO) plan. With a PPO plan, members have the freedom to choose any doctor or hospital in the network. If they receive medical services from a doctor who is not in network, the services are usually still covered — they just have to pay a higher share of the medical costs.

An HMO is a less expensive option, but members do lose some of the flexibility of a PPO plan. HMOs don’t generally cover out-of-network care except in the case of an emergency. If a member gets medical services from a doctor not in the network, they normally are responsible for all the costs for those services.

What are the main advantages of an HMO?

With HMOs, the first advantage you usually hear about is cost. Insurance carriers can negotiate rates with providers differently for an HMO, which allows them to charge lower premiums. The deductibles are typically lower than comparable PPO plans, as well.

Another big advantage of an HMO involves the quality of care. With an HMO’s narrow network, care can be more coordinated and, in many cases, that integration can help make the outcomes better. Organizations pay less, while employees see a number of benefits in terms of how their care is managed.

How have HMOs evolved from what was available in the past?

The overall structure is similar, but there are some important differences to keep in mind. Many HMOs now offer some benefits for care received outside of the HMO’s network or service area. And in most cases, referral from a primary care physician (PCP) is no longer required to see a specialist. However, it’s still recommended that members choose a PCP to make sure they get the care they need. When PCPs coordinate care with specialists, it actually relieves some of the burden on the patient and more consumers are seeing that as a benefit.

How should organizations decide if this option makes sense for them?

With an HMO, access to care is one of the most important factors. HMOs are often a better option for organizations that have a limited number of office locations, where access to care isn’t an issue. If your employees live in localized areas, an HMO can definitely be a good option. In rural areas, it might be less practical.

Organizations should talk to their insurance carrier to evaluate whether an HMO makes sense for their employees.

Insights Health Care is brought to you by Medical Mutual