How to improve company performance by integrating health and safety

In the workplace, the concepts of health protection and health promotion have long existed side-by-side. The former places primary focus on worker safety, the latter on worker health.

What’s become more evident in recent years is that making a distinction between the two is not the best way to optimize either. Companies improve their employee and financial performance when the perspectives are aligned.

“Research has shown that development of a true ‘culture of health,’ at a company is dependent on integrating employee safety and employee health,” says Dr. Michael Parkinson, senior medical director for Health and Productivity at UPMC Health Plan and UPMC WorkPartners. “Keeping employees healthy and keeping them safe, are essentially the same thing.”

Smart Business spoke with Parkinson about the importance of integrating employee health and safety.

What is health protection?

Health protection traditionally encompasses all aspects of on-the-job worker safety. In recent decades, through the creation of the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH), there’s been an added emphasis on understanding ways to make the workplace safer.

And, partly as a result, OSHA-reported worker deaths have dropped from 38 per day in 1970 to 12 per day in 2012. Through increased use of risk assessment, safety training, improved protective equipment, better mechanical safety engineering, etc., worker safety has improved. However, the underlying health status and behaviors of the workers themselves was overlooked.

What is health promotion?

Health promotion is an umbrella term for workplace wellness programs. Employers introduced worksite health promotion programs to keep employees healthier and to reduce health care and productivity-related costs. These could include health risk appraisals, biometric screenings, employee events such as weight races, the introduction of on-site health coaching and smoking cessation assistance or weight-loss programs.

How does the term Total Worker Health™ apply to these concepts?

NIOSH created the national Total Worker Health™ initiative to enable employers to combine safety — traditionally very prominent in any company’s leadership and management consciousness — with health promotion efforts that are historically underappreciated as a contributor to safety and company overall performance.

According to an American College of Occupational and Environmental Medicine study, ‘a growing body of evidence’ indicates that there are significant benefits when health and safety policies, practices and programs are integrated. Healthier employees are safer employees and vice versa. Both contribute to the organization’s bottom-line effectiveness and success. Health impacts safety. Safety impacts health.

When wellness programs emphasize correcting workplace hazards, they are likely to get greater acceptance. For example, poor dietary habits, lack of physical activity and obesity all contribute to mental errors at work, higher rates of musculoskeletal disease and disability and workplace safety risks. Healthy behaviors are every bit as relevant to corporate success as a safety harness for job-specific risks.

What are keys for success for an integrated program?

Leadership and management should realize, and clearly state, how poor health impacts workplace safety and job performance. Engaging teams of employees to identify practical actions to improve health and safety should be solicited. Obtaining the active engagement of management once some actions have been identified is critical.

The integration of workplace wellness and occupational health requires a holistic approach to the health and well-being of each employee and their family.

Worker health cannot be addressed solely by reducing workplace hazards (safety) nor does it make sense to make individual health paramount (wellness) and ignore how work-related demands, stressors and conditions contribute to poor health. A Total Worker Health™ perspective can make our companies and employees the highest performing and most successful.


Insights Health Care is brought to you by UPMC Health Plan

How to size up the metallics — bronze, silver, gold and platinum health plans

Gold, silver and bronze are familiar categories for fans of the Olympic Games, but before the advent of the Affordable Care Act (ACA) in 2009, it was unlikely that many Americans associated those metals with health insurance.

“The terms bronze, silver, gold and platinum are part of a new era of health insurance comparison shopping,” says Adam Pittler, director of Product Development of UPMC Health Plan. “These metallic levels have been designed to help persons purchasing health insurance by providing more information.”

The Open Enrollment period for ACA coverage in 2016 that began Nov. 1, 2015, ends Jan. 31, 2016.

Smart Business spoke with Pittler about the “metallics” and how they can impact health insurance decisions in the years ahead.

Why do plans on the ACA Marketplace use the metallic terms?

The metal tiers are in place to provide consumers with a standard measurement to make it easier to compare plans and to understand which plans offer more comprehensive coverage and cover a greater portion of health care costs.

Plans in each category are assigned what is referred to as an ‘actuarial value.’ That refers to the share of health care expenses that the specific plan will cover.

If, for instance, you decide to purchase a bronze plan you will need to pay the most out of pocket. The plans are rated up from there — silver, gold and platinum, the highest. Platinum plans are the most generous and carry the highest premiums, but also have the lowest out-of-pocket costs. For example, a bronze plan will cover 60 percent of health care costs, a silver plan will cover 70 percent, a gold plan 80 percent and a platinum plan will cover 90 percent.

It’s important to remember that the metallic categories do not correspond to the amount or to the quality of care that you get with that plan.

Do the plans have any similarities?

All plans — bronze, silver, gold and platinum — must provide a minimum level of coverage in 10 categories, which are known as essential health benefits. These include prevention and wellness, ambulatory (outpatient) care, laboratory services, emergency care, hospitalization, maternity and newborn care, pediatric care (medical, dental and vision), mental health and substance use disorder services, prescription medications, rehabilitation and habilitation.

So, it doesn’t matter which metallic level you choose, all plans are guaranteed to provide at least this level of benefits.

How do you evaluate plans on the same metallic level?

You need to carefully review the details of each health insurance plan that is offered at that level. This includes the cost of monthly premiums, deductibles, copayments and coinsurance. All insurers are required to provide an easy-to-read summary of benefits and coverage to help compare plans.

Even though two plans might be on the same level, the cost to an individual consumer may differ. This could be because of out-of-pocket expenses that are accrued and are dependent on the health services needed.

What about tax credits?

Consumers looking to maximize tax credits and subsidies should probably look to silver level plans. The sizes of the tax credits are based on income level and the cost of the second-lowest silver plan in each region. The tax credit remains the same for all levels. So, it covers more of the premium at a silver level than it does at the gold and platinum levels.

Persons who are entitled to subsidies need to enroll in a specific silver plan in order to receive it.

How important is it to estimate costs?

Most insurance purchasers are focused totally on the cost of the premium and do not think about what their estimated total health care costs could be for an entire year. That means trying to make an estimate of what your out-of-pocket liability will be.

You have to determine if a higher monthly premium would be worth it in order to decrease out-of-pocket expenses.

Insights Health Care is brought to you by UPMC Health Plan

What you need to know about health care transparency tools

Price and quality transparency is more than just a trend in health care; it’s an expectation. With the cost of the same medical procedure varying sometimes by more than 100 percent even within the same region, the need for transparency by health care consumers could hardly be greater.

“Without having good, solid cost and quality information, the modern health care consumer is pretty much in the dark,” says Kim A. Jacobs, vice president of Strategic Business Development, Consumer Innovation, and Commercial Strategy and Performance for UPMC Health Plan. “Transparency is the future of health care and, as consumers, health plan members need the tools that help them make the best and most well-informed decisions.”

Smart Business spoke with Jacobs about how health care costs and quality can become more transparent for employees and how that can help drive down the high cost of health care.

What kind of information do health care consumers need?

Being able to manage both the quality and the cost of their health care is something that will enable consumers to make the best treatment decisions for themselves and their families. Ideally, you want them to have price and quality information readily available so they can easily read and compare. Having both cost and quality information is essential because, in health care, there is not always a correlation between higher costs and better health care quality.

Why has health care cost and quality transparency become an important topic?

Health care trends suggest that there will be an increasing need for cost and quality information from health care consumers in the years ahead. With health insurance plans requiring members to handle more of the upfront costs of care — through high deductibles and coinsurance — a lack of good, valid information could translate into them paying much more for care that may actually be substandard.

Consumers won’t be literally ‘shopping’ for care as they might for other retail items, but, just like retail consumers, they are entitled to information that enables them to select high-quality and affordable health care. Providing consumers with quality and cost transparency tools can give them the ability to do this.

By having easy access to consistent, accurate information about quality, price and service options when choosing a physician or health service, consumers will be able to make more informed choices.

Will transparency tools replace consultations with physicians?

No, not at all. It will always be important for families to talk with their physicians about any plan of care. The primary physician’s knowledge of a patient’s history is invaluable. In addition, the convenience and comfort connected with using a familiar physician cannot be discounted. Transparency tools can serve as a way to educate patients in terms of cost and quality, and they can use that knowledge to have a more informed conversation with their physicians.

How do effective transparency tools work?

Transparency tools are often powered by crowdsourced data from consumers and physicians. What these tools can do is focus intelligence about a variety of conditions. For instance, the top treatments for persons with the same condition can be highlighted, as well as the most popular treatment chosen by other users of the tool.

With these tools, users can compare treatment options, and learn about side effects, costs and typical patient preferences. These tools also can compare costs for the same procedure at different facilities in the same region.

How do these tools benefit employers?

Transparency tools support an employer’s efforts to encourage employees and families to make informed choices based on good information about quality and cost, including out-of-pocket costs.

When health care consumers are only able to learn the actual cost for a procedure at the time they get their bill, it can lead to them feeling somehow cheated by the process. This adds to an erosion of trust in the health care system and could contribute to dissatisfaction with an employer that offers plans that don’t include any form of transparency.

Insights Health Care is brought to you by UPMC Health Plan

How to make sense of tax-free financial accounts for your health benefits

Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs) and Health Reimbursement Arrangements (HRAs) are three of a number of tax-advantaged financial accounts that employers can make available to employees looking for health benefit options in what can be a confusing marketplace.

“To pay for their medical expenses, employees have a number of tax-free options that they can explore,” said Ryan C. Wasileski, director of Ancillary & Specialty Product Administration for UPMC Health Plan. “The differences between them often are the kinds of insurance plans they work with, who owns the account, who controls the account and who can put money into it.”

Smart Business spoke with Wasileski about HSAs, HRAs and FSAs, and how they can make sense for employers and employees.

What exactly is an HSA?

An HSA is similar to a 401(k) retirement account, except that the money goes for medical expenses. HSAs, only available through HSA-compatible insurance plans, combine a high-deductible health insurance plan with a tax-advantaged savings account.

Employees own the account and money can be deducted from their paycheck, pretax, and deposited into their HSA. Employee contributions, interest earned and dollars spent on qualified health care expenses are all tax-free. Employers may contribute to HSAs, and employees also can invest, once they reach a certain level of savings.

HSAs do not limit when money has to be used by, therefore employees have the freedom to build their balance up for future medical expenses, invest in a variety of mutual funds or use for current out-of-pocket medical expenses. Employees who leave their job can keep their HSA.

What is an FSA?

With an FSA, the employer sets up the account and owns it, but employees get to decide the qualified medical expenses they choose to pay for. It’s considered ‘flexible’ because of its compatibility to be offered with just about any employer-sponsored health plan.

Similar to HSAs, employees and employers can make tax-free contributions to the account. FSA money cannot be invested, however, and must generally be used before the end of the plan year.

The IRS guidance issued in 2013 began allowing Health FSAs to carry over unused balances of up to $500 remaining at the end of a plan year, to be used for qualified medical expenses incurred in subsequent plan years. Carryovers are optional and make a good alternative to the grace period.

Employees who leave their employer generally lose their FSA coverage.

How do HRAs differ from HSAs and FSAs?

A HRA is a benefit that is set up by the employer for employees or retirees. It is a fund that pays for medical expenses that are not covered by a health plan. These could include deductibles, coinsurance or both.

The employer owns the HRA fund and can decide which expenses will be covered. For the employer, any money that is given to an employee for use as a medical expense is tax deductible. In addition, employees do not need to pay taxes on money received from an HRA if used for qualified medical expenses. The employer has the option to allow a rollover of HRA funds from plan year to plan year.

What do employers like about FSAs, HSAs and HRAs?

Many employers are attracted to high-deductible plans combined with account-based plans because it gives the employee more control of their health care by having them assume a more active role. They have a financial stake in lowering their costs.

The term consumer-driven health plan often describes the increased responsibility of employees or consumers. Increased financial responsibility increases consumer awareness and market competition, and ultimately leads to greater health care quality and availability to lower costs.

A well-designed consumer-driven health care plan will include a high-deductible health plan, account-based plan and wellness and disease management programs. Studies show consumers in these plans have increased consumption of preventive care services, healthy behaviors, care engagement and lower cost than other types of plans — even for patients who are high users with chronic medical conditions.

Insights Health Care is brought to you by UPMC Health Plan

How a private exchange can balance health care products with cost

The Affordable Care Act is probably best known for its Federal Marketplace, or exchange, but as the law evolved it has helped increase the popularity of another product: private exchanges.

Private exchanges are increasingly seen as a viable business option because they offer employers predictable cost control through defined contribution, while also empowering employees to become smarter consumers.

“Private exchanges are increasing in popularity because they may offer a strong balance of product and cost choices, decision support that empowers employees to become health care consumers, and administrative and financial benefits to employers,” says Kismet Toksu, president of EBenefits Solutions, a subsidiary of UPMC.

Smart Business spoke with Toksu about why private exchanges can make good business sense for employers.

What are some of the differences between private and public exchanges?

Either the federal or state government sponsors a public exchange. An employer, broker or association may sponsor a private exchange. While public exchanges serve individuals or small employer groups of up to 50 lives, private exchanges, typically, serve the employer group market. Private exchanges also vary on the size of companies they target. Due to rules that govern public exchanges, the products offered are more limited than those available on private exchanges. Another big difference relates to customer experience and service.

What are some of the advantages of a private exchange over a public exchange?

One is an increase in options, both in terms of benefits that may be offered and companies that offer products.

With a public exchange plan, members may choose coverage for medical expenses and prescription drugs only. Private exchanges may offer more than medical and prescription plans, such as dental and vision coverage, disability, accident or critical illness. Even non-medical plan options may be offered. Private exchange plan options have fewer limitations and may be more customized.

In addition, there is more cost certainty for employers, who are often responsible for paying the largest portion of the coverage. This type of funding is called defined contribution. Employees may use the defined contribution to offset costs of the products they select.

How can an employer benefit from going to a private exchange?

First, an employer may continue to reap tax benefits by providing employees access to health insurance. An employer also may retain control over their benefit offering. When employees understand the true cost of their options, they tend to be more cost-effective, which is an advantage for both the employer and employee.
A private exchange may reduce the administrative burdens while maintaining employee loyalty associated with offering coverage.

How do employees benefit from private exchanges?

On a private exchange employees have the opportunity to select a plan that best fits his or her needs and budget. Private exchanges provide decision support not often available elsewhere. Employees may also find that private exchanges provide better customer service.

Is there a set amount that an employer must contribute to a private exchange?

The amount an employer contributes is determined entirely by the employer. With a defined contribution plan, the employer gives the employee a set amount for health care and the employee increases that, as he or she sees fit. A defined contribution can cover the entirety of an employee’s plan, or only a portion of the total cost.

What else do you need to know about private exchanges?

Remember that no two private exchanges are the same. Some offer individual plans; some offer group plans targeting specific group sizes. The types of benefits offered — such as dental, vision or disability — may vary, depending on the exchange. Certainly the member experience and quality of support varies. Also, private exchanges are only available to employees of companies that choose to participate in it.

Insights Health Care is brought to you by UPMC Health Plan

How to help employees with chronic health conditions

Living with a chronic condition is a reality for many Americans. estimates that more than 125 million Americans live with at least one chronic illness. It is predicted that by 2020 that figure will rise to 157 million Americans.

The National Center for Health Statistics defines a chronic disease as any illness that lasts three or more months. The most common chronic conditions include heart disease, diabetes, kidney disease, autoimmune disorders, lung disease and multiple sclerosis.

For many, living with a chronic condition means living as much of a “normal life” as possible, and that would include being part of a workforce.

“Living with a chronic illness is especially difficult for persons who need to work every day,” says Debi Vieceli, RN, a cardiac care manager for UPMC Health Plan. “Employers need to know how they can help employees as much as possible to lead normal, productive work lives.”

Smart Business spoke with Vieceli about ways that employers can help their employees with chronic health conditions.

How should an employer assist an employee who has a chronic condition?

First, you need to recognize the fact that a chronic illness can disrupt a person’s life. It can affect a person’s appearance, their physical abilities and independence. The employee might be tired quite often and in pain.

Among the things an employer can do is to encourage employees with chronic conditions to seek out support groups, where they can share experiences and learn about coping mechanisms. If possible, an employer could enable such a group to be established in the workplace, or facilitate communication between employees who live with chronic conditions.

How do chronic illnesses affect your health care costs?

Seventy-five percent of health care costs are driven by lifestyle-related chronic illnesses. That’s why it’s so important to use case management, wellness programs, and health and productivity solutions to manage these employees and their related health care claims.

What kind of advice can an employer give to employees with a chronic condition?

It’s essential that persons with chronic conditions be personally involved in their own treatment.

Becoming an active participant in your treatment is one way to decrease the stress of the situation. Exploring treatment options and developing relationships with caregivers is also a positive step for a person with a chronic condition.

Following a healthy diet is important because good nutrition can result in better health. Those with chronic conditions should follow all special dietary instructions and be aware of the food decisions they make on a daily basis.

Are there tips that make sense for a person with a chronic condition?

For everyone, exercise is important, but that is especially true for persons living with chronic conditions. Walking or working out at a gym is good for the whole body and being able to do this can help you to feel better about yourself.

Remember, before starting any exercise program, talk to your doctor about what works best for you and what would help you develop a proper level of fitness.

Because people with chronic conditions are usually on a medication regimen, it’s always good to develop some sort of reminder system. This will enable people to be sure they are taking the right medications and at the right time.

Nothing is more important to a person with a chronic condition than making healthy choices. To prevent the exacerbation of existing chronic conditions, you need to stop smoking, eat a healthy diet and get regular exercise.

Insights Health Care is brought to you by UPMC Health Plan

How to weigh the pros and cons of self-funded vs. fully insured health plans

For companies that must deal with how best to handle health insurance costs, there’s a decision that needs to be made fairly early in the process. Should a company choose to be fully insured, or should it opt to be self-insured?

“Choosing the right kind of health plan is an important part of the success and growth of a company,” says John Mills, senior director of consumer products at UPMC Health Plan. “There are a lot of misconceptions about which plans are right for which kinds of companies and you have to look at all the evidence before you decide.”

Smart Business spoke with Mills about the advantages and disadvantages of self-funded and fully funded plans for companies large and small.

What is the difference between self-funding and fully insured?

The traditional definition of self-funding is when a company pays for its own medical claims directly, usually while a third-party administrator (TPA) processes claims, issues ID cards and performs the function of a health plan.

In contrast, when a company chooses to be fully insured — the more common option for smaller businesses — the company pays a set premium price to the carrier that is fixed for the year and is based on the number of employees enrolled each month. The insurance company assumes the financial and legal risk of loss if claims exceed projections.

Can small companies afford to be self-funded?

Companies with fewer than 250 employees are often afraid that they will be exposed to too much risk with a self-funded plan.

However, smaller companies can still afford to be self-funded because they can purchase stop-loss insurance, which limits the amount of claims expenses an employer would be liable for, per covered employee, per year. This protects a company against some sort of catastrophic event involving one or more employees. Stop-loss insurance reimburses an employer’s health plan for claims above a pre-set limit.

What are the advantages of self-funding?

The most obvious advantage is paying for actual claims incurred by your employees. This means there is no chance of being ‘penalized’ if your employees in a given year use fewer medical services than had been anticipated. Any positive results that come from a company instituting wellness programs and smoking cessation campaigns can have a direct result on the bottom line.

Also, a company can easily obtain a company-specific claims report that can reveal, for instance, what percentage of claims are out-of-network, and how much is being spent on emergency room visits. This kind of information can provide direction when it comes to customizing benefit changes.

What are the advantages of fully funded plans?

Cost certainty is a major one. You know at the beginning of the year what will be your health care costs and they remain in place until a new deal is struck. Also, the health insurer assumes all of the risk and the company is spared any exposure.

What are some disadvantages to self-funding?

Self-funded plans that greatly exceed anticipated costs can create problems. Although stop-loss coverage can protect an employer from paying excessive claims in a given year, after a major incident, the cost of the stop-loss coverage the company purchases is likely to rise. It may also be more difficult to get lower rates from other stop-loss providers.

Moreover, higher-than-expected claims in self-funded plans can make it more difficult to return to a fully funded plan later. And, any organization that chooses to run a self-funded plan internally, rather than use a TPA, can run up higher-than-expected administrative costs.

Self-funding is not a quick fix and savings are not always guaranteed or immediate. In order to make a good decision, you need to study past coverage utilization, cash flow and the health status of the employees being covered.

Insights Health Care is brought to you by UPMC Health Plan

How to deal with alcohol and drug abuse in the workplace

Abuse of alcohol and drugs in the workplace is a reality that employers cannot afford to overlook. According to a 2008 study by the Substance Abuse and Mental Health Services Administration, more than 70 percent of the admitted drug and alcohol abusers in the country are employed, and a majority of those are full-time employees.

The costs to an employer can come in different forms. A study by the National Institute on Drug Abuse found that drug-using employees are 2.5 times more likely to have absences of eight days or more, three times more likely to be late for work and five times more likely to file a workers’ compensation claim.

“Alcohol and drug abuse on the job can cost employers money in many ways. Some of the ways are easily visible, such as higher health care premiums. Other ways are more covert, such as absenteeism, accidents and theft,” says Jan Nedin, MBA, MSEd, RCC, a senior account manager at LifeSolutions, UPMC Insurance Services Division.

Smart Business spoke with Nedin about how to address alcohol and drug abuse at your organization.

What’s the first step to proactively approaching this problem?

Employers must develop a substance abuse policy. It should include:

  • A requirement that all employees report to work and remain free of alcohol, mood-altering drugs and other intoxicants.
  • Acknowledgement that the company recognizes alcoholism and drug abuse as illnesses that are major potential problems regarding health, safety, security and productivity.
  • A statement indicating that behavior and performance problems related to alcohol and drug abuse should be identified early and dealt with constructively via professional evaluation and treatment.
  • A clear statement that chemically influenced behavior and/or performance will not be tolerated and could result in discharge.

How can an employee assistance program (EAP) help?

An EAP is a confidential consultation, assessment and referral service available to employees and supervisors to deal with recognition and treatment of substance abuse problems, as well as other personal problems that may be affecting an employee’s performance. It is an extremely valuable tool in dealing effectively with these problems.

What roles do supervisors play?

Supervisors need to know the company policies and procedures, monitor employees’ performance and behavior, and document performance problems. It is not a supervisor’s job to diagnose drug or alcohol problems — that should be left to the professionals. An EAP consultant can train supervisors on when to refer drug abuse and alcohol matters to the EAP for assessment.

What else is important to remember?

Design appropriate health plan coverage. Efforts to help the employee will be much more challenging unless health plan coverage is in place that allows employees to get treatment as needed.

Consider pre-employment and random drug screening. This is not the answer, but rather a tool that must be utilized wisely and cautiously. Pre-employment screening can weed out undesirable applicants so you have less of this problem to deal with after hiring.

If unionized, involve the union. When unions are present, they must be involved for the program to be effective.

Secure good legal counsel. Be sure to have policies and procedures reviewed and approved by a good labor relations attorney prior to implementation.

Don’t make it a witch hunt. Turning a program into a concentrated search for substance abusers may be counterproductive. Place your emphasis on recognizing and helping those who exhibit problems.

Do not concentrate solely on drugs. Alcohol, which is also a drug, can be just as serious a problem, if not more so, and all should be equally addressed.

LifeSolutions is part of the integrated partner companies of the UPMC Insurance Services Division, which offer a full range of insurance programs and products. The partner companies include UPMC Health Plan, UPMC WorkPartners, UPMC for You (Medical Assistance), Askesis Development Group, Community Care Behavioral Health and E-Benefits.

Jan Nedin, MBA, MSEd, RCC, is a senior account manager at LifeSolutions, a UPMC Insurance Services Division. Reach her at (412) 454-8488 or [email protected].

Insights Health Care is brought to you by UPMC Health Plan

How to construct an employer health and productivity road map

Improve performance, optimize efficiency and deliver value. That’s what employers are always under pressure to do. What many employers do not realize is that an integrated approach to safety and health can play a major role in creating healthier, high-performing workforces.

“Employers can have a major influence on the health and care behaviors of employees,” says Dr. Michael Parkinson, senior medical director for health and productivity at UPMC Health Plan. “Employers have a major role to play in both improving health and reducing health-related costs.”

Smart Business spoke with Parkinson about how to best improve employee health and productivity and reduce health costs.

What is the connection between employee health and company productivity?

Growing competitive and economic forces increasingly challenge employers and leaders of all organizations. A core asset of any organization is the health and productivity of its workforce, its ‘human capital.’ And as visible leaders, employers can influence their employees. It makes sense to provide an integrated, incentivized strategy to address the core drivers of poor health, excessive medical costs and lost productivity. Healthier employees are safer employees, and healthy, alert employees reinforce properly designed workplaces and safety policies.

By following an integrated and incentivized strategy that addresses the core drivers of poor health, excessive medical costs and lost productivity, employers not only improve the health and care behaviors of employees and their families but also add dollars to both their top and bottom line.

Total health management is increasingly being recognized as a business necessity, not a ‘nice to do.’

What’s the first step?

Building a culture of health, performance and productivity has been shown to be a critical determinant of the health and competitiveness of any business.

A comprehensive assessment of environmental drivers of health and productivity is an essential first step to determine an organization’s strengths and needs. The work environment is not just the traditional physical workplace, but also attitudes, behavior policies, compensation schedules and promotion opportunities.

Creating simple, reinforcing messages in corporate vision, compensation, and promotion and benefit alignment sends the message that employee and family health is core to the organization’s success.

How can healthy behaviors be improved?

Assisting employers to create the infrastructure to sustain health, wellness and productivity is a key responsibility of a health plan. A health plan can help sustain health and productivity through consultation, educational support, benefit alignment, and the creation of a wellness committee to initiate and sustain wellness efforts.

The recognition and rewarding of healthy employee champions is a key leadership message, along with making it known that the employer wants to assist employees and their families in achieving health goals.

By offering employees a health plan with appropriately designed and communicated incentives, employers have an evidence-based method to improve behavior change and increase employee engagement. Account-based, consumer-directed plans with additional targeted incentives for health improvement and care management decisions increase employee engagement and produce health care costs savings.

What results can an employer expect from an integrated and incentivized strategy?

The majority of the known causes of excessive health care and productivity costs — stress and mental health, absenteeism, short- and long-term disability, workers’ compensation, occupationally-related illness and injuries — can be addressed by an employer using a comprehensive and integrated strategy supported by targeted tactics, programs and practices.

By improving the health status of employees (and their families), by assisting them to get involved in their medical care decisions with their doctors and by directly targeting specific ineffective and inefficient medical practices and delivery modalities, both the employer and the employee can improve health and produce savings.

Dr. Michael Parkinson, MPH, FACPM, is the Senior Medical Director of Health and Productivity at UPMC Health Plan. Reach him at (412) 454-5643 or [email protected].

Insights Health Care is brought to you by UPMC Health Plan

How telemedicine and telehealth are increasing access

When it comes to telemedicine and telehealth, the future is most definitely now. Advances in technology have spurred advances in telemedicine and carry with it the potential to increase access to care, improve quality and reduce costs.
“Telehealth solutions have the capacity to improve the quality of care, improve access to care and reduce the cost of delivering care,” says Dr. Stephen Perkins, vice president of Medical Affairs for UPMC Health Plan. “It has the potential to reduce costs for both physicians and patients.”   

Smart Business spoke with Perkins about telemedicine and telehealth and their potential to improve care and reduce costs.

What is the difference between telehealth and telemedicine?

Telehealth is a general term describing the delivery of health-related services and information by the use of telecommunication technology. It can include phone calls between physicians, videoconferencing or even robotic technology.

Telemedicine has a narrower definition: The specific use of medical information that is exchanged from one site to another via electronic communications for the health and education of a patient or a health care provider for the purpose of improving patient care. It includes consultative, diagnostic and treatment services.

Historically, hospitals and health systems in rural areas have been most closely connected with telemedicine, as travel times and a lack of specialty physicians has made telemedicine more attractive. However, the entire health care industry, urban and rural, national and even international, could benefit from its widespread use.

What are the most significant benefits from telehealth and telemedicine?

Certainly, the top benefit would be increased access both for patients and physicians.

Persons who live in remote areas have not always had access to the latest medical advances. With telemedicine, there is the capacity for specialists to evaluate a patient’s condition from afar. Homebound patients could have their conditions monitored and reduce the number of trips they need to make to a physician’s office.

With telemonitoring technology, a physician can oversee the progress of a patient and help the patient avoid problems. Telehealth technology breaks down many barriers to access to care.

What technologies are used in telehealth?

Many different technologies can be used. Among them are: videoconferencing, the Internet, store-and-forward imaging, streaming media, terrestrial communications and wireless communications.

What are some examples of telehealth?

Telehealth can mean e-visits, whereby patients do not have to come into their physician’s office for a routine problem, but correspond via Internet and may even get a prescription for their condition, if needed. This way, routine matters do not tie up a physician’s time, and patients do not need to miss work or arrange for day care in order to get medical advice for minor matters.

In some instances when someone has a chronic condition requiring consistent monitoring, or they are homebound with a stroke, a telestroke program allows them to be seen by a specialist.   

Are there barriers to telehealth becoming more widespread?

Telemedicine implementation can be expensive and time consuming, which may make it difficult for health system executives to see the value, especially since not all patients will use the services.

In addition, with telehealth’s ability to transcend state boundaries, there may be issues regarding licensing and certification. Policies regarding telehealth licensing vary greatly between states.

How will this impact health care costs?

While the initial cost of the technology may be high, the overall impact should be to reduce costs. If monitoring a condition becomes easier because of telehealth access to patients, that should improve preventive care and reduce the number of emergencies, which will help to hold down costs. If telehealth advances can bring specialist care to places where it has never been before, that, too, should mean more effective treatments and, ultimately, lower costs.

Dr. Stephen Perkins is a vice president of Medical Affairs at UPMC Health Plan. Reach him at (412) 454-7682 or [email protected].

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